CARE HOMES FOR OLDER PEOPLE
Locharwoods 23 Carrs Crescent Formby Liverpool Merseyside L37 2EU Lead Inspector
Mrs Trish Thomas Unannounced Inspection 18th August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Locharwoods DS0000038689.V295388.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. Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 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.V295388.R01.S.doc Version 5.2 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. 10/02/2006 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.V295388.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An un-announced visit was carried out and discussion took place with the manager, Mrs. Linda Anderton and two members of staff. Nine residents and one visitor were spoken with, and their comments on standards of service are contained in the report. Residents’/ representatives’ written comments stating their opinions on quality were read. Records compiled in the home relating to care practice, staffing and health and safety were read. A tour of the premises and grounds was carried out. The owners, Mr. & Mrs. Pearson attended during the inspection. What the service does well: What has improved since the last inspection?
Requirements from the last inspection have been addressed. In the sample of care files, which were read, there were action plans in place to meet the assessed needs of the residents. Improvements were noted in the style of report writing and the terms of reference in use.
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 6 Staff who administer residents’ prescribed medication have received relevant training and are aware of the need to follow procedures in the management, recording and storage of drugs held in the home. All staff are involved in serving drinks and food to residents, and they have now received training in Food Hygiene. Mr. Pearson provided an up to date Landlord’s Gas Certificate to the Commission for Social care Inspection shortly after the inspection of February 2006, which is valid for twelve months after issue. Updates in mandatory training and National Vocational Qualifications achievements are ongoing and staff appear to be enthusiastic in taking up the training on offer. Work on improving the environment for residents has progressed. The reception area, stairs and corridor have been re-carpeted and bathrooms toilets and three bedrooms have been recently refurbished. What they could do better:
Staff were providing a good standard of care to a resident of high dependency regarding fluid intake and pressure care, however this had not been fully documented in the resident’s care plan. To ensure that the home provides a full summary of the care provided, a requirement is made that pressure care, skin integrity and fluid monitoring are fully documented for this resident and for future best practice. There were good stocks of food in store and it was held in secure containers (freezers, fridge and plastic boxes with lids). Due to the nature of the storage area, (which is a large wooden shed), it can be prone to the presence of insects and mice. The windows, where cobwebs form, must be kept clean, as must the fridge. A requirement is made that cleaning these areas is regularly maintained. The owners have ordered an alternative unit, which will be more suitable for storing food. To ensure that residents are protected in case of fire, alarm systems tests in the home must be carried out every week. There are a number of omissions in the fire book where this has not been done and a requirement is made that these be carried out with consistent regularity. A recommendation is made regarding medication records. Situations may arise where a pharmacy printed record has not been provided, and the record of the drug, dose and time of administration is hand written by a member of staff. To avoid error, it is recommended that the writer signs the record and has a colleague check and sign also.
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 7 A recommendation is made regarding keeping a record of the diets of those who are diabetic. This is to ensure that they are receiving a nutritious and balanced diet, which suits their medical condition and promotes ongoing good health. A recommendation is made that staff files be organised into a standard format. The content of the sample of files, which were read, was satisfactory (in accordance with schedule 2 Care Home Regulations 2001). The files were disorganised and difficult to follow. 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.V295388.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 Locharwoods DS0000038689.V295388.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. No prospective resident moves into the home without having his/her needs assessed and being assured these will be met. EVIDENCE: The care files inspected contained records of assessments of residents’ needs, carried out by home’s staff and relevant professionals, prior to admission. The standard assessment document in use by staff of Locharwoods addresses health, personal care, and social support needs. Assessment outcomes form the basis of individual care plans. Residents’ mobility needs are recorded in their initial assessments and risk assessments. Their support needs are updated as care plans are reviewed. The building has good access to the exterior for those in wheelchairs, a passenger lift, hoist and bath and toilet aids. Staff on duty confirmed they have received training (and updates) in moving & handling. Residents’ religious beliefs are recorded on their care plans and ministers from a number of religious denominations visit with regularity. A visitor who commented on
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 10 the service provided by Locharwoods said, “They couldn’t do more for……., staff are very caring and thoughtful and ……….is comfortable and well looked after.” Locharwoods DS0000038689.V295388.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. The residents’ health, personal and social care needs are set out in an individual plan of care. Residents have access to health care and paramedical services to meet assessed needs. The needs and treatment of a resident who is frail and at risk of developing pressure sores had not been fully documented. EVIDENCE: There were care plans in place for all eighteen residents and sample of three was tracked. The individual’s health, personal and social care needs had been recorded their care plans. There were action plans in place to meet assessed needs and these had been adjusted as necessary, in accordance with the outcomes of reviews. It is a requirement that for residents of high dependency, pressure care, skin integrity and fluid intake are fully documented. For residents who are diabetic, it is advised that their diet be fully recorded and held on the care plan, to ensure they are receiving a diet in accordance with their medical condition, and which promotes their ongoing good health.
