Inspection on 17/11/09 for Lily House

This inspection was carried out on 17th November 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lily House 16/09/09

Lily House 19/08/08

Lily House 30/08/07

Lily House 22/08/06

Lily House 05/10/05

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Random inspection report Care homes for older people Name: Address: Lily House 143 Lynn Road Ely Cambridgeshire CB6 1DG zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Elaine Boismier Date: 1 7 1 1 2 0 0 9 Information about the care home Name of care home: Address: Lily House 143 Lynn Road Ely Cambridgeshire CB6 1DG 01353666444 01353666445 lily.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne (Eton) Limited care home 44 Number of places (if applicable): Under 65 Over 65 21 44 dementia old age, not falling within any other category Conditions of registration: 0 0 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 44 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP Dementia Code DE Date of last inspection Brief description of the care home Lily House is situated on Lynn Road approximately one mile from the centre of Ely. It is a purpose built home that offers care for up to 44 older people, some of whom have dementia. Accommodation is provided on two floors and consists of 44 single Care Homes for Older People Page 2 of 10 Brief description of the care home bedrooms of which 43 of these have en-suite facilities. There are five bathrooms, one shower room and eleven additional WCs. There are lounge and dining rooms in the home and two quiet rooms. Enclosed gardens surround the home for people to visit and sit. Local amenities include shops, cafes pubs, restaurants and a cinema. Information about current fees, including any additional costs, can be obtained from the home. A vacancy has arisen for a registered home manager. A copy of the inspection report is available at the home or via the CQC website at www. cqc.org.uk Care Homes for Older People Page 3 of 10 What we found: During our key unannounced inspection (KI) of the 16th September 2009 we found insufficient evidence that people were actively consulted about their care. During this random unannounced inspection (RI) of the 17th November 2009, we saw that there was a care plan and agreement for someone who chooses to smoke cigarettes although it was unclear if this agreement was still valid, as their care plan was dated 2008. According to the management team there are arrangements in place to introduce new care plans and these will be developed in consultation with the people or their representatives. At our KI of the 16th September 2009, due to a serious concern, we made a requirement to ensure that people were given the right type of food and drink so that they would not be placed at the risk of choking. We looked at two peoples care plans and we case tracked one of these people. Findings indicated that this requirement has now been met as care plans had been updated; the speech and language therapist (SALT) had visited these two people and had assessed their ability to swallow; the SALT had recorded, within the care plans, what type of food the person should be given so that there was a reduced risk of choking for when these two people had a drink and ate their food. We also saw that there was a prompt recorded of when the SALT was to revisit the home. When we visited one of the two residents they were able to tell us what type of food they were given and we saw, at lunch time, that they had been given pureed food as was prescribed by the SALT. We asked a member of staff, to assess their knowledge of this persons care plan for nutrition and diet, and they were able to accurately tell us what type of food, i.e. pureed, that this person was to have. Although we had made no requirement about care planning and monitoring of a persons pain we saw that action had been taken in response to our findings during our KI of September 2009. We saw that the person had a care plan for pain relief and, although there was no record of how the pain monitoring tool was used, there was now a pictorial pain monitoring tool in place. We saw the person was calm and relaxed and was showing no observable physical or verbal signs that they were currently in pain. In our report of the KI of the 16th September 2009, we recorded that the personal care provided to one of the residents was of an unacceptable standard, as they had offensive body odour. During this RI we visited the same person and generally the standard of their personal care had improved in that they had no offensive body odour. We saw that other people were clean and well dressed. The staff also told us (unsolicited) that peoples personal care and general activities of daily living were based on choice and the staff considered that, due to a change of management since our KI in September 2009, this change, and change in culture, had positively benefited the residents sense of wellbeing. We found that the home was relaxed and had a calm atmosphere. We looked at the practices and procedures for the safe handling, use and recording of medicines. At our KI in September 2009 we made a requirement that all medicines were to be locked away when not in use as we had found prescribed creams and ointments in communal bathrooms and the medication trolley was left unattended while medication was being given to people. On this inspection we did not find any medication in communal areas and we observed medication being given to people at lunchtime and saw that medication was not left unattended and accessible to unauthorised people. We Care Homes for Older People Page 4 of 10 consider this requirement has been met. We made a requirement for the records made when people are given their medicines to be accurate and complete. On this inspection, the accuracy of the medication records had improved significantly but noted that when medicines are given at times, which are different to those on the printed record form, the actual time it is given is not clearly recorded. This could result in people receiving medicines too close together and a further requirement has been made about this. We also saw that when peoples medication is omitted, the reason for the omission is not always recorded so a specific requirement has been made about this. We made a requirement for when medicines are prescribed on a when required basis there must be clear guidelines for their use so that people receive treatment that is appropriate and consistent. On this inspection we saw that there was written guidance for most people who are prescribed such medication but there were still omissions for some people. We have taken the view that, as this has improved, we are confident that this can be managed by the home. On inspection of the medication storage rooms we noted that these were secure and the temperatures monitored and recorded each day but that the temperature readings are taken from the air-conditioner controller unit which is what the air-conditioner is set at rather than the actual air