Inspection on 23/08/05 for Lister House, The Royal British Legion

This inspection was carried out on 23rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lister House, The Royal British... 16/01/07

Lister House, The Royal British... 14/02/06

Lister House, The Royal British... 01/03/05

Lister House, The Royal British... 14/09/04

Lister House, The Royal British... 20/11/03

Lister House, The Royal British... 28/04/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lister House, The British Legion Southgate Ripon North Yorkshire HG4 1PG Lead Inspector David White Unannounced 23 August 2005 09.30 am rd 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. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lister House, The British Legion Address Southgate Ripon North Yorkshire HG4 1PG 01765 607878 01765 690917 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) The Royal British Legion Mrs Mary Edna Petronelle Fowler-Watts Care Home with Nursing 60 Category(ies) of Old Age Mixed Gender 55 registration, with number Physical Disability 5 of places Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 01/03/05 Brief Description of the Service: Lister House is a large purpose built building set in its own well kept grounds within reasonable walking distance of Ripon Town Centre with its range of leisure and shopping facilities. The home is owned by The Royal British Legion and admission to the home is generally specific to people who are serving or have served in the Military or Associated Arms and their dependants. There is a hydrotherapy pool and on site and a staffed physiotherapy department. There is a major redevelopment programme for the facilities that is ongoing at the present time. This includes plans to build a new 16 bedded EMI unit within the grounds of the home. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over six hours. The inspector looked around the environment, spoke to four service users, two members of care staff, the chef manager and the registered manager of the home. The care records of the four service users spoken to were looked at along with a number of other records and documentation. What the service does well: The quality and variety of food provided is enjoyed by service users, one of whom said the food was “marvellous”. Service users are encouraged to be independent. Service users and relatives views are listened to and acted upon. Modern equipment, aids and adaptations are in place to meet all service users needs. The environment is very clean, bright and spacious and enables service users to have access to and from all parts of the building. Service users enjoy the activities programme. A thorough assessment of service users is carried out before they come into the home to make sure the home has the staff and equipment to care for them properly. The management and staff team are committed towards providing a good quality of life for the service users. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: 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, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 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 standard(s) 1, 3, 5 and 6 Service users are aware of the care, services and facilities provided by the home and feel confident that their needs will be understood and met by the home’s staff. EVIDENCE: Prospective service users and their relatives are given information about the home prior to admission. Service users said they were offered the chance to visit the home with their relatives prior to making a decision about moving into the home. The admission procedure is very thorough and this makes sure that service users are properly assessed and that staff are fully aware of their needs. Information is gathered from service users’ relatives and other care professionals such as care managers and doctors as part of the assessment process. Any risks are identified as part of the pre-admission process. Staff have a good understanding of the needs of the residents and receive a wide range of training specific to the needs of the service users in their care. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 9 One service user spoken to was receiving intermediate care. She was very clear about the purpose of her stay at the home and the care that would be provided to help with her rehabilitation also saying that the care she was receiving was “very good”. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10 Staff are provided with a good supply of information within the care plans from which they are able to deliver individualistic care to meet the health and personal care needs of the service users. The care planning documentation does not show how social and emotional care needs are being met and this has a potential to place service users at risk. In general health care needs are being met but slow response times to call bell requests mean that the health, welfare and dignity of the service users is not being protected. The medication system is well maintained. EVIDENCE: The service users looked clean and tidy and well cared for. The records of four service users were inspected. Individual care plans provided good detailed information from which care staff can deliver care based on current needs and areas of risk. The assessment information included the personal interests, likes and dislikes of the service users. However the information within the care plans was based solely on individuals’ physical care Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 11 needs and did not mention the social and emotional support that was being provided. Service users have access to a GP, dentist and chiropodist whenever they choose and input from specialist services is recorded within the care records. There is a physiotherapy department on-site at the home and a hydro-pool. A number of risk assessments are in place to promote each individual’s safety and independence and regular reviews of care are carried out. Three of the service users spoken to said that “the care is very good” and feel they are treated in a respectful manner by all staff. One service user feels that his dignity has been affected by the failure of staff to respond to call bells within a reasonable time. The call bell alarm for this service user was observed to be out of his reach if he did need to use it. To prove his point about the lack of response to call bells the service user made a call bell request whilst speaking to the inspector. Twenty minutes after the call bell request had been made there still had been no response from the staff. The care plans of those service users receiving intermediate care were specifically aimed at promoting their independence and rehabilitation. The medication systems in the home are good and Medication Administration Records were accurate and up to date. A random check of the Controlled Drugs stock was made against the records and these tallied. Some service users choose to self-medicate and risk assessments had been carried out to support service users to be able to do this. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 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, 13, 14 and 15 Social activities are well organised and provide enjoyment and stimulation for people living in the home. Meals are nutritious and offer a healthy and varied choice for service users. EVIDENCE: The home has an activity co-ordinator who has developed an activities programme. Service users spoken to said they enjoyed the bingo, quizzes and dominoes as this helped to “keep their minds active”. One service user had enjoyed a trip out from the home to Blackpool. There is a chapel on-site and a number of service users enjoy attending church services. Relatives and visitors are encouraged to visit the home whenever they wish. Each of the service users spoken to said that they are able to live their preferred daily routines and their likes and dislikes are recorded within their care records. The home has recently employed a new chef manager who has introduced new menus. All the service users were full of praise about the quality and variety of the meals provided. One service user said the meals were “marvellous”. Some service users need assistance with eating and a service user was able to Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 13 confirm that staff are very supportive in giving him the assistance he needed to enjoy his meals. The chef was aware of service users’ specific dietary needs. