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Inspection on 26/09/07 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 26th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 manager and staff provide a calm and stable environment for residents, where they are able to spend their day as they wish. Staff are dedicated to ensuring residents safety and work with residents to ensure they live in a pleasant homely setting. Residents spoken with indicated that they feel safe residing in the home and that they are well taken care of. A number of resident choices are evident in pastimes, hobbies and meals, which are varied and well presented; The food is very well thought of and residents feel respected and enabled to socialise in a manner that is comfortable for them. All residents spoken with indicated that they are satisfied with the overall care given in the home.

What has improved since the last inspection?

Three out of the four requirements set at the last inspection have been addressed. Care plans are now reviewed to help make sure that residents are receiving appropriate care. There is good evidence that residents receive appropriate healthcare from external professionals when prompted by a change in their health. New windows have been fitted throughout the home. The rear gardens have been made safe and secure from the public being able to walk round the back of the home.

What the care home could do better:

Whilst the gardens have been made safe they are mainly laid to slabs and brick walls. This is not particularly inviting. As many residents have confusion and are limited in going out, they would benefit from a garden that is able to stimulate the senses. Whilst the physical dependencies of the residents are relatively low, there should be more suitable moving and handling assessments in place for all resident`s to ensure their safety. There is insufficient evidence of staff being trained in all of the mandatory Health and Safety subjects. This must be done at the required frequency to ensure residents receive appropriate care and their safety is promoted. Staff files are inconsistent and not all contain the required documentation. The manager must ensure all staff have the satisfactory pre-employment checks conducted and recorded to ensure the protection of residents is promoted.

