CARE HOMES FOR OLDER PEOPLE
Lorna House Devons Road Torquay Devon TQ1 3PR Lead Inspector
Stella Lindsay Unannounced Inspection 15th February 2006 10:45 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 Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lorna House Address Devons Road Torquay Devon TQ1 3PR 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) 01803 329908 01803 606532 Crocus Care Limited Ms Linda Christine Vans-Colina Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (24) Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th August 2005 Brief Description of the Service: Lorna House provides residential care for up to 24 older people who may have physical disabilities, and who may have mild levels of mental confusion. The house is a large detached property with a level garden in the Babbacombe area of Torquay, by Cary Park. There are 20 single rooms, 9 of which have en suite facilities, and two double rooms, both en suite. There are three bathrooms, two of which have Aquatec powered bath seats. Accommodation is on two floors, with a stair lift. Access around the ground floor is level, with a ramp to the garden via the front door. There is a dining room and a large lounge, leading to an attractive conservatory. The Crocus Care car is freely available for local journeys, with a charge for petrol for longer journeys, and a minibus has been provided. The service is not aimed at people with advanced dementia or severe physical disabilities, though best efforts are made to continue caring for residents whose health deteriorates after moving in to the home. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Wednesday in February 2006, between 10.45am and 3.15pm. As well as discussion with the Registered Manager, the inspector met with three staff on duty, eleven residents, and one visiting relative, and thanks all for their time. Care records and staff training records were examined. The Commission for Social Care Inspection has introduced key standards to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home please refer to the report of the Announced Inspection which took place on 9th August 2005, when most of the core standards were inspected and four were found to have been exceeded. What the service does well: What has improved since the last inspection?
A solid ramp with handrails has been built, leading from the conservatory to the garden, completing this project. Not only does this allow for easy access for residents to the garden, but also in warm weather will allow them to use the attractive conservatory in comfort, as the door could safely be left open. A new toilet had been fitted in the main bathroom, which had also been redecorated. The call bell system had been checked professionally, and now the printouts can be read – and they showed that calls are answered very promptly by staff – mostly within the minute, but never taking longer than two minutes.
Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 6 The method of administering medication at breakfast-time had been brought in line with accepted good practice, for the protection of residents. Residents were most appreciative of the series of outings that had taken place, since a minibus had been provided, and a new handyman/driver appointed. Care staff were pleased with the ‘Lets Talk’ discussions that have proved popular. A new method of auditing food hygiene and safe working methods in the kitchen, called ‘Safer Food Better Business’ has been implemented, with training attended by the Chef and the Manager, to assure the health of the residents and staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents’ needs are carefully assessed before they move into the home. EVIDENCE: The needs of new residents are considered carefully before accommodation is offered. Two residents had been recently admitted. The Registered Manager had received an assessment of their needs from a health professional, and gathered further information by phone from family members and a previous care home. It is recommended that information gathered verbally is recorded. There was also a discharge report from a hospital which was not found to be very helpful. The Manager stated that she works together with the family to judge whether the Home is meeting their needs. The Manager visits prospective residents unless the distance makes this impractical. All admissions are on a trial basis. Senior care staff draw up a care plan, from the Manager’s assessment of the person’s needs. Intermediate care is not offered at Lorna House.
Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed, except to assure the inspector that the medication was being correctly administered at breakfast time, as at other times of day. EVIDENCE: Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 A good variety of activities is maintained, and residents are encouraged to maintain their own interests, to promote their physical and mental well-being. EVIDENCE: Residents’ privacy is respected, but they are encouraged to be sociable. Six regularly come to the dining room for breakfast. Exercise sessions are held every Monday morning, with records kept of who attends. A qualified Physiotherapist had visited and given staff programmes of exercises for individual residents, to maintain their mobility. Art and Craft are provided professionally. Staff have been developing their skills in leading social activities. They have provided bingo, skittles and quizzes for some time, but have recently introduced a popular and successful ‘Let’s Talk’ session, using general set questions to encourage residents to talk about their experiences or their interests. Residents were pleased to tell the inspector about trips they have recently enjoyed. These included drives to Teignmouth and Dawlish, a shopping trip, and at Christmas there was a trip to see the lights, combined with a chip supper. Residents can receive guests in their room, or the lounge, conservatory or garden. Encouragement to do so is included in the Service Users’ Guide. The inspector was able to meet one visiting relative, who said that the staff were
Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 12 very helpful, and kept in touch with her by telephone, bringing her news when she was unable to visit. Residents are encouraged to handle their own money, and all have personal possessions in their room. They are encouraged to keep mobile and to get out and about or get involved in activities in the home. They would be able to see their own care records on request. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 13 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): These standards were not assessed. EVIDENCE: Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 14 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): 19,20,21,22,26 Lorna House is suitable for the purpose of caring for frail elderly people, and the Registered Provider has plans to carry out the work that is still required to make the building safe and hygienic throughout. EVIDENCE: Lorna House is a large detached property in the Babbacombe area of Torquay, by Cary Park. The garden is level, and residents confirmed that they are able to walk around it. A solid ramp with handrails has been built, leading from the conservatory to the garden, completing this project. Not only does this allow for easy access for residents to the garden, but also in warm weather will allow them to use the attractive conservatory in comfort, as the door could safely be left open. The dining room is bright, in spite of being a large room with only one window – the lighting is good, and the room has been newly redecorated. A ridge is apparent across the dining room floor. The Manager stated that this is the site of an old party wall. It may be that the new carpet has accentuated the effect of the ridge, or may be camouflaging it. Following advice from an
Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 15 Environmental Health Officer the dining room furniture has been re-arranged to avoid residents tripping. A long-term solution to levelling the floor must be found. A new toilet had been fitted in the main bathroom. The call bell system had been checked professionally, and now the printouts can be read – and they showed that calls are answered very promptly by staff – mostly within the minute, but never taking longer than two minutes. There are three bathrooms. The main bathroom, which is in frequent use, had been redecorated, and a new toilet fitted. The flooring still needed attention. At present there is only one ground floor communal toilet. A sliding door has been provided for it, to enable residents with walking aids to use it and maintain privacy. The Registered Provider has plans to provide an accessible shower and a toilet instead of the ground floor bath, and quotations for this work had been seen. This will be a benefit for residents. The laundry floor had not been sealed, as was required at the last inspection, as its refurbishment is in the same building project as the planned accessible shower, which will be adjacent. There are plans to install a sluice sink and a sluicing machine for cleaning commode pots. Quotations have been gathered, and the Manager stated that the flooring will be renewed in the course of this project. Staff lockers are currently located in the laundry, though there is not a great deal of space for them, and it is not good practice with regard to basic hygiene. A system is in place to prevent cross infection of laundry. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 16 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): 29,30 A good training effort continues, to maintain a competent and committed staff team. EVIDENCE: The Home has a sound system for recruitment of staff. Three references had been requested on behalf a newly recruited carer. However, no proof of identity had been retained on file, as is required for the protection of residents. The Home has an Induction programme available, though no-one is currently working through it. The newly recruited member of staff had completed the Home’s own initial induction, and was engaged in NVQ3 in care. The Manager stated that she will discuss training needs with all staff during their bi-annual appraisals in February and March 2006, and then will draw up a chart showing the training needed for the year. There had been over twenty training days in the past year. All care staff had received Training in the Protection of Vulnerable Adults. Other training included Moving and Handling, Control of Infection, and Health and Safety. Four staff had been involved in numeracy, literacy and IT skill training. Ten care staff had completed a day course in Dementia Care. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 17 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): 31,35,38 EVIDENCE: The Manager has achieved the Registered Managers’ Award. She is now working for her NVQ Assessors’ award. She has recently been awarded a Front Line Management certificate. She has three-monthly meetings with the other Crocus Care managers, and gives herself monthly goals to assure the home of continuous improvement. All residents have help from either their solicitor or a family member to manage their money. The Home does not collect a pension for anyone, or pay any money into a bank account. Small amounts of cash are kept for seven residents, for such things as writing materials, clothes, toiletries and chiropody. All transactions are recorded, with the initials of two staff. Fire training had been provided on July 2005, and was booked again for 20/02/06. Up-dates for Night care staff are due six-monthly, and the
Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 18 Registered Provider had stated her intention of providing Fire training threemonthly, to assure competent staff response in the event of an emergency. A risk assessment must be carried out for the storage of oxygen, and warning labels attached to the door or entrance to where it is kept. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 19 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 4 2 2 X X X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 20 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 2 3 Standard OP19 OP26 OP29 Regulation 23 23 17 Requirement The dining room must have a safe and level floor. Previous timescale 30/11/05 The laundry floor and a bathroom floor must be sealed. Previous timescale 31/03/05 The record of all persons employed at the home must include proof of identity. Previous timescale 30/09/05. There must be a record of Night Care staff’s up-dates in fire training every three months. A risk assessment must be carried out for the storage of oxygen, and warning labels attached to the door or entrance to where it is kept. Timescale for action 31/08/06 31/08/06 30/04/06 4 5 OP38 OP38 23(4)d 13(4)c 30/06/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 21 1 2 3 4 OP3 OP19 OP22 OP26 While assessing the needs of a prospective resident, information gathered verbally should be recorded if it contributes to the judgement or future care. A shaded area in the garden would be a benefit in warm weather. An Occupational Therapy assessment should be requested for the resident with mobility needs who recently moved into a smaller room. It would be good practice to locate the staff lockers away from the laundry. Lorna House DS0000018390.V274522.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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