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 12 All residents of the home had been registered with local G.P.s and referrals are made for input from district-nursing services when necessary. There are arrangements in place for residents to receive paramedical services on a regular basis. The chiropodist was on the premises during the inspection and residents were receiving treatment in private. A resident said, “I have nothing to worry about here, everything is taken care of.” The home has a procedure for the management of residents’ prescribed medication, which is stored in a locked trolley. Staff who are designated to administer medication receive relevant training and updates. Medication administration records were satisfactorily maintained. As a safety measure, in instances where, (in the absence of a printed record from the pharmacy) a member of staff handwrites the medication record, it is advised that the drug, dose, the dose, the time(s) of administration and name of the resident, be checked by a colleague and they and the writer sign the record as being accurate. Residents are accommodated in single bedrooms and those who commented said that staff respect their privacy and they spend their time as they choose without undue intrusion. A resident said, “The staff are always polite and kind. They are there when you need them, but don’t intrude.” A number confirmed that they receive their mail unopened and their personal business remains private. A resident who was in her bedroom said, “I am comfortable here, isn’t this a nice room. I have everything I want.” Locharwoods DS0000038689.V295388.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. Residents’ social, cultural, religious and recreational interests are addressed, their rights are respected and they receive a wholesome and nutritious diet. EVIDENCE: The home’s statement of purpose and a summary of residents’ rights, are placed in the hallway for residents and visitors to read. Residents were spending time either in their bedrooms, the lounges or conservatory and there was a relaxed and pleasant atmosphere in the home. An activities calendar is posted in the hallway where arranged events for the month, arrangements for religious observance and access to advocacy services are made known to residents. Residents said they play bingo sometimes or have a quiz. The manager, Mrs. Anderton, said that community activities are available through local churches and pub lunches are arranged for those who wish to go. A resident said that there is always room for improvement where social events are concerned, as each individual has their own opinion, “The food is good but we could do with more things to do. I’m not complaining, sometimes people don’t take part.” Another resident said she does not get involved in arranged activities, preferring to remain in her bedroom. Residents confirmed that their visitors are made welcome and staff respect their privacy. A visitor said, “They
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 14 are so good here, I cannot thank them enough for all the support and care.” A relative wrote, regarding the care provided in Locharwoods, “Thank you all for showing our mother such kindness and care.” A resident said, “The food is lovely here. I have gained weight since I came in here. I was very thin before. I have a whole new wardrobe of clothes now.” Residents said that if they don’t want what is on the menu, they are offered an alternative. Comments were, “There is plenty to eat here.” “The food is lovely.” “We want for nothing. The dining room is very nice and the kitchen is next door, so the food is nice and warm when we get it.” Locharwoods DS0000038689.V295388.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. The residents’ right to make a complaint is respected and they are protected from abuse. EVIDENCE: Residents and their representatives/advocates have access to the home’s complaints procedure, which is clear and includes the stages and timescales for the process. A record of complaints and investigations is maintained in the home. There have been no complaints made to the Commission for Social Care Inspection regarding Locharwoods, in the past twelve months. The home has an adult protection procedure to be initiated if abuse of a resident is suspected, and the manager said that staff have recently received training in protection of vulnerable adults. The home has a recruitment procedure and there are systems in place for the vetting of staff through Criminal Records Bureau and Protection of Vulnerable Adults clearances prior to persons taking up employment in the home. Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 16 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 quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. The building is well maintained and comfortable and there are very good standards of hygiene throughout the home, other than in the food store. EVIDENCE: The building is maintained to a very good standard and there is an ongoing maintenance and refurbishment programme. The home is in good decorative order and the grounds are well tended and attractive. Since the last inspection, the bathrooms, toilets and showers and three bedrooms have been refurbished. Also, the hall, corridor and stairs have been re-carpeted. Residents said they were satisfied with their accommodation and they appeared relaxed and at ease in the home. The building is maintained to very good standards of hygiene, other than in the food stores. Food is stored in a large wooden shed in the rear garden, which is kept locked. Perishables are stored in freezers, in plastic containers and the
