CARE HOMES FOR OLDER PEOPLE
Llilibet Lodge 6 Rothsay Road Bedforf MK40 3PL
Lead Inspector Dragan Cvejic Announced 11/04/2005 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. Llilibet Lodge Version 1.10 Page 3 SERVICE INFORMATION
Name of service Llilibet Lodge Address 6 Rothsay Road, Bedford, MK40 3PL 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 , Ms Charlotte Drake Vivien Stone CRH 25 Llilibet Lodge Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11/10/04 Brief Description of the Service: Lillibet Lodge was situated in a nice, quiet area of Bedford, not far from the town centre and with easy access to the river bank. The building provided accommodation in a homely environment. Individual bedrooms were located on three floors connected by a lift. A lower, large lounge accommodated most of the mobile service users who enjoyed company. There were, in addition, two smaller lounges for privacy for those who wanted a quiet corner, or had major mobility problems. The main, lower lounge was accessible by 5 steps. The home had a lift connecting the upper lounge and floors. The garden was mainly paved and used by service users even in colder weather. A garden shed accommodated tumble driers for drying laundry. The owner explained the plans to transform some internal areas and relocate the laundry room. Most service users were mobile and relatively independent, but staff were there to help those who needed it regarding mobility. The home specialised in caring for older people with dementia and Alzheimers decease. Llilibet Lodge Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection and the home was prepared for it. The inspection was done within 7 hours. A pre-inspection questionnaire was sent to the CSCI office 7 days prior to the inspection. The CSCI office also received 5 service users comment cards. The inspector used different methodologies to obtain the evidence for this report: reading documents, case tracking, speaking to 15 service users, attending a review meeting with a Social worker, home manager and 4 visitors: family members. The manager took the inspector around the home. An activity was taking place during the visit, an external activity co-ordinator visited the home and commented to the inspector that “ this is a good home, residents are great.” What the service does well:
The service specialises in care for older people with dementia and Alzheimer’s disease. There were a number of organised, stimulating activities. The activity lady came in with a dog and it was obvious that service users knew the dog and liked him very much. The home encouraged independence and promoted service users’ abilities to remain independent as long as possible. At the review meeting that was taking place at the same time as the inspection, the social worker explained the benefits of music therapy for people with dementia to the relatives of a service user. A service user’s review demonstrated a huge improvement for that service user, originally admitted from hospital. She had started eating, her mobility improved and care needs could be met by the assistance of one carer, opposing initial support provided by two care workers. “She has never been so happy since she developed dementia”, the family commented. “She did not eat in hospital at all and now she eats”. Service users that were sitting in the lower lounge stated that they liked that lounge and it was their choice to spend their time in it. Although junior staff members did not have direct access to service users’ files, documentation kept in the home for service users was in order, effectively arranged in files and contained clear and sufficient information on service users. A service user stated that she felt more dignified since “they gave me a bell, so I can call them if I need assistance to go to the toilet”. Her key worker stated that “it took some time, but she managed to learn to use the call system and now she feels much happier.”
Llilibet Lodge Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
The home needed to produce a better service user’s guide. Although the home offered a homely environment, some doors, like the toilet upstairs, were not marked and could be confusing for service users with dementia having only a number on the door. The laundry room did not have a sink, but the sink in the toilet next door was used for hand washing. The owner stated that there were plans for moving the laundry to another room. This move would provide the space for a staff room, that did not exist at the time of this inspection. Staff commented that moving and handling training could be better and longer. The owner explained that a new training provider was found and that training was going to improve in quality. The home also must have a fire risk assessment on site. Llilibet Lodge Version 1.10 Page 7 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. Llilibet Lodge 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 Llilibet Lodge 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, Although the service users commented that they had got sufficient information in writing on admission, the home did not give sufficient and concise information to the relatives. EVIDENCE: The home was supplying a pack made up of three documents on admission. The statement of purpose and contract were detailed, but the service user’s guide was not updated and did not contain sufficient information. This was visible during the meeting with relatives held at the time of the inspection. The manager, however, asked family members of the referred service user many questions to identify properly the needs, habits, likes and dislikes of a prospective service user. The social worker was asked to provide sufficient and detailed information about the referred service user. An initial assessment, carried out prior to this meeting was improved by the information gathered from the relatives and social worker that attended this meeting. Relatives were pleased with the services and facilities shown to them prior to admission and on this, the review meeting, held at the time of the inspection. The son also stated: ”I am absolutely god smacked, she (relative-mum) shows a fantastic improvement.” The social worker commented: “This is a lovely building, lovely care and good staff training.”
