CARE HOMES FOR OLDER PEOPLE
Lillibet House 65 De Parys Avenue Bedford Address 3 Postcode
Lead Inspector Dragan Cvejic Announced 05/04/2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lillibet House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Lillibet House Address 65 De Parys Avenue, Bedford, MK40 2TR 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) Category(ies) of registration, with number of places 30 Ms Charlotte Drake Naomi Percival (under application) Lillibet House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1 named service user under the age of 65 Date of last inspection 09/12/2004 Brief Description of the Service: Lillibet house is a residential home for older people situated in a residential street, not too far from the centre of Bedford. The home was registered for 30 service users over 65 years of age, but specialised in caring for dementia, Alzheimers decease and minor physical disabilities. The home offered accommodation in 30 single rooms that corresponded to the required size, with washing facilities (sink). Rooms were fully furnished, but encouraged service users to bring in their personal items, such as pieces of furniture, TV, music systems, ornaments and pictures. This, three storey building, apart from 12 rooms on the ground floor, 12 on the first and 6 on the top floor, also offered the pleasant communal areas that created a homely environment. A passengers lift connected all three floors. but the two steps connecting the new extension to the rest of the building limited access to this area for less mobile service users. The home had ramps that allowed easy access to the garden to all, including wheelchair users. Bathrooms and toilets were evenly positioned throughout the home and were equipped with appropriate facilities, rails, raising seats etc. Additional shower room on the ground floor provided choice to service users who preferred a shower to bath. Front of the house provided 3-4 parking spaces. Back garden was secure within the bricked wall protecting the grassed area in the middle, surrounded by the path made of slabs. Lillibet House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection. It was combined with a complaints investigation and was carried out during 12 hours. The information about the home in a form of the pre-inspection questionnaire had not been returned prior to the inspection. The inspector used case tracking methodology as the main method of collecting evidence, meaning that the inspector examined in details documentation, care and service for proportionally chosen number of service users. The inspector also read documents, observed staff helping service users with their needs, toured the building; and spoke to the owner, the manager, 2 staff members, 1 visitor and 8 service users. An anonymous complaint was investigated with the owner and the manager, and the inspection findings provided some extra evidence that helped reach the outcome of the complaint. The reason that this report is written in the past tense is that the writing of the report occurred some time after the findings were recorded during the inspection. What the service does well:
The home specialised in caring for service users with dementia and Alzheimer’s disease. The home’s layout and facilities were appropriate for the needs of service users. Well maintained and comfortably furnished, the home created an atmosphere where service users were able to enjoy a company of others, support and help by staff and where they felt “at home”, as one service user commented to the inspector. The records and documents kept in the home about the service users contained sufficient information for staff to relate to when they were offering support and care to service users. The home organised collecting information on service users history, medical conditions, what they liked and disliked and what they wanted to achieve in the home. Privacy and dignity were respected. A service user spoken to commented: “ I am quite independent, but when I need any help, they know how to help me.” Another service user, coming with different cultural needs stated that, “they are good, they help me a lot”. She stated that she did not want any particular dish from her cultural background because “the food is really good.” The cook stated that she would offer alternatives to service users that wanted something outside of the usual set menu. The home was in the process of introducing a day in the month when one service user would choose the meal for everyone for that day. Lillibet House Version 1.10 Page 6 The complaints procedure was displayed in several places around the home. The owner and the manager were strict with staff, but made sure that vulnerable service users were protected from a potential abuse and felt safe. What has improved since the last inspection? What they could do better:
The statement of purpose was appropriate and was given to service users’ relatives, together with the home’s short and concise brochure. This brochure presented the service user’s guide, but did not meet the contextual standard. Although a satisfactory solution was to give both documents, it was suggested that the home draw up a service user’s guide that would meet the standard. The well written and maintained care plans only were missing service users’ or their representative’s signature. Although the home provided activities and engaged external co-operative individuals for this purpose, the service users commented in their questionnaire that the activities could be better, more stimulating; and it was obvious that this area required reviewing and planning with the involvement of service users. The home could consider reorganising some of the routine daily tasks, such as mealtimes, and make it more interesting and stimulating for service users. Further training on activities for people with dementia and Alzheimer’s disease would help the home organise activities at a local level, without spending extra money and satisfy service users’ wishes and needs. Another option would be engagement of the local community in the activity programme. Service users could provide suggestions and should be listened to.
