Inspection on 15/01/09 for Lorna House

This inspection was carried out on 15th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lorna House 25/01/07

Lorna House 15/02/06

Lorna House 09/08/05

Lorna House 17/12/04

Lorna House 27/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lorna House Devons Road Torquay Devon TQ1 3PR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Finniear     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Lorna House Devons Road Torquay Devon TQ1 3PR 01803329908 01803606532 clare@crocoscare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Linda Christine Vans-Colina Type of registration: Number of places registered: Crocus Care Limited care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 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, and another from the conservatory. There is a dining room and a large lounge which leads 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 Care Homes for Older People Page 4 of 26 Over 65 24 24 24 0 0 0 Brief description of the care home 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. Current fees range from #320 to #350 per week. The most recent CSCI inspection report was available in the entrance hall. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: To complete this inspection we recieved an Annual Quality Assurance document from the home, which gave us information about how the home is run; we sent questionnaires to staff and people living at the home; we visited the home without them knowing the date we were coming; we looked at policies and procedures, records and care plans; we spoke to the people living at the home and the staff who work there; we talked to the manager and we went round the building, looking at the environment peope live in. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Risk assessments and subsequant action needs to be undertaken for the low bannisters, window restriction and hot surface protection. This helps to ensure that people are protected from the risks of falling from open windows or coming into contact with hot surfaces. The manager needs to make sure that all moving and handling practices at the home are in accordance with best practice. Some cleaning chemical data sheets need to be obtained so that people know what to do if a chemical is accidentally misused. Activities provided need to include people with severe or multiple impairments. This is so that everyone at the home has the opportunity to take part in valued or stimulatijng activities. Care Homes for Older People Page 7 of 26 The first aid kits need to be re-stocked, so that equipment needed is immediately available in an emergency. Care plans would benefit from additinal information being available on peoples social and personal history. This helps staff to understand the whole person they are caring for. The homes manager must make sure that day care arrangements do not mean staff time is reduced for people living at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is clear information available about the home which can be given to people before they move in to help them make a judgement about whether Lorna House is the right place for them. Evidence: Lorna House has a residents handbook, which contains information about the home in an easy to understand format. This gives people information about the services the home provides and any rules or restrictions about residency there. It also contains information about how and to whom complaints hould be made and a copy of the terms and conditions of residency is supplied with the information. There is also a statement of purpose which is available in the home. This details information about the management of the home and some of their policies and procedures, informationon qualifications of staff and procedures for example the Fire Care Homes for Older People Page 10 of 26 Evidence: precautions. Discussion was held with the manager about the last two admissions to the home and we looked at the pre-admission assessments she had undertaken. Pre-admission assessments help to enaure that the home can meet the persons needs, and in this instance involved visits to the person at their previous placement. A trial visit and trial day was then organised, which helps the person get a feel of what living at the home may be like before they make a commitment to come in. It also gives them the opportunity to meet the other people already living at the home and see the accommodation available. Completed contracts were seen for both recent admissions. Contracts set out what fees are to be paid, by whom and what people can expect to receive in return . They also explain periods of notice required and under what circumstances people might have to leave the home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the care and support they need. Evidence: Each person living at Lorna House has a care plan, which details the care or support they require and how this is to be achieved. Plans were being rviewed regularly, and were a good reflection of the care being actually delivered as discussions with care staff and people living at the home identified. Plans would benefit from some additional information being made available on peoples social and personal history, and on how they like their care to be delivered. This is helpful when people may have a progressive memory loss. Discussion was held on aids and adaptations available to support people. These included raised toilet seats, grabrails, adapted bathing and showering facilites and specialist beds where indicated. Some of the homes beds are of an older style and quite low for older people to get up from and the manager said these are on a Care Homes for Older People Page 12 of 26 Evidence: programme for replacement. Discussion was also held on the need for a new hoist. At the time of the visit Occupational Therapists were visiting the home to advise on this. The home has good links with visiting and community medical and nursing services and it appearred peoples healthcare needs were