Inspection on 19/08/08 for Littleborough Home for the Elderly

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Littleborough Home for the Elderly Regent Street Littleborough OL15 8BH Lead Inspector Bernard Tracey Unannounced Inspection 07:45 19 August 2008 th 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 Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 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. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littleborough Home for the Elderly Address Regent Street Littleborough OL15 8BH 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) 01706 370801 Littleborough Care Home Ltd Mrs Alison Unwin Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home: Code PC, to people 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. The maximum number of people who can be accommodated is: 26. New Service Date of last inspection Brief Description of the Service: Littleborough Home for the Elderly is a well established care home on the outskirts of Littleborough Lancashire, the ownership having changed in May 2008. The home is situated near to the village of Littleborough and is a purpose built care home. Level access is provided to the home. Accommodation is on two floors and a passenger lift is provided. There is a small patio area that is used by residents in fine weather. Parking for approximately six cars is provided to the front of the home. The home makes charges over and above the weekly care and accommodation fees that are listed after this section, for: chiropody, hairdressing and newspapers and magazines. Fees charged by the home provided in August 2008 are: £382.00p per week, personal care. The home does not provide Nursing Care. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. We (the Commission of Social Care Inspection) undertook a key inspection, which included an unannounced visit to the home. The staff at the home did not know the visit was going to take place. The home is well established but has changed owners and this is the first inspection since the change of ownership. Several weeks before the inspection, questionnaires were sent out to the residents and their relatives. The questionnaires asked what people thought of the care and services provided by the home. The manager was also asked to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, these comments have been included in the report. We spent over five hours at the home. During this time, we looked at care and medicine records to ensure that health and care needs were met and also studied how information was given to people before they decided to move into the home. A tour of the building was undertaken and time was spent looking at records regarding safety in the home. We also examined files that contained information about how the staff were recruited for their jobs, as well as records about staff training. We spent time speaking to five residents, as well as speaking to four staff, including the manager. We have not received any complaints about the service. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This is the first inspection since owner registered the service with the Commission of Social Care Inspection. Since purchasing the home, the provider has paid particular attention to replacing the laundry equipment, and generally improving the environment in which the residents live. The provider informs us that he has further plans to further improve the home. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 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 Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Standard 6 does not apply Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents should not be admitted before they have received a full assessment from staff at the home as this can lead to inappropriate admissions to the home. EVIDENCE: We examined the Statement of Purpose and found that the document needs updating. The previous manager’s details were still referred to in the document. Details of how to contact the Commission of Social Care Inspection must also be included. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 10 We examined the documentation for three residents, including the two most recent admissions, and although the individuals had been assessed by the local authority social worker, the provider could not properly demonstrate that a detailed assessment had been carried out by the home prior to the resident being admitted. This meant that there was no confirmation from the home that they were sure they could meet the current health and social care needs of the potential residents. Key areas such as personal hygiene, mobility, diet, continence, sleep, communication, risk of falls and social care are necessary for the manager to decide if the home can meet the needs of prospective residents. Standard 6 was not assessed, as intermediate care is not provided. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Care plans do not always fully demonstrate how aspects of health, personal and social care needs would be met. EVIDENCE: We examined three care plans during our visit to the service. The detail contained in the care plans varied, as did the consistency of records maintained in them. Of the three files we examined in detail, two did not give clear instructions and guidance on how the care needs of the residents were to be met. There had been no detailed assessment by the Registered Provider prior to admission to the home and subsequently no plan of care was written down to assist the staff in meeting the needs of the residents. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 12 Two care plan indicated that residents had not been weighed since admission. An assessment to monitor skin integrity had not been completed. One individual had also been assessed as at risk of falling, a care plan to inform the staff how this risk is minimised had not been devised. A further care plan examined indicated that a resident had no nutritional assessment and had not been weighed in the preceding month. The medications system was safe. Medications were securely stored; the prescription administration sheets were filled in accurately and there was an accurate record of medicines received into the home and arrangements have been made for the disposal of unused medicines. Appropriately trained staff administered medication to residents. The home is required to provide a fixed metal cupboard for the safe storage of Controlled medicines. Hand written records of prescribed medication that had been made were not signed, checked and countersigned. Current guidance indicates that ‘there is no legal impediment to a care home constructing a handwritten MAR chart but that there is a potential for error when charts are regularly re-written’. It is recommended that all hand-transcription is signed, independently checked and countersigned. Currently no resident manages their own medication. Residents’ wishes regarding gender preferences of carers involved in personal hygiene and continence care are actively promoted through staff deployment, where practicable, to maximise respect and dignity for clients and all residents are addressed by their preferred form of address. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality outcome in this area was considered good. This judgement has been made using available evidence, including a visit to this service. The social activities in the home, provide the residents with enjoyment and interest. EVIDENCE: An activities organiser is in place who encourages residents to participate in the day’s activities and ensures that individual attention is given, as well as the more organised group programme. During the course of conversations, residents spoke frequently about making choices, for example, in relation to what they do during the day, what time they got up or went to bed, and whether they spent time with others or alone. The home has contact with a local church whose members visit the home on a regular basis. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 14 The dining tables were appropriately set for breakfast and lunch. Without exception, residents received appropriate and sensitive assistance with their meals. Meals were taken in a relaxed environment, soft music playing in the background, with staff and residents regularly interacting with each other. Time was taken for residents to eat their meals and staff would ask each person if had they finished or would like a further helping. Staff were observed to assist those residents requiring help in a caring, sensitive and unhurried way, gently encouraging the resident to continue with their meal until they had finished eating. Menus were nutritious and balanced and included a good variety of meat, fish, fresh vegetables and fruit. The cook confirmed that, should a resident request something that was not on the menu, alternative meals were available. Residents said they were asked in the morning what they would like from the choices for lunch and tea and all felt this was a good idea. There were many compliments and expressed satisfaction by residents and relatives in respect of the food offered by the home. Residents have two hot meal options at lunch and a hot or cold option at teatime and residents who have soft diets now receive the same menu as those on normal diets to increase variety. Tables are set with cups, saucers, cutlery and condiments for all meals and trays are provided for those who wish to eat in their rooms. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and relatives have confidence that their concerns will be dealt with. Abuse policies and procedures are in place to protect the residents. EVIDENCE: The complaints procedure is available in the main entrance of the home for all visitors to see and the procedure is also provided to each resident on admission. Returned surveys from relatives confirmed they knew of the complaints procedure but had not had any occasions to use it. They said that staff were approachable and if they had any concerns they would speak with the manager. Records show that most of the staff have received training in the protection of vulnerable adults. Staff spoken with said they had training in understanding what abuse was and what to do if they suspected abuse. Records were available of staff training. Staff also confirmed they had undertaken NVQ training and this also included information and training in abuse. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 16 The staff are provided with information in what to look for and how to recognise abuse and what actions to take if they suspect potential or actual abusive situations. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents live in pleasant, safe, comfortable and well-maintained surroundings. EVIDENCE: We discussed further planned environmental improvements with the manager, which confirmed the information that had been provided in the Annual Quality Assurance Assessment that had been completed by the home as part of the inspection. Renewal and maintenance plans include new furniture and decoration of the lounge/dining areas, upgrade to bathroom and toilet areas, serving area from kitchen to dining area to be installed, to improve service at mealtimes and the provision of a conservatory to provide an enhance sitting environment for the residents. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 18 Four residents spoken to were very pleased with their individual rooms and one said that they had “brought in a number of personal possessions, to make it feel more homely”. We looked at a number of bedrooms, all were clean and comfortable and all of them were personalised with pictures and ornaments. The laundry was sited away from the food preparation area and was seen to be clean and orderly. Sufficient and suitable equipment was provided and laundry was attended to efficiently. Residents said staff kept the building clean and odour free, inspection of the premises supported this view. Discussion with staff verified that sufficient staff and equipment were provided to ensure the home was maintained in a clean and hygienic condition. An infection control policy was in place and training was provided in this area. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The residents were cared for by sufficient numbers of staff who were suitably qualified and trained, and therefore had the knowledge and skills to meet the needs of the residents. EVIDENCE: The staff group has the skills and management support it needs to ensure that residents receive good care. There is a comprehensive recruitment policy and procedure and when three staff files were checked, it was evident that the manager follows the procedure and ensures the interview process, CRB checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Residents spoken to were very happy with the amount of staff on duty and said “they are always helpful and available to see to anything you need doing and nothing is too much bother”, “The attitude of all the staff is excellent”. We checked the rota which told us that sufficient staff were on duty, and we observed this to be the case when we where there. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 20 Comments from residents during the visit and in comment cards were all complimentary. They told us, “The staff are wonderful, nothing is too much trouble”; “You feel they all genuinely care” and staff are “caring and well trained”. Records were available to indicate that staff received training from the start of employment with induction training to ongoing training and NVQ. Staff were positive about working in the home; they said that they enjoyed working there; that they delivered a good quality service and they said they received a good standard of training. The staffing rotas were available and indicated that staffing levels were maintained at appropriate levels to meet people’s care needs. The staff team was well established and the turnover of staff was low. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The new owner in the process of improving the day-to-day management within the home to ensure the overall quality of the service for people will be improved and maintained. EVIDENCE: The owner has the experience and is competent to run the home. He is about to apply to be registered as the manager with the Commission for Social Care Inspection, following the resignation of the previous manager. He is working to improve services and provide an increased quality of life for residents. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 22 There is a strong emphasis of being open and transparent in all areas of running of the home. The Owner is supported well by a competent staff team, and the home generally has a low staff turnover rate. Discussion with people in the home, staff and information from comment cards all indicated that the manager’s style of management was one of openness. Relatives of the people living in the home praised the staff for the individual support they gave them. Comments included, “My stay here is best summed up as comfortable and happy”. A visitor wrote “I am always made welcome by everyone” A selection of safety contracts for equipment and services in the home were viewed. The gas, lift and fire prevention certificates were in date. The fiveyear periodic electrical certificate was now due; it was agreed that when the electrical inspection had been completed a copy of the certificate would be forwarded to the Commission. The policies and procedures in the home ensure that the health, safety and welfare of the residents and staff are promoted and protected. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 23 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 3 X 3 X 3 X X 3 Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? New Service 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 OP3 Regulation 14 Requirement Timescale for action 10/10/08 2 OP7 15 3 OP8 13(4(c) New residents are admitted to the home only on the basis of a full assessment carried out by the staff. This will ensure that the service user is confident that their needs can be met. Each service user must have a 10/10/08 care plan in place that accurately reflects their present needs so that the care staff will be able to give them the right care. 10/10/08 Risk assessments must be reviewed and updated and action needed to address the risks, be transferred to each person’s care plan. Attention should be specifically given to pressure sores, weight loss and infections. This will ensure that each resident will have a plan in place, which will try to make sure the risks are lessened and the right care given. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 25 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. 4 Standard OP8 Regulation 14 (1) (a) (2) Requirement Timescale for action 10/10/08 5 OP9 13 (2) 6 OP31 9 (1) (2) (a) (b) Nutritional screening must be undertaken to ensure that an accurate record of residents’ weights is maintained and appropriate action taken, including referral to the dietician, if needed. The manager must ensure that 10/10/08 an appropriate metal cupboard fixed to the wall is available in the medicine room. This will ensure that controlled drugs are safely stored. The home’s manager must apply 30/10/08 to the Commission for Social Care Inspection to become registered. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 26 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 Refer to Standard OP1 OP9 Good Practice Recommendations The owner should update the Statement of Purpose so the prospective residents have the correct information regarding the home. It is recommended that all hand-transcription is signed, independently checked and countersigned. Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Area Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Littleborough Home for the Elderly DS0000071634.V366339.R01.S.doc Version 5.2 Page 28 - 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!