Lillibet House Version 1.10 Page 7 The complaints procedure was displayed around the home, but the home should encourage complainants to complain to the home in a formal way, so that complaints might be investigated locally, by the home, and be used as a tool to improve services and provisions. Junior staff should have easier access to service users’ files. They stated that they found it difficult to ask every time they wanted to see a file. Senior staff commented that files could be seen at any time, on request. Although one bathroom, that was temporarily locked for the safety of one service user, did not have a major effect on the bathing programme in the home, the manager should seek another solution and keep the bathroom open. A new hoist was needed for the extension, because of two steps that separated this area from the lift and the rest of the home. The risk assessment did not address potential action if the hoist breaks down, or if a service user falls in the extension and require hoisting for own safe manual handling procedure. The manager stated that there were enough staff on duty and the staff’s oncall system provided extra safety. The manager should still, however, make sure that staff on duty can respond to potential emergences at all times, day and night. The manager should analyse how often the home had to employ new staff to replace those that were leaving and give suggestions to the owner how to keep staff working longer in the home. This could include reviewing the job contract. The owner must make sure that senior, supervisory staff receive proper Supervision and Appraisal training in order to provide good formal supervision to staff. The home must draw up a fire risk assessment in negotiation with fire officer. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lillibet House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Lillibet House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 The home was providing sufficient information for potential service users to make an informed choice about the suitability of the accommodation. Although the individual documents were brief, given together to the potential users and relatives they provided all the necessary information about the home. The home was able to meet the service users’ needs. EVIDENCE: The statement of purpose was a comprehensive document and provided information about the service and provisions. The service user’s guide was a very brief brochure and described the home only when read together with the statement of purpose. The contract was also a brief, one page document, but if read with the info pack given to potential service users, satisfied the requirements regarding the content and range of the information. Inspected contracts were signed either by service users or their representative. The form used for the assessment of needs of potential service users was well designed and provided all necessary information about the home prior to admission. The home was able to meet the service users’ needs. The home offered a trial visit of 6 weeks.
Lillibet House Version 1.10 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) 7-10 The evidence demonstrated that the home cared for individuals and showed respect to their personal needs. Senior staff members knew service users, their habits, wishes and needs well. EVIDENCE: Service users’ files were very well organised and contained sufficient information on each individual, and were related to the information gathered during the initial assessment. However, some care plans were not signed by service users or their representatives. This file contained risk assessments and appropriate charts that corresponded to assessed needs. Some had bath charts, some weight charts, usually combined with nutrition and toilet charts. The home reacted to changing needs. One of inspected files addressed change in the “dependency profile”: “now eats in his room to prevent distress from and to others”, or “resists all contact”. Hourly observations were recorded where the need was indicated. Although review sheets, dated and signed, did not indicate where the change was recorded, different handwriting and date in care plan corresponded to this sheet. Medication was recorded appropriately and kept secure. Administration of controlled drugs was also correct.
