Inspection on 26/07/07 for Loran

This inspection was carried out on 26th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Loran 16/07/08

Loran 31/07/06

Loran 25/01/06

Loran 13/06/05

Loran 25/11/04

Loran 29/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Loran 106a Albert Avenue Anlaby Road Hull East Yorkshire HU3 6QU Lead Inspector Eileen Engelmann Key Unannounced Inspection 26th July 2007 09:30 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 Loran DS0000000861.V347118.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. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Loran Address 106a Albert Avenue Anlaby Road Hull East Yorkshire HU3 6QU 01482 355996 01482 571230 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) Sandco 1(T/A Hill Care Services) Ms Brenda Johnson Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (35) of places Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 Brief Description of the Service: The large old house and extension is behind the properties on Albert Avenue, Hull. It accommodates 35 older people, some of whom may have dementia, in single and double rooms (22 new singles have en-suite shower and toilet). The facilities within the home and grounds include a chair lift and a passenger lift, a large conservatory, a secure garden and car park. Local shops, health services and pubs can be found near by, and the home is on a bus route to the city centre. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the entrance hall of Loran. Information given by the manager on 26/07/07 indicates the home charges a fee of £334.50 per week and that there are no additional charges other that those for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. A full list of prices for these additional services is available from the manager. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out with the manager, staff and people using the service of Loran House. The visit took place over 2 days and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Informal chats with a number of people and staff took place during this visit; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of relatives, people living in the home and staff and their written response to these was good. We received 2 back from relatives (13 ), 9 from staff (60 ) and 14 from people using the service (93 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission for Social Care Inspection within the given timescale. The views of outside professionals and other visitors to the service have been listened to and analysed as part of the inspection process. Progress has been made by the home since the last visit in July 2006 to meet a number of requirements and recommendations from the published report. Some aspects of the service around paperwork and staffing levels require further development and implementation, and these have affected a number of areas of practice and stopped the home from improving its quality rating. The manager is aware of the action needed to move the home forward and this has been discussed in detail during this visit. Care within the home remains good and people using the service and their relatives have expressed high levels of satisfaction during this visit about the staff, manager and standards of care. What the service does well: All of the people living in the home were positive about the home and like living there. Three people said they loved living at the home and the care was very good. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 6 People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. What has improved since the last inspection? What they could do better: The people working in the home do not always write down what care each person living in the home needs to make their life and health better. They should be talking to the residents more to find out what they like and how they want to be looked after. This helps the residents to have choice in how they are cared for and helps them stay as independent as possible. People in the home must be given a better choice of social activities to keep them happy and offer them the chance to join in with others. The person who owns the home must look at having more staff on duty to do social activities and give the manager time to make the changes asked for in this report around paperwork and other areas of care. This will make the service better and improve the quality of life for those people living in the home. People who are working in the home have to be given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 7 People who are working in the home have to attend more training around safe working practices to make sure they look after their health and safety and that of the people living in the home. People working in the home must have regular meetings with the manager or people in charge of the home to talk about the care that they are giving and how well they do this, so they can have someone tell them if they need to change what they are doing or get advice on how to do their job better. This makes sure that standards of care in the home stay high and people who live there get well looked after. Information gathered from the people who live in the home, the people who visit them and those who help look after their health, must be put together into a report and this should be published so anyone with an interest in the home can see what the people using the service think about it. We would like to thank everyone who completed a questionnaire and/or took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Loran DS0000000861.V347118.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 Loran DS0000000861.V347118.