This inspection was carried out on 1st October 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.
CARE HOMES FOR OLDER PEOPLE
Littlebourne House 2 High Street Littlebourne Canterbury Kent CT3 1UN Lead Inspector
Wendy Gabriel Unannounced Inspection 10:15 1 October 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 Littlebourne House DS0000023469.V249045.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. Littlebourne House DS0000023469.V249045.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Littlebourne House Address 2 High Street Littlebourne Canterbury Kent CT3 1UN 01227 721527 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) Mrs Maralyn Hussein Mr Michael Moreland Mrs Luciana Jarmaine Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Littlebourne House DS0000023469.V249045.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th June 2005 Brief Description of the Service: Littlebourne House is registered to provide care for up to 35 older people. The Home is situated by the main road in the rural village of Littlebourne and is surrounded by attractive gardens mainly to the rear of the premises and with some parking spaces to one side of the house. There are two double rooms in the Home and one is maintained for single use. Bedrooms are spacious and light. A conversion to a property in the grounds provides a further 11 single en-suite bedrooms. The conversion adjoins the house by a large all weather conservatory that provides further day space for all Service Users. Littlebourne House DS0000023469.V249045.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a Saturday morning. The Housekeeping Manager was the responsible person on duty at that time as the Registered Provider was on leave and the Registered Manager was on a day off. In addition there were four carers on duty including a senior. There was also a domestic assistant, cook and kitchen assistant. The home has two vacancies and the Housekeeper advised the Inspector that a new resident was due into the home the following week. During an accompanied tour of the premises the Inspector spoke to approximately eight residents and was told by all of them that the staff were very kind and would always respond to the call bell. One resident said that she had known the staff ‘so long now that I feel part of them’. Another two residents said that the staff had been most welcoming when they first came to live in the home. The premises were clean and tidy and free from unpleasant odours. There was evidence of decorating being undertaken in one empty bedroom. There were three requirements made at the previous inspection and all three have since been undertaken with slight adjustments only to be made to two documents to complete the requirement. Some paperwork was unavailable to the Inspector because the Registered Providers office was locked, however, all the documents relating to care were available for staff. A requirement was made for medication administration records to be signed appropriately and for a date to be added when medication has ceased to be used. Staff confirmed that training is ongoing and that a specialist company now provides training for all the staff. There was evidence in the staff office of training courses booked for staff. Notices in the staff room also indicated some policies such as complaints and daily routines for staff. What the service does well:
The home has been proactive with its five-year plan for rebuilding and redecoration. This year a new sluice and laundry is to be provided. A resident in the new extension said that her room was lovely, as she had been allowed to bring most of her own furniture with her. The extension has en-suite bedrooms with their own lounges or balconies overlooking the grounds. Staff said that in addition to the four care staff on duty each morning and most afternoons there would sometimes be five or six carers on duty. This would be to enhance care if for example a resident was sick. Residents all said how kind Littlebourne House DS0000023469.V249045.R01.S.doc Version 5.0 Page 6 and helpful the staff were and communication noted between one resident and carer was obviously warm and understanding. 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. Littlebourne House DS0000023469.V249045.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 Littlebourne House DS0000023469.V249045.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): 1. Adequate information is available to prospective residents to enable an informed choice about where to live. EVIDENCE: The Home has reviewed the statement of purpose following an earlier requirement. This now contains practically all of the information as indicated by the National Minimum Standards. The complaints policy is to have a few changes regarding names however it contains the basic information required. The Inspector was unable to have access to the service users guide that was being printed at the last inspection as the office but the housekeeping manager believed that they had been printed and returned to the home. The statement of purpose also contains the ethos of the home as well as information for residents about the facilities and services. Littlebourne House DS0000023469.V249045.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): 9. Missing signatures on medication administration leaves recording susceptible to inaccurate information. EVIDENCE: Medication is kept in individual locked containers in every residents’ bedroom. This has the benefit of storing information specific to individual residents for ready access to the senior staff who administer medication. The medication administration records had a few spaces where the person administrating the medication had not signed. The home has usually maintained a secure and thorough medication administration system with clear and comprehensive arrangements. The requirement to ensure the records are signed was discussed with the senior carer as the unsigned spaces did not identify if medication had been taken or refused or not given. The senior agreed to ensure this would be undertaken rigorously in future. Three large tubs of identical medicated cream were seen in a bathroom, they had no name on and only one had a date on. A requirement was made to remove them from this area. Littlebourne House DS0000023469.V249045.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): EVIDENCE: Standards 12 to 15 were not inspected on this occasion. Littlebourne House DS0000023469.V249045.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 Residents know their complaints will be listened to and acted upon. EVIDENCE: Since the previous inspection the home has reviewed and simplified the complaints procedure. A recommendation was made to alter some wording on the procedure for accuracy. No complaints have been received since the previous inspection. One resident said she knew whom to turn to if she had a worry about anything, but added there was nothing for her to worry about as the staff were always very helpful to her. Littlebourne House DS0000023469.V249045.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): 24.25.26. Residents have safe comfortable bedrooms with their own personal possessions if desired. Residents’ live in safe comfortable surroundings. Residents’ live in a clean and safe home. EVIDENCE: The premises were seen to be safe, comfortable and bright and cheerful. Furnishings and fittings are as domestic, low-tech and unobtrusive as is compatible with fulfilling their purpose. The home encourages residents to bring in their own furniture if they wish and bedrooms were comfortably furnished and with personal possessions. One bedroom does not have an ensuite because of the choice of the current resident. The same resident uses almost exclusively the bathroom adjacent to her room. All other bedrooms are en-suite and the newer bedrooms also have sitting rooms or balconies overlooking the rear garden. Littlebourne House DS0000023469.V249045.R01.S.doc Version 5.0 Page 13 Littlebourne House DS0000023469.V249045.R01.S.doc Version 5.0 Page 14 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 Residents’ needs are supported by the numbers and skill mix of staff. EVIDENCE: All staff undertake a six week induction including a three week assessment. The Registered Provider has purchased a TOPSS approved induction and training course and includes written work. Staff have previously confirmed that they ‘shadow’ an experienced member of staff when first employed. NVQ is ongoing and training is well underway. There was written evidence on display for staff to attend manual handling training in the weeks following the inspection. The rota was fully covered and staff confirmed that there are usually four carers on duty but that this increases to five occasionally and six if a resident is poorly and staff require extra help. A member of staff said that the team working had made work easier and another member of staff confirmed this. They added that residents’ needs had not decreased but their way of working had improved. Littlebourne House DS0000023469.V249045.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 The Registered Provider runs the home in the best interests of the residents. EVIDENCE: The Registered Provider has promoted clear lines of responsibility among the staff and this includes the Registered Manager, Administrator, Housekeeping, Night care and Training managers. The housekeeping manager confirmed that supervision is given but said it was not recorded. A recommendation was made for this as a useful tool for furthering the best interests of the staff. Littlebourne House DS0000023469.V249045.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 2 X X X X x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x X X X X X 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x x Littlebourne House DS0000023469.V249045.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 Standard OP9 OP9 Regulation 13 13 Requirement Medication administration to be signed and handwritten information to be dated. Medicated creams are to be removed from the bathroom. Timescale for action 01/10/05 01/10/05 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 2 Refer to Standard 1 36 Good Practice Recommendations The statement of purpose is to be completed. Formal supervision is to be recorded. Littlebourne House DS0000023469.V249045.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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