Inspection on 16/07/09 for Livesey Lodge

This inspection was carried out on 16th July 2009.

CQC found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Livesey Lodge Livesey Drive Sapcote Leicestershire LE9 4LP Lead Inspector Keith Charlton Key Unannounced Inspection 16th July 2009 09:30 DS0000073227.V376488.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Livesey Lodge Address Livesey Drive Sapcote Leicestershire LE9 4LP 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) 01455 273536 Greenleaf Healthcare Limited Mrs Georgina Margaret Timms Care Home 24 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - DE The maximum number of service users who can be accommodated is: 24 This is a newly registered service. 2. Date of last inspection Brief Description of the Service: Livesey Lodge provides care for up to 24 older persons. The home is purpose built, and situated in a residential area on the edge of the village of Sapcote. It is a single storey building, which is accessible throughout to residents with limited mobility. Communal areas consist of a large lounge, a dining room/conservatory, and a reception lounge. There are 20 single bedrooms, ten with en suite facilities, and two double bedrooms, both with en suite facilities. The home is set in mature gardens and there is car parking at the front for visitors. The current fees per week range from £385 to £400. Further information about the home is available from the Owner or the Manager. Livesey Lodge DS0000073227.V376488.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 0 Stars. This means the people who use this service experience poor quality outcomes. ‘We,’ as it appears throughout the Inspection Report, refers to ‘The Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is selfassessment tool completed by a representative of the service. We have sent surveys to people who use the service along with staff. When we receive these surveys back we will include the results of them if received before the final Report is published. The unannounced site visit commenced on the 16th July 2009 and was carried out by Keith Charlton. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was ‘case tracking’. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Livesey Lodge. Three residents were selected. Discussions were also held with eight residents, three relatives, the Deputy Manager, and three members of staff. What the service does well: All the people we spoke to said that staff at Livesey Lodge were very friendly, kind and hard working. We saw this for ourselves. Residents said that there were no rules and they could follow their own lifestyles in the way they wanted. Medication records were kept up to date and had information about people’s medical conditions that staff could refer to protect residents health. Most people liked the food supply. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Residents welfare could be more effectively met by ensuring that: Assessments are detailed and contain all aspects of individual needs to make sure staff can meet those needs from day one of a person’s admission. Residents must not be admitted outside of the registration category as the service has not been assessed and approved as able to do this. Contracts need to be supplied so people are aware of the terms and conditions of their residency. All aspects of care – e.g. proper toileting programmes, action to meet identified needs such as weight and eating identified by staff in the plans include action on how to meet this need, dates of health checks etc, are in Care Plans, to assist staff to meet all residents needs. Medical services must be contacted if people have potentially serious injuries and staff must always follow proper moving and handling practice to protect people and themselves from injury. Medication needs to be safely given to residents to prevent infection and must be kept in a cabinet that meets current security standards. The food supply needs to be reviewed to ensure meat is of a good quality and people are given what they want. All residents hobbies and interests need to be recorded and action is taken to meet these needs, including the needs of residents with dementia, and to provide outings based on residents preferences. Residents Meetings should be arranged to gauge the views and act on how people want the service to meet their needs. The Complaints Procedure needs to be clearer for residents and their representatives, so that the complainant has a choice as to who to go to reach a proper resolution to their concerns. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 7 Maintenance issues need to be attended to quickly to provide an attractive, odour free and safe home for residents. A ramp is needed so that residents can use the garden if they wish. The home needs to review the signing of the home to assist residents with dementia – e.g. photos of residents on their bedroom doors, and memory boxes with treasured items for individual residents, to provide prompts and stimulation to make everyday living clearer for them, particularly for residents with dementia. There were comments regarding how busy staff were, and we also saw this, so an increase in staffing would mean swifter care and increased supervision provided to people. The manager needs more time to manage the service and make sure that it always runs to promote the quality of life for people. The staff training programme needs to become more comprehensive through making sure all staff receive thorough training to increase their skills in delivering good quality care for residents. Staff references need to be in place before staff start employment to make sure the right staff are employed to protect people’s welfare. Residents must have a safe environment, effective fire safety needs to be observed, the security of the home needs to be always maintained, that there are Risk Assessments for safe working practices in place to eliminate risks for residents and that regular staff supervision and staff meetings are in place to support staff to give more effective care for residents. A quality assurance system is needed to ensure that the way the home is run is checked and suggestions for improvement are put in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2,3. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Livesey Lodge do not have their needs assessed in detail before moving into the home, which means that needs may not be met. EVIDENCE: Residents were not able to confirm that they had been provided with sufficient written information about the home but some relatives spoken with said they had enough information at the time of the admission to make up their minds about the home, though another relative said that she had not been provided with any information and we did not find a contract in place for one resident. We case tracked a person living in the home who had moved into Livesey Lodge in the past. We also checked that this person had his needs properly Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 10 assessed prior to moving in, to ensure that the staff at the home could meet their needs and we found that the assessment system had information regarding residents needs though some sections had not been completed - e.g. medical condition, medication, continence, allergies, mobility, past health checks, no information regarding hobbies etc. This is needed to ensure that staff provide the care needed for residents at a time where they can be anxious about moving into a place they don’t know and will naturally be feeling anxious. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Livesey Lodge do not receive adequate health and social care practice. Care Plans are not robust enough to fully meet the care needs of resident and staff have not read all the Plans, for people to have their needs fully met. EVIDENCE: Residents and relatives spoken with could recall having a care plan. Yes, they come round with the plan and we can look at it and sign it, one resident said. However there was one comment received that stated that relatives had not been informed that there were care plans. The Deputy Manager said that plans are available to relatives with the consent of residents if they are able to give this. This information needs to be provided to residents/relatives. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 12 The AQAA stated that management were going to do a more person centred approach to care plans. We checked the care plans of three people living at the home who were case tracked. Plans showed detail regarding the support required by staff to meet the physical health of people living at the home, though there was little information to inform staff of the residents personal history, which would help to ensure their social and emotional well being is fully supported. Continence information was recorded though this assessment needed more detail to work out the individual needs of a resident so staff could prompt before people needed to go to the toilet. The Deputy Manager said this would be followed up. Staff said they had not read all Care Plans - this is needed so that they can fully understand and meet residents needs. Risk assessments were in place in terms of falls risk, nutrition, moving and handling etc but whilst they recorded the risk they did not record what action was needed to ensure protection of residents health. We received information from a Community Nurse who said that she and her colleague witnessed a resident being lifted by staff when she needed the use of a hoist. This was also supported from the comments made by a relative. This is unacceptable practice and could injure the person and the staff assisting. The Deputy Manager said this had been done due to a relative not agreeing to proper hoisting procedures, but this had now been rectified to protect the health of the resident and staff assisting her. Accident records were checked and medical services were not always contacted when a resident had a potentially serious injury. A monthly audit is recommended to be in place to review why accidents happened so that preventative steps could be put in place, thus protecting residents health. Residents said when they were not well then staff were quick to alert medical services, though there was one comment that a staff member did not know how to contact the out of hours service properly. We checked the medication records, and found that there was generally good recording of the administration of the medicines in the home, and we saw evidence of staff training, though we also saw medication being supplied from the uncovered hands of a staff member, which compromised infection control. There was good information on medication sheets regarding allergies, as needed medication etc so that residents health is protected. Controlled medicines storage was in a secured office cabinet, though this does not conform to the latest legal requirement. The Deputy Manager said the pharmacist would be contacted to supply a new cabinet that meets current requirements. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 13 We spent time watching staff interaction with people living at Livesey Lodge. We saw staff being friendly and caring to people throughout the day doing their best to meet the needs of people living at the home though we also saw staff struggle to meet their needs, particularly in the afternoon when staff said to residents they would have to wait as one staff was helping a resident to toilet and the other was talking to relatives. Relatives also confirmed that staff were friendly to residents. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not enough opportunities for people at Livesey Lodge to take part in activities and have a stimulating lifestyle. EVIDENCE: Residents said they had music and movement and an organist for two days a week but few games and quizzes, or trips out - to the local shops, gardening centres etc. Residents said that they liked current activities but there were not enough of them and there used to be more in the past such as bingo and a singer who came and sang and also played games with them. A resident said We need more activities because we get bored but staff seem too busy with coping with everything. There were no current list of activities displayed anywhere. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 15 We saw TV was on in the main lounge though no one was watching it – music of peoples choice could have been played instead. There was no evidence of staff taking residents out to the garden in good weather, which would have benefited a resident with dementia as it stated on her care plan that she loved gardens. There was no specific activities for dementia residents and no evidence that memory boxes had been set up to help residents with reminiscence or training for staff on providing specialist activities for people with dementia. There were some comments that there needs to be more one to one time with residents (which was also stated on Care Plans), especially residents with dementia, and there needs to be more outings. There were comments as to other activities that could be offered - crafts, school children visiting, film night, nostalgia talks etc. There was no evidence that Residents Meetings were arranged to gauge views and act on how people want the service to meet their needs. The relations between staff and residents were observed to be relaxed. Residents said there were no rules and they could choose to go to the lounge or stay in their bedrooms, choice of food, getting up and going to bed times etc. Visitors are welcomed at Livesey Lodge and we were informed by visiting relatives that they could come at any reasonable time and they were always greeted in a friendly way by staff. Residents largely said they enjoyed the food: The food is good and kitchen staff are always helpful, one resident said. A resident was seen being supplied with a cooked breakfast by staff, which she said she always looked forward to and it was really nice. Lunch was a choice of two hot dinners though a resident said he did not fancy these and would have preferred fish and chips instead. The Deputy Manager said this would be followed up in the future. There was another comment that there were too many processed foods like sausages and beefburgers and fresh meat was preferred. Food was well presented and looked appetising, and was followed by fresh strawberries and cream. Three vegetables were served with the first course this choice showed a commitment to healthy eating. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff understand how to protect residents but due to weaknesses in the recruitment procedure, residents may not be fully protected from abuse. EVIDENCE: Residents said if they had a complaint they would be take it to the Management where they thought it would be sorted out. There have been no recorded complaints since the new Provider has taken over. The AQAA stated that staff have been trained in protecting residents from abuse. We spoke with staff and asked what they would do if it was reported that abuse had happened and staff knew what to do to report it. The Complaint procedure did not give the option to go to the Lead Agency, the Adult Care Department, at the initial point of the complaint. Staff were not found to have full proper checks as a written reference was not in place for one staff before employment commenced, which would not protect residents from potentially unsuitable staff. A criminal records check could also Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 17 not be located – the Provider said this would be sent to us as it had been obtained. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Livesey Lodge live in a generally homely and well maintained environment though signing the home would make it clearer for residents with dementia. EVIDENCE: All residents spoken with said they liked their bedrooms: My bedroom is kept clean and I can all my things in there, one resident said. Residents and staff said that communal areas and some residents bedrooms had been redecorated so they looked much better. The AQAA stated that redecoration was continuing to make the home more attractive. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 19 We saw people at Livesey Lodge living in a home that was in the process of being refurbished and it was generally well maintained environment though one bathroom floor had a bag full of continence pads in it which was malodouress and a tripping hazard - the Deputy Manager moved this to prevent an accident. There were no other odours. The furnishings in communal areas are homely, and people can bring their personal possessions into their bedrooms. The service has not yet improved the environment to further help residents with dementia, e.g. photos on residents doors to orientate them to their bedrooms, colour coding toilet doors, pictures of residents favourite scenes on bedroom doors etc to make facilities clearer, e.g. orientate residents to go to their own bedrooms etc. There was a suggestion on this inspection that the home should have a ramp from the lounge to the garden so residents can use the garden - the maintenance person confirmed this was on his list to do. We saw that there was a broken lock to a bathroom door thereby compromising the privacy of residents. The Deputy said this would be followed up. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are not fully met as staffing levels are not sufficient and staff training is not complete. EVIDENCE: There were a number of comments received by us that said that there were not enough staff to meet residents needs regarding personal care. There was also a comment that there needs to be proper staff cover for sickness and holidays as this was not always the case, and so have an effective bank of staff to fall back on. The AQAA stated that there are good staffing levels but we did not see this to be the case. There are three care staff on duty in the morning, but this includes management who also have other duties. This staffing level then drops down to two staff in the afternoon before rising to three staff from tea to the evening. However there are also no domestic staff so care staff are busy on these duties which takes them away from caring for the residents. . For a home of this size, which now has high dependency residents (the AQAA stated that there are six residents who need the help of two staff both during Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 21 the day and night), and an increasing number of residents with dementia including one resident with regular challenging behavior, it would be expected that staffing levels would be higher to ensure residents needs are fully met and that that there are dedicated domestic staff in place on a daily basis. From information supplied by the Deputy Manager there has been no increase in staffing since the new Provider took over, when the company were granted registration to include people with dementia. As indicated earlier in the Report we also saw staff struggle to meet their needs, particularly in the afternoon when staff said to residents they would have to wait as one staff was helping a resident to toilet and the other staff member was talking to relatives. We also found in care notes that a resident was going into the bedrooms of other residents at night and disturbing them, so a review of whether there is enough staff on duty at night to cope with residents needs is also needed. The staffing situation needs to be reviewed by the Provider to ensure residents needs are always met. A staff member said that she had been encouraged by management to do recent training courses and we found that staff have been on a number of training events to help update their practice on areas such as Moving and Handling, Fire Safety, Medication, they are to do Infection Control training, Dementia etc though it was not clear as to who had and had not attended as there was no Training Matrix. Other essential training such as Challenging Behavior and issues regarding residents health conditions were missing - e.g. Sight and Hearing Impairment, Stroke, Parkinsons Disease, Mental Health conditions, Diabetes etc to increase staff skills in dealing with these needs. The Deputy Manager said that these would be added to the training programme. There was evidence of induction training for new staff and the recommended skills for care induction folder was in place, though the Deputy Manager was not aware of any new staff using this. The AQAA stated that nearly fifty per cent of staff have received NVQ training in care skills and that it was aimed that all staff are trained to this standard. Staff records showed that proper checks had not fully been carried out to protect residents from unsuitable staff as there was a missing reference from one staff file. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are not properly in place to protect the health and safety of residents. EVIDENCE: The Deputy Manager manages the home at present as the Provider stated to us that the previous Manager has just left. The Provider confirmed an applicant will be applying for registration for this post in the near future. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 23 We talked with the Deputy about whether the management has had to make any Deprivation of Liberty referrals to the appropriate Agency. As the Manager has not yet received training on this issue she was unable to comment. Training on this important issue is needed to ensure management meet their legal obligations and do not unintentionally deprive people of their liberty. Sue has been updating the staff with training to meet the needs of residents, and this was confirmed by the staff spoken with. Staff informed us that they were able to tell management of the problems they were facing but there are no regular meetings and supervision to support them and check that their practice meets residents needs. We could not see how management finds out whether people are satisfied with the services of the home as satisfaction questionnaires have not been supplied to residents or other relevant parties, to see if improvements in the service are needed. There was no evidence of staff meetings discussing relevant issues – care, training, working practices, activities, food etc, which would show involvement in the running of the home and how to improve the service. Financial records kept for a resident are satisfactory. There