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6. People who use 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 wanting to use the service undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. However, improvements to staff training must take place to ensure the health, safety and well being of the people using the service is maintained and promoted. EVIDENCE: At the last visit in July 2006 a requirement was made for ‘The Service user guide to be written in plain English and made available in a format suitable for the residents’. Checks at this visit show that the requirement has been met. Copies of the statement of purpose and service user guide are on display in the entrance hall and available to anyone wanting to read them. These documents are now available in a clear print format, and a larger print version can be Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 10 produced on request. The Service User Guide did not include the price of fees and the costs of additional services, but the manager dealt this with during this visit. At the last visit in July 2006 a requirement was made ‘Each resident must be provided with a statement of terms and conditions at the point of moving into the home’. Checks at this visit show this has been met. Information from the surveys shows that the majority of people received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. Some people within the home are self-funding and their files show that information about fees and fee increases is sent out to the person responsible for each individuals finances and sufficient notice of changes to the prices is given in writing. At the last visit in July 2006 a requirement was made ‘The registered provider must ensure that the home develops a needs assessment and carries this out for individuals who are self-funding and without a Care Management Assessment/Care plan’. Checks at this visit show the requirement has been met. The home has developed its own needs assessment for privately paying people since the visit in July 2006. Checks of four care files showed two individuals were admitted in 2007 and this assessment process was used to decide if placements could be offered and then information from them has been used to develop their care plans. Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Discussion with the manager indicated there is a formal, written process of offering placements to people who are interested in using the service. This is not used all the time and it was recommended that the manager become more consistent in using this approach, as a matter of good practice. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of their specific problems/abilities and the care given on a daily basis. Discussion with people showed that they were satisfied with the care they receive and have a good relationship with the staff. Comments from the surveys said ‘Any questions I have asked have always been answered fully, staff have always taken time to speak to me on matters regarding my Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 11 relative’s care’, ‘any small matter I have broached with the home has always been dealt with quickly’, and ‘the staff at Loran house seem happy in their work and it reflects in the care they give’. The home has an equal opportunities policy, which is used when employing staff. The home employs two overseas staff and some individuals with a disability; people using the service are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has 1 male care staff as well as the 18 female members. The manager said that she would discuss this with people wanting to use the service during the assessment process. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. There is evidence that the home has thought about introducing more specialist training looking at conditions linked to old age, but uptake of these courses is slow and places limited. The responsible individual must make sure that staff have the skills and knowledge to deliver the services and care which the home offers to provide. This will help to develop a consistently high standard of care, which maintains and promotes the people’s health, safety and wellbeing. Information from the annual quality assurance assessment and discussion with the people living in the home indicates that the majority of the people are of white/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use 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. The quality of the record keeping and risk assessments for care plans must be improved to ensure the needs of people using the service are met and their health and wellbeing protected. EVIDENCE: At the last visit in July 2006 two requirements were made ‘The registered provider must ensure that the residents care plans set out in detail the action staff must take to meet all aspects of health, personal and social care needs of the residents, and evidence that individuals are able to input to these and are agreed and signed by the resident or representative’. Checks at this visit show that the requirement is partly met, but further work is needed to meet the criteria of standard 7. ‘The resident’s care plan must include risk assessments (where appropriate) for bed rails, kettles and microwaves used within their bedroom’. Checks at this visit found this requirement was met. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 13 A recommendation made in the last report (July 2006) says ‘The manager should access training on Care Planning so that staff have the necessary skills and knowledge to produce care plans of a high quality’. Discussion with the manager indicates that this has not taken place and so the recommendation will remain in this report. The overall quality of the care plans has improved since the last visit in July 2006, but the content of the plans is very task orientated, with little information being recorded about the emotional and social needs of the people using the service. The evaluation process of the care being given is not always taking place each month and is very brief. It does not include the views and opinions of the person whose care is being reviewed. This was discussed with the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Risk assessments are in place for moving and handling, bed rails (where applicable), falls and smoking within the home, but assessments must be extended to include nutrition and pressure sores. These assessments must be carried out for all new people coming into the home and reviewed on a regular basis, so the staff can