Lillibet House Version 1.10 Page 11 Privacy and dignity were respected, although not all service users used the opportunity to hold the keys of their bedrooms. Wishes in case of death were recorded in service users’ files. A service user whose conditions deteriorated beyond the homes’ ability to meet these new needs was referred through social services to a more appropriate setting. Lillibet House Version 1.10 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) 12-15 Although service users’ preferences regarding activities were recorded in the initial assessment and the home had an activity programme, Users’ needs in this area were not met. EVIDENCE: The home provided activities and recorded on activity sheets service users attendance. However, these records repeatedly demonstrated “TV” and similar. There was no evidence of service users’ involvement in decision making when activities were determined. Several service users commented on the comments cards and to the inspector that “there were not enough activities”, especially not enough stimulating activities for service users with dementia and sensory impairments. The home did not have an allocated responsible person to monitor and take a lead on activities and this probably affected the quality of provisions in this area. Mealtime was more of a task, rather than an opportunity to be used as a form of social activity. There was a feeling that there were not enough staff at this particular time. This was noticed by the inspector during, and by some relatives that had contacted the CSCI office prior to, the inspection. Service users’ relationships also influenced this feeling. A service user commented to the inspector that “some service users do not communicate with each other”. Visitors were welcome in the home and would have an opportunity to see their relatives in private if that was a wish of any of the parties. Although the home
Lillibet House Version 1.10 Page 13 was in the community, service users’ conditions and the routine of daily life limited community connections to relatives. Service users’ autonomy was highly respected and promoted. A service user proudly stated to the inspector that she could “do most things for myself and staff help me only when I want”. Most service users had some of their possessions with them in the home. The home also supported independent financial agreements and asked relatives to support service users who needed help with financial matters. Some service users even had small amounts of cash with them. The home kept some personal allowances for those who insisted that this arrangement was the best for them. These records were accurate and corresponded to balances in individual money pockets. Quality and quantity of food were appropriate, all service users spoken to the inspector expressed their satisfaction with food. Sampled food was tasty and nutritional. Service users that were able to use the dining room had their food served in an attractive manner, but those eating in other areas were served food on small, movable tables and the attractiveness was limited to the food on the plate. Mealtimes were quiet and had been seen more as a task than as enjoyable social time. Lillibet House Version 1.10 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Although there were several complaints and concerns, raised mainly externally, and to the CSCI office, it seemed that all off them were of a constructive nature aiming to improve the services and provisions. The home’s strong objections and dismissal of the non substantiated elements could present a detriment to reporting minor concerns. Protection of service users was ensured as much as possible. EVIDENCE: The home had a clear complaint procedure displayed around the home and had not received any complaints directly. However, there were several complaints and concerns expressed to the CSCI office and Social Services. The home acted on substantiated elements, but very strongly objected and dismissed those elements found not substantiated. The management style and strict rules, policies and procedures ensured the protection of service users. The home had a very robust procedure still in force on dealing with allegations of potential abuse. Lillibet House Version 1.10 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19. 20, 21,22 and 24 The home was located in a wide, residential avenue and suitable for its stated purpose. All were single bedrooms, and communal areas were appropriate in relation to standards and corresponded to the needs of service users. EVIDENCE: The home was located in a wide, residential avenue and suitable for its stated purpose. The organisation employed a maintenance man to cover both organisation’s homes on an “on-call” basis. The owner stated that a cyclical maintenance programme existed that so all areas of the home were redecorated on a time-scaled programme. New flooring had been installed in the bathroom on the second floor. There was a temporary measure introduced in the home to keep one bathroom locked and used under staff’s control, as a measure identified in one individual service user’s risk assessment. This fact did not limit facilities provided for the rest of service users. Paved area of the garden was used by several service users. Bathroom downstairs had been considered for changes to re-lay the bath within it, that was in a slightly uncomfortable position for care workers. New extension was not accessible by the hoist due to two steps at the entry to that area and it was suggested that the home provided a designated hoist for that area. The number of bathrooms
