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Inspection on 02/05/08 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 2nd May 2008.

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

The Registered Providers had provided a statement of purpose and Residents Guide to the Home, and all new Residents applying to the Home would be appropriately assessed by the Manager before an admission was arranged. The senior staff and care staff were found to be very attentive and supportive of people staying in the Home, and completed a satisfactory level of administration to support this level of care. The people spoken with also said how helpful staff were to them, which was observed during this visit to the Home. Residents were found to be well protected by the Complaints procedure and the Safeguarding Adults procedure in the Home. The Home was found to be well maintained throughout. The greater majority of the administrative arrangements to ensure that the Home met the standards set by law were found to be in place.

What has improved since the last inspection?

Staff are now fully aware of their responsibilities should the Home be subject to a fire.

What the care home could do better:

A Residents Guide needs to be provided to every person staying in the Home by placing a copy within each bedroom. Improvements were also needed to the Resident`s Plans of Care. This is to ensure that staff, and those staying in the Home or their representatives, are aware of all of their needs and the staffs means of meeting those needs. The record of the distribution of medication needed to be improved to ensure that people were receiving the medication proscribed for them. When appointing new staff, the Manager needs to follow proper recruitment procedures to ensure that only appropriate people are appointed to work with people staying in the Home.

CARE HOMES FOR OLDER PEOPLE Liversage Court Residential Care Home 1 Liversage Place Derby Derbyshire DE1 2TL Lead Inspector Steve Smith Unannounced Inspection 10:50 2nd May 2008 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.V363825.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.V363825.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 2TL 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 linda.baghurst@liversagetrust.org.uk The Liversage Trust Charity Ms Judith Ann 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.V363825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2007 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. The Home provides 40 single en-suite bedrooms over two floors. People staying 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. People staying in the Home also have access to well-maintained, secure landscaped gardens that have extensive patio areas with water features. The Home is within easy access to the entire city centre amenities. Information about the service is provided through the Statement of Purpose and Residents Guide, both of which are available in the Home. A copy of the Residents Guide is available in each bedroom. At the time of this visit to the Home a flat rate charge was made for a room at Liversage court Care Home of £353.00 a week. Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Two Star. This means that people who use the service experience Good quality outcomes. This unannounced visit took place over a period of nearly 8.00 hours. Discussion was held with two Residents, and the records of four Residents were ‘case tracked’. Discussion was also held with the Administrator of the Home, with an Acting Deputy Manager and with two members of the care staff. A number of records were examined, the bedrooms of four Residents were also examined, and all public areas of the Home were looked at. Information provided by the Registered Providers about the home was examined. The Commission’s Residents questionnaire was also sent to ten Residents, but only seven were returned at the time of this visit. Ten questionnaires were also sent to relatives of those staying, and six were returned. Ten questionnaires were also sent to staff, and five were returned. What the service does well: What has improved since the last inspection? What they could do better: Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 6 A Residents Guide needs to be provided to every person staying in the Home by placing a copy within each bedroom. Improvements were also needed to the Resident’s Plans of Care. This is to ensure that staff, and those staying in the Home or their representatives, are aware of all of their needs and the staffs means of meeting those needs. The record of the distribution of medication needed to be improved to ensure that people were receiving the medication proscribed for them. When appointing new staff, the Manager needs to follow proper recruitment procedures to ensure that only appropriate people are appointed to work with people staying in the Home. 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.V363825.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.V363825.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): Standards 1, 2, 3 and 6. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. All new Residents moving to the Home were appropriately assessed prior to their admission, so that they, and their relatives, were reassured that their needs would be met. EVIDENCE: The Registered Providers had provided a good statement of purpose for the Home together with a Resident’s Guide, which informed people staying in the Home, and their relatives, of what the Home provided. The Guide was well completed, and included information from those staying in the Home on what life was like in the Home. The Residents Guide also contained information on how, if necessary, people staying could contact the Commission, the local Social Services Dept and the local Health Authority. In the Annual Quality Assurance Assessment (AQAA), completed by the Manager, she also indicated that potential new Residents were given sample menus, as well as the financial implications of taking a place at the Home. However, the Residents Guide was Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 9 given to