quickly identify people at risk and ask outside professionals for their help and advice. This will ensure people using the service get the right treatment and equipment to meet their needs as quickly as possible. Information from the surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. One relative commented that ‘ the staff contact me if my relative has a fall or becomes ill, they get the doctor out when needed and keep me informed’. Another person said ‘the staff have gone through the care plan with my relative, discussing her likes and dislikes and have done their best to make the change to residential care an easy one’. At the last visit in July 2006 a requirement was made ‘Care staff must maintain the personal hygiene of each resident by offering regular baths’. At this visit it was seen that this has been met. Discussion with the people in the home showed that they can have a bath or shower on a regular basis and that they are satisfied with the service they receive. Observation of staff during the visit showed that some individuals are ‘wet’ shaving male clients in the lounges. This is not dignified or an acceptable practice and must stop. The issue was discussed with the manager who Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 14 assured us that she would talk to the staff and people using the service and find them a more appropriate place for this personal care. Two people said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. People have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that people and their relatives are satisfied with the level of medical support given to the people living at the home. At the last visit (July 2006) a requirement was made ‘Accurate records must be kept of all medication received, administered and leaving the home or disposed of to ensure there is no mishandling’. Checks of the medication records showed that this has been met. A recommendation was made at the last visit that ‘The manager should audit the medication charts weekly to ensure staff are completing these correctly’. Evidence was seen that this has been met and there is a lot of improvement in the quality of the documentation of the medication as a result of the audits. The home uses the Nomad medication system and information from the training matrix shows that nine members of staff have undergone medication training since the last visit in July 2006. In response to the last report the manager has introduced photographs of people living in the home; these are now part of the medication sheets and help staff identify individuals and prevents errors occurring. Staff are recording all medication received in from the pharmacy, and putting the amounts received onto the medication charts. Checks of the medication records show that staff signatures and stock levels balance and there were no controlled medications in the home at the time of this visit. One area of practice that could be improved is ∗Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Two staff members should sign the entry to indicate they have both witnessed that the information on the sheet is correct. At the last visit in July 2006 a requirement was made ‘Where residents have chosen to share a room, screening must be provided to ensure their privacy is not compromised when personal care is being given or at any other time’. Observation of the premises showed that this has been met. Curtains have been provided in two of the double rooms and a screen is available in the third double room. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 15 People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were ‘the staff treat people living in the home with kindness and respect, providing a warm, calm and person centred atmosphere. We feel safe here’. One person said ‘the staff are wonderful, they respect our wishes to be independent whenever possible and give us the support and help we need to enjoy our lives here’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use 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 are provided with choice and diversity in the meals provided by the home. Individual wishes and needs are catered for and people have the option of when and how they participate in mealtimes. Improvements are needed to the range of activities on offer for people using the service, to ensure they are given the opportunity for stimulation or recreational activities to suit their interests or abilities. EVIDENCE: At the last visit in July 2006 a requirement was made ‘The registered provider must ensure that residents have the opportunity to exercise their choice in relation to leisure and social activities; that these choices are recorded and they are offered a range of stimulating activities both inside and out of the home’. The requirement has been partially met and will remain on this report. Checks at this visit showed that the manager has made definite attempts to introduce a better range of events and activities for the people in the home, Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 17 but there still needs to be a daily programme of social activities and more 1-1 interaction with those less able to join in with group events. Staff are recording in the care plans where people are attending activities, but constraints on staff time prevent them from being able to carry out activities on a regular basis. There is a need for a dedicated activities co-ordinator within the home. Information supplied by the manager, staff and people spoken to indicates that the home has an entertainer booked once a month, which is enjoyed by everyone using the service, the library provides big print books and these are changed every three months, an occupational therapist visits once a month and takes people to ‘days gone by’ and since the last visit people are going out each week to an over fifties club at the local pub, where people can play bingo, have a drink and a sing-a-long with the local community. One person told us that ‘ I enjoy having a larger or two, and the staff are excellent at taking us out when our families are too busy’. The Reverend Bagshawe