CARE HOMES FOR OLDER PEOPLE
Lilybank Hydro Chesterfield Road Matlock Derbyshire DE4 3DQ Lead Inspector
Rose Veale Unannounced Inspection 17th October 2005 10:25 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 Lilybank Hydro DS0000002062.V257290.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. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lilybank Hydro Address Chesterfield Road Matlock Derbyshire DE4 3DQ 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) 01629 580919 01629 760019 Bakewell Care Homes Limited Mrs Sandra Purdy Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 4 Day Care Date of last inspection 19th July 2005 Brief Description of the Service: Lilybank Hydro is situated in the town of Matlock. There is a range of facilities in the town, including shops, pubs, restaurants and public transport. The home provides personal care for up to 34 older people, plus 4 day care places. The home is an older, converted building with accommodation on the ground floor and two upper floors with good views over the surrounding countryside. There are attractive and well maintained gardens to the rear of the home. The home and garden are fully accessible to residents. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 4 hours on one day. There were 27 residents accommodated in the home on the day of the inspection, including 2 residents for respite care. Residents and staff were spoken with during the inspection. The care records of 2 residents were examined, plus other records related to the staffing and management of the home. What the service does well: What has improved since the last inspection? What they could do better:
Some of residents’ assessed needs were not included on their care plans, potentially resulting in their needs not being fully met. Although daily records were kept of the temperature of the fridge used to store medication, the records were not of the maximum and minimum temperatures. It is necessary to check these temperatures to ensure the safe storage of medication. Records of residents’ personal money did not include two signatures on each transaction. This is necessary to safeguard residents and staff.
Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 6 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. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 7 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 Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 8 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): EVIDENCE: These standards were not assessed at this inspection. Of the key standards, Standard 3 was assessed and met at the last inspection, Standard 6 does not apply. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 9 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 and 9 The care plans were generally good, however, as some assessed needs were not included, not all residents’ needs were fully met. Medication in the home was safely stored and administered to ensure the health and welfare of residents. EVIDENCE: The care plans of two residents were examined. Although generally detailed and comprehensive, some of the assessed needs of the residents were not included on the plans. For example, there was no care plan regarding the use of medication prescribed on an ‘as required’ basis. Medication in the home was administered using the Boots monitored dose system. Medication was securely stored and was administered by staff who had undergone appropriate training. There was a record of the daily temperatures of the drugs fridge, but not the daily maximum and minimum temperatures as required. The Medication Administration Records, (MARs), were seen and these were correctly completed. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 10 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): 14 Residents were supported to exercise choice and control over their lives. EVIDENCE: Residents spoken with said that they were able to make their own choices, such as the time they got up or went to bed, and choice of meals. Two residents said that their choices were limited by living in a care home, but they accepted this. They said they would like more activities, particularly social activities as they wanted people to talk with. An activities coordinator working for 30 hours per week had very recently been appointed. Information about local advocacy services was available to residents. Residents were encouraged to bring in their own possessions and bedrooms were well personalised. Staff spoken with were clear that residents should be supported and encouraged to make their own choices. Staff were knowledgeable about the care needs and preferences of residents. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 11 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 The robust complaints procedure ensured that complaints were taken seriously and acted on appropriately. EVIDENCE: The home’s complaints procedure was satisfactory. The acting manager had introduced new documentation for reporting complaints. Two recent complaints were documented with the action taken and the outcome recorded. Residents spoken with were aware that there was a complaints procedure. One resident commented that minor complaints made informally to staff were usually acted on. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 12 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): 26 The home was clean and hygienic, providing a pleasant environment for residents. EVIDENCE: On the day of the inspection the home was clean with no offensive odours. The laundry was situated in the basement of the home and was well equipped. The home employs laundry staff to cover every day. Staff at the home have had training in the control of infection. Staff spoken with said they used disposable gloves and aprons as necessary. Regarding the environment of the home, three requirements made at the last inspection had been met. The first floor bathroom had been decorated and repaired. The two radiators identified as a potential risk had been covered. No fire doors were seen to be wedged open on the day of the inspection and it was noted that several alarm activated closure devices had been fitted to fire doors. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 13 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 and 29 Staffing levels appeared generally sufficient to meet residents’ needs. However, staffing levels did not always take account of busy periods, and there was a lack of staff available to cover, potentially putting residents at risk. The home’s recruitment procedure ensured the protection of residents. EVIDENCE: The staff rota for the home was seen. The staffing level was three care assistants on duty throughout the 24 hour period, well supported by domestic, laundry and catering staff. The hours worked by the new acting manager were supernumerary but were not recorded on the duty rota. The rota showed that there was a relatively small number of care assistants employed, some of whom regularly worked between 48 and 60 hours per week. Consequently, sickness and holiday cover was difficult to arrange and usually resulted in staff working even more hours. The home rarely used agency staff to cover shifts. Residents spoken with said that staff were usually available when they were needed. Two residents said that staff did not seem to have as much time to sit and chat as they used to. Staff spoken with said that it would benefit residents and staff to have another care assistant on the morning shift as this could be particularly busy. The use of the Residential Forum care staffing tool was discussed with the new acting manager to provide guidance for staffing levels to meet the assessed needs of residents. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 14 Staff records were examined. Photographs and recent identification information had been included as required at the last inspection. A new system had been introduced for staff records and the files seen were well organised and contained all the required information. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 15 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): 31 and 35 The procedure for handling personal money was not sufficiently robust to fully safeguard residents. EVIDENCE: The acting manager had been in post about 4 weeks on the day of the inspection. She said she had recently applied to the Commission for Social Care Inspection, (CSCI), to be the registered manager. CSCI had not been informed of the appointment of the new manager, this was a requirement at the last inspection. Residents and staff spoken with said they were still getting to know the manager. Staff said that they were pleased there was a manager in post and that they thought the new manager would ‘get things done’. Records were seen of residents’ personal money kept in the home. The records were clear and well organised with receipts kept. The records did not have two signatures by each transaction. The money was kept securely. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 16 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 X X X Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 17 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 2 3 Standard OP7 OP9 OP27 Regulation 15 13(2) 17(2) Requirement The care plan must include all the assessed needs of the resident. The maximum and minimum temperatures of the medication fridge must be recorded daily. The staffing rota must accurately record all hours worked by staff in the home, including the manager. The records of residents’ personal money must have two signatures for each transaction. Timescale for action 30/11/05 30/11/05 30/11/05 4 OP35 13(6) 30/11/05 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 Refer to Standard OP27 Good Practice Recommendations The Residential Forum care staffing tool should be used to provide guidelines for the staffing levels required to meet the assessed needs of residents. Lilybank Hydro DS0000002062.V257290.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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