CARE HOMES FOR OLDER PEOPLE
Loudoun House Ridgeway Road Ashby de la Zouch Leicestershire LE65 2PJ Lead Inspector
Mrs Carole Burgess Unannounced 29 June 2005 09:30 am
th 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 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. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Loudoun House Address Ridgeway Road Ashby de la Zouch Leicestershire LE65 2PJ 01530 412184 01530 412184 surjit@rushcliffecare.co.uk Rushcliffe Care Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Susan Roberts Care Home (CRH) 35 Category(ies) of DE(E) Dementia - over 65 (20), LD(E) Learning registration, with number disability - over 65 (4), MD(E) Mental disorder of places over 65 (4), OP Old age (35), PD(E) Physical disability - over 65 (10), SI(E) Sensory impairment - over 65 (4) Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No person falling within category DE(E) may be admitted to the home when 20 persons who fall within category DE(E) are already accommodated within the home. No person falling within category MD(E) may be admitted to the home when 4 persons who fall within category MD(E) are already accommodated within the home. No person falling within category LD(E) may be admitted to the home when 4 persons who fall within category LD(E) are already accommodated within the home. No person falling within category PD(E) may be admitted to the home when 10 persons who fall within category PD(E) are already accommodated within the home. No person falling within category SI(E) may be admitted to the home when 4 persons who fall within category SI(E) are already accommodated within the home. Servise users between the the age of 55-65 years who fall within the above catagories and were residents in the care home at the date of registration continue to reside there. To be able to admit the person named on variation application 49975 dated 24th June under PD into the home. Date of last inspection 1st December 2004 Brief Description of the Service: Loudoun House is a residential care home for thirty-five older persons of both sexes. It was opened in 1959 and refurbished in 1999. The home provides care for a limited number of older persons with learning disability, mental disorder, physical disability and sensory impairment. It also provides a small number of day or part day care placements whereby a limited number of older persons spend a few hours and have lunch at Loudoun House before returning home. Accommodation is on two floors and can be accessed by stairs or passenger lift. The home is bright and clean with a high standard of décor throughout and provides a safe and caring environment for all of the residents. Bedrooms are mostly single, with a hand washbasin; with one double bedroom, and there are adequate toilet and assisted bathing facilities throughout the building. There are a number of lounges and kitchenettes for the use of residents and their visitors. In addition, there is a large dining room, with a bar. The home is surrounded by well-maintained gardens and there is a patio and seating at the front and side of the home. The home is accessible by public transport and there is sufficient parking for visitors.
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This is an overview of what the inspector found during the inspection. This inspection took place over one day. An opportunity was taken to look around the home, view records, policies and care plans and to talk to staff residents and their relatives and visitors. The primary method of inspection used was ‘case tracking’ which involved selecting four residents and tracking the care they receive through a review of their records, discussion with them, the care staff and observation of care practices. Many of the residents were seen during the inspection and five of the residents and five relatives spoken with gave the inspector their impressions of the home. What the service does well: What has improved since the last inspection?
The home has a Registered Manager to ensure that there is good leadership and stability in the home. The open and positive attitude of the staff is in contrast to the situation some twelve months ago, when the home had transferred ownership from Leicestershire County Council to Rushcliffe Care Limited in March 2004 and staff were feeling anxious about the changes which had occurred. This noticeable change ensures that staff work well together to provide the best care for the residents. A flexible approach to staffing has improved staffing levels and the residents felt that, there were usually sufficient staff on duty. One resident said that occasionally, if they were ‘a bit short’, staff continued to be prompt in answering the call bells and attending to her needs.
Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 6 Rushcliffe Care are moving towards an integrated, computerised system of record keeping and have provided training for the staff. Residents care plans are now comprehensive and regularly reviewed. What they could do better: 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. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1, 2, 3, 4, 5 & 6. The admission process is well managed and residents are given clear information regarding the service; thereby ensuring that the residents’ health and welfare needs are met (although not all files examined contained a copy of the residents contract/Terms and Conditions). EVIDENCE: There is a comprehensive Statement of Purpose & Service Users’ Guide. However, only more recent residents had a signed copy of the contract/Terms and Conditions in their files. The pre-assessment process is detailed and robust and reflective of the health and welfare needs of the residents. A visitor said that he had visited the home prior to his relative taking up residence in order to compare it with other homes in the area. The home does not provide intermediate care.
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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 standard(s) 7, 8, 9 & 10. Residents are looked after very well in respect of their health and personal care needs. EVIDENCE: Care plans have been revised from those used by the previous provider. They are now detailed and reflect residents’ specific and individual needs. Contact with other healthcare professional is well documented. The quality of record keeping is reflective of the high standard of care observed during the inspection and ensures that the needs of the residents are met. Medication policies and procedures are sound. However, on the day of inspection the drug fridge required defrosting to ensure that medicines are stored at the required temperature. Residents said that they were very well cared for; that staff answered the call bells promptly and were respectful and kind and that their health care needs such as GP and hospital visits were well supported. Relatives said that they were consulted and were able to voice general comments and/or concerns at any time, but both residents and their relatives had no complaints or concerns about the care which the home provides.