visits monthly for those who wish to see him either in private or at church service and communion. The home provides special meals and cake for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to us showed a high level of satisfaction. One person said ‘all the staff are friendly and will take time to talk to me, they also take time to converse with my aunt. There is always staff visibility whenever I visit’ Comments from the relative surveys show that people have recognised the manager’s and staff efforts to improve life for the people using the service. Individuals said ‘Loran staff try hard to meet the needs of people and they have done better recently by giving them more choice of mealtime menus and entertainment’, and ‘we are generally satisfied with the level of care on offer. The staff are always keen to involve people in the various activities’. One person living in the home told us that ‘ I love living here as I am surrounded by company and that is much better than being on my own in my old house’. At the last visit in July 2006 a requirement was made ‘Residents and their relatives and friends must be informed of how to contact external agents (e.g. Advocates), who will act in their interests’. At this visit we were able to see evidence that showed this has been met. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 18 A recommendation made at the July 2006 visit was that ‘The manager should discuss the role and accessibility of advocates from the community with the residents’. The manager has put systems into place to make sure that this recommendation has been met. The home acts positively to promote people’s independence and will offer individuals support to achieve this aim. One person who spoke to us looks after his/her own finances and they collect their pension from the local post office and, with some assistance from the manager, paid their bills and expenses. The manager said that since the last visit in July 2006 she has talked to the Social Service teams and Age Concern about having advocacy input in the home. Advice and information is displayed on the notice boards around the premises and this includes contact information for people wishing to use these advocacy services. As part of this process the manager has tried to raise awareness within the home by introducing 1-1 talks with people using the service, where issues such as advocacy are discussed and needs looked at. At the last visit in July 2006 a recommendation was made ‘The manager should consider how she could incorporate residents’ views into the development of the menus’. At this visit feedback from the relatives and people living in the home indicated that this has been met. People in the home were very complimentary about the food being served at the lunchtime meal. Individuals were seen to have good appetites and enjoy the food on offer. Presentation of the meal was good and it had been made from fresh ingredients. Staff were on hand to offer individuals help with eating and drinking if they needed this, and everyone was given sufficient time to eat within a social and relaxed environment. Entries written into the managers diary showed where she had discussed the meals and choices with individuals living in the home, and what action had been taken to improve their dining experience. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use 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. Improvements to the recording aspect of the complaint system must be made, although people are confident that their views are listened to and acted on. EVIDENCE: At the last visit in July 2006 a requirement was made ‘A record must be kept of all complaints made and includes details of investigation and any action taken’. The requirement was partially met and will remain on this report. At this visit it was seen that a record of complaints has been introduced and only one has been received in the past 12 months. We found that although the information about the complaint and the outcome was recorded, the action taken by the staff member who was dealing with the issue to achieve the outcome was not. The manager said that she would speak all the staff to ensure they were confident of how to fill in the paperwork. There is evidence of improvement in how the home deals with complaints, and a reduction in the number of complaints being made. People spoken to are very satisfied with the staff, service and manager. Individuals said they have received copies of the complaints procedure and are confident of using this if needed. Other people wrote that the home takes appropriate action when an issue has been raised. One person said ‘ my relative did not like her mattress on her bed and the home ordered her a new one straightaway. My relative is very happy about this’. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 20 The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Information in the staff training files showed that since the last visit in July 2006 four senior members of staff have attended the safeguarding training for the protection of adults from abuse, and the manager said that she plans for all staff to attend this training over the next year. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26. People who use 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 are provided with a safe, comfortable and clean environment. They are able to personalise their own rooms, and the provision of door locks means that their personal belongings can be kept secure. EVIDENCE: At the last visit in July 2006 a requirement was made ‘The registered provider should ensure that repairs, redecoration and refurbishment as highlighted in the environment section of this report are carried out within the given timescale’. Checks done at this visit showed that the majority of issues raised in the last report have been actioned and therefore the requirement is met. The home recently suffered damage during the local flooding, with rain water coming up into the home through the office and spreading into two lounges, Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 22 the conservatory, dining