CARE HOMES FOR OLDER PEOPLE Lilac House Care Home 2 Lilac Grove Beeston Nottingham NG9 1PA Lead Inspector Andrew Sales Unannounced Inspection 26th September 2007 10:00 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 DS0000008708.V349404.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. DS0000008708.V349404.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 DS0000008708.V349404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. There are now no restrictions on the age or the numbers of service users with Dementia. 8th August 2006 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. There is currently a variation for two service users who have dementia. 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 lift. There is a small rear garden, which can be accessed by the lounge. The fees for this service are currently £290.00 to £334.00 per week. This does not include hairdressing and chiropody. Further details can be found in the providers ‘Service User Guide’, which is available at Lilac House. DS0000008708.V349404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and involved a visit to the site on Wednesday 26 September 2007 at 10.00am. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably District Nurses and Social Workers. We also use information gathered throughout the year, to support our judgements. This may include notifications from the provider, complaints or concerns and the pre-inspection questionnaire, which the provider is required to complete prior to a visit to the service. On this occasion we received the pre-inspection documentation from the provider. This also provides evidence for us to make informed judgements when assessing the National Minimum Standards (NMS). The primary method of inspection used during the visit to this service was ‘case tracking’. This involved selecting three residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. We also spoke with two other residents, who were able to give us their views about the service. We also spoke with two members of the care staff who were also very helpful. We spent part of the day discussing records, documents and policies with the deputy manager. All of the key standards were inspected on this occasion. What the service does well: The manager and staff provide a calm and stable environment for residents, where they are able to spend their day as they wish. Staff are dedicated to ensuring residents safety and work with residents to ensure they live in a pleasant homely setting. Residents spoken with indicated that they feel safe residing in the home and that they are well taken care of. A number of resident choices are evident in pastimes, hobbies and meals, which are varied and well presented; The food is very well thought of and residents feel respected and enabled to socialise in a manner that is DS0000008708.V349404.R01.S.doc Version 5.2 Page 6 comfortable for them. All residents spoken with indicated that they are satisfied with the overall care given in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can DS0000008708.V349404.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. DS0000008708.V349404.R01.S.doc Version 5.2 Page 8 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 DS0000008708.V349404.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are fully assessed before moving in to the home and are confident the service will meet their needs. The home does not provide intermediate care. EVIDENCE: All of the files we looked at contained an extended social work assessment, which had been obtained prior to their admission. All files contained care plans conducted by the manager. All of the assessments were adequate and contained sufficient information to enable staff to ensure that they could meet the residents assessed needs. There were action plans for care workers. All of the residents were very keen to explain how living at the home has improved their quality of life in terms of care, company and social stimulation. DS0000008708.V349404.R01.S.doc Version 5.2 Page 10 They said they liked the homely environment and services available. They all felt that prior to moving into the home that it was suitable for their needs and a place they wanted to live in. Residents also told us that they had been able to stay at the home prior to moving in. Intermediate care is not provided, though the home is able to provide respite care for agreed temporary periods. DS0000008708.V349404.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal care needs of residents are planned for and met by knowledgeable staff who strive to make sure residents using this service are treated with respect. EVIDENCE: The assessments and plans of care we looked at detail each area of need with action plans for staff. Some risk assessments were also present. Some attention is placed in the need to prevent pressure sores, falls and to promote safe working practices. Daily records are well maintained by care staff and professional input from district nurses and GP’s is well documented. We saw some evidence that moving and handling assessments have been conducted but these are a box ticking exercise, which is inadequate. They are not supported with action plans for staff. DS0000008708.V349404.R01.S.doc Version 5.2 Page 12 Residents and staff told us the care planning process was accurate and helped staff to respond to any changes in residents needs. Resident’s care plans contain details of each individual’s health care needs, including tissue viability and continence risk assessments. There is evidence that people have been appropriately referred to health care professionals. Care plans contained records of visits by district nurses, General Practitioners and other professionals. We were told that residents can register with a GP of their choice. There was only partial evidence of people being consulted over their care plans. If this is due to communication difficulties, consultation with advocacy services should be considered. The homes medication administration systems are satisfactory. There is a policy and procedures for receiving, recording, storing, handling, administering and disposing of medicines. The home is registered with the local pharmacist and support and advice obtained as and when needed. The pharmacist visits and conducts and audit of the homes medicines. We were told that the manager has attended updated medication training, staff have had training from the local pharmacist and that two people now countersign handwritten medication instructions. Staff were observed during the visit interacting positively with individuals. Residents told us that the staff provide a good standard of care and any areas of concern would be discussed with the manager. Residents also commented very positively on the conduct and attitude of the staff. They said ‘the staff are wonderful, they are always on hand to help and they are always polite’. DS0000008708.V349404.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel they retain much of their independence after moving into the home. Resident’s maintain contact with family and friends. EVIDENCE: Residents told us they were happy with the level of activities within the home and outside. Resident’s commented that the philosophy of the home and the attitude of the staff enabled them to make choices and felt they were generally well respected. They also felt that staff were always willing to sit and talk with residents when they had time away from essential duties. Residents spoken with said that they were able to spend the day how they wanted to and were able to get up and go to bed when they wanted to. Staff were seen interacting with residents positively and ensuring that they had drinks through out the day. There is no information available on what activities DS0000008708.V349404.R01.S.doc Version 5.2 Page 14 take place, however residents told us that they were involved in various things such as singing, board games, reminiscence and going out for walks supported by staff. Evidence from the diary notes supported this. Staff spoken with, were well aware of residents individual preferences and respect residents choice on occasions where they chose not to participate in events. Residents told us they thought the food was very good and there was two or three choices at lunchtimes. They said they can have soup or salad or hot snacks in the evening and were happy with what was available. The cook showed us lunch which was home made and innovative. Residents said how they were always trying new things and enjoyed the food very much. We looked at the kitchen facilities, where appropriate cleaning schedules were in place and fridge and food temperatures were monitored and recorded. DS0000008708.V349404.