Llilibet Lodge Version 1.10 Page 10 Llilibet Lodge Version 1.10 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 standard(s) 7,8,9,10 The documents held for service users in their files were well organised, structured, systematically sorted and contained sufficient information that allowed staff to work in a consistent and effective manner. EVIDENCE: The service users’ files were well organised. Care plans contained sufficient information on identified needs and clearly stated issues, responsibilities and expected outcomes. As these plans were filled in by the senior members of staff, junior staff commented that they would like to have easier access to the files. Some service users declined to take part in their care planning and this was recorded in the actual plans. Where the service users were taking part in the process, the care plans were signed. These files contained different charts, such as weight, nutritional, bowel movement, fluid intake and activity attendance charts, that enabled staff to closely monitor, plan and execute the care process according to the service users health care needs, and their wishes and preferences. Relatives of service users were involved in the process when service users agreed to this involvement, as was the case with the service user’s review that happened during this inspection.
Llilibet Lodge Version 1.10 Page 12 The medication processes, administering, explaining the effects to service users, recording and storage were appropriate. The privacy and dignity of service users was respected and promoted. Their individuality was recognised, they were addressed by their preferred name, as recorded in care plans. One service user commented: “ They help me in the way I want them to. “ Another service user stated: “Oh, yes, they always come if I ring the bell.” The social worker who conducted review had a private conversation with the service user in her room and demonstrated that privacy was respected. Llilibet Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 The home had a range of social activities that fulfilled the weekday routine of the home. A social worker and the manager talked highly of the effects of the activities on service users’ progress during the review meeting. Many service users made a progress. EVIDENCE: The home had a structured activity programme that contained a variety of organised activities. An activity person came in for a regular activity on the day of the inspection and 14 service users took part. The home kept records of attendance for activities to ensure that all service users benefit from the organised activities. At the time of the inspection, the manager stated that service users did not have meetings where they could discuss activities or other issues regarding the running of the home. The reason for not having these meetings was the service users’ incapacity to comprehend and rationalise some of these management issues. Service users that did have this ability, exercised their rights and choice on an individual basis, with their key-workers. Relatives present for the review commented to the inspector that they always felt welcomed and received enough information about their relative in the home. Llilibet Lodge Version 1.10 Page 14 Several service users commented that the food was good and confirmed that they had a choice. A service user that used to eat independently, but slowly, as served food the first, which allowed her plenty of time to eat and maintain her level of independence. Llilibet Lodge Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home had a complaints procedure. Service users were protected from abuse by policies, procedures and practical arrangements for delivering care within the home. EVIDENCE: A complaint procedure was displayed in the home. The statement of purpose contained the procedure too, and, being one of the documents given to referred service users, was made available to service users, relatives and other professionals involved in the care process within the home. The home had not received any complaints since the last inspection. The home had a whistle blowing policy, but some junior staff were not aware of the specific terminology of this document. When spoken to about the procedure, they confirmed their knowledge, but the manager would need to explain the specifics that this particular procedure relates to the whistle blowing policy. The job description was also very strict regarding absences, responsibilities and other issues directly or indirectly related to the protection of service users. The care plan and risk assessment for a particular service user were reviewed and updated on a two weekly basis, after the hazard of possible verbal abuse toward other service users was identified. The home did not hold any service users’ money, and recorded their representatives, be it relatives or authorised social workers or other professionals with power of attorney or guardianship. Llilibet Lodge Version 1.10 Page 16 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) 19.20,21,22,24,25 and 26 The layout of the home provided a very homely feeling. The design of the home was appropriate for the category of service users accommodated. Despite the lack of the planned cyclical maintenance plans, the home was in a very good state of repair. EVIDENCE: The owner’s presence in the home ensured that all maintenance tasks were dealt with when the need arose. A problem with the hot water supply, occurred and identified during the inspection, was addressed straight away and plumbers came out within ½ hour. The home did not have a fire risk assessment on site. The lower lounge, separated from the main entrance area by five steps, was the main area where most of the mobile service users spent their time, and provided a warm and cosy place to sit and relax. The home had sufficient number of lavatories and washing facilities. Toilets on the first floor were not clearly marked.