room, 12 ground floor bedrooms and a number of corridors and hallways. All floor coverings have been removed, electrics in the building have been checked and the insurance company has been out to estimate the costs of the damage. People living in the home are very positive about the incident, saying ‘staff acted very quickly to ensure we were moved upstairs to safety. We were able to stay in the home by making do and sharing rooms for a short while’. The interior of the home is a little untidy due to the staff having to rescue items in a rush and find somewhere to put everything whilst the home is being refurbished, however care has been taken to ensure fire exits remain clear and walkways are free of obstacles. There remain some areas of the environment that need attention and these include • The front extension staircase carpet is wearing on the treads and the provider should consider replacing this, as it could be a potential hazard if the wearing continues. This was in the last report and no action has been taken to replace this. • Linen seen in the bedrooms is old and stained and should be replaced. • There are a number of blown glass panels, in the conservatory door and some bedroom windows, which should be replaced. • The downstairs toilet requires a new toilet roll holder, as the one provided is broken. • A number of armchairs around the home are looking old, worn and stained and should be considered for replacement. • There has been a water leak through the ceiling of the ground floor bathroom and the ceiling needs repairing. • All areas affected by the floodwater need replacement floor coverings. The responsible individual must make sure these are fitted as soon as possible and an action plan with timescales given to the Commission for Social Care Inspection. Loran Care Home was originally a Vicarage and has had extensions built on to the old house to create more modern facilities for the people who live there. The new rooms have shower and toilet en-suites, whilst the older rooms have space and high ceilings. There are numerous staircases to the first floor and accessibility to this area is aided by use of the stair lift or passenger lift. The corridors are wide enough for a wheelchair or person using a Zimmer frame to pass along comfortably and thought has gone into providing flat walkways for those with difficulty mobilising. Discussion with the staff indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence within the home, this includes mobile hoists, slide sheets, turntables, moving belts and handrails. The new bedrooms have been provided with lockable drawers, but this facility has not been extended to the older rooms. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 23 At the last visit in July 2006 a requirement was made ‘Each resident must be supplied with lockable storage space for medication, money and valuables and is provided with the key, which he or she can retain (unless the reason for not doing so is explained in the care plan)’. At this visit it was seen that no action has been taken to meet this requirement and it will remain on this report. Overall the environment is clean, warm and comfortable with few malodours present. Comments from the surveys indicates that people using the service find the home to be spotlessly clean and are satisfied with the laundry service provided by the home. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use 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. Improvements must be made around the deployment and numbers of daytime staff, to ensure staff can attend training and the needs of the people within the home are met. EVIDENCE: Comments from the staff, relatives and people using the service indicate that the home is extremely busy at times and individuals may wait for attention at peak times, but people feel that there is a good standard of care being given to the people living in the home. Survey responses said ‘the staff are warm, welcoming and friendly’. Information from the annual quality assurance assessment and staff rotas about the number of staffing hours provided, and information gathered during this visit about the dependency levels of the residents, was used with the Residential Staffing Forum Guidance and showed that the home is 72 hours a week short of the recommended guidelines. These figures do not include the manager’s hours or those for domestic and cleaning activities. During this visit it has been seen that activities for the people in the home are not always taking place because of time constraints and staff availability (see Daily life and social activity), staff supervision is not up to date as the manager lacks the time to carry this out (see management section) and staff training is not up to date as places are limited and date specific and staff cannot always attend due to covering staff sickness and annual leave. These factors impact Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 25 onto the quality of life experienced by the people living in the home and are preventing this service from moving forward. At the last visit in July 2006 a requirement was made ‘The registered provider must ensure there are sufficient staffing numbers and skill mix of staff to meet the assessed needs of the residents, the size, layout and purpose of the home at all times, and additional staff are on duty at peak times of activity during the day’ with a given timescale of 01/10/06. Discussion with the manager and checks of the staffing rotas and dependency levels of the people in the home show that no changes have been made to improve staffing within the home and the requirement will remain on this report. Checks of the staffing rotas and discussion with the manager showed that the home employs a ratio of 1 male to 18 female care staff and two of the staff are from different countries and cultures. Information from the manager indicates that there are 9 male people and 24 female people living at the home. Discussion with individuals using the service indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police/Criminal Records Bureau checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. There is an induction and foundation course that meets Skills for Care specification for new members of staff, and 39 of the care staff have achieved an NVQ 2 or 3. It was recommended in the last report that ‘The registered provider should ensure 50 of care staff achieves NVQ level 2 by the end of 2007’. At this visit it was seen that the home is working towards achieving this target and the recommendation will remain on this report. At the last visit a requirement was made ‘The registered provider must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the residents. Specialist training on the elderly and diseases relating to old age must be included in the training programme’. This requirement has been partly met and will remain in this report. At the last visit in July 2006 a recommendation was made Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 26 ‘A monitoring system should be put in place to assess the skills and knowledge of the staff, and determine how successful the training has been’. At this visit it was seen that the manager now has a training matrix in place, but no percentages of staff attending training has been calculated from this. This recommendation is partly met and will remain in this report. The home provides a mandatory staff-training programme that links to training provided by Hull City Council. Information from the staff training files and training matrix indicates that the majority of the staff are up to date with their basic fire and moving and handling safe working practice training, but some need to attend training and/or updates on health and safety, infection control, safeguarding of adults and food hygiene. There is evidence that the home has thought about introducing more specialist training looking at conditions linked to old age and dementia, but uptake of these courses is slow due to staff being unable to attend because of needing to cover the care shifts, and within the Council Training Facilities places on the courses are limited and date specific. The responsible individual must ensure the staff receive basic mandatory training and more specialised training that reflects the different care needs of the people living in Loran Care Home. The provider must also look at the staffing levels to ensure sufficient numbers of staff can attend the training whilst maintaining care levels within the home. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use 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. Management practices must improve to ensure staff receive sufficient training and supervision to enable them to meet the needs of the people in the home and the aims and objectives of the home. EVIDENCE: The home’s manager is experienced in managing a care home and staff feel well supported and informed to carry out their duties. The manager of Loran has worked for the company for 18 years; she has been in post at Loran for 8 years. The manager has completed her NVQ 4 in Care and is looking towards starting her Registered Manager’s Award. She has attended a range of training courses including Palliative Care in March 2007, Safeguarding of Adults in February 2007, Food for thought in November 2006 and the Mental Capacity Act in June 2007. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 28 At the last visit in July 2006 three requirements were made ‘Residents meetings must be restarted to obtain feedback from individuals relating to the services provided by the home’. This requirement is now met. ‘There must be an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for residents’. This requirement has not been met and will remain on this report. ‘The views of family and friends and of stakeholders in the community (e.g. GP’s, chiropodist, district nurses) must be sought on how the home is achieving goals for residents’. This requirement has been partly met, but could be developed further to include more regular questionnaires and a wider range of people being asked for their viewpoints. The requirement will remain on this report. The manager has started to carry out 1-1 talks with the people in the home, the issues discussed and any action taken is recorded in a diary. The manager said this is proving to be more effective than holding resident meetings as people are more open to discussion on an individual basis than as a group. One person said’ I get to see the manager every day and she will always listen to any concerns and make sure these are dealt with quickly, I like being able to talk to her in this way’. Satisfaction questionnaires were sent out to relatives and people in the home in December 2006, but the home has not produced an annual development plan from the information gathered from these. People spoken to in the home said they felt that some changes are taking place due to their views being expressed to the management. These include better meals and activities being provided recently and any niggles/grumbles being dealt with immediately. At this visit there were no copies of the regulation 26 visits available for us to see. Discussion with the manager indicates that these reports are not being completed although the provider is in regular contact and visits the home every week. The responsible individual must ensure the regulation 26 reports are completed and a copy kept in the home at all times. At the last visit in July 2006 a recommendation was made ‘The manager should assist residents to open their own bank accounts where needed’. This recommendation has been met. Checks of the financial records showed that people are able to have personal allowance accounts in the home. These records are computerised and detail the transactions undertaken and the money held for each person, the manager updates these each week. Information from the manager indicates that the Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 29 majority of people have a family member or representative who looks after their monies and these individuals make sure the personal allowances are sent/brought into the home. Where personal allowances build up above £100, arrangements are