CARE HOMES FOR OLDER PEOPLE
Lillibet House Lillibet House 65 De Parys Avenue Bedford Bedfordshire MK40 2TR Lead Inspector
Dragan Cvejic Unannounced Inspection 09 September 2005 07:30 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 Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 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. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lillibet House Address Lillibet House 65 De Parys Avenue Bedford Bedfordshire MK40 2TR 01234 272206 01234 272205 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) Mrs Charlotte Drake Lorraine Miskelly Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Including one resident under the age of 65 years, agreed with the NCSC. 05/04/05 Date of last inspection Brief Description of the Service: Lillibet house is a residential home for older people situated in a residential street, not 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 disease and minor physical disabilities. The home offered accommodation with 30 single rooms that corresponded to the required size, all with washing facilities (wash basin). The rooms were fully furnished, but the home encouraged service users to bring in their own personal items, such as items of furniture, TV, music systems, ornaments and pictures. This three storey building, has 12 rooms on the ground floor, 12 on the first and 6 on the top floor, it also offered pleasant communal areas that created a homely environment. There is a lift to all three floors. There are two steps connecting the new extension to the rest of the building and this limited the access to this area for the less mobile of the service users. The home had ramps that allowed easy access to the garden for all, including the wheelchair users. The bathrooms and toilets were evenly positioned throughout the home and were equipped with appropriate facilities, rails, raising seats etc. An additional shower room on the ground floor provided choice to service users who preferred to shower rather than use the bath. At the front of the house, there is provision for 3-4 parking spaces. The back garden was secure, there is a brick wall protecting the grassed area in the middle and it is surrounded by paving slabs. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during 7 hours on a weekday. The manager arrived during the beginning of the inspection and provided useful explanations and information. The methodology used were case tracking, document reading, observation of practise, gathering of information from 6 service users and 3 staff members. What the service does well: What has improved since the last inspection?
A new manager who is covering maternity leave of the previous manager has managed the home. She brought in many innovations, improving the conditions for service users and standards of care. New medication process was introduced. Senior staff were trained to deal with medication by the pharmacy that delivered the medication. A new medication
Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 6 trolley was obtained to ensure better storage, administering and easier monitoring of medication. Fire risk assessment was carried out after the last inspection. A fire officer was called in for consultation and the appropriate training for staff followed the visit and the advice that was given. Training improved both in quantity and quality. A new moving and handling training provider delivered appropriate quality training and staff were now confident to use the hoists and other aid facilities. Service users were happier with these new procedures. Staff turnover was significantly reduced and no one had left the home since the new manager started. This created a compact and strong staff team. Activities were revisited and new recording system was introduced. It allowed staff to accurately assess attendance and monitor effectiveness of each organised activity and its effects on service users. Service users stated that new manager was friendly, professional and good listener. A new key-working practice was introduced and key workers had allocated time to spend with service users for a general chat, in addition to the practical help and support. Service users were very pleased with this and liked very much that time. The manager went a step further and explained this key working system to relatives when they visited service users. Staff satisfaction was much better. A staff member said: “we now take users out for a short walk, they love it, it is so nice. It helps us developing a relationship with service users.” What they could do better:
Records kept in service users’ files were well organised and kept, but the property list called “personal inventory” for individuals was not dated and signed. Corrections and new entries to this list must be initialised and dated. Records of service users’ personal allowances must be signed by either service users or their representatives/families. When the staff help service users to use their credit or other withdrawal cards to withdraw money as asked by service users, these transactions, in particular, must be signed by the service users or their representatives. The current recording system for users’ personal allowances must be reviewed and arranged differently to enable better protection and accuracy, to allow easy audit and to have back up forms of signed receipts and recorded details of transactions. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 7 The manager should start reviewing the staffing level in relation to the increasing service users needs. The home should start using a form just received for reporting significant events to the regulation authority. 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. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 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 Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 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 the following standard(s): 1,3,4,5,6 The home provided effective information about the services and provisions allowing potential service users to make an informed choice of the home where they wanted to move in. EVIDENCE: The home carried out a full and comprehensive assessment of referred service users. The format used to record assessment, addressed all relevant areas. The files inspected demonstrated that the assessment was tailored to the home’s ability to meet the needs of referred users. One of service users spoken to commented that she remembered being assessed in her home prior to admission. The other user did not remember the assessment process, but confirmed that she visited the home prior to her admission and that she was offered a trial period. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 10 The service users files and appropriate monitoring charts demonstrated how the assessed needs were met. The statement of purpose and service user’s guide were not updated in regards to changes introduced by the new manager, but her prioritising skills were applied appropriately and she was aware of the need to review these documents in the near future. The home did not provide intermediate care. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The home had a well organised and good records held in the service users’ files. Records included care plans and risk assessments that were used effectively to identify, organise, deliver care and monitor service users needs. EVIDENCE: The service users’ files contained records, covering: basic details, details and reasons for admission, names of user’s representatives, initial assessment, care plan, care plan review sheet, appropriate charts for monitoring individually identified areas, such as weight, nutrition, elimination, bathing, skin conditions, risk of falls, activities, observation, or other relevant to each individual. A risk assessment was drawn up covering risk of falls, nutritional risks, pressure sores risk assessment and general risk assessment addressing any other potential risk. An example was shown in two inspected files, where aggression and agitation was addressed in one and taking other users cups with drink as a result of confusion in another. A service user stated: “food is good and we have a choice” This statement was confirmed during the lunch, when a service user chose a different meal not on the menu and it was provided.
Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 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 the following standard(s): 12,14 The service users had a choice to join various activities organised in and out of the home and benefited from new approach to activities. EVIDENCE: The new manager addressed the activities organised in and out of the home. Short outings in the local area were introduced and both staff and service users commented that it was enjoyable experience. A new recording system was also introduced. Now it was demonstrable for each individual which activities they joined in and when they refused to take part. This system also increased staff involvement and provided an additional opportunity for one to one contact. The home encouraged service users to arrange with their families to be helped with their finances and personal allowances. Some service users wanted the home to keep their money secure. The balances checked were accurate, but the records did not have service users or their representatives’ signatures on transactions. Transactions were not recorded with sufficient details and receipts were hard to audit against records. The manager also should consider a safer place for money held. Individual lists of possessions brought into the home were not dated and signed and additional entries and corrections were not initialised.
Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 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 the following standard(s): 16,18 The home dealt with complaints in a constructive way and ensured all complaints were investigated and acted on to eliminate negative and to promote positive elements. Protection of service users was ensured as much as possible. Service users felt safe. EVIDENCE: The manager explained how the home dealt with complaints through a recent example, where the complainant was invited to come and discuss the outcome and the way that the complaint would be used to improve further services and provisions. The home displayed a large print notice stating, ”Abuse is wrong, report and prevent abuse”. The staff spoken to confirmed that they would condemn abuse and report any potential allegations. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 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 the following standard(s): 19,26 The home’s location, environment and maintenance were appropriate and met the requirements from the standards and needs of service users. EVIDENCE: The home was located in a wide, residential avenue and was suitable for its stated purpose. The manager ensured that all faults were reported immediately and the owner approved the engagement of the appropriate contractors and purchase of the replacement items. The carpets were replaced in some areas and the manager was monitoring the state of the home. The home was clean, bright and hygienic. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The staff team were competent and stable and with good leadership were able to meet the needs of service users. EVIDENCE: With the appointment of a new manager, staff turnover was significantly reduced. No one left the home during her time in the home. The rota was clear and indicated the duties. The staff ratio on each shift was assessed according to needs and number of service users currently in the home. The manager offered reassurance that with new admissions more staff would be employed both for day and night shifts. Recruitment was appropriate and the staff’s files contained 2 references, job application, induction and foundation booklet where initial training was recorded and a contract. However, some contracts were not signed and not all staff were given a copy of contract that contained terms and conditions. Staff training was various and staff commented that the quality of training was lately much improved. Service users noted that the staff were using the hoists with confidence and more appropriately since the new training was provided. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,36 Service users’ money was not appropriately protected. Staff were regularly supervised and supported to meet the service users’ needs. EVIDENCE: Although the service users’ money was locked away, the storage was not the best solution and the manager was asked to find another solution. Records of individual personal allowances matched the amounts held by the home, but the records did not contain sufficient details on transactions. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 17 In the case where the home held a credit card for a service user, the “his or his representative” signature was missing against the money withdrawn from bank on his behalf. The home had a list for supervision displayed. The staff confirmed that both supervision and staff meetings were regular with the new manager in post. A content of supervisions was appropriate. Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 18 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 2 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 1 3 X X Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO 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 14 Regulation 17 Requirement Timescale for action 10/11/05 2 35 16(l) The service users’ property list must be dated, signed and kept up to date with dates and signatures when new entries or corrections are made Service users’ money held by the 01/11/05 home must be stored securely and transactions records must be signed by service users or their representatives RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lillibet House DS0000014927.V248978.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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