CARE HOMES FOR OLDER PEOPLE
Lister House 13 Heaton Road Heaton Bradford West Yorkshire BD8 8RA Lead Inspector
Sue Dunn Announced Inspection 09:30 1 December 2005
st 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 Lister House DS0000019882.V251441.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. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lister House Address 13 Heaton Road Heaton Bradford West Yorkshire BD8 8RA 01274 494911 01274 541359 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) Lister House Limited Mrs Jacqueline Mitchell Care Home 32 Category(ies) of Physical disability (32), Physical disability over registration, with number 65 years of age (32), Terminally ill (2), of places Terminally ill over 65 years of age (2) Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 09 June 2005 Brief Description of the Service: Lister House is a large detached Victorian Property in a quiet backwater in the Heaton area of Bradford. The property has been extended to provide accommodation for 32 people who require nursing and personal care. The home has well maintained gardens and some off road parking. An internal courtyard provides a secluded outdoor seating area. The home is pleasant and domestically furnished to provide a ‘homely’ comfortable environment for the service users. People are encouraged to bring personal possessions into the home to enhance their rooms. Half the 26 single bedrooms have en suite facilities. The 3 remaining rooms are doubles. Food is of a high standard, with efforts made to provide for all tastes. A good programme of events and activities take place in the communal areas. Staff are trained and expected to meet the high standards set by the proprietors. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection, which was announced, was undertaken by one inspector. The inspection started at 9.30am and finished at 5.00pm. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents. A pre inspection questionnaire and comment cards were sent to the home before the inspection. Five comment cards were returned from residents and 5 from relatives and visitors. The pre inspection questionnaire had not been returned. What the service does well:
The home provides each resident with a large print copy of the Terms and Conditions of their occupancy. The manager expects a comprehensive Pre admission assessment from the person making the care referral. This is followed by an assessment by herself to look at what will be needed to meet nursing care and other social, recreational and emotional care needs. The information allows the home to prepare the resources required on admission. The manager and other members of the operations team have a friendly relationship with residents through their regular contact. Comments from relatives to improve the service are always welcomed. The home provides training for people doing their NVQ in catering, offers a good range of freshly cooked meals and will make provision for any ‘favourite’ foods. Special diets are catered for. The home makes arrangements for people from different cultural backgrounds to receive social and emotional support and translators if required. Staff pay attention to the small individual details which make people comfortable. Residents said they felt well cared for. Systems are in place for the maintenance and upkeep of the building. Residents were clean, comfortable and well dressed. It was apparent from peoples’ appearance that that the care of personal clothing and hair is seen as important. The home provides a range of suitable activities and entertainment. Residents participate if they wish or remain in their own rooms. Staff talk with residents about topics of mutual interest.
Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 6 The home is run with the well being and protection of residents in mind. The staff are valued and supported in their personal development. The care staff have the opportunity to become senior care workers as they gain confidence. The manager delegates tasks to nursing staff as part of their professional development and in order to give them knowledge about the management of the home. Overall the records were of a good standard. What has improved since the last inspection? What they could do better:
The residents contracts should include the number and type of room to be occupied. More opportunity should be made for people to eat in the dining room rather than assuming everyone wants to eat at tray tables. A returned comment card from one person said that though the care was good communication with families could be improved but gave no specific examples, another felt there were not always enough staff. The home does provide residents and their relatives with information about the complaints procedure but one person did not seem to be aware of this. An underlying odour was noted in two bedrooms in contrast with other areas of the home.
Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 7 In the interests of equal opportunities there should be more than one person on an interview panel. Each person should have a training record to show what they have achieved and when. There must be evidence to show that staff supervision takes place at least 6 times a year. The maintenance records should be available for inspection at all times. 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. Lister House DS0000019882.V251441.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 Lister House DS0000019882.V251441.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): 2,3,4 Service users are provided with information to enable them to make an informed choice about the home. The admission process is good and includes introductory visits. EVIDENCE: Each service receives a contract and a copy of the Terms and Conditions of their residency in large print. Most people are referred to the home from hospital. The manager expects a detailed assessment of needs from the hospital. This is followed by a thorough assessment by the home to ensure that the necessary resources for care can be provided at the point of admission. It is usual for family or friends to visit the home as part of the admission process. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 10 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): 7,8,9,10,11 The health care needs of residents are met and care plans provide clear and detailed instructions for staff to follow. Residents benefit from good communication within the staff team. Residents are treated with respect and the home is diligent in their support and care of people who are dying. EVIDENCE: The care plans are thorough, well balanced and easy to follow. There is a care plan for nursing and health care needs and a care plan linked to this which gives care staff clear guidance, including action based on risk assessments, on the care they give. Care staff contribute to care plans and the daily records therefore the nurse in charge is able to update and amend care plans from a sound evidence base. The written information from care staff was good and relevant. Nursing records were detailed and could be cross referenced to the intervention by other health professionals. The medication system was satisfactory and though not pre dispensed suits the needs of the home which has a thorough system of checks. All the residents spoken with felt they received good care and emotional support.
Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 11 The home has introduced a care pathway system to super cede any existing care plan as people are approaching the end of their life. This focussed approach involves an ongoing assessment and action plan and a flow chart to assess pain and keep pain under control. The home notifies Care Direct and the GP as soon as the care pathway is introduced to ensure that any back up support or medication arrives quickly. Family, friends, and translators if required, are kept informed and involved. Lister House DS0000019882.V251441.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): 12,13,14,15 Residents are encouraged to be part of the decision making process and make choices about their lifestyle. People are valued as individuals and staff are sensitive to the feelings of people having to rely on others for their personal care. People are supported to maintain contact with family and friends and visitors are welcomed at the home. A good, varied and nutritious diet takes account of individual tastes but more could be done to improve the dining arrangements. EVIDENCE: There were several people from mid European backgrounds living in the home with support from their communities and translators when required. Some people were in their rooms watching TV or reading. There was gentle background music in the lounge where people had been involved in decorating the Christmas tree and several entertainers visited in the afternoon. People were comfortable with knee rugs, juice was available for everyone and some had a glass of sherry. The cat had made itself comfortable on one person’s knee. The manager and proprietors know each resident and value each person for their individuality. A member of staff felt meals were unhurried and activities were well done, though people had to rely on relatives to take them out.
Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 13 Residents in the lounge knew where the call bells were and how to use them. They said that staff who were in and out of the lounge areas usually responded well. Some people felt they had ‘lived too long’ and old age was ’not much fun’. The nurse was sensitive to peoples’ feelings and the indignities endured by people who had to rely on others for all their intimate personal care. People said they had everything they needed and they were very satisfied with the food. The practice of providing meals on individual tray tables reduces the opportunity for mealtimes to be a social occasion. More could be done to give people the opportunity to eat in the dining room. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 14 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 If residents and their relatives raise their complaints with the proprietors their views are listened to, taken seriously and action is taken to resolve issues. Residents can be sure that their rights are protected. EVIDENCE: The home has a satisfactory complaints procedure which residents are encouraged to use. Every person or their representative receives information which includes details of the complaints procedure. The manager has always taken complaints seriously and investigated thoroughly. One person didn’t like anything about the home but admitted that nowhere would be suitable as she wished to be in her own home. A comment card from a relative queried why people had to purchase their own blood glucose monitors and nebulisers. The same person said they were not aware of the complaints procedure and felt there were not always enough staff. Another relative felt the care was good but that communication with relatives could be improved. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 15 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): 19,20,24,25,26 The home offers a clean, safe, ‘homely’ environment for the residents. Systems are in place for the upkeep and maintenance of the building and to reduce the risk of cross infection. Some work is needed to maintain odour control in two of the bedrooms to the same high standard found elsewhere in the home. EVIDENCE: A brief tour of the building found the communal areas and bedrooms clean and comfortable, though temperatures varied in some parts of the home. An underlying odour was detected in two rooms. The management was aware of this. Policies and procedures are in place to avoid the risk of cross infection. The level of personalisation of bedrooms, which was in many cases dependant on support from relatives, varied between ‘homely’ and the basics provided by the home. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 16 Several separate communal areas allowed scope for people to meet with visitors in private. The main lounge was cheerful with Christmas decorations and suitable background music created a soothing atmosphere. The home is currently advertising for an additional maintenance person. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 17 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): 27,28,29,30 Staff appeared competent and knowledgeable and had good written information to guide them on meeting the needs of the service users. Training records however did not show who had done what training. There were good recruitment procedures in place to protect service users. However, in the interests of good practice and equality of opportunity there should be more than one person on an interview panel EVIDENCE: A recently employed care worker discussed the process of recruitment, selection and induction. The post had been advertised in the local newspaper and after completing an application form based on the job description she was interviewed by one of the proprietors. An interview checklist showed the questions asked. The period of induction included working alongside an experienced care worker for a period of four weeks during which time there was training in moving and handling, accident recording, fire safety, and adult protection. She was given the opportunity at the end of each shift to discuss the day and ask any questions. Other staff were described as approachable and helpful. The induction checklist had been signed to show the topics covered. The nurse who assisted with the inspection was competent and compassionate with a good knowledge of the people in her care which was backed up by the quality of recorded information. She had recently done a course on palliative care described as ‘excellent’.
Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 18 The staff training record gave a list of training courses during 2005 but did not identify who had done what training therefore it was not possible to check the skill mix on each shift. The home has a system for career progression. One person felt that staff skills could be improved if senior and more junior staff worked together more often. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 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 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): 32,33,35,36,37 EVIDENCE: The home is managed and run as a family concern with all members of the group actively involved in the day to day operations of the home. The manager sets high standards and provides clear leadership in which staff are encouraged to develop. A core group of nursing and care staff have worked in the home for a long period and are committed to maintaining a good quality of life for the residents. One person said she enjoyed every minute and wanted to come to work each day. Past voluntary visitors and health professionals have had sufficient confidence in the home to choose it for themselves or their own relatives. The home holds a separate float of money for every resident. Either the resident or two staff will sign for the money as it is needed. Receipts and records are kept of all monies spent.
Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 20 The home carries out two staff appraisals a year and can approach the proprietors privately at any time. However in order to meet this standard there must be evidence to show that staff have had at least 6 formal supervisions a year. The pre inspection questionnaire had not been completed and the maintenance manager was not available to discuss the maintenance records on the day of the inspection. Lister House DS0000019882.V251441.R01.S.doc Version 5.0 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. 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 3 3 4 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 x x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 4 3 x 3 2 3 x Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 22 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 OP36 Regulation 18 Requirement There must be evidence to show that all staff have formal supervision at least 6 times a year Timescale for action 31/03/06 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 4 Refer to Standard OP29 OP26 OP37 OP15 Good Practice Recommendations Interviews should be carried out by more than one person Odour control should be improved in the two bedrooms identified Arrangements should be made to ensure maintenance records are available for inspection at all times More could be done to encourage people to use the dining room at mealtimes Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Lister House DS0000019882.V251441.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
