CARE HOMES FOR OLDER PEOPLE
Locharwoods 23 Carrs Crescent Formby Liverpool Merseyside L37 2EU Lead Inspector
Mrs Trish Thomas Unannounced Inspection 10th February 2006 12:30 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 Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 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. Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Locharwoods Address 23 Carrs Crescent Formby Liverpool Merseyside L37 2EU 01704 832047 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) locharwoods@hotmail.com Mr Stuart Gordon Pearson Mrs Charlie Pearson Mrs Linda Margaret Anderton Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 18 OP. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 26/08/05 Date of last inspection Brief Description of the Service: Locharwoods is a care home for 18 older people. The home is owned by Mr. S. and Mrs. C. Pearson. Mrs. Linda Anderton is the registered manager. Locharwoods is a large converted house in pleasant and secluded gardens. Situated in a quiet residential area of Formby, the home is close to shops and local amenities. Locharwoods is staffed throughout the day and night and provides personal care, single accommodation, meals, laundry and in-house social activities. Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used during this inspection included, discussion with residents to obtain their opinions on the home, and with two members of staff. The manager, Mrs. Anderton, was not on duty and Mr. Pearson, (joint owner), assisted with the inspection. Care files and health & safety records were read. Several areas of the building were seen, including the lounges and dining room, residents’ bedrooms, and the utility and storage areas. Requirements from the last inspection were checked, and a number of standards were assessed. For a full account of scoring for National Minimum Standards assessed during the year April 05/06, this report should be read alongside that for the inspection of 26th August 05. What the service does well:
The home has a pleasant atmosphere, and residents were satisfied with staff conduct and competence. Residents said that staff are very good and they had no complaints. Visitors said that there is always a welcome and the home is always clean and pleasant when they call in. Residents said they were satisfied with their lifestyle in the home and every attention is paid to their care and comfort. Those who were spoken with looked well cared for and appeared at ease with staff and in one another’s company. Mrs. Anderton and Mr. & Mrs. Pearson have been pro-active in reviewing policies and procedures in accordance with National Minimum Standards, and improvements to this aspect of service have been noted over recent inspections. A copy of the Service User Guide is left in the reception area and is available to residents and visitors who may wish to read it. The building is well maintained and a refurbishment programme has been undertaken since the present owners took over. The environment is bright, clean and comfortable and residents’ bedrooms are pleasant and personalised. The home provides single accommodation, some bedrooms having en-suite facilities. Communal space consists of two lounges, a conservatory and a dining room. A training programme has been established in line with mandatory and NVQ requirements, and there is a system for formal supervision and appraisals.
Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 6 Mrs. Anderton holds a management qualification. She has worked in the home for a number of years and along with the long-term staff, has provided continuity to residents through the change of ownership. What has improved since the last inspection? What they could do better:
In order to ensure that residents receive the care, which they need, care plans must contain written details of the action to be taken to meet assessed needs. Staff are have good observation skills and compile records of residents’ condition and support needs, in daily diary sheets. An example observed during the inspection related to a resident’s agitation and behaviour patterns, which had been referred to. The information had not been transferred to the person’s care plan. There were no strategies set out for staff to follow, in addressing the resident’s behaviour, to provide support or to relieve the person’s obvious anxiety and distress. The majority of care records were well written. Some wording in daily records, relating to the behaviour of a resident was inappropriate. It is the responsibility of the manager to ensure that care records are written in language, which respects the resident’s dignity. The manager must arrange for all staff who administer residents’ medication, to received training. The home must be able to demonstrate the competence of staff who administer medication, by arranging ongoing training and instruction. In this way, errors in the administration and auditing of prescribed medication will be avoided. Mr. Pearson said he had previously experienced some problems in arranging for a qualified gas engineer to visit the home. He had recently managed to contact an engineer, and a visit had been arranged for a future date. The home must be able to provide evidence that services are regularly maintained, to avoid risks to residents, staff and visitors. The manager must provide CSCI
Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 7 with a copy of the home’s up to date Landlord’s Gas Certificate, by the date stated. To ensure that staff are competent in food hygiene and best practice in handling food, the manager should arrange for all staff who serve/handle residents’ food to undertake training in Basic Food Hygiene. 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. Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 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 Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 All residents have a care plan with sets out their health, social and personal care needs. Care plans, which were sampled, did not contain sufficient detail as to the action to be taken to meet the individual’s assessed needs. All residents are registered with a G.P. and have access to community nursing and paramedical services. The home has systems in place for managing residents’ prescribed medication. Not all staff who administer medication had received related training. EVIDENCE: Care plans were in place for all residents and a sample of 3 care plans was tracked. In reading the care plans, it was evident that further developments are required regarding action to be taken to meet residents’ assessed needs. Needs which staff had recorded in residents’ individual daily records, had not been transferred to their care plans. There were no strategies in place to meet incidents of challenging behaviour, which had been recorded. The use of language in some records was inappropriate. More detail is required with regards action to be taken by the home to meet residents’ health care needs.
Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 11 All residents had been registered with a G.P. Residents were receiving treatment from the visiting chiropodist on the day of inspection. One resident was receiving district-nursing services twice weekly, for pressure care. The home has a system in place for managing residents’ prescribed medication, which is blister-packed and stored in a secured trolley. A senior member of staff, who was spoken with, had responsibility for administering residents’ prescribed medication. She had received instruction in Locharwoods’ medication procedures, but had undertaken no formal training, since taking up employment. Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14,15 The lifestyle in the home is relaxed and in-house and community based activities are arranged for residents. Residents maintain contact with family/friends and the community, and have access to personal representation and advocacy services. Policies and practice in the home are aimed at supporting residents to exercise choice and control over their lives. Residents receive a balanced and wholesome diet in pleasing surroundings. EVIDENCE: The home has an activities diary, which is displayed prominently in the hallway for residents’ information. Mr. Pearson said that residents, who have no family or personal representation, are provided with details of local advocacy services. Residents’ religious beliefs are recorded on their care plans. There are links with local churches and visits from religious ministers are arranged, in accordance with individual belief and preference. In-house activities are arranged and one resident said she enjoys taking part in a quiz. Five residents spoken with in the lounge said they had no complaints. A resident said, “I have no problems. It is all very nice.” There were books and magazines in
Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 13 evidence and a choice of two lounges and a conservatory as communal space. The garden is accessible, secluded, and was said to be, “Enjoyed by residents in warm weather.” A resident was spoken with in her bedroom, where she was entertaining two visitors. Staff had served them with a tray of tea. The visitors said that there is always a welcome, and they had found the home to be clean and pleasant when they called in. The resident said, “I am not too happy about being in a care home, but the staff here are very pleasant, and the place is lovely. The dining tables and serviettes are always spotless.” Residents’ meetings are arranged and the home’s statement of purpose, complaints procedure and inspection reports are placed in the hallway, where they are accessible to residents, along with menus and the activities diary. The kitchen and food storage areas were visited. The kitchen was clean and well organised with a new dishwasher installed. Food stores and freezers are sited in a large wooden building in the rear garden. The food storage areas were hygienic and well stocked with secure containers provided for dry foods. Kitchen records were satisfactorily maintained. Two recommendations from the Environmental Health Officers’ visit regarding provision of fly-screens and replacement wall tiles, were outstanding. Mr. Pearson said that fitting flyscreens to the exterior of the kitchen windows, where the ramp is sited, would need careful consideration. The fly-screens would cause an obstacle to residents who were using the ramp. The chef is qualified and discussed the menus on offer. Various main meals, light meals, snacks and puddings are provided. Menus are regularly reviewed and copies are placed in the hallway where residents may read them. Alternatives are offered to residents’ if required and special dietary needs are catered for. The dining room was beautifully presented and obvious attention had been paid to the dining tables, which were laid with clean linen and cutlery. Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. The home is comfortable and well maintained. There is obvious commitment by Mr. & Mrs. Pearson, to ongoing improvements to the environment. The home is maintained to a good standard of hygiene. EVIDENCE: A walk of the ground floor was carried out and discussion took place with Mr. Pearson. The home looks bright and clean and recent attention to decoration, furnishings and flooring throughout the communal areas was evident. Ensuites have been recently refurbished, non-slip flooring has been fitted where necessary and a new carpet is planned for the hallway and stairs, which have recently been decorated. Decoration and furniture replacement in bedrooms is ongoing, and refurbishment of a ground floor bedroom, (in progress during the last inspection), had been completed to a good standard. The exterior of the building and gardens are well maintained and give an excellent first impression of the home. The rear garden has seating arranged and is accessible to
Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 16 residents who wish to sit out in fine weather. Residents said they were comfortable in the home, and had all they need. Mr. Pearson said that the next phase of improvements to the building includes replacement of the wooden food stores with a more substantial building, new tiling in the kitchen, improvements to the laundry, and replacement of the hall carpet. The home was clean and odour free at the time of inspection. Visitors confirmed that the home is consistently clean and pleasant. Domestic staff are employed and cleaning schedules maintained. The laundry is organised and well equipped. There is a small sluice room accessed from the laundry. The home has procedures for infection control and C.O.S.H.H. (control of substances hazardous to health). Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29,30 Over fifty percent of staff employed in Locharwoods, have NVQ qualifications. The home’s recruitment procedure is based on protecting residents. The home follows an ongoing training programme. EVIDENCE: The manager, Mrs. Anderton, was not on duty. The achievement percentage for NVQ qualifications among the staff group, was discussed with Mr. Pearson. He confirmed that about 70 of care staff have an NVQ qualification. A member of staff said she has commenced NVQ 3. Staff files contain the information referred to in schedule 2, Care Home Regulations and Mr. Pearson said that all Criminal Records Bureau clearances for staff were up to date. Night staff posts had been advertised at the time of inspection. Job candidates complete an application form and are interviewed with references and clearances obtained for successful applicants. Discussion took place with two members of staff. The home has an ongoing training programme and updates in mandatory training are ongoing. Some staff have not received Basic Food Hygiene and a recommendation is made that this is provided for all care staff and kitchen staff who serve or handle food.
Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 18 Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Locharwoods has a manager who is qualified and experienced to run the home. There are systems in the home to take into consideration, residents’ opinions, wishes and feelings. The home follows health & safety procedures and records were up to date, other than as stated. EVIDENCE: The home’s manager, Mrs. Anderton, is registered with CSCI. Mrs. Anderton has a management qualification and has many years experience working in Locharwoods. Discussion took place with Mr. Pearson and residents’ care files were read. The home has an annual quality assurance assessment. Residents are provided
Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 20 with questionnaire and the home takes action on their opinions and preferences. Q.A. Questionnaires were held on residents’ care files. Health & Safety procedure and certification were, in general, satisfactorily maintained. The home’s Landlord’s Gas Certificate was out of date. Mr. Pearson said that the engineer was due to attend to this. A requirement is made that a satisfactory certificate is obtained. Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) Requirement The manager must ensure that residents’ care plans contain the action to be taken to meet assessed needs. The manager must ensure that care records are written in language, which respects the resident’s dignity. The manager must arrange for all staff who administer residents’ medication to received training. The manager must provide CSCI with a copy of the home’s up to date Landlord’s Gas Certificate by the date stated. Timescale for action 20/03/06 2. OP7 12(4)(a) 20/03/06 3. OP9 13(2) 20/03/06 4. OP38 13(4) 20/03/06 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 OP30 Good Practice Recommendations The manager should arrange for all staff who serve/handle
DS0000038689.V283632.R01.S.doc Version 5.1 Page 23 Locharwoods food to undertake training in Basic Food Hygiene. Locharwoods DS0000038689.V283632.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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