Llilibet Lodge Version 1.10 Page 17 The owner explained plans for re-organising laundry and some bathing facilities that would improve provisions for service users. A currently used washing machine had a sluice programme. This was important in light of the current laundry room that did not have a sink and the sink used was located in the toilet next to the current laundry room. Individual rooms corresponded to the size required by the National Minimum Standards. Service users that shared bedrooms confirmed that that was their choice and the manager stated that this arrangement provided the benefits of company to those that shared rooms. Individual bedrooms were arranged in a homely style with many personal possessions. During the review, the family of a prospective service user was encouraged to help the service user personalise her new room. All rooms had lockable facilities, but the owner explained that only those service users that had the abilities and wanted to, held the keys. The central heating complied with regulations, radiators were guarded and water taps had mixing valves installed to ensure water temperature complied with the safe standards. The faulty hot water taps were attended to immediately upon identifying the problem. Llilibet Lodge Version 1.10 Page 18 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 The home employed skilled, experienced and sufficient staff to respond to the needs of service users. EVIDENCE: The staff’s rota showed clearly the staff duties. The staff ratio was determined by the recommendations from the Department of Health and the manager’s assessment of service users’ needs. This approach ensured the service users’ needs were met at all times. The home had an effective recruitment procedure. Two references, a CRB disclosure, proof of identity, job description and a signed contract were part of staff’s files. Very strict terms and conditions were explained in the contract and staff were asked to sign on reading and understanding of the main home policies and procedures. Although staff were not familiar with the expression “Whistle Blowing” policy, they had the knowledge of how to deal with alleged abuse. The home offered essential training to staff that varied in quality. While the dementia course was highly praised by staff, moving and handling was criticised. The owner explained that the new training provider had been approached in order to improve training quality. All new staff were undertaking TOPSS training. Llilibet Lodge 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) 31,32,33,35,36,37 and 38 The management of the home was quite authoritative, but this principle ensured better protection of service users. The responsibilities were strictly divided through the hierarchical structure. EVIDENCE: The manager was experienced and skilled. She had applied for registration and the date for her interview was booked with CSCI. The manager and the owner created the ethos of the home whereby the service users were protected and cared for in a respectable and positive atmosphere. The manager explained that the lack of service users’ meetings was due to their incapacity to comprehend management issues, caused by their health conditions. The emphasised management hierarchy in the home ensured that all staff were clear of their direct roles, but their involvement in the management was channelled and limited to their roles. An example of this was the fact that senior staff were writing details in the service users’ files as
Llilibet Lodge Version 1.10 Page 20 and when reported by junior staff. Junior staff could ask to see the files, but were not entering any details themselves. At the time of the inspection there were no staff facilities in the home, but the plans for moving the laundry room involved creating a staff room. Strict rules imposed on staff in their contract and in working practices ensured better protection of service users. The owner organised quality assurance reviews through adaptation of some existing questionnaires for service users, while still searching for the format appropriate for this home. The manager was consulted, but the overall responsibility for the development, business file and budget, lay with the owner. The home had public liability insurance. The home budget was created and monitored outside the home. The home avoided dealing with service users’ money and directed service users to their families, relatives, legal representatives, advocates (Age Concern) or social services to support them with financial matters. Service users spoken to were happy with this arrangement. A service user thanked the inspector for forwarding her queries regarding her finances to a social worker. Family present at the review were also supported by the social worker who conducted the review to gain information on the financial aspects of the service user’s residence. This principle ensured full onsite financial protection. The home kept up to date records of service users possessions, but the dates were not recorded when changes occurred. The staff files contained records of supervision, but the quality of these formal sessions was not clear. The owner, however, stated that there was a planned supervision and appraisal training for senior staff that would significantly improve quality and produce effective outcomes from these sessions. Records kept in the home were in order and accurate. The manager stated that all eligible people could have access to records on request. The staff received mandatory training and certificates were kept in their files. The home did not have a fire risk assessment on site. An infection control policy and procedure were displayed and respected. The policies and procedures were reviewed and updated by the owner and the manager’s responsibility was to pass on service users’, staff and personal comments to the owner in cases where there was a need to change policy or procedure. Accidents/incidents were accurately recorded and reviewed with the intention to minimise further risk. Llilibet Lodge 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 2 3 3 3 x 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 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 2 2 x 3 3 2 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 Standard No 16 17 18 Score 3 x 3 3 2 3 x 3 2 3 2 Llilibet Lodge 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 1 Regulation 5 Requirement The home must produce a service users guide that corresponds to the requirement and contain details of the home as required by the regulation 5 The toilets on the first floor must be appropriately marked to meet the needs of service users with dementia. The home must have a fire risk assessment on site. Timescale for action 30/06/05 2. 21 23(2)(a,n 15/06/05 3. 4. 8 23(4) 30/06/05 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 26 19 30 Good Practice Recommendations The home should execute the plans for relocating laundry room and making it as required by the National Minimum Standards The home should consider creating staffing facilities, including facilities for the purpose of changing and storage facilities, as described in regulation 23(3) The home should ensure the training organised for staff is of appropriate quality including moving and handling training
Version 1.10 Page 23 Llilibet Lodge 4. 32 5. 33 6. 7. 36 38 The home should create the atmosphere where all the staff, including juniors were given the opportunity to express their innovative, creative and developmental comments in an open and transparent style.This must include free and confident access to service users files. The home should carry out regular quality assurance reviews and provide an action plan based on the analysis and comments collated in the process. The business plan should be devised and held in the home from the outcome of quality assurance reviews. The home should provide adequate training to the supervising staff in order to ensure effecive supervision. Staff training on safe working practices should include training on prevention of abuse that explains the vocabulary used in care industry, such as a Whistle Blowing and further enable staff to react in the expected way to ensure the highest possible level of protection for service users. Llilibet Lodge 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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