Lillibet House Version 1.10 Page 16 was within the set ratio, but the service users had their preferred bathrooms making an unequal percentage of usage for individual washing facilities. One bathroom was used by one service user only and a shower was used by two service users. All bedrooms in the extension had commodes. A passenger’s lift connected all three floors. Grab rails were installed in some parts of the home and in toilets. The home was equipped with the top of the range call system. Lillibet House Version 1.10 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The staff team were competent and with good leadership were able to meet the needs of service users. EVIDENCE: The staff employed by the home were able to meet the needs of service users. The staff turnover affected the consistency of care, as new staff went through an induction training programme. The home did not deploy agency staff, but engaged permanent staff to cover for absences. The manager was also doing some care shifts on week days. Although the manager stated that staff ratio was at the range of 5 morning and 5 afternoon staff, the rota demonstrated that there were days when 4 members of staff were on duty. The night was normally covered by 3 staff, but the rota, again, demonstrated a few nights when only two staff were on duty. The manager stated that staff deployment was appropriate and an on-call system was in place in case of any unexpected event. Afternoon care staff provided a catering service in the afternoon, as the cook worked morning shifts. The manager stated that one staff member could be engaged on kitchen duties after 4pm, when most daily routine duties had been completed, without affecting the standard of care. The owner commented that staffing level was adjusted according to the number of service users present in the home at any one time. Eight staff members were NVQ trained and a further 3 were enrolled on the programme. The staff’s turnover also affected the percentage of NVQ trained staff being just under 50 , as required by the standards. The company had a recruitment procedure that ensured the protection of service users. The staff commented that the contract was “quite strict” in stating bonuses but also possible deductions from the pay. However,
Lillibet House Version 1.10 Page 18 the staff stated that they were given this information prior to employment and it was up to them to join the company or not. Staff files contained the signed contracts, job descriptions, copies of the documents to confirm identity, 2 references, CRB disclosures, supervision sheets and training certificates. The staff spoken to stated that they were “a good staff team and helped each other.” The company offered good training opportunities that included TOPSS requirements and specialist training related to the conditions of service users. Lillibet House Version 1.10 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37 and 38 The home was managed and run by combined leadership between manager and the owner. This combination ensured health safety and welfare of service users were promoted and protected. EVIDENCE: The home was managed by the skilled and experienced manager who was in the second, final year of her NVQ4 and was working towards the Registered Manager’s Award. The manager was in the process of registration with the CSCI. The manager was accessible and open. The owner was also closely involved in running the home. The owner’s authoritative style ensured better protection of service users. The home’s alternative to whistle blowing seemed to be very effective and consisted of a displayed procedure in case of any suspicion. Although the owner was still researching the systems for quality assurance, the initial review had already been carried out and questionnaires were distributed to relatives of service users. The home was on the way to producing their own quality assurance programme. The home did not have a business plan, but the
Lillibet House Version 1.10 Page 20 owner’s presence on a regular basis, the maintenance and renewal programme, and set yearly budget demonstrated investment in provisions for service users and insurance certificates were displayed. The home encouraged service users to keep control of their financial affairs, to engage their families or legal representatives to help them if and when needed and provided a safe system for deposited personal allowances to the home for safe keeping. Supervision records demonstrated the regularity of supervisions provided to the staff, but the way the supervision was organised was not clear among all staff. The home did not have an appraisal process. The owner stated that there was a plan to train the manager and all seniors prior to setting up the appraisal process. Records kept in the home, especially for service users were accurate and up to date, apart from the missing signatures, as mentioned earlier. Some junior staff stated to the inspector that they did not have contact with service users’ files, but the manager stated that access to service users main files would be allowed to all staff on their request. The owner, the manager and the home ensured that health, safety and welfare of service users were respected and protected. The home needed to risk assess the emergency moving and handling equipment requirements, particularly in relation to access to the extension. Staff commented that the quality of moving and handling training could be better. The owner explained that this had been identified and an alternative training provider was being sourced to rectify this problem. The home did not have a fire risk assessment and the manager agreed to contact the fire service for advice and to produce this document in negotiation with fire officers. Lillibet House Version 1.10 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 2 x 3 x x STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 3 3 2 2 2 Lillibet House Version 1.10 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Timescale for action 15/06/05 2. 12 16(m,n) 3. 22 13(4) The care plans must be discussed and agreed with service users and be signed by them or their representatives The activity programme must be 30/06/05 reviewed, discussed with service users and their views taken into account when new plan of activities is planned. The potential risk of not being 30/07/05 able to respond appropriately in cases of falls if the only hoist breaks down, or the falls occur in the extension was too high and must be risk assesses, and a plan od action established. 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. Refer to Standard 18 15 Good Practice Recommendations The homes brochure that represents the service users guide should be updated or redesigned to include or refer to other documents that contain required details Mealtimes should be reviewed and reorganised in the way that induces satisfaction of service users and not the staff
Version 1.10 Page 23 Lillibet House 3. 4. 27 38 task only The manager should ensure that the staff ratio determined on rota is maintained all the time and staff number per shift does not fall bellow specified numberl A fire risk assessment should be drawn up and present in the home. This issue should be discussed with the fire officer during forthcoming visit Lillibet House Version 1.10 Page 24 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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