made for the families to collect this for safekeeping. For those individuals without family, this money is now put into a non-interest bearing account. It is recommended that information around this practice is put into the service user guide so individuals can make up their own minds as to whether they wish to open their own account, which would pay them interest on their personal monies. At the last visit in July 2006 a requirement was made ‘Care staff must receive formal, structured supervision at least six times a year’. This has not yet been met and will remain a requirement on this report. The manager told us that supervision records were lost in the floodwater that entered her office in the past month. She attended supervision training from Hull City Council in December 2006 and has been improving practices within the home. Staff supervision is taking place, but is still a slow process that needs to become more effective to ensure staff are giving a high standard of care and following the homes aims and objectives for meeting people’s needs. The manager said that she lacks the time to carry out regular supervision sessions with the staff and this has made it impossible to meet this requirement. (See comments in the Staffing section of this report) At the last visit in July 2006 a requirement was made ‘The registered person must ensure that records required for the protection of residents and the effective and efficient running of the business are maintained, up to date and accurate. This includes statement of terms and conditions, assessment of need, care plans, medication records, staff training, quality assurance and supervisions’. This has been partly met and will remain on this report. There have been improvements made to the statement of terms and conditions, the assessment of need and medication records. However, further work is required to ensure care plans, staff training, quality assurance and staff supervisions are up to date and records are monitored, evaluated and reviewed on a regular basis. These issues have been documented throughout this report. At the last visit in July 2006 two requirements were made ‘The registered person must ensure that the health and safety of the residents and staff is protected by complying with the relevant guidance and legislation around the maintenance of the electrical systems and equipment and regulation of the design solutions to control risk of Legionella’. This requirement has not been met and will remain on this report. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 30 ‘The registered provider must ensure all staff attend safe working practice training’. This has been partly met and will remain in this report. A recommendation made at the last visit in July 2006 was ‘The manager should complete a monthly audit of the accident records to help spot any problems or recurring themes’. This has now been met. There is no evidence in the home that the provider has an electrical wiring certificate in place or that steps have been taken to test the water supplies within the home for Legionella. These are outstanding issues from the previous report and must be given priority in the action plan for meeting the requirements of this report. The manager has completed generic risk assessments for the premises and a fire risk assessment has been completed and reviewed. Accident books are filled in appropriately, and the manager has completed a monthly audit on these to help spot any problems or recurring themes. Staff are able to access safe working practice training although uptake has not always been as good as it should be over the past year. The responsible individual must make sure all staff attend this training. Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 3 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 2 2 Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes. 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 OP4 Regulation 12(1) Requirement The responsible individual must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. So people can be confident that their needs relating to old age and personal conditions are recognised and managed appropriately. The responsible individual must ensure that people’s care plans set out in detail the action staff must take to meet all aspects of health, personal and social care needs of the people using the service. This will ensure that people receive the right care to protect their health and wellbeing, and their wishes, choices and rights as individuals are promoted and protected. (Given timescale of 01/10/06 was not met) The responsible individual must Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 33 Timescale for action 01/12/07 2. OP7 15(1) 01/11/07 ensure staff use a variety of different and creative methods to help people using the service to contribute to their own care plan. So that people are able to have a say in the decisions made about their lives and play and active role in planning the care and support they receive. 3. OP8 17(1)(a) The responsible individual must make sure staff are proactive in preventing people from developing pressure sores and that risk assessments for this purpose are completed in full and reviewed on a continuing basis. So people using the service can be confident that their health and welfare is protected. The responsible individual must make sure that nutritional screening is undertaken on admission and subsequently on a periodic basis. So people’s health and wellbeing are protected and their nutritional needs are met. The responsible individual must make sure staff shave people in a more appropriate place than the communal lounge. So that people’s privacy and dignity is upheld. The responsible individual must ensure that people are offered a range of stimulating activities both inside and out of the home. So people are able to exercise their choice in relation to leisure and social activities and routines of daily living. 