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are safeguarded by the homes complaints and adult protection procedures. EVIDENCE: We looked at a satisfactory complaints policy and procedures, which are displayed throughout the home. We looked at complaints records, which are well maintained. The manager has recorded four complaints this year and two were upheld, with evidence of the manager addressing their concerns. Residents told us that they would raise concerns with the registered manager if they felt the need to. Staff told us they would support residents to make complaints even if they were considered minor concerns. We looked at an appropriate Whistle Blowing Policy and a policy detailing Adult Protection Procedures. The homes policies and procedures for responding to suspicion or evidence of abuse, or neglect, are generally satisfactory. The home has comprehensive policies regarding resident’s money and financial affairs. We were informed that only one resident’s money was held for safe DS0000008708.V349404.R01.S.doc Version 5.2 Page 16 keeping. We checked the records for this person, which showed appropriate records were maintained and cash balances were accurate. Two staff told us they had received training in adult protection issues and were fully aware of their responsibilities to safeguard older people. This was explained to us by describing what form of abuse may occur, what they should look for and what their responsibilities were if there was suspicion or evidence of bad practice in the home or in public. DS0000008708.V349404.R01.S.doc Version 5.2 Page 17 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): 19,20,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The home’s layout is suitable for the needs of the residents enabling residents to be as independent as possible; there is a passenger lift to the first floor. The owners have had new windows fitted throughout the home, which has improved the appearance inside and out. Residents told us they were pleased with the facilities and found their bedrooms and communal areas pleasant and relaxing. DS0000008708.V349404.R01.S.doc Version 5.2 Page 18 The gardens to the rear have now be made secure. The gardens are very bare and laid to concrete. For those residents who cannot get out much, they would benefit from the very least, having colourful and scented plants and shrubs to look at whilst sitting out. We looked at the laundry area, which is appropriately equipped. Residents said they felt their clothes were washed and stored appropriately and they were encouraged to be included in this where possible, with help from the staff. We saw appropriate cleaning schedules in operation throughout the home including the kitchen and laundry. The home smells clean and fresh and residents said how important this was to them. DS0000008708.V349404.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the staff are committed and competent, they have not received all of the training required by legislation. This could potentially place residents at risk. EVIDENCE: Staff files contained the appropriate recruitment records to show that residents are protected. One file only contained some of the required documentation, though the manager and staff member explained that they had been employed at the home for twenty years and they were busy getting new references and a new Criminal Records Bureau (CRB) check completed. Residents spoken with said that staff were available to assist them when they needed help and observation during the morning showed that enough staff were available during the busy period to ensure residents needs are met appropriately. Evidence was seen on staff files that staff received induction training when starting work and staff confirmed that they had induction training that covered DS0000008708.V349404.R01.S.doc Version 5.2 Page 20 different aspects of care in the home ensuring residents received appropriate care. The staff we spoke with, demonstrated a sound understanding of their roles and responsibilities and a great insight into the methods of promoting independence whilst supporting older people. They told us that they had attended numerous some training courses in the past but and have not had any of the regular updates in all of the mandatory Health and Safety training courses. From the comments and observations made, the staff team are held in high esteem amongst the residents for their commitment, attitude and support. There was evidence that staff receive supervision on a regular basis and staff members did confirm this during our discussions. DS0000008708.V349404.R01.S.doc Version 5.2 Page 21 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): 31,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well and there is leadership, guidance and direction to staff to ensure residents receive consistent quality care. This results in practices that promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: Residents and relatives told us the home was well run and the management team were always on hand for support and advice. Staff spoken with, confirmed that they felt supported by the manager and that they are approachable to discuss any issues. DS0000008708.V349404.R01.S.doc Version 5.2 Page 22 Residents felt that the home’s success is due to the culture of putting residents first and respecting their choices. Residents stated that they felt they were consulted about day to day issues. A relevant policy with regards to the safe keeping of resident’s personal allowances is in place and followed. We checked one resident’s cash held with their accounts records, which were accurate. The staff confirmed they receive supervision and attend regular team meetings. Supervision records were observed. Some records of appraisal were viewed. Some staff files contained records of supervision and appraisal. Staff spoken with also supported this process. Staff files showed that they have not undertaken training in mandatory health and safety subjects. Staff spoken with, were very aware of health and safety procedures. Risk assessments were observed on individual files and are in place for the building and individual residents. Records for Health and Safety monitoring and the servicing of systems and appliances were recorded in the providers own quality assessment submitted to us prior to the inspection and these were found in general, to be up to date. DS0000008708.V349404.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 DS0000008708.V349404.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 13(4,5) Requirement Make sure adequate risk assessments are conducted for the moving and handling of service users. All staff should receive training in all of the required mandatory health and safety subjects. Timescale for action 30/10/07 2 OP30 18(1) 28/02/08 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 OP20 OP29 OP7 Good Practice Recommendations It is recommended that the gardens are landscaped to provide a more stimulating environment for residents. It is recommended that you audit staff files to ensure all staff have the documentation required in schedule 3 of the regulations. It is recommended that more evidence of consultation with service users is recorded when planning the care for each individual. DS0000008708.V349404.R01.S.doc Version 5.2 Page 25 DS0000008708.V349404.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000008708.V349404.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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