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Inspection on 10/05/07 for Liversage Court Residential Care Home

Also see our care home review for Liversage Court Residential Care Home for more information

This inspection was carried out on 10th May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Liversage Court provides a comfortable and homely environment for the people who live there, and people are encouraged to personalise their rooms with their own possessions and furniture. Management and staff recognise the importance of providing opportunities for the people living in the home to join in with activities and entertainment and dedicated staff time is provided by an activities coordinator, who supports residents with one to one time as well as group activities. The importance of maintaining links with family, friends and the community is also recognised and supported. A number of residents have continued to access facilities in the community, such as the local shops and attendance at church services. Residents were very positive about the meals provided at the home, and stated that they were provided with choice and variety, and they have been able to influence choices on the menu following consultation at the regular residents` meeting.

What has improved since the last inspection?

Good progress has been made with the requirements made at the last inspection and all have been addressed by the home`s management. The documents used for planning and delivering care have been completed with an increased level of precision. Assessments of need are carried out as people arrive at the home so they can be reassured that the care they receive will be right for them and will be given as safely as possible. All aspects of health and safety matters of the home have been carried out, including the required staff training and the environment of the home has continued to be maintained in ways that have increased resident comfort and facilities. Staff are now well supported to do their jobs properly and the management of the home has stabilised again with the appointment and registration of a new manager who has made a positive impact on the overall running of the home..

What the care home could do better:

There has been one instance of poor recording in the medicines record, which could lead to mistakes being made, and not everybody has received fire safety training in the past year.