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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 standard(s) 12, 13, 14 & 15. Residents experience a stimulating and varied lifestyle at the home with visitors encouraged and a variety of activities made available. Meals are well presented and nutritious and staff are caring and supportive of residents and their relatives. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 11 EVIDENCE: Visitors came and went throughout the day. An activities officer provides a programme of daily activities for the residents. During the inspection residents took part in a film quiz and listened to music – the big band sound - and some of the ladies had their nails varnished. Residents said that there were occasional trips out arranged. One lady said that she would love to go to Skegness for the day, which she had enjoyed when she was younger. Residents are supported to be as independent as possible. If they are able to go out alone residents are provided with cards with the home’s details and staff note the time of departure and expected time of return to ensure their safety. Residents spoken to said that staff are respectful and very caring and both residents and relatives said that the staff were excellent and provided a very high standard of care. Menus are balanced and appealing, and are flexible enough to accommodate individual preferences and healthcare needs. They are freshly prepared and are of a good standard and the residents said that they enjoyed their meals, which were ‘very good’. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16, 17 & 18. Arrangements for receiving and responding to complaints are sound. EVIDENCE: Residents, their relatives and staff comments demonstrated that people feel at ease discussing any concerns with the Registered Manager and staff ensuring an ‘open ethos’ in the home. The home has received one complaint/concern from a resident’s relative since the last inspection. This was dealt with appropriately. The home’s complaints process reflects the government’s adult protection guidelines, set out in the No Secrets’ publication and staff are aware of their responsibilities. Adult protection training for staff is arranged for 7th July 2005. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 20, 21, 22, 23, 24, 25 & 26. A comfortable, clean, homely and safe standard of accommodation is provided for the residents. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 14 EVIDENCE: The home is safe and well maintained with many adaptations to suit residents’ specific needs. It is decorated and furnished to a high standard that creates a comfortable and homely environment, and there is a system of maintenance and refurbishment. However, the carpet of the first floor corridor is looking a little faded and may require replacing in the near future. There is safe garden area and the home is set in pleasant surrounding with grass, shrubs and seating areas. A relative commented that the bushes around the path required trimming back to allow for wheelchair access. Residents’ rooms are clean and well decorated, and residents are able to bring items of their own furniture and possessions with them to personalise their rooms. There are sufficient toilet, bathing and assisted bathing facilities. Hot water temperatures are checked to ensure they comply with Health and Safety legislation and were satisfactory when checked during the inspection. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30. Staff at the home are well trained and supported, and employed in sufficient numbers to meet the residents needs. EVIDENCE: The Registered Manager maintains overall responsibility for the home and is usually supernumerary. Staffing levels, at the point of inspection were satisfactory and in line with the Department of Health Residential Forum Guidelines and were sufficient to meet the residents’ needs. Residents and their relatives said that they felt staff were capable and caring, and that there were, generally, sufficient staff on duty to meet the needs of the residents. Training for staff is well planned and supports staff in providing for the varied needs of the residents. The Registered Manager stated that all care staff hold National Vocational Qualification (NVQ) in Care, Level 2 or above (although evidence of this was not available at the time of inspection. Extensive ‘in house’ training supports staff in meeting the residents’ health and welfare needs. The recruitment process is administered centrally at Epinal Way Care centre, Loughborough and is robust.
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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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 & 38. The newly appointed Registered Manager, with effective supervision of staff, manages the home efficiently to protect the rights and needs of the residents. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 17 EVIDENCE: The home has a newly appointed Registered Manager with 8 years of experience in care. She is currently undertaking the Registered Managers Award and the NVQ Assessors qualification. The atmosphere within the home has improved significantly since the previous inspection when staff were still unsettled following Rushcliffe Care taking over the home from the local authority. There is an ethos of openness in the home; staff are friendly and helpful towards the residents, their relatives and each other. Staff support the residents to make decisions in their everyday life, which promotes independence. Residents’ personal allowances are kept safe and appropriately managed. The Registered Manager has commenced yearly staff appraisals and is to implement supervision (a regular review of staff performance and training needs) to ensure that staff maintain the standards of care expected throughout Rushcliffe Care Limited. Health and Safety Policy and Procedures, such as regular recorded fire drills and fire alarm tests are completed, to ensure the health and safety of the residents and staff. Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4
COMPLAINTS AND PROTECTION 4 4 3 4 3 4 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 4 4 4 3 3 3 3 4 Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 19 NO Are there any outstanding requirements from the last inspection? 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 Regulation NONE Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 2 Good Practice Recommendations The Responsible Persons are recommended to ensure that all residents are provided with a contract/Terms & Conditions (Regulation 5 (1) (b) (c) & (3)) and that a copy is retained in the residents file. The Responsible Person is recommended to ensure that medicines are stored at the correct temperature. The Responsible Individuals are recommneded to ensure that the grounds are kept tidy and accessible to all residents. 2. 3. 9 19 Loudoun House C51 C01 S58947 Loudoun House V218975 290605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection The Pavilions 5 Smith Way, Grove Park Enderby, Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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