temperature. It was also evident that the temperatures of the fridges, that are used to store medicines, are also read from the settings on the digital thermometers rather than the actual temperature inside the fridge. We raised this on our last inspection and expected this to be managed by the home, but it has not been. We still expect this to be managed by the home as medication stored at incorrect temperatures could result in people receiving medication that is ineffective. We made a requirement for staff authorised to administer medicines to have up- to - date training and an up - to - date assessment that they were competent to give medicines to people. We looked at training records for three staff members and spoke to two of them. We saw certificates of attendance at a training course provided in October 2009 for all people who handle medication and this was verified by staff and we also saw that there was a documented assessment of competence in training files. We consider this requirement has been met. We noted, at our KI of September 2009, that the record of complaints was less than satisfactory as there was insufficient recorded evidence to say how the home had responded to all the complaints that the home had received. Although we had made no requirement about this we expected, as part of the homes quality assurance, for action to be taken to improve this area. To assess what action had been taken we looked at the current record of complaints and we found that there was satisfactory action taken. The home had received one complaint (which we were aware of) and had responded to this in a listening manner and within the required 28-day time period. On the basis of information we had received about the home, from November 2008 onward and from our findings during our KI of September 2009, we made a requirement for the staff to be trained and competent in reporting any suspected abuse against any of the residents. Although we did not ask the staff about their knowledge of abuse and safeguarding we looked at the staff training records, the competency assessments of the staff and we also spoke with the management team of the home. Evidence indicated that Care Homes for Older People Page 5 of 10 this requirement has been met. We have received no concerns that there has been any delay in reporting any incidents of suspected abuse; the staff training records indicated that 74 of the staff have attended training in safeguarding (ten of the staff had attended this training on the 5th November 2009) and arrangements were in place for other staff to attend this training on the 24th November 2009. A competency test for one of the staff was seen; questions within this test included the different types of abuse and what to do if the staff suspected any abuse i.e. to immediately report such suspicions. Those staff who told us that they had yet to attend up to date safeguarding training were aware that they were to attend this at a future date. According to the management team there is the expectation that 100 of staff will have attended this training by the 24th November 2009. Since our last KI there has been a change of home Manager. She has previous experience in managing care homes and has previously worked as an approved Registered Manager. The staff told us that they felt the change of leadership and management of the home was a positive one: we were told that the staff were given clear direction as to what they should be doing; they felt that the training opportunities had increased and they felt motivated to attend such training. We were also told that, due to an improved level of staff morale, this had a positive outcome for the residents as the home was more relaxed and the manner in which the residents care was provided was more organised, less rushed and that peoples choices were valued. A requirement had been made for all of the shifts worked to have at least one person on duty who had a current first aid certificate. The certificates of training, attended on the 11th November 2009 by six of the staff, were seen and compared with the current off duty roster which ended on the 22nd November 2009. With the exception of the night duty shift for the 19th November 2009, the remaining duty hours, for that week, had someone on site, who had a current first aid certificate. The management team said that they would ensure that the night duty of the 19th November 2009 would have a person working at the home who had a current first aid certificate. We consider that this requirement has been met. Although requirements were not made for the training of staff in fire safety and moving and handling, we expected action to be taken, as part of the homes quality assurance, for an improved attendance of staff in safe moving and handling and fire training. We examined the Training statistics record and other training records and we spoke with the management team: evidence indicated that there has been action taken to improve this staff training with 94 of staff having attended fire safety training; 88 of staff have attended fire drills and 71 of the staff have attended training in safe moving and handling with a further safe moving and handling training arranged to take place on the 19th November 2009. During our tour of the premises we found a bottle of cleaning solution, which had a sign, on the outside of the bottle, indicating that it was a hazardous substance. The bottle was found in the unlocked servery (located opposite Peace Lounge on the first floor) and was unsafely stored within an unlocked cupboard beneath the sink area. We informed the Manager at 10:35 and immediate action was taken to remove this hazardous substance. At 13:05 we returned to the servery and found that, indeed, the bottle of Sprint cleaning fluid had been removed. We found no other hazardous substances stored in such an unsafe manner. Care Homes for Older People Page 6 of 10 As we were looking around the premises we assessed what action had been taken to improve the closure of two fire doors. At our KI of September 2009 we found that one of the doors to the kitchen, opposite Swan store 2 room, was not fully closed and we found that the door of the upstairs servery would fully close only with some effort. When we returned to the servery, to check if the bottle of cleaning fluid had been removed, we found this door was not fully closed. We discussed our findings with the management team who told us that work had been carried out on these two doors but would look at the issue again. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 When medicines are given at 15/12/2009 times which are different to those on the printed record form, the actual time it is given must be clearly recorded. This will ensure people do not receive medicines too close together. 2 9 13 When medication is omitted, 15/12/2009 the reason for the omission must be clearly recorded. This will ensure staff can respond appropriately. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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