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 Service users concerns are listened to and dealt with appropriately. The lack of sufficient information about prospective employees within the organisation’s recruitment procedures does not ensure that the people living in the home are protected from abuse. EVIDENCE: The home has a complaints policy and procedure which service users, relatives and others have access to. The home has not had any complaints since the previous inspection. Service users are aware of who they would need to see if they had any concerns. Adult protection policies and procedures are in place and staff are given adult abuse training from the point of induction. Three staff files of the most recently appointed members of staff were inspected. Each file had a completed application form from each member of staff. However the application form has not been updated by the organisation for a long time and does not seek a full employment history from people applying to work at the home. This lack of information could potentially put service users at risk of harm. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 22 and 26 The refurbishment work is being carried out to a very high standard providing service users with a very pleasant environment in which to live in. EVIDENCE: The home is very clean with modern and up to date facilities. Since the previous inspection a number of bedrooms have been refurbished to a very high standard. Some of these bedrooms were looked at and found to be very spacious, bright and geared towards the needs of the service users. All the updated bedrooms have en-suite facilities with specialist aids and adaptations such as overhead tracking hoists to promote the comfort and independence of the service users. One of the dining lounges has also been refurbished and has a “bistro corner” where service users and relatives can sit and have a cup of coffee. There is also a tea bar within the home. The physiotherapy suite is being developed to improve the facilities within it. The grounds are spacious and are accessible to all service users. Service users feel that the changes to the environment have been “advantageous”. In particular service users spoken to who have moved into newly refurbished bedrooms were extremely pleased Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 16 about having their own en-suite facilities which they feel provides them with more privacy. Service users said that their bedrooms are always kept clean. Laundry assistants are employed to look after service users personal clothing and sluicing facilities are available to deal appropriately with soiled items. A random check of the hot water temperatures was made and these were found to be within safe limits. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 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 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 Service users needs are met by an enthusiastic and well equipped staff team. Recruitment procedures are not robust enough to protect people living in the home. EVIDENCE: The duty rotas show that the home is sufficiently staffed to meeting the needs of the service users. Staffing levels have recently been reduced due to staff sickness and leave. One part-time vacancy exists for a qualified nurse as well as around 60 carer hours. Agency workers are used to cover shifts and are usually well known to the service users. The shift patterns of the staff have now been changed so that there is a three-shift system. This has lead to a reduction in the number of double shifts that are being worked by nursing staff and carers. The staff files of three recently employed staff showed that all the necessary pre-employment checks had been made with the one exception as previously mentioned in this report under the heading complaints and protection. Staff receive induction training so that they are aware of the principles of care and know what to do in various situations such as a fire in the home or if they thought a service user was being abused. Staff spoken to had a good understanding of the service user group and their needs. Specialist training and input is provided to equip the staff with the knowledge and skills to meet the specific needs of the service users. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 18 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, 36 and 38 The home is well managed and the management communicate a clear sense of direction for staff. Systems are in place to seek the views of service users, relatives and others about the home and views and opinions are acted upon. Proper attention is given to health and safety matters in the home. EVIDENCE: The registered manager has over 10 years experience of running the home. Service users and staff spoke well of the manager saying that she was “approachable and helpful”. The registered manager has been very busy with the refurbishment programme and a lot of her time is spent dealing with the management of the ongoing work. There is currently no deputy manager at the home to overlook the clinical aspects of care at the home. This has lead to the manager having to be more heavily involved in a clinical role and in addition to the workload created by her other management responsibilities this has meant that the manager is trying to balance the demands of several different roles. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 19 This situation means that the manager is working under pressure. The deputy manager vacancy needs to be addressed as soon as possible so that a suitable deputy manager can be appointed to provide clinical leadership and so ease the workload burden for the manager. The organisation has a number of systems in place to seek the views of service users, relatives and other professionals about the home. Pamphlets/questionnaires are usually sent out to service users, relatives and others requesting information from them about the home. Resident meetings are held every three months and are recorded. Monthly staff meetings are held and these are documented. Each month a senior member of the organisation makes a monthly-unannounced visit to the home and reports their findings to the Commission. Staff spoken to said that they have some group supervision amongst each other but could not recall receiving individual formal supervision. The registered manager said that individual supervision was taking take place but on a more informal basis. Proper regard was being given to the health and safety of the environment for service users, staff and visitors. A number of satisfactory safety reports and certificates were seen relating to the premises. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 20 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 3 x 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 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 x 3 x x x 3 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 1 3 2 3 1 x 1 x 3 Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 21 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 7 Regulation 15 Requirement Service user plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their social and emotional needs. The registered manager must make sure that arrangements are in place to make sure that all call bells can be accessed by each service user and that call bell requests are responded to promptly. The registered provider must have robust recruitment procedures in place to safeguard service users from potential abuse. The registered provider must make sure that full employment histories are obtained from prospective employees through the homes recruitment process to safeguard the service users wellbeing. All staff must receive formal supervision. Timescale for action 31/10/05 2. 8 12 As from 23/08/05 and after 3. 18 13 31/10/05 4. 34 19 31/10/05 5. 36 18 31/10/05 Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 22 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 32 Good Practice Recommendations It is recommended that a deputy manager is appointed to support the registered manager in providing management and leadership in the home. Lister House, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross, York YO32 9GZ 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, The British Legion J53 J04 S39577 Lister House V244013 230805 Stage 4.doc Version 1.40 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. 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