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 17 fridge. The windows of the shed needed cleaning as cobwebs and spiders were observed. The fridge interior was grimy and in need of attention. There has been a recent problem with mice in the shed, and manager said a new storage unit (either tin or plastic) has been ordered to replace the present arrangement. Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. Residents are protected by the home’s recruitment and vetting procedures and staff numbers and skills. EVIDENCE: Reference was made to the staff rosters and the pre-inspection questionnaire, which had been completed by the manager. The home maintains care staffing levels and employs domestic and cooking staff. There has been low staff turnover since the last inspection, only one staff member having left. There is an ongoing training programme and staff receive mandatory training and updates. During the past twelve months, staff training has included Handling and Distribution of Medicines, Dementia and Diabetes updates, NVQ2 & 3, Basic Food Hygiene and First Aid. Training undertaken during July and August includes, Safety in the Workplace, Moving and Handling and Fire Safety. Over fifty percent of staff have NVQ2 or above. The home has a recruitment procedure, which includes advertising posts, interviewing staff, taking up two references and CRB and POVA clearances. Staff are issued with job descriptions and contracts of employment and the home has grievance and disciplinary procedures. Two staff files were read and the contents were satisfactory. Although the files were held secure in accordance with the home’s confidentiality policy, they were disorganised and difficult to follow. As a best practice recommendation it is advised that staff files be organised into a standard format to contain the information stated in Schedule 2, Care Home Regulations 2001.
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. The home is well managed and residents’ opinions are valued. Fire systems tests were not being carried out with consistent regularity. EVIDENCE: The manager, Mrs. Anderton has many years experience in residential care for older people and she holds a management qualification. Two members of staff who were spoken with said she is supportive and approachable, and residents said she is a very kind and pleasant person. Staff said they receive ongoing support if needed and regular one-to-ones (formal supervision). The home has a quality assurance system and quality questionnaires are distributed to residents and their representatives twice yearly. It is evident
Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 20 that residents’ /representatives’ comments are valued and remedial action taken in response to any negative feedback. Reference was made to the pre-inspection questionnaire where it is stated that the home does not become involved in residents’ financial affairs. The current scale of charges in the home is £398.00 per week. Extra charges are stated as for hairdressing, newspapers and chiropody. Residents who commented said that they, or their representatives, manage their financial affairs and staff do not intrude or have any involvement. Health & safety/ maintenance certification was up to date and fire equipment had been maintained. In reading the fire book, it was noted that there were gaps in the fire systems tests (required to be carried out at weekly intervals) in April, June, July and August 2006. The latest was a gap of nearly three weeks, the last systems test being on record as 1st August 2006. Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement The registered person must ensure that pressure care, fluid intake and skin integrity of residents of high dependency are fully documented. The registered person must make arrangements for the food store and fridge to be thoroughly cleaned and maintained to the highest standards of hygiene. The registered person must arrange for fire systems tests to be carried out weekly. Timescale for action 20/08/06 2. OP26 13 (3) 20/08/06 3. OP38 23 (4) 20/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 Page 23 1. OP9 It is advised that handwritten medication administration records be signed by the writer and checked and signed by a colleague. It is advised that diabetic diets are recorded and held with the individual’s care plans. It is advised that staff files be arranged in a standard format to contain the information stated in schedule 2. 2. 3. OP15 OP29 Locharwoods DS0000038689.V295388.R01.S.doc Version 5.2 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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