was no evidence of staff meetings discussing relevant issues – care, training, working practices, activities, food etc, which would show involvement in the running of the home and how to improve the service. Safe working practice risk assessments were in place though they did not cover all risks in the home so these need to be expanded, e.g. the Manager was asked to review the Risk Assessment on window restrictors to ensure intruders cannot enter the building, whether radiators need covers to prevent burning risks to residents, any health and safety in all areas used by residents etc. There was evidence that hot water temperatures were to be tested on a three monthly basis but this had not been done since January 2009. The service was served an Immediate Requirements Notice regarding testing for hot water as it was measured as being over 10c over the National Standard level of close to 43c, so that residents are not scalded. A toilet bathroom floor had a bag full of continence pads in it which was a tripping hazard - the Deputy Manager moved this. A comment was made in a survey that infection control could be improved, e.g. by the availability of bacterial hand wash to help minimise infections. Fire records were in place with regular fire drills though fire bell testing and emergency lighting testing had not been done on a weekly or monthly basis to meet the standards of the Fire Service. Staff were asked about the fire drill procedure and they all knew what to do except one staff member missing out Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 24 one step of the procedure. The Deputy Manager was asked to review the Risk Assessment and follow up the requirements of the Fire Report of 2005, as there was no evidence that this had been done. We also saw that a wedge had been used to the kitchen fire door which meant that this was a risk if a fire happened as the fire door would not then close to protect people in the home. Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 25 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 1 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 1 Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 OP2 Regulation 4 Requirement Each service user needs to be provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). Residents must not be admitted outside of the registration category of the service. Care plans must include all relevant care details – individual toileting programmes, detailed action if a need is identified etc so as to have a care plan which supports their individual requirements, and staff need to read and follow the plans, so as to ensure people’s conditions are managed effectively. The Provider must ensure that staff refer residents with potentially serious injuries to medical services, and that proper moving and handling practices are in place to ensure residents health needs are met. DS0000073227.V376488.R01.S.doc Timescale for action 16/09/09 2. OP3 14 16/08/09 3. OP7 15 16/09/09 4. OP8 12 16/08/09 Livesey Lodge Version 5.2 Page 27 5. OP9 12 A proper controlled drugs cabinet 16/10/09 that conforms to current legal requirements need to be in place, and that staff issue medication to residents that follow infection control procedures, to protect residents health and medication security. An Activities programme needs to be set up that meets the needs of residents so as to provide proper stimulation to people. Staffing levels must be reviewed and increased as necessary, e.g. care and domestic levels, to meet all residents needs. Staff references need to be in place to protect residents from unsuitable staff. The Manager must be aware of the Mental Capacity Act and be able to make proper Deprivation of Liberty referrals, to ensure all residents needs are met. 16/10/09 6. OP12 16 7. OP27 18 16/08/09 8. OP29 17 16/08/09 9. OP31 10 16/09/09 10. OP31 26 The Provider must send the 16/09/09 Regulation 26 Monthly Reports to CQC so that we can ascertain how the home is running and dealing with the Requirements of this Report. The Provider needs to ensure health, safety and welfare of residents and staff in relation to fire and safe working practices. 16/08/09 11. OP38 13 Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 28 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 Residents should only have been admitted only on the basis of a full assessment, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. The Provider needs to review the food supply to ensure that residents always receive a varied, and nutritious diet, which is suited to individual wishes. The complaints Procedure needs give the complainant the opportunity to go to the Lead Agency to make their complaint. A ramp is needed to the garden so residents can enjoy this space. The home need to review the signing of the home to assist residents with dementia to provide prompts and stimulation to make everyday living clearer for them, particularly for residents with dementia. Staff need to be trained in all aspects of care to ensure residents needs are fully met. Residents and other relevant people – GPs, Social Workers etc need to be provided with opportunities to comment on the care residents receive, and for this to be analysed with an action plan produced to make sure these improvements are made. Staff need to receive regular individual supervision to ensure their performance is monitored and support can be given to them. 2. OP15 3. OP16 4. OP19 5. 6. OP30 OP33 7. OP36 Livesey Lodge DS0000073227.V376488.R01.S.doc Version 5.2 Page 29 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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