CARE HOMES FOR OLDER PEOPLE
Liversage Court Residential Care Home Liversage Street Derby Derbyshire DE1 2LD Lead Inspector
Brian Marks Unannounced 24 May 2005 9.15am 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 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 C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Liversage Court Residential Care Home Address Liversage Street Derby DE1 2LD Telephone number Fax number Email 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 Patricia Blurton PC Care Home only 40 Category(ies) of OP Old age - 40 places registration, with number of places Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 6 Day Care Places Date of last inspection 27 January 2005 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. Service users 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. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over a morning. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. At the home, apart from examining the home’s documents, care files and records, time was spent looking around the building and speaking to 7 of the residents. The manager and staff were also spoken to, and they were observed throughout the visit, looking after and dealing with residents and visitors. What the service does well: What has improved since the last inspection?
Identified problems with the system of management of medicines have been largely dealt with and resident safety improved. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 6 Changes have continued to be made to the documents that support the home’s care service to increase consistency, and progress has been made in improving the range of activities available for residents at the home through the appointment of a member of staff dedicated to this task. 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. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 People do not come to live at the home without the manager or deputy identifying the services they need from the home. This makes sure that the care provided is right as soon as they move in. EVIDENCE: From the files looked, at all residents came to the home following a discussion with the manager, or deputy, who completed an assessment of the type of services that would be needed and who was able to confirm that the home could provide those services. From the sample of files looked at, other professionals were also involved in helping to make sure that everything was in place to help individual residents. A care plan was developed for each resident after they had moved to the home, to help make sure that services were properly organised. (See next section also). The home does not provide an intermediate care service so Standard 6 does not apply. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The care of all residents, including health care, was planned and given in a way that respected individuality and privacy, although further work is required with the documentation that supports care activities to ensure consistency and safety. EVIDENCE: The records of 3 residents were looked at closely and these people were also spoken to during the inspection. The care plans did not all contain completed documents, particularly assessments about the areas of risk affecting welfare and safety. All care plans had been initially signed by residents to indicate their agreement to proposed services but not to any changes in care. These had not been included in the documents following the monthly evaluation, although routine changes were recorded in daily log sheets. This could lead to help being given that was based on outdated information. These issues had been raised as requirements at the last inspection of the home. Service users confirmed that they had a good relationship with the home’s staff, whom they said worked very hard and treated them with respect and with care – ‘They are always there as soon as you ask. Staff look after you right’.
Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 10 All those that needed it had regular contact with their doctor or nurse, and the records examined and observation of a District Nurse visiting a number of residents confirmed this. None of the residents spoken to looked after their own medicines and this was managed by the home on their behalf. However, although the overall management of medicines was satisfactory and a number of issues raised at the last inspection had been dealt with, hand written records which indicated a change had not been dated, which could lead to unsafe practice. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 14 Residents were generally happy with their lives at the home and were able to arrange their lives to suit themselves. A more regular programme of activities was needed to meet the recreational and leisure interests of residents. EVIDENCE: All the residents spoken to talked about the home in very positive terms and about the life they enjoyed there. They are free to use all of the building without any restrictions and to arrange their daily routines to suit themselves. They receive visitors on an unrestricted basis, and 2 residents spoke about the friendship they had developed since they had moved in – ‘We do as we please, it’s a nice atmosphere here’. Others spoke of going out regularly with their families and another about retaining contact with old work friends. They also receive visits from people from the local church who help them to enjoy a regular service. Whilst the manager described a newly appointed member of staff being in post to take responsibility for activities, the residents spoken to felt that there wasn’t much arranged on a regular basis and that they spent much of their time sitting in the lounges or in their rooms. There were no written records of activities taking place within the home available for examination Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home makes sure that all of its residents are protected from harm by having robust policies and procedures in place and by a programme of staff training and awareness. EVIDENCE: Training records indicated that all staff had received training in relation to the protection of vulnerable people and their responsibilities in reporting any incidents that may concern them. The deputy managers had also attended training in relation to this matter from the local Social Services Department. Previous inspection reports indicated that the home has robust policies and procedures in place to manage any incidents abuse of people within its care; there have been no recent referrals made under these procedures. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is clean hygienic and offers good standards of comfort to residents in both their bedrooms and communal areas, and this had led to high levels of resident satisfaction. EVIDENCE: Observations made during the inspection and comments from residents indicated that the home was routinely maintained and decorated. A lounge area was being fully renovated at the time of the visit, which caused some disruption to residents but it was recognised the need to do this to maintain standards. All garden areas are well maintained, and safe for use by service users; a gardener was cutting the hedges during the inspection. All residents are accommodated in single rooms with en-suite facilities. The home was very clean and tidy, and free from odours at the time of this inspection. Residents commented very favourably about the laundry service of the home and all those spoken to, or observed in lounge areas, wore clean and well-presented clothing. An issue around hygiene in the kitchenettes, raised at the last inspection, had been resolved by changes in staff practices.
Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these Standards was specifically examined at this inspection. EVIDENCE: Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The home is well managed by a registered manager who receives regular support from a representative of the Trustees. EVIDENCE: The manager is registered with the Commission for Social Care Inspection and has extended her qualifications by completing an appropriate training course in management. A representative of the Trustees carries out monthly visits to the home as required by law and his reports are sent to the local office of the Commission for Social Care Inspection. The Criminal Record Bureau check, required by law, for the Responsible Individual for the Trustees has not been completed through the area office of the Commission for Social Care Inspection; this was required in the inspection report dated August 2004. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 2 x x x x x x x Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 17 Yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(2) Requirement The Registered Person must ensure that ongoing changes to care recorded in the day to day logs is incorporated into evaluation statements, and care plans must be amended to accurately reflect the current needs of the service user. (Previous timesacle of 31/10/04 not met) The Registered Person must ensure that care plans are evaluated on an ongoing basis with the involvement of the service user, and agreed and signed by the service user whenever capable and/or representative (if any). (Previous timescale of 31/10/04 not met) The Registered Person must ensure that risk assessments in relation to general risks, tissue vialability and nutritional status are completed for all service users. (Previous timescale of 31/10/04 not met) If the Medication Administration Chart (MAR) chart is handwritten or altered by a member of staff this must be dated by them and Timescale for action 31 August 2005 2. 7 15(1) 31 August 2005 3. 8 12(1) 31 August 2005 4. 9 13(2), 17(1) 31 August 2005 Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 18 5. 9 13(2), 17(1) 6. 31 19 checked and dated by a second member of staff. (Previous timescale of 31/10/04 not met) A new entry must be made on the MAR chart if there is any alteration to the strength, dosage or preparation of a medication being administered to a service user. The Registered Person must obtain a Criminal Record Bureau check through a local area office of the Commission for Social Care Inspection. (Previous timescale of 31 October 2005) 31 August 2005 30 June 2005 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 12 Good Practice Recommendations The manager should devlop a programme of and maintian records of all arranged activities that take place within the home. Liversage Court Residential Care Home C52-C02 S1986 Liversage Court V229756 240505 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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