CARE HOMES FOR OLDER PEOPLE
Lillibet Lodge 6 Rothsay Road Bedford Beds MK40 3PW Lead Inspector
Dragan Cvejic Unannounced 03 August 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 Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Lillibet Lodge Address 6 Rothsay Road Bedford MK40 3PW 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) 01234 340712 charlotte_@tiscali.co.uk Mrs Charlotte Drake Vivien Stone care home 25 Category(ies) of OP - Older people (25) registration, with number DE(E) - Dementia over 65 years (25) of places PD(E) - Physical Disability over 65 years (25) Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11/10/04 Brief Description of the Service: The home is situated in a nice, quiet area of Bedford, not far from the town centre and with easy access to the riverside. The building provides accommodation in a homely environment, a large lounge accommodated a large number of service users who enjoyed company and there were, in addition, two smaller lounges for privacy for those who wanted a quiet corner. The home had a lift connecting the upper lounge and floors. A lower lounge was accessible down four small steps or by walking through the garden. The garden was mainly paved and is used by service users even in colder weather. A garden shed accommodated tumble driers for drying the laundry. Lillibet Lodge cared for 25 service users with dementia and general age related problems. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during two visits to the home on 29/07 and 03/08/05. The complaint made to the CSCI was investigated during this inspection. The methodologies used were case tracking, documents reading, talking to the service users, staff and the management. The proprietor called on the telephone and spoke to the inspector during the inspection. On the first day the inspector spoke to 8 service users, 4 staff and a visiting district nurse. On the second day the inspector spoke to 4 service users, one care assistant, the manager and to the proprietor by phone. Three visiting relatives also contributed to the inspection and provided their comments. The inspection showed a good level of care and some minor shortfalls in records kept on service users. This was addressed using the appropriate standards and requirements that resulted from the findings. What the service does well:
Two of the inspected service users’ files had comprehensive admission documentation. Previous care notes and plans were used in the assessment. The manager visited and assessed potential service users prior to the admission. Upon admission, the home implemented a care plan with goals and objectives to encourage and promote users’ strengths. For example, service users with mobility problems on admission were encouraged to use all their remaining ability to improve walking. “I am so glad I can walk again”, stated a service user whose programme resulted in her walking a short distance with a frame. Several service users commented that their dignity, wishes and preferences were respected. “I love my coffee first thing in the morning, they know I don’t like milk and so they don’t give it to me. “I am so happy here”, said a service user that greeted the inspector in the early morning. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 6 A visiting diabetic nurse stated: “This is one of the better homes that I visit.” She was taken to a diabetic service users’ room to give them their regular insulin injection. “The staff tell me if there are any changes for the people I visit”, she continued and concluded: “Their records are quite useful for us, they work with less mobile people and call us in to help with insulin dependent users.” A service user described what she would do, if she wanted to complain: “I would not speak to the “boss”, but would definitely say to my key worker if I was not happy with something, all the girls are nice.” The structure of the staff team was clear. Staff knew their roles and what was expected from them. A cook stated that “staff were happy, busy but effective”. The activities offered were varied and appreciated by the service users. Three users stated that they loved the entertainer that comes to the home and sings songs with them all once a week. What has improved since the last inspection? What they could do better:
The home had a clear admission procedure and generally assessed all new service users. However, when users were transferred from the “sister” home, the admission assessment was done, but was not appropriately recorded on the admission form. In the case of a transfer, the home did not create a new
Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 7 care plan; they reviewed the existing plan that was transferred together with the service user. Moreover, the complete file was transferred and although this meant that more information was available, it was not appropriate to simply review records, as this home operated differently and had its own individuality. These comments were identified as a part of the complaint investigation and addressed to the management team and the owner. The records of medication did not match the actual amount of medication kept in the medication trolley and the monitoring process was complicated, by changing the way of recording medication, the audit could be made simple. The manager also needs to identify the best way to mark the doors and make orientation easier for service users. 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 Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 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 Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 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) 3,4,5 Generally service users were appropriately assessed prior to the admission, but there was a case where the assessment was not correctly recorded and this raised the question if the service user’s needs could be met. EVIDENCE: The assessment form used for the initial assessment was appropriate. In most cases the form was filled in appropriately and presented the base for creating a care plan. In an isolated case, the assessment form was not filled in (it was transferred from a “sister” home). Although there was evidence that the assessment was done, the form was not filled in. The format for recording the care process for service users was well designed. In 3 inspected files the records were appropriate and matched the service users statements and the care practice observed. Appropriate charts were introduced when a specific need for close monitoring was identified. These documents and users comments confirmed that service users’ needs were met. In one isolated case, the lack of the appropriate assessment form and continuation of the file transferred from the “sister” home did not demonstrate that the needs of a service user were met.
Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 10 There was evidence of users’ relatives visiting the home prior to admission. A visitor spoken to confirmed her satisfaction with the possibility to choose the home. She continued and stated that her relative was well looked after in the initial month. There was evidence of engaging health professionals in the care process and the consultant psychiatrist visited the home on the day of the inspection. In practice, the trial period was effectively used to finalise the assessment review. In three inspected cases the evidence showed that a trial period was effective. In one case, the trial period was not clearly identified, as the file for a service user was transferred from the “sister” home. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 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 The home used effectively the initial assessment and trial period to identify needs and to set a care plan for service users. Care plans were reviewed regularly and were used to ensure that service users’ needs were met. EVIDENCE: The home had a good format for recording necessary information about service users. The file format contained basic details, an activity list, a moving and handling risk assessment, general risk assessment, property list, dependency profile and old daily reports sheets. However, the property list was not signed, dated and up dates were not correctly recorded in 2 out of 4 inspected files. The care plan itself addressed all main areas on the actual format and the staff, usually senior, filled in all relevant details. Care plans were signed by either users themselves or their relatives. The file also contained the individually identified charts to monitor meeting the health care needs. Controlled drugs were correctly recorded and administered. The regular medication was also correct, but the medication prescribed on a “when there is a need” basis was not recorded correctly, as the stock and returned amounts did not mach the actual number of tablets. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 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) 12,14 The home recorded service users preferences in their files and responded to the identified likes and dislikes, wishes and interests by introducing relevant processes, procedures and working methods. EVIDENCE: Four service users were dressed in the way that their records showed as their preferences. An early morning coffee was served, without milk to a service user that did not like milk. She stated: “They always give me my morning coffee without milk”. Activities organised in the home were varied and the home tried to respond to the interests of service users. Two service users stated that they were happy and sang along with the visiting entertainer once a week. Information on activities was displayed on the board in the hall. Service users were encouraged to bring in their personal items and make their rooms personalised and homely. Some records of users’ possessions were signed, but some were not. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home had a clear and appropriately timed complaints procedure. It ensured that all complaints were looked into and responded to. EVIDENCE: On the first day of the inspection a displayed procedure did not have a telephone number of the regulation authority and this was pointed out. On the next day, it was corrected and the phone number was inserted. The home showed their efficiency to respond to shortfalls identified during the inspection. The complaint received by the home and forwarded to the CSCI was also investigated during this inspection. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21 The home’s location and layout were appropriate for service users and their conditions and made them feel at home. EVIDENCE: The home was suitable for service users, well maintained and ensured that users’ enjoyed living in a comfortable and homely environment. The maintenance book showed that all issues were addressed and dealt with straight away. Routine maintenance was carried out according to plan. The home had sufficient number of lavatories, but the bathroom on the first floor was not marked to make the orientation easier for service users. The home was clean and bright. A visitor commented that her relative in the home had all she needed and was well looked after. She stated: “My relative is very happy here”. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 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 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 home ensured that service users needs were met by employing sufficient and skilled staff for each shift. Service users were well cared for. EVIDENCE: The home employed sufficient and knowledgeable staff to respond to service users’ needs. Staff knew their roles and duties. “We know what is expected of us, it states in the contract”, a staff member stated. The manager explained that the rota was created according to the number of service users currently present in the home and their needs. More staff were working on the morning shifts, when most personal care was provided to service users. The home did not use agency staff, but when cover was needed, they engaged staff from the “sister” home. This procedure was negotiated and monitored by the proprietor. The home changed the training provider to ensure better quality of training. The staff commented on the improvement in training since a new training provider was delivering training. The amount and the variety of the training provided were appropriate. All new staff were trained according to TOPSS principles. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 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 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) 31,32,37,38 The home was managed by the newly registered manager who had the experience and skills to run the home in the best interest of service users. Both service users and staff were happy by the management of the home. EVIDENCE: The manager had skills, experience and knowledge to run the home. She was registered with the CSCI since the last inspection and worked continuously on self development. She created a more open and inclusive atmosphere, in which both service users and staff were encouraged to participate. Service users meetings were held once a month. Staff confirmed that service users were providing individual comments and suggestions during their regular meetings with their keyworker. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 17 Records kept about service users were secure, but staff stated that they could be made available to a service user on request. A district nurse commented that files were very good, informative and useful for district nurses team. The moving and handling process was observed and was appropriate. A service user commented that she was helped in the way that she liked. A Fire risk assessment has been carried out since the last inspection. Staff spoken to confirmed that they had attended training in fire safety, first aid, moving and handling and food hygiene during their induction. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 x
COMPLAINTS AND PROTECTION 3 3 2 x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x 2 3 Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 19 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 Requirement Timescale for action 01/10/05 2. 7 15 3. 9 13 The admission assessment process must be carried out in all cases including transfer cases and there must be a written copy of that assessment held in the home The home must draw up a care 15/10/05 plan for all service users and not accept transferred plan from another home. The medication records must 01/10/05 accurately present the current amount of medication held in the home, including medication kept as a stock. 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 14 21 37 Good Practice Recommendations Service users possession lists should be signed and dated and any change should have appropriate date and signature. The manager should arrange marking the bathroom/toilet on the first floor. The manager should monitor records and take appropriate
I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 20 Lillibet Lodge action when gaps are identified, as with signatures, dates and discrepances. Lillibet Lodge I51 s14928 Lillibet Lodge v2427999 030805 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Clifton House 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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