potential Residents when they were visited in their own homes, prior to admission. A copy was not provided in their bedroom in the Home, and staff did not know whether the original copy given to people in their own homes was always brought with them, should they be admitted. The records of four people staying in the Home were examined during this visit and a copy of the statement of terms and conditions of residency or a contract, if purchasing their care privately, was found in each file. This ensured that peoples legal rights were protected, and was also detailed in the AQAA. When new people were admitted to the Home, the Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting each person, copies of which were seen. The Manager also assessed all people sponsored by Social Services Depts. If the people were self-funding from the outset, the Manager completed her own summary of needs, which were also seen during the visit. This was also detailed in the AQAA, which explained that the assessment process of each potential new Resident included the potential Resident, their relatives and all involved ‘care professionals’. Standard 6 does not apply to this Home. Liversage Court Residential Care Home DS0000001986.V363825.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): Standards 7, 8, 9 & 10. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Peoples health and personal care needs were met. Medication was administered appropriately to meet peoples needs. EVIDENCE: To help assess Standard 7, the Resident’s Plan of Care, the records of four people staying in the Home were examined, for the purpose of case tracking. These were found to be well completed, providing almost all the necessary information to staff. This information was also found in the AQAA. However, the following issues were found to need addressing. The Plans of Care were rather brief and lacked detailed guidance that staff should follow. For example, in one Plan of Care it said – ‘Full supervision and support to be given by staff’ and ‘(Resident) to be bathed by one carer’. Similar very general comments were made throughout the Plans of Care, with staff action being described as ‘needs assistance’ or ‘encouragement in this area needed’. Although details of what staff should actually do for each person Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 11 was not clearly recorded, staff were aware of people’s needs and ensured that they were met. All these records, however, were found to be up to date. The Manager had also not provided, in the Plans of Care, the required information for people suffering with dementia. As a result staff were not appropriately informed of the needs, and means of meeting those needs, of each person with dementia staying in the Home. Those people staying in the Home who were sponsored by Social Services Depts did not have a review undertaken by the Manager, but this was needed to ensure that all peoples needs were kept up to date. The Manager had not indicated in each file that she had reviewed the records of each Resident at regular intervals. The files were also not well organised, as they did not have different section dividers, and no confidential records section was found in any of the files examined. The AQAA completed by the Manager recorded that the plans of care needed improvement in a number of areas, which would be supported as a result of this visit to the Home. Staff were observed talking and assisting Residents with meals in the dinning room and in the lounge of the Home. This was seen to be done very positively, with a relaxed atmosphere, which was enjoyed by the Residents. Staff were appropriately maintaining the records of Residents health needs. However, a full record of Residents meals was not maintained within the Home, although a record was kept of those people who had been classed as ‘vulnerable’. All medication and the method of distributing it to people staying in the Home was examined. This showed that a well maintained record was kept. It was explained during this visit that the system had been recently altered and that senior staff were still getting used to the system. However, the following issues needed to be addressed. A review of all of the Medication Administration Record (MAR) sheets was undertaken and a number of signature gaps were found. Code letters were provided at the bottom of each MAR sheet. One of these was a letter ‘F’, which was defined as any other issue that needed a definition. This letter was found to be used on at least 4 MAR sheets, but no definition as to it meaning was provided. The vast majority of entries on the MAR sheets were typed by the pharmacy. However, a number of entries were hand written by staff. These were late entries that occurred as a result of a Doctor’s visit, but Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 12 these were found not to have been completed correctly. They should all have been signed by two staff, to ensure they were correctly completed, they should have been provided with the date the medication was to start and stated the Doctor who authorised the medication. The AQAA stated that the Manager recognised that improvements were needed in the way some Doctors saw their patients, as some saw them in the office and occasionally in the lounge areas of the Home. The Manager planned to ensure that in future all people were seen in their bedrooms. This plan was supported during this visit to the Home. Discussion was held with people staying in the Home. They said that staff were very good at listening to their views on how they liked to be cared for and staff would carry out their wishes. They also said that their care needs were always met with dignity and respect. As a result, they felt very safe in the Home, and had to have a strong sense of well being. One Resident said ‘…for me all staff are ok’. Another said that staff ‘listen to my wishes and always do things the way I want’. All staff were observed to be very caring in their dealing with people in the Home, and spoke to them in a caring manner. Staff were also spoken with, and they were able to describe very positive ways of assisting people within the Home. Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. The quality in this outcome area was Excellent. This judgement was made using available evidence including a visit to this service. Peoples preferred lifestyles were respected by the Home, and people were given a wholesome and appealing diet in pleasant surroundings, that enhanced their well being. EVIDENCE: People staying in the Home were asked about the activities provided. Those spoken with said that regular activities took place. They said that such activities as bingo, dominoes, cards, quizzes took place and that news tapes and story tapes were provided. They described the Easter Bonnet event, held recently in the Home, and said that Christmas card and birthday card making took place. Resident Meetings were described and the Activities Committee was explained as the places were all of the events were discussed and decided upon. One person said ‘We are kept pretty busy!’ Staff described the action undertaken by the Activities Coordinator, who, according to the AQAA, started working in the Home during the last 12 months, and works in the Home five afternoons a week. In addition to the above, staff said that the Coordinator organises ‘massage’ events, 3 different church services, afternoon and evening entertainment provided by professional Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 14 entertainers, bulb planting, which recently took place, and an in house shop, which was available to people staying in the Home. Despite this good level of activities, according to the AQAA, the Manager wishes to continue to develop the role of the Activities Coordinator, which is a positive decision. People staying in the Home said that they decided when they got up and went to bed. One person said ‘I get up and go to bed when I want, I am independent’. People also said that in the main they have one bath a week. Someone said ‘Every Friday, I do it all myself’, indicating that this person did not need a staff member to be present during the bath. When this sort of decision, made by staff, is appropriately made, it is always supported by the Commission. Relatives and friends of people staying in the Home were able to visit at any time, and could always be seen in private. The staff spoken with also said that relatives could visit at anytime. It was said that people could chose where they wanted to see their relatives, in one of the lounges, or in the person’s bedroom. People staying in the Home also said that they were able to take part in national and local elections, via a postal vote. They also said that they could go to the shops, and that a trip to a public house took place last year. People staying in the Home were able to say that the Home provided good meals and that a choice was available at breakfast, dinnertime and teatime meals – ‘A choice is always available. Six different cereals are provided and a cooked breakfast if you want it. There is a choice at dinnertime and at teatime, when you can have sandwiches or a cooked meal’ Staff also confirmed this. People and staff said that drinks and snacks were always provided between meals, and that people could also ask for additional drinks at anytime. Mealtimes were never rushed, which was witnessed during this visit to the Home. Staff were also seen to assist Residents with meals, which was seen to be done in a caring and helpful way. The AQAA indicated that it is the Manager’s wish to further improve the meals offered by the Home, providing further choices, with a restaurant style menu. Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 & 18. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Complaints made to the Manager were addressed to meet peoples needs. The protection policies and procedures provided meant that people staying in the Home were well protected. EVIDENCE: People spoken to said that if they had a complaint to make they would tell the Manager or ‘Anyone in the office, it is always put right’ one person said. The Commission had not received any notice of complaint since the last visit to the Home, in May 2007. Since that visit, the Manager had recorded three complaints. These complaints was examined and a good system was found to operate. Good procedures were seen for both written and verbal complaints. The Registered Providers complaints procedure detailed that all complaints would be responded to by the Registered Providers or Manager within at least 28 days. The Registered Providers had a Safeguarding Adults procedure that included a ‘Whistle Blowing’ policy, which staff were also aware of. This meant that a procedure was in place to allow staff to inform the Manager of any inappropriate actions by other staff. The Manager had copies of the Public Interest Disclosure Act of 1998, and of the Dept of Health’s policy called ‘No Secrets’. It was confirmed that all allegations and incidents of abuse would be Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 16 promptly followed up and that all actions taken would be recorded. The policies and practices laid down by the Registered Providers ensured that all staff understood physical and verbal aggression that may have been expressed by people staying in the Home. However, the Manager did not have a policy stating that staff could not benefit from ‘Residents’ wills. Staff were also asked about this and they said they were only aware that the could not receive gifts from people staying in the Home, but they did not know about benefits from wills. Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 & 26. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. The Home was well maintained throughout, providing all people staying in the Home with a safe, comfortable environment in which to live. EVIDENCE: A tour was made of the public areas of the Home, and included four of the bedrooms of people staying in the Home. The Home was most pleasantly decorated throughout, and the lounges and dining room was most pleasant to sit in. The bedrooms seen were not large, but provided sufficient space and provision for each person staying in the Home. The Registered Providers had also provided appropriate furnishings in all locations seen during this visit. Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 18 Toilets were easily available to everyone staying in the Home, were clearly marked, and were provided with handrails where necessary. A call system was also available throughout the Home. All bedroom doors were provided with locks, which Residents could choose to use. All radiators were appropriately guarded, and could be controlled within each bedroom. The Home had appropriate sluicing facilities, and laundry was washed at appropriate temperatures. The AQAA, completed by the Manager, indicated that maintaining the fabric and contents of the Home was a high priority, and that plans were being made to redecorate the home and improve the gardens still further. However, the following issue needed attention: Lighting in the bedrooms visited was provided by a 60 watt bulbs only. Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. A good level of care staffing was provided to meet the needs of people staying in the Home. However, suitable recruitment practices were needed when recruiting new staff to the Home. EVIDENCE: Levels of care staffing were examined for the 3 weeks beginning 7 April 2008. This showed that a good level of staffing was being provided. The Home’s AQAA stated that the Registered Providers ensured that a manager or deputy manager was provided for every shift throughout the day and night. At the time of this visit to the Home it was found that over 50 of care staff had a qualification of at least NVQ level 2 in Care; 14 of a total of 19 staff. This was confirmed by the Manager’s AQAA, and stated that she hoped to encourage more staff to achieve this qualification during the next 12 months. However, of those staff that work regular night shifts, only 1 of the 4 staff had an NVQ level 2 in Care, which needs to be resolved as soon as possible. The records of two new staff employed during the past 12 months were examined to see whether the Manager had obtained all relevant information about them. It was found that almost all information had been obtained. However, no photograph had been taken of either member of staff, and the history of employment of one of the staff had only been taken over the Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 20 previous 10 years, and not back to when they had left school. This was needed to allow the Manager to check whether the potential member of staff had worked in care in the past, to allow an additional reference to be obtained if needed. All other information was found to be satisfactory. Staff spoken with were able to confirm that they had been given copies of the General Social Care Council’s code of conduct and practice. It was stated that all new staff would be provided with induction and foundation training, which was confirmed by staff. It was also said that all care staff were provided with at least three paid days training a year, which again was confirmed by staff spoken with. The records of all of this training was seen. All staff also had an individual training and development assessment and profile. Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 & 38. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Management arrangements at the Home were in place to ensure that Residents care was maintained at a positive standard. EVIDENCE: The Manager was appropriately qualified to manage the Home, having an NVQ level 4 qualification in Management and Care. A senior manager was found to be inspecting the Home on a monthly basis, so ensuring that peoples care, and the maintenance of the Home itself was satisfactory. He also interviewed staff to ensure that they were also satisfied and happy with the care provided to the people staying in the Home. The annual development plan for the Home was seen, which had been completed in conjunction with a senior manager/Registered Provider, that Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 22 reflected the aims and outcomes for people staying in the Home. Surveys had been undertaken of people staying in the Home and their opinions of the operation of the Home, and these had been published. The Manager also discussed with people staying in the Home the operation of the Home at Residents meetings, and at Amenities meetings, as confirmed by those people staying in the Home interviewed during this visit to the Home; the minutes of these meeting were posted on one of the Home’s notice boards. Talking with staff it was evident that they were able to demonstrate the Home’s commitment to lifelong learning and development of each person staying in the Home. However, the opinions of peoples families and friends or of GPs and District Nurses were not routinely obtained on how well they thought the Home was achieving goals for those staying. It was said that this was to be achieved during this coming year, which was also stated in the AQAA. The AQAA also stated that it was the Registered Providers intention to use this coming year to bring about a considerable improvement in the Quality Assurance programme of the Home. It was seen that the personal money of people staying in the Home, and held by the Home, was maintained satisfactorily. However, the savings of some people were discussed with the staff and an action plan decided upon. Staff were asked about the supervision they received from the Manager or other senior staff in the Home. They said that this was done on approximately a 2 monthly basis, when their own needs and the needs of the people staying in the Home were discussed. Senior staff were able to confirmed that supervision was provided by the Manager, or senior staff, for all care staff working in the Home. The training required by the Regulations was examined. This showed that training in Moving and Handling, Fire Safety, First Aid, Food Hygiene and Infection Control were all up to date. This was also confirmed by staff spoken with. In addition to this mandatory training, the Manager supplied information about a considerable addition training that the Home provides for its staff. From copies of the Registered Providers maintenance schedule, forwarded to the Commission prior to the inspection, it was found that all necessary maintenance and repairs were being appropriately addressed. Staff in the Home were not able to show that the Registered Providers had provided risk assessments on all safe working practices of staff; that is for care staff, catering staff and domestic staff. They were also not able to show that the Registered Providers had provided a written statement of the policy, organisation and arrangements for maintaining those safe working practices. Finally, the staff were able to show that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 23 government bodies. With the assistance of the Fire Service, fire safety notices were also posted in relevant places around the Home. Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 24 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 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.V363825.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 17 Sch 3 No 3(q) Requirement Each Resident, or their representative, should have the opportunity to discuss their rights to choice, freedom and decision-making while staying in the Home. The outcome needs to be recorded in each Resident’s records, at least on a 6 monthly basis. When distributing medication to people staying in the Home senior staff must always sign the Medication Administration Record (MAR) sheets on every occasion. This is to record that the medication has been given out to each person at the required dose and at the required time. When senior staff choose to enter a code letter ‘F’ on to the MAR sheets this must always be defined. This is to indicate why that particular code letter has been used. When staff have to enter additional medication on to MAR sheets as a result of a Doctor’s Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 26 Timescale for action 27/06/08 2. OP9 12(1) 13(2) 27/06/08 visit, this must always be checked and signed by two staff, state the day on which the medication is to commence and state the Doctor authorising the additional medication. 3. OP29 19 & Sch 2 The Manager must ensure, when appointing new staff, that all the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004, are obtained. Of two staff’s records examined, it was found that no photograph had been obtained of either employee. In addition, a full history of employment must be taken, dating back to when the person left school. This is to allow additional references to be obtained from a relevant employer, to ensure the person had not been dismissed due to offences against those looked after. 27/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP1 No. 1. Good Practice Recommendations A copy of the Residents Guide should be made available in the bedroom of each person staying in the Home. This is to make sure that information is readily available to the person staying, or their relatives about the operation of the Home. Resident’s Plans of Care should not include generalised terms, such as ‘assistance needed’, as this does not provide enough information to care staff. Guidance to DS0000001986.V363825.R01.S.doc Version 5.2 Page 27 2. OP7 Liversage Court Residential Care Home staff should be written in detail, to ensure that all staff know how and to what degree assistance is needed by each person staying in the Home. The Manager should formally review each person’s Plan of Care and risk assessment at 6-monthly intervals. The formal review should include the person themselves, their representative and, if appropriate, their other relatives, the Manager and other involved staff. One of these reviews could be conducted by the Social Services Dept, although the Manager should provide formal written input to the review of the welfare and care provide to the person. The Manager should review each Resident’s file on at least a monthly basis. She could indicate that this has been done by signing the record with a red or green pen. People’s Plans of Care should be well organised, and be provided with section dividers to ensure that each section contains the relevant information. Each Resident’s file should contain a ‘confidential’ section. This section should be used for records made by staff that the Resident should not see and for information passed to the Home by professionals to which the Resident had not been made party. 3. OP8 A record should be maintained of all the meals provided in the Home against the name of the person who had them. This is to ensure that adequate meals are had by all people staying in the Home. The Home procedures and staff handbook should be up dated to include a section stating that staff cannot benefit from peoples wills. This to prevent anyone working in or at the Home being able to take advantage of someone staying in the Home. The main lighting in peoples bedrooms should be provided at 100 watts. If an alternative power setting is requested by the person staying in the room, this must be recorded within their personal file. The Registered Providers and Manager should ensure that at least 50 of staff who work nights have at least an NVQ level 2 in Care as soon as possible. 4. OP18 5. OP19 6. OP28 Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 28 7. OP33 The Quality Assurance practice of the Home should be completed, in that the views of relative and friends of those staying, and of professionals, such as Doctors and District Nurses, should be obtained so that the practice of the Home can be reviewed and further improvements made, if necessary. Arrangements should be put in place to allow the savings of the Residents identified during the visit to the Home to be significantly adjusted. The Registered Providers should provide risk assessments, for all staff, on all working practice topics in order to ensure that significant findings are recorded and that all staff are safeguarded. They must also provide a written statement on the policy, organisation and arrangements for maintaining safe working practices in the Home. 8. OP35 9. OP38 Liversage Court Residential Care Home DS0000001986.V363825.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V363825.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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