Inspection on 26/06/07 for Littlecoates House Care Home

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Littlecoates House Care Home 24/06/09

Littlecoates House Care Home 05/06/06

Littlecoates House Care Home 10/03/06

Littlecoates House Care Home 02/12/05

Littlecoates House Care Home 07/01/05

Littlecoates House Care Home 08/07/04

Littlecoates House Care Home 23/02/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Littlecoates House Care Home Littlecoates Road Grimsby North East Lincs DN34 4NN Lead Inspector Eileen Engelmann Key Unannounced Inspection 26th June 2007 10:15 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 Littlecoates House Care Home DS0000002792.V344041.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. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littlecoates House Care Home Address Littlecoates Road Grimsby North East Lincs DN34 4NN 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) 01472 343833 01472 354743 CKB Building Services Limited Position Vacant Care Home 46 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (30) of places Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The DE(E) unit`s policies and procedures must relate specifically to the needs of service users with dementia. The garden area of the home must be developed to meet the needs of service users with dementia care needs and to include stimulation to the individuals involved. This must be completed by 20 April 2005 Risk assessment to be provided if bedroom doors are to be locked denying access to the service users Staff should not be rotated between the rest of the home and the dementia unit such that there is a greater than 10 turnover of staff in the dementia unit, over a 2 month period The staff employed by the unit must undertake appropriate recognised specialist training in relation to dementia care and care of the elderly. 5th June 2006 3. 4. 5. Date of last inspection Brief Description of the Service: Littlecoates House is situated on the outskirts of Grimsby. It is close to local amenities including shops, post-office, doctor’s surgeries, chemist, golf club, public houses and Grimsby college. The accommodation for the service users is provided over one storey. All entrances, fire exits, and inner doors are wide enough for wheelchair users to access. All of the service users individual rooms include en-suite facilities. Car parking is provided to the rear of the building, and there is a risk assessment covering the building and the grounds. The gardens are well kept and there is an enclosed patio area in the centre of the home. This has recently been developed to include an enclosed garden. Littlecoates House is registered for the care of Older People. This includes up to 16 placements for elderly service users with dementia related needs. The current fees for services provided through the home range between £345£385. The management have also recently included a £5 a week top up fee for all residents except respite individuals. Records showed that this had been discussed previously in service user and carer meetings. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. The latest inspection report for the home is available from the manager on request. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last visit in May 2006 the registered manager for the home has left her post and Cherry Sykes has taken on this role. Ms Sykes is not registered with the Commission but for the purposes of this report is referred to as the manager throughout the text. This unannounced inspection was carried out with the manager, staff and residents of Littlecoates House Care Home. The inspection took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Informal chats with a number of residents and staff took place during this visit; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of relatives, residents and staff and their written response to these was adequate. The inspector received 7 back from relatives (35 ), 7 from staff (45 ) and 11 from residents (55 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. Since the last visit in May 2006 the Commission has been notified of one formal complaint, which was dealt with by the home and resolved. There has been one safeguarding of adults referral made in April 2006 and this remains ongoing. What the service does well: The people who move in to the home have their needs fully assessed so that the people working in the home can be sure that they have the skills to look after them. This means that people living in the home are well cared by those working in the home and in a way that the people living there prefer. The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. All of the people spoken to are positive about the home and like living there. Two individuals said they love living at the home and the care is very good. People living in the home and relatives expressed their satisfaction during this visit regarding the care given, service received and the living environment of the home. People working in the home do their best to meet the needs of those living in the home. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 6 People being cared for have good access to professional medical staff and are able to been seen by external services such as dentists and opticians. 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 Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Littlecoates House Care Home DS0000002792.V344041.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 Littlecoates House Care Home DS0000002792.V344041.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): 3, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment arrangements for the residents, prior to admission, is satisfactory, and this enables them to be confident that their needs can be met by the service. EVIDENCE: Each resident has their own individual file and four of those looked had a need assessment completed by the funding authority or the home before a placement is offered to the resident. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the resident and family. It is recommended that the manager should make sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. This will help the manager to assess if the home and staff are achieving the aims and objectives for the service. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 10 Residents and relatives are very pleased with the care and support given by the staff: one person said ‘the staff are supportive and helpful towards new residents and very good at information giving’. Survey responses show that everyone using the service is confident about the care and satisfied that the individual needs of the residents are being met. One relative said ‘my mother gets the care and support she requires and the staff do an excellent job of keeping individuals well dressed and comfortable’. The home employs four staff from overseas including France, Germany and Zimbabwe. Residents are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has two male care staff as well as the 59 female members. The manager said that she would discuss this with prospective residents during the assessment process. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of the residents, including dementia care. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of the residents. Information from the Annual Quality Assurance Assessment and discussion with the residents indicates that the majority of the residents are of white/British nationality. The home does accept residents with specific cultural or diverse needs and everyone is assessed on an individual basis. One person in the home does not have English as their first language, but two of the staff are fluent in this person’s native tongue and others communicate with picture boards and simple phrases in the appropriate language. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Littlecoates House Care Home DS0000002792.V344041.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 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the residents are clearly documented and are being met by the service and staff. Improvements to the staff performance around time keeping and recording within the medication system must be made, to ensure the residents’ health and welfare are protected. EVIDENCE: Individual care plans are in place for all residents and the four examined set out the health, personal and social care needs identified for each person. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living, but these were not always reviewed on a regular basis. This was discussed with the manager and she said she would make sure staff included this in the monthly evaluation. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 12 Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individuals care plan. Management strategies and specific care plans are in place for those individuals with challenging behaviour and staff are completing incident records to show how often this is occurring. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that residents have input to this process (where possible), and family/representatives are also invited to the reviews with the resident’s permission. This process also takes place for self-funding individuals. Residents or their representative have signed the care plans at the point of their being written to show they agree with the content, however there is little evidence that residents are consulted on a regular basis about their care, especially when staff are completing the monthly evaluations. Staff commented that individuals with dementia care needs were unable to contribute to their care plans and the staff depended on the families to give them feedback. Visitors said that ‘the staff keep us up to date with our relatives conditions and problems by using the phone or face to face contact’. The manager should look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Information from the surveys indicates that residents and relatives feel that overall the home gives the support and care that individuals require. One resident said ‘ I like to be independent and the staff respect this, I am able to do my own thing and the staff will give me support when I ask for it’. A number of the resident surveys said that ‘ staff give us the support and care we need, but not all the staff listen to us and act on what we say. It depends on who is on duty’. These comments were discussed with the manager who said she would talk to the staff and make sure they understood the importance of good communication and listening skills. Two residents said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Residents have access to a range of bathing facilities including disabled access showers, hoist assisted baths and step-in baths. One visitor said ‘the staff do a good job of making sure my relative is clean, shaved and well dressed at all times’. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 13 One person whose care was looked at during this visit has sore heels and is receiving input from the District Nurse and has pressure relieving equipment in place. Staff are completing turn charts and monitoring the person’s pressure areas. Where individuals are using bed rails, a risk assessment is completed and signed by the person or their representative. Bumpers are provided to prevent injuries from the rails and some individuals have mattresses/crash mats at the side of their beds to prevent injuries occurring should they roll out of bed. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (where appropriate) on their care and feel involved in their lives. Overall there is a good level of satisfaction with the care being given to the residents. The home has reported four maladministration errors of medication since the last visit in May 2006 and the inspector found reference to another in a care plan dated the day before this visit. Discussion with the manager indicates that the home has carried out disciplinary actions against the staff and made sure the individuals received additional medication training. The number of incidents is not acceptable practice and the manager should monitor the competencies of the staff on a regular basis. During this visit it was seen that staff are taking a very long time to complete the medication rounds. The morning round (9am) was still in progress at 11am and medications were being recorded as given at 9am. Discussion with the staff member indicated that she would delay the midday round (12 noon) accordingly. It was seen that this was being done at 1.30pm. A communication note in a resident’s care plans indicated that the staff had taken so long to do the evening medications, the day before this visit, that the night staff had taken over from them at 10.15pm. This is not acceptable practice given that medications are being recorded as given at the times printed on the medication sheets and do not bear any resemblance to the actual times they are given. This could put residents health and well being at risk and the responsible person must make sure that the medication practices within the home are reviewed and amended to become effective and efficient. Checks of the medication records showed that overall these are well maintained and kept up to date, however there were two areas which they could improve •It was noted that medication already held in the home when a new medication sheet is started is not added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. •Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff should include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 14 Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. Resident and relative comments show they are very satisfied with the care and support offered by the staff. Chats with the residents revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were ‘the staff treat residents with respect’, ‘we feel safe here’, ‘staff constantly check on us to see that we are okay, this is done in a positive way without being intrusive’. One visitor said ‘I visit my sister every day and she is well looked after, staff are very friendly and courteous’. Observation of the service showed there is good interaction between the staff and resident, with friendly and supportive care being given to assist residents in their daily lives. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 15 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 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with choice and diversity in the meals and activities provided by the home. However, improvements must be made to the time management of mealtimes to make sure individuals nutrition and health needs are met. EVIDENCE: The home employs two activity co-ordinators who between them have around 25 hours a week to carry out social activities and organised trips/events. Information about the weekly programme of activities is on display in both units, however some relatives commented that they would like more notice about the trips outside of the home, so they could arrange visits around these or help with the outings. Discussion with the residents and information from the surveys indicates most people are happy with the level of activities; one individual said ‘ there are plenty of things to do and everyone is given the chance of joining in’. The home has access to the mobile library and large print books for those who have difficulties reading; there is a minibus available for trips out weekly and recent ones have included ice-creams at Cleethorpes, a ‘lads day out’ where Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 16 the male residents went to the pub for lunch and dominoes and various shopping trips. Discussion with the manager indicates that the home has visits from the ‘TimeCare’ group every two months, who carry out reminiscence work with the people on the dementia unit and this is well received. The activity staff keep records of the sessions completed and information about who participated, comments are also included in the individual care plans. Resident/relative meetings are held every 3 months; these are used as an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Good records are kept of all the social interactions going on in the home and evidence seen at this visit indicates that residents are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. There are 6 weekly in-house church services from the Church of England, and a representative from the catholic faith will visit anyone, wishing to take communion, on request. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to the inspector showed a high level of satisfaction. One individual said ‘ the staff supports everyone including relatives, we can have a meal if we like and are always made to feel at home when we visit’. There are some leaflets and information booklets about advocacy and help groups in the community, which are available to visitors and residents in the entrance hall. Discussion with the manager indicated that a number of individuals have a family member or a solicitor acting on his/her behalf regarding finances. One resident spoken to was quite clear about his rights as an individual and said that ‘I want to retain my independence for as long as possible and staff understand this and support my decisions’. Walking around the home it was seen that staff were not as efficient as could be expected at collecting dirty cups and plates from residents bedrooms and the lounges, a number of rooms had breakfast pots within them at 11.30am and two or three cups from breakfast and the mid-morning drinks round. Comments from a number of relative surveys said that ‘there is insufficient staff on duty at mealtimes, as a lot of people need help with eating and Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 17 drinking’ and ‘the meals are okay, but sometimes they are lukewarm’. This was evidenced during the lunchtime meal that the inspector observed during this visit. Staff on the older person unit were not organised during the meal and individuals were left asking for assistance to eat. One pureed meal was placed on a table in front of a resident and left there for at least 10 minutes to go cold, another individual said they could not eat their meat, but just needed it cutting up. Five visitors were seen to be assisting their relatives to eat and drink, and these individuals said that they enjoyed doing this task for their loved one. Discussion with the manager indicated she was aware of the problems and had introduced two meal sittings at lunch in the past, but this had been stopped because the more able residents had complained they had to wait for their lunch. It is recommended that the manager look at the organisation of the meals again as there remain problems and people using the service are not satisfied. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 18 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 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that residents’ views are listened to and acted upon. Staff have good knowledge and understanding of Adult Protection issues, which protects residents from abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the statement of purpose and service user guide; it is also on display within the home. Information from the resident and relative surveys indicates most people know how to make a complaint if they needed to, but a few individuals felt that not all are listened to, past on or acted on urgently. This was also evidenced in the satisfaction questionnaires given out by the home to users of the service. Observation during the day showed that the manager acted promptly to resolve an issue over lunch and that the complaints records indicate that formal complaints and niggles and grumbles are documented and acted on appropriately. Discussion with the manager indicated that she has introduced a complaints/compliments slip and collection box for these in the entrance hall of the home, in response to the feedback from people using the service. This allows individuals to write down any issues for the manager to investigate and action if needed. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 19 Information from the home given in the Annual Quality Assurance Assessment indicates the home has received four formal complaints since the last visit in May 2006, all have been investigated and resolved. The home has also had two safeguarding of adults referrals made and one person has been referred to the Protection of Vulnerable Adults list. At the time of this visit one safeguarding referral is ongoing around the death of a resident and is waiting for further input from the coroner and police. The home has acted appropriately in referring issues and co-operating in the subsequent investigations. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Information in the staff training files showed that they all have received Safeguarding of Adults training. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 20 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, 22, 24 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing residents with a comfortable and homely place to live. EVIDENCE: The inspector walked around the building and found it satisfactory and suitable to meet the needs of the residents. The home is comprised of two units, one for dementia clients and one for older people. The home has an ongoing maintenance and refurbishment programme and the manager was able to show the inspector work that has been completed since the last visit in May 2006 and discuss work that is planned for this year. Dementia Unit There is a quiet room off the main lounge and this is used by visitors and by the hairdresser as additional communal space. Residents have access to an enclosed and secure garden area, which has flat walkways for those with Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 21 mobility problems and well-kept lawn and flowerbeds. A variety of benches and seats are provided for the residents to sit out in the sunshine. Discussion with the manager indicated that the home has purchased some hi-lo beds for certain residents, to aid with their care in getting them into and out of bed and attending to their needs when they remain in bed for all cares. Observation of the unit showed there are some areas that need attention and these include: • • • • • • The unit has its own dining area and it was noted that a couple of the double glazed windowpanes are ‘blown ‘ and need replacing. The small office/kitchen area off the lounge requires a new drawer on one of the units as it is missing. The corridor carpets are stained and should be considered for replacement. The lounge carpet is very stained despite regular cleaning and the manager said it is due to be replaced by the end of next week. Bedroom 43 has had its roof leak during the recent heavy rainfall, the resident has been moved to another bedroom and a contractor has been called to assess the repairs needed. Pictures on the wall that are designed for residents to touch different textures and items are place too high up for them to be effective and should be lowered. Older Persons Unit This part of the home is split into different corridors each with their own name so residents find it easier to navigate their way to their room. There is an enclosed and secure central courtyard for residents to sit out in, with a pond, planted and paved areas and a selection of seats and tables provided. Doorstops have been fitted onto bedroom doors where residents have expressed a wish for their doors to remain open, these de-activate at the sound of the fire alarm. Walking around this section of the building it was noted there were some areas that needed attention and these include: • • The entrance hall carpet is stained and requires cleaning or replacing. One of the bedroom doors wasnot closing properly and could be a fire risk. The responsible person must make sure this is adjusted to close properly. Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious enough room for people in wheelchairs or with walking frames to move along comfortably. The home is built on a single floor with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff and manager indicates that there is a wide Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 22 range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes mobile hoists, stand aids and handrails. Bathrooms are fitted with rise and fall baths, walk-in baths and fixed hoists, shower rooms are designed for disabled access. Specialist nursing beds and hospital beds are provided where residents have an assessed need, and these aid staff in caring for the residents and make life more comfortable for individuals who spend a lot of time in bed. Pressure relieving mattresses and cushions are provided by the community services and the home, where residents are deemed at risk of developing pressure sores. Two residents spoken to are very pleased with their bedrooms, they are individually decorated and are en-suite. Double rooms are provided with privacy screens and, where requested, individuals have door locks fitted and are given their own key. Information in the care plans indicates all residents have been asked if they wish a door lock fitting and their consent or not is recorded. Not all bedrooms have a lockable drawer provided for residents to keep their valuables or money safe. The responsible person should consider fitting these as furniture is replaced. Laundry services are provided in two areas, one is for dirty laundry and has two washers and two tumble driers to cope with the washing produced in the home. The other area is for clean laundry and staff are able to iron and hang clothes and linen in this area. There is a large quantity of unclaimed clothing and the manager said she has introduced a communication book between the care staff and laundry staff. Individuals can write in the book if residents or relatives have complained of missing items and the laundry staff can them check if these are in the system. There are odours around the building that are linked to people’s incontinence problems and the responsible person must look at the hygiene and infection control measures that are in place, to see if these can be improved and the odours eliminated. A number of residents are MRSA positive and it was noted that these individuals have posters on their doors saying they are infectious and giving staff infection control instructions. It was discussed with the manager that there are more discrete and dignified ways of identifying areas for infection control and the inspector asked that the posters be removed. Staff have been issued with aprons and gloves for personal protection during care giving, and hand gels for disinfecting hands is available throughout the home. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 23 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): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of recruitment, induction and training of staff are good with appropriate employment checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that residents are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: Comments from the residents and relatives are on the whole very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. Survey responses said ‘the staff create a good atmosphere; it is caring, comfortable and safe. Staff are supportive, friendly and professional’. Some individuals said ‘staff are busy and you sometimes have to wait for attention, but they do their best’. At the time of this visit there were 13 residents in the dementia unit and 25 on the older persons unit. Staffing rotas show that there are two groups of staff during the day (one for each unit) and at night the home is staffed as one unit. The home utilises a variety of different shift patterns to ensure cover is provided at peak activity times and on the whole the dementia unit has 4 care staff in a morning and 3 during the afternoon, the older person unit has 5 care staff in a morning and 4 during the afternoon and there are 4 staff on duty during the night. The manager’s hours are supernumerary to these. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 24 Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the residents, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. There is an induction course for new members of staff, and 30 of the care staff have achieved an NVQ 2 or 3. The home provides a mandatory stafftraining programme and is includes some more specialised training to help staff develop their skills and knowledge around diabetes, dementia, safeguarding of adults and challenging behaviour. There is no evidence that staff have received training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The manager said that she has employed more male carers in the past as she is aware that the majority of staff are female, but as people move on the numbers of male to female staff have reduced. She is aware that this may affect resident’s wishes regarding gender choice for giving of personal care, and this is discussed before an individual is offered a placement at the home. Comments from the manager indicate that the majority of the current residents are from a white British background, but the home is able to offer a range of services when they are approached from someone of another culture or ethnic group. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police/Criminal Records Bureau checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 25 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, 36 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of residents, staff and relatives. EVIDENCE: The registered manager for the home left her post in December 2006 and since this time Cherry Sykes has taken on the role and responsibilities of running the home. Cherry came to Littlecoates House in August 2006 as a trainee manager and has previous management experience in other care facilities. She is in the process of doing her Registered Managers Award and hopes to complete this by the end of April 2008. She has sent in her manager application for registration to the Commission For Social Care Inspection: there Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 26 have been some delays in processing this and she was advised to follow up her application with the registration team in Sheffield. The home has a system of Quality assurance and monitoring in place: the manager is responsible for completing monthly audits of staff practice and records within the home and the registered individual does spot checks and completes the regulation 26 visits. Meetings for the staff and residents are taking place; minutes are kept and are available for any interested parties to read. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the inspection reports are met. Feedback is sought from the residents and relatives through regular meetings and satisfaction questionnaires, and the manager has produced an annual development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The results of the resident surveys are on display in the entrance hall of the home. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Residents are able to have pocket money accounts within the home and hand written records are maintained for these. Each person has their own wallet for money and receipts and the manager or administrator completes a separate accounts sheet for each resident as money is put into or taken out of their account. The operations director for the home audits these monthly and documents her visits on the records. Staff supervision files show that individuals receive formal supervision with their line managers on a regular basis and staff appraisals are also completed each year. This was requirement in the last report and is now met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Accident books are filled in appropriately and a number of regulation 37 reports have been completed and sent on to the Commission. However, not all incidents have been reported where appropriate, and time was spent discussing this with the manager. There appears to have been some lack of clarity over what needs to be reported, and the manager assured the inspector that the practice of reporting incidents would get better. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement The responsible person must make sure that medications in the custody of the home must be handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971. So residents receive their medication at the right time and their health and safety is not put at risk. The responsible person must make sure that staff are available to offer help and assistance with eating and drinking to those residents who need this care. So the residents’ health and nutritional needs are met. The responsible person must make sure the repairs and refurbishments asked for in this report are carried out. To provide residents with a safe and hygienic environment and protect their health and safety. The responsible person must make sure the home is kept DS0000002792.V344041.R01.S.doc Timescale for action 01/09/07 2. OP15 12(1) 01/09/07 3. OP19 13(4) 01/10/07 4. OP26 16(1)(2) 01/09/07 Littlecoates House Care Home Version 5.2 Page 29 (k) clean, hygienic and free from offensive odours. So the health and safety of the residents is protected. 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 OP3 Good Practice Recommendations The manager should make sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. The manager should consider how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. The manager should monitor the competencies of the staff, on a regular basis, around the giving of medication. Staff should ensure that medication already held in the home when a new medication sheet is started is added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The manager should look at the organisation of the meals again as there remain problems and people using the service are not satisfied. The responsible person should provide lockable drawers for all bedrooms. The registered person should make sure that 50 of the care staff have achieved NVQ 2 or equivalent by the end of April 2008. The manager should ensure care staff have access to equality and diversity training as part of the rolling programme of training within the home. The manager should achieve the Registered Managers DS0000002792.V344041.R01.S.doc Version 5.2 Page 30 2. 3. 4. OP7 OP9 OP9 5. OP9 6. 7. 8. 9. 10. OP15 OP24 OP28 OP30 OP31 Littlecoates House Care Home Award by the end of April 2008. Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Littlecoates House Care Home DS0000002792.V344041.R01.S.doc Version 5.2 Page 32 - 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. 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