01/11/07 12(1) 4. OP12 16 (2)(m)(n) 01/11/07 Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 34 (Given timescale of 01/11/06 was not met) 5. OP16 17(2) The responsible individual must 01/11/07 ensure that a record is kept of all complaints made and that this includes details of any investigation and action taken. So people can be confident that their views and opinions about the service and care are listened to and appropriate action is taken to resolve any issues. (Given timescale of 01/10/06 was not met) 6. OP19 23(1)(2) (a) The responsible individual must make sure that all repairs and renewals as highlighted in this report are carried out. All areas affected by the floodwater need replacement floor coverings. The responsible individual must make sure these are fitted as soon as possible and an action plan with timescales given to the Commission for Social Care Inspection. This will enable people using the service to live in a safe and wellmaintained environment, which meets their needs and the outcomes of the statement of purpose. Each person must be supplied with lockable storage space for medication, money and valuables and is provided with the key, which he or she can retain (unless the reason for not doing so is explained in the care plan). So people can be confident that DS0000000861.V347118.R01.S.doc 01/12/07 7. OP24 23(2)(m) 01/12/07 Loran Version 5.2 Page 35 their medication, monies and valuables are kept safe and secure at all times. (Given timescale of 01/05/07 was not met) 8. OP27 18(1)(a) The responsible individual must ensure there are sufficient staffing numbers and skill mix of staff to meet the assessed needs of the people, the size, layout and purpose of the home at all times, and additional staff are on duty at peak times of activity during the day. So people can enjoy a good quality of life and be confident that their health and social care needs will be met. (Given timescale of 01/10/07 was not met) 9. OP30 18(1)(a) (c) The responsible individual must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the people using the service. Specialist training on the elderly and diseases relating to old age and dementia must be included in the training programme. So the health, safety and welfare of the people in the home is protected and promoted, and staff have the skills and knowledge to provide a high standard of care. (Given timescale of 01/11/06 was not met) 10. OP33 24(1)(a) (b)(2)(3) The views of family and friends and of stakeholders in the community (e.g. GP’s, DS0000000861.V347118.R01.S.doc 01/11/07 01/12/07 01/11/07 Loran Version 5.2 Page 36 chiropodist, district nurses) must be sought on how the home is achieving goals for people living in the home, and there must be an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for people. So the home can demonstrate that it is offering a quality service and value for money to the people using the service, and is listening to their views and opinions and taking action to meet its aims and objectives and produce favourable outcomes for people. (Given timescale of 01/01/07 was not met) The responsible individual must 01/11/07 ensure the regulation 26 reports are completed and a copy kept in the home at all times. So providing evidence that the provider is aware of issues within the home and is taking action to resolve them where needed. Care staff must receive formal, 01/11/07 structured supervision at least six times a year. So staff can receive feedback and support around their work practices and career development needs, and people using the service receive care from competent and experienced people who understand their roles and responsibilities. (Given timescale of 01/11/06 was not met) 11. OP33 26(4)(5) 12. OP36 18(1)(2) Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 37 13. OP37 17 The responsible individual must ensure that records required for the protection of people using the service and the effective and efficient running of the business are maintained, up to date and accurate. This includes care plans, staff training, quality assurance and supervisions. So providing evidence that the home is meeting its aims and objectives as outlined in the Statement of purpose, and the needs of the people using its services. 01/11/07 14. OP38 23(1)(a) The responsible individual must 01/11/07 comply with the relevant guidance and legislation around the maintenance of the electrical systems and equipment and regulation of the design solutions to control risk of Legionella. This will ensure the health, safety and wellbeing of people living or working within the home is protected and maintained. (Given timescale of 01/11/06 was not met) The responsible individual must ensure all staff attend safe working practice training. To ensure the health, safety and wellbeing of people working or living in the home is promoted and protected. (Given timescale of 01/11/06 was not met) 15. OP38 18 01/12/07 Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 38 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. 2. Refer to Standard OP3 OP7 Good Practice Recommendations The manager should make sure that prospective people receive a formal written offer of placement, in line with the homes policies and procedures. The manager should access training on Care Planning so that staff have the necessary skills and knowledge to produce care plans of a high quality. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The responsible individual should ensure that all staff receive safeguarding of adults training by July 2008. The responsible individual should ensure 50 of care staff achieves NVQ level 2 by the end of 2007. A monitoring system should be put in place to assess the skills and knowledge of the staff, and determine how successful the training has been. The manager should complete the Registered Manager’s Award by the end of 2008. The manager should make sure that information, about the banking arrangements and non-interest bearing account for personal monies of people using the service, is put into the service user guide. 3. OP9 4. 5. 6. OP18 OP28 OP30 7. 8. OP31 OP35 Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Loran DS0000000861.V347118.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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