CARE HOMES FOR OLDER PEOPLE Liversage Court Residential Care Home 1 Liversage Place Derby Derbyshire DE1 2TI Lead Inspector Brian Marks Key Unannounced Inspection 10th May 2007 09:00 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 Liversage Court Residential Care Home DS0000001986.V336269.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. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Liversage Court Residential Care Home Address 1 Liversage Place Derby Derbyshire DE1 2TI 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) 01332 291241 01332 205201 The Liversage Trust Charity Judith Hampton Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 6 Day Care places Date of last inspection 23rd May 2006 Brief Description of the Service: Liversage Court is a purpose built two-storey building, located in a cul-de-sac close to the city centre of Derby. Liversage Court provides 40 single en-suite bedrooms over the two floors. Residents enjoy easy access around the building, and can access the first floor either by the stairs or the shaft lift. Lounge areas are located on both floors, with a spacious dining area on the ground floor. Residents also have access to well-maintained, secure landscaped gardens that have extensive patio areas with water features. Liversage Court is within easy access to the entire city centre amenities. Information about the service is provided through the Statement of Purpose and Service User Guide, both of which are available in the home. A copy of the Service User Guide is available in each room. The current accommodation fee for Liversage Court is £334 per week. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key unannounced inspection that took place at the home over a period of a day. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and other relevant documents and preparing a structured plan for the inspection. At the home, apart from examining documents, care files and records, time was spent speaking to one of the deputy managers, who was in charge of the home during the visit, the home’s administrator and six of the staff working on the morning shift. The care records of four people who use the service were examined in detail and they were interviewed along with six others and three visitors who were at the home during the day. In addition fifteen residents returned written survey forms before the inspection started. No other inspection visits have been made to the home since the last Key unannounced inspection 23 May 2006. What the service does well: What has improved since the last inspection? Good progress has been made with the requirements made at the last inspection and all have been addressed by the home’s management. The documents used for planning and delivering care have been completed with an increased level of precision. Assessments of need are carried out as people arrive at the home so they can be reassured that the care they receive will be right for them and will be given as safely as possible. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 6 All aspects of health and safety matters of the home have been carried out, including the required staff training and the environment of the home has continued to be maintained in ways that have increased resident comfort and facilities. Staff are now well supported to do their jobs properly and the management of the home has stabilised again with the appointment and registration of a new manager who has made a positive impact on the overall running of the home.. 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. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 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 Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not come to live at the home without the care they need being identified, and being reassured that the home is right for them. EVIDENCE: The documentation for assessing resident needs and for care planning and recording has continued in place since the last inspection and a sample of four files was examined – related to three recently admitted and one established residents. All three recent admissions had been made following referral by Social Services care managers and had been at the home on a permanent basis for six months, three months and two months respectively. All have ‘front sheet’ details completed and also have completed assessments from care managers, which described the problem areas they required help with. Additionally the two most recently admitted had a ‘New Residents Assessment’ carried out at the point of coming to live at the home by one of the home’s senior staff. This process had been carried further to include specific assessments of risk areas such as pressure sores, safe moving and handling, nutrition and falls as well as a description of general areas of risk that may be Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 9 present. The assessment documentation in all files was completed to the same standard, which was an issue requiring attention from the last inspection, and staff are now working with residents using information that allows them to work consistently and safely. The home does not offer an intermediate care service so Standard 6 does not apply. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning arrangements at the home promote safety and consistency in caring for residents and care is given in a way that respects individuality and privacy. EVIDENCE: All residents have their own file containing care records and four of these were looked at in detail during this inspection. The care plans identify key areas that people need help with, as well as their preferences and abilities, and areas in which they are independent. Additionally, by incorporating information from the initial assessments of risk, care activities are identified. These are routinely evaluated on a monthly basis and revised where necessary. The files indicated that residents had been consulted within the process of care planning and within the programme of reviewing progress; safety and consistency is supported within the current system and practice. Records in the care files examined indicated regular contact with outside healthcare services and people spoken to confirmed that they saw their GP or other professional promptly and without any problems. Two community nurses Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 11 were seen in the home during the morning of the inspection and an emergency admission to hospital was made following the visit of a consultant doctor. Residents and relatives spoke very positively about the staff working at the home, and that they were attentive to individuals’ privacy and dignity needs and supported them in careful ways that made them as independent as possible. Staff were observed routinely knocking on bedroom and toilet doors before entering and conversations between staff and residents was polite and respectful, with staff taking time to understand people with communication difficulties and loss of memory. The relatives spoken to commented that they were satisfied with the care at the home and that they were always welcomed and kept informed about any changes about their family member. None of four residents whose care was being looked at in detail looked after their own medication and the one person in the home who does manages things safely. Generally systems for storage, recording and administration of medicines were satisfactory at the time of this visit, although the written records of one resident for one medication were missing for a short period and this type of oversight is an indication of unsafe practice. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for residents to engage in leisure and social activities have continued to improve, and the catering of the home is a service viewed very positively by them. EVIDENCE: All of the residents spoken to were very positive about living at Liversage Court and the recent arrivals all reported that they had been able to settle in quickly. They described the routines of the home as being flexible and that they are able to please themselves about how they spent their time during the day. They are encouraged to remain as independent as possible and two of them had been out to local shops that morning. Dedicated staff time for activities was provided on weekdays by an activities coordinator, supported by the care staff, and the social diary of the home indicated that a good range of events and leisure time had taken place recently. Two residents were particularly enthusiastic about a recent visit to a local pub and this had not been restricted to just the able-bodied. Visiting by family and friends is unrestricted and a number of residents regularly go out with their families Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 13 Residents are encouraged to personalise and to bring in their own possessions to the home, including furniture. Two residents visited in their rooms had their own telephones fitted also. All of residents spoken to were positive about the meals provided at the home, although one did say that after a time they become a bit repetitive. However, following speaking to the kitchen staff, her request to have more ‘cosmopolitan’ options as the second choice had been adopted and the kitchen staff said that they willingly support such requests. Residents confirmed that they were offered a varied diet that included choices for all meals and a dietician had been consulted in the development of the menus, so that nutritional balance is maintained. Residents are given the opportunity to comment on the menus at their regular group meeting with the home’s management and staff. The kitchen staff indicated that they are informed of the dietary needs of new residents, and special arrangements such as for people with diabetes are satisfactorily managed. Purchasing, storage, stock managing and cooking arrangements in the kitchen are satisfactory, and the recommendations from the last visit of the Environmental Health Officer have been dealt with. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect residents from harm. EVIDENCE: Residents were made aware of the complaints procedure through the Service User Guide, as well as the procedure being on display. Written and verbal feedback indicated that none of the residents had had cause to complain whilst living at Liversage Court and neither the home’s management nor the Commission has received any formal complaints about the care and services provided at Liversage Court during the past year. The home’s written records did include two problems that had been raised verbally by relatives and also indicated immediate satisfactory resolutions to these. The people spoken to also said that their concerns were listened to, taken seriously and acted upon: ‘There is always someone in the office or staff around to listen to what you have to say’. Appropriate procedures are in place to safeguard and protect residents from harm, and these are supported through staff training, provided as part of their preparation when they start work at the home. The management team have also attended more extensive training provided by the local authority. There had been no incidents of use of the statutory procedures during the past 12 months but the manager has previous experience of the matter. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical state of the home produces an attractive, homely and safe environment in which to live and work, and standards have been continued to a high level. EVIDENCE: From a selective tour of the building, the standard of maintenance was found to be satisfactory with the planned programme of continued redecoration and improvement ongoing since the last inspection. This has included redecoration of bedrooms as they are vacated and redecoration of all bathrooms and toilets and two of the lounge areas. As noted previously the recommendations made at the last visit by the Environmental Health Officer have been dealt with, as have those from the last Fire Officers visit. The communal areas and bedrooms of the home visited during this inspection were very clean and tidy and free from odours. Residents and family members Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 16 spoken to had no complaints about the laundry service of the home and all residents observed in the home wore clean and well-presented clothing. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are met by a group of staff who are on duty in good numbers and who have been properly recruited and trained, so that they work consistently and safely. EVIDENCE: The people living in Liversage Court benefit from a stable staff team, who have worked together for a number of years. A recently recruited member of the staff team commented that they felt well supported by more experienced staff members and that morale in the group was positive and had improved since she had started working at the home last year. Residents and staff commented that staffing hours were sufficient to meet the needs of the current resident group, and this was supported through observation. However records indicated that gaps in the daily roster were covered, and staffing levels maintained, through the use of agency staff which has become an increasingly used option. Some of the residents and staff commented unfavourably about the impact this had had on their care – that consistency and quality suffered. Residents were supported by a staff team that was provided with the necessary induction and training, so that they had the skills and knowledge to deliver the care that the home offers to provide. The written induction programme for the last member of staff to be recruited was examined and this indicated successful achievements of the various elements being signed off by the manager. The general training records examined indicated a good mixture Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 18 of opportunities being offered to staff that varied in style from formal instruction on external courses to video-based packages that staff can work through at their own pace. The management have set a requirement for staff to receive annual updates in a number of care related topics and the administrator described plans to develop more group based activities that will serve to produce a staff group better equipped to met the needs of the residents in their care. A good level of achievement has been made with training in the National Vocational Qualification level 2 and the target, set nationally, has now been achieved. Residents are protected from potential risk of harm through robust recruitment and selection procedures and all the retired checks and procedures are carried out before new staff start working at the home. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good administration and management systems and is a safe place to live and work; its operation reflects the wishes and preferences of the people that live there. EVIDENCE: Since the last inspection there has been a change of manager and the new manager has been in post since the end of 2006. She has successfully registered with CSCI and has already completed a recognised management qualification. During the inspection everybody spoken to was positive about the impact she has already had on the home; staff in particular felt that communication had improved and that ‘the manager is building the team up again and people are coming to work with a smile on their face’. Staff indicated that they worked as a team, and supported new staff as well as each other. Additionally the management at the home have received good support from Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 20 the Trustees and the Responsible Individual, acting on their behalf, has made his own monthly visit to the home and submitted a written report to CSCI, as required by law. The managers of the home have carried out annual surveys of both resident and staff views of the operation of the home and the residents meeting has continued with staff support; another was planned for the day after the inspection. Last year’s Annual Plan for the home has been successfully completed but it was written in broad terms rather than as specific targets to be achieved which would allow for a more accurate assessment of progress taking place. The systems for the safe keeping of residents’ personal spending money have been in place for some time and these remain unchanged from the last inspection. Systems are in place to for the home’s managers to meet with staff on an individual basis and since the last inspection these have been taking place at the required regularity. Because of this staff are being supported to carry out their work and its quality is now being properly monitored. An audit the health and safety standards and equipment servicing at the home was carried out and standards were found to be generally good, although the record of staff fire safety training indicated that three members of the total staff group had not attended either of the last two training update sessions; this programme is intended to help them to understand their responsibilities and what they should do in case of a fire. Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 4 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 3 X 3 Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 12(1) 13(2) Requirement The written records for administering resident medicines must be accurately maintained so that accountability and levels of safety within the system can be clearly demonstrated. All staff must be fully aware of their responsibilities to make sure that residents and colleagues are safe should there ever be a fire at the home. Timescale for action 30/06/07 2. OP38 18(1)(a) & (c) 30/09/07 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 When people are admitted to the home a picture of their previous social experiences should be developed so that staff can get to know them and support them in a more complete way. If residents look after their own medication, this should be carried out safely and complete records maintained in the carer file. DS0000001986.V336269.R01.S.doc Version 5.2 Page 23 2. OP9 Liversage Court Residential Care Home Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Liversage Court Residential Care Home DS0000001986.V336269.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!