being supported well. On the day of the visit District nurses were visiting the home, along with Occupational therapy sevices and one person was being accompanied on a hospital visit. The homes medication management systems were seen and found to be satisfactory. Staff receive training in medication administration and the home uses a blister pack system which is pre filled by the local pharmacist. This helps to reduce the risk of errors in medication and ensures staff can easily check that medication has been given. Where people are at the home on respite care and bring in medication this should only be administered from the original packaging not from a complaince aid filled by a relative. This is beacuse staff giving out the medication would not be able to tell what that medication was. The home has a system for assessing the risks of accidents and level of First aid provided. A first aid kit seen needed some re-stocking. People spoken or who completed questionnaires said they were generally happy with the care they received. One wrote Should my mother have a problem she always recieves the support needed. and on the visit one person said The carers are very good. They are like friends to me and we always have a laugh Another person said staff sometimes forgot things and another Some carers run through the task and are not so thorough as others. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are able to exercise choices in their daily lives. meals are home cooked and well presented. Evidence: Lorna House has a programme of activities available each day which is on display in the homes hallway. On the day of the visit staff were holding a music quiz and reminiscence session with people in one lounge. The home has several spaces where people can choose to sit, including a bright and sunny conservatory and main lounge with television. There are level gardens around the home with seating areas. The home is situated near Cary Park and is a level walk to local shops, services and the sea front at Babbacombe. People spoken to confirmed they were free to join activities if they wished. One person felt isolated as they had a dual hearing and visual impairment which meant they had limited opportunity to participate in some activities. Specialist advice is being sought to support them. Visitors were much in evidence on the day of the site visit and people who completed Care Homes for Older People Page 14 of 26 Evidence: questionnaires said they felt able to visit at any time. One person spoken to on the visit said how much they welcomed still being involved in their relatives care. The home has a small shop where people can buy small items such as toiletries, birthday cards and tights. Any profits from this go into the residents fund which helps in paying for trips out. There are many photographs of recent events which the home has plans to show. The cook at the home was able to discuss the meal provision and special diets the home can cater for. The meal on the day of the site visit was roast chicken and vegetables which was thoroughl enjoyed. There are home made cakes and fresh fruit available. People spoken to said the food was very good. Supplementation is available if needed for people with poor appetities and discussion was held on nutritional assessments now being undertaken. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected through the homes systems for managing complaints and protection of adults. Evidence: Lorna House has a complaints policy and procedure, which was well understood by the people spoken to or who completed questionnaires. Two complaints have been made during the year which were partially upheld and another was discussed during the site visit. This related to concerns over staff bringing their children into work and a high workload from daycare clients which took time away from the permanent people who live at the home. The manager agreed to investigate and respond to CSCI with her findings. The home has a history of responding well to complaints which are invstigated fairly and action taken as a result when required. Adult protection training is given to staff and the home has a policy for Whistleblowing and protection of adults. These should help to ensure people are protected from abuse or abusive practices. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 environment is clean, warm and comfortable. Some areas of risk need assessing and addressing to ensure people are safe. Evidence: Lorna House is a period property, set in a level residental area, close to Cary park, local shops, a church and the sea front at Babbacombe. During the site visit a tour was made of the accommodation and service areas, and documentation regarding the environment was seen, including service records and contracts for maintenance of equipment. All areas of the inside of the home were clean, warm and comfortable. Odour control was very good. Some areas of the outside of the building required maintenance, especially to windows and window frames, and this also affectd some rooms internally, where one old sash window was wedged with wooden wedges and carrier bags to stop drafts and rattling. Communal areas were well maintained and homely, with a large television lounge and attractive bright conservatory. Peoples individual rooms varied considerably from some that were quite small to larger rooms with period features and large bay windows. Rooms have ensuite facilities. Some furnishings are old and discussion was Care Homes for Older People Page 17 of 26 Evidence: held on replacement and refurbishment schedules. There is a choice of bathing facilities including a walk in shower/wet room and baths with hoists. Laundry facilities are capable of achieving a sluicing cycle in the wash, so that any soiled items can be properly disinfected, reducing any risks of infection. Some risk assessments needed to be reviewed, in particular in relation to window openings and radiator covers. Some radiators were not covered or protected and one felt presented a significant risk due to a high surface temperature. The bannisters seen on the frst floor landings were low and could present a risk from people falling. The manager agreed to address this without delay. Plans are being developed to provide an additional ground floor toilet. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are satisfactory however the homes manager must make sure that day care arrangements are appropriately staffed. Evidence: On the site visit time was spent looking at records and policies in relation to staff employment, training and supervision. Discussions were held with staff on duty and people living at the home about how well the homes staffing meets their needs. People who completd questionnaires felt that although the staff were knowledgable and capable they were sometimes rushed or short of time to support them. just prior to the inspction a complaint was recieved in relation to the amount of time taken up by day care cleints. Although this was not an issue on the day of the visit this might in part explain the comments. On the day of the site visit which was unannounced there were four care staff and the manager on duty, 2 cleaners, a cook, a kitchen porter, and a handyman on duty. One person was off sick. Although busy staff still had time to talk to residents and take part in activities planned. Lorna House has a new induction programme for staff which looks comprehensive. Training records showed staff recieve training in core areas and also on topics that perticularly relate to the people at th home. Supervision and appraisal sessions are Care Homes for Older People Page 19 of 26 Evidence: regularly held with staff where training needs are identified along with any areas where they may not be working to their full potential. Records for these were seen. The manager is involved in daily handovers so that she can keep in touch with care tasks and day to day welfare issues. Staff records seen showed that a full recruitment procedure is followed through, including the taking up of criminal records bureau checks and references. Staff on duty who were spoken to showed a good understanding of the needs of the people they were caring for. Those who completed questionnaires felt there wereusually or always enough staff on duty to meet peoples needs. They also felt they received a good level of support from the management of the home. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well managed. Some attention is required to risk assessment and moving and handling practices. Evidence: The manager of the home is experienced and well qualified for her role. Regular meetings are held with the other Crocus Care managers, and recently managers have been assessing each others homes. This helps ensure conistency throughout the group and offer fresh eyes to look at the service. There is an indepth quality assurance system which comproses a series of audits and consultation with stakeholders to provide regular reports and action plans to imrove the quality of the service. The last report for Lorna House was seen, along with the action plan developed as a result. Small amounts of cash are kept for some residents, as a float to pay for small items of Care Homes for Older People Page 21 of 26 Evidence: expenditure such as hairdressing and chiropody. Records for the accounting of this were seen for two people and fod to be accurate and balance with the cash held. Reciepts are obtained for expenditure. Time was spent looking at the health and safety arrangements at the home on the site visit. Equipment is regularly serviced and contracts are in place for the disposal of clinical waste, pest control, maintenance of hoists and fire precautions. Some risk assessments were needed for the bannisters, window restrictors and hot surface protection, to ensure people are kept safe and forseeable risks reduced. The manager stated that all hot water outlets have regulated water temperatures, which helps to protect people from being scalded by hot water. Data sheets were needed for some cleaning materials. These contain information about what to do if these are accidentally misused. The last visit by the Environmental Health officer was in December 2008, and the water systems were tested for legionella bacteria in September 2008. Fire drills and practices are regularly undertaken and the fire officer is due to make a visit to the home in the near future to look at their arrangements. A full wiring check has been undertaken of the premises. Discussion was held with the manager on moving and handling practices as during the visit staff were seen to be moving a person in ways that did not reflect current best practice. The manager confirmed that appropriate equipment wa s available for supporting people with their mobility and that she would address this with the staff. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 Risk assessments must be 19/03/2009 undertaken and action taken as a result for the window openings, radiator covers and low bannisters as identified. This will help to protect people living at the home from forseeable risks. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans would benefit from additional information being available on exactly how people wish for their care to be delivered, and more information when it can be gained on peoples social and personal history. Medication should only be administered from the pharmacist supplied packaging. The First Aid kits should be checked and re-stocked regularly in accordance with the homes risk assessment. The homes manager should consider ways to involve people who are more frail in the activities programme, perhaps through more person centred activity. 2 3 4 9 9 12 Care Homes for Older People Page 24 of 26 5 27 Taking in a small number of day care clients must not mean that staff are unable to meet the needs of the people living at the home in an unhurried way. Moving and handling practices should be assessed to ensure they are safe and based on best practice. 6 38 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!