Inspection on 01/07/08 for Lucas Court Nursing Home

This inspection was carried out on 1st July 2008.

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

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

Lucas Court Nursing Home 06/01/09

Lucas Court Nursing Home 14/12/08

Lucas Court Nursing Home 07/11/08

Lucas Court Nursing Home 21/10/08

Lucas Court Nursing Home 29/06/07

Lucas Court Nursing Home 12/06/06

Lucas Court Nursing Home 18/10/05

Lucas Court Nursing Home 26/04/05

Lucas Court Nursing Home 30/09/04

Lucas Court Nursing Home 28/04/04

Lucas Court Nursing Home 07/01/04

Lucas Court Nursing Home 18/08/03

Lucas Court Nursing Home 15/05/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Lucas Court Nursing Home Northampton Lane North Moulton Northampton Northants NN3 7RQ Lead Inspector Kathy Jones Unannounced Inspection 1st July 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lucas Court Nursing Home DS0000012628.V368746.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. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lucas Court Nursing Home Address Northampton Lane North Moulton Northampton Northants NN3 7RQ (01604) 493233 01604 493234 lucascourt@schealthcare.co.uk 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) Southern Cross Healthcare Services Limited Mrs Lynda Miller Care Home 60 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (60), Physical disability (6), Physical disability over 65 years of age (6) Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. All service users in the category of DE(E) must be accommodated on the first floor. Two named female service users may be accommodated in the category of Mental Disorder, until such time as they leave the home. No further service users may be admitted in this category No one falling in the category of DE(E) may be admitted into the home where there are 28 service users who fall within the category of DE(E) already accommodated in the home No one falling in the category of PD may be admitted into the home where there are 6 service users who fall within the category of PD already accommodated in the home No one falling in the category of PD(E) may be admitted into the home where there are 6 service users who fall within the category of PD(E) already accommodated in the home. No one falling in the category of OP may be admitted in the home where there are 60 service users who fall within the category of OP already accommodated in the home. To be able to admit the named person under 65 years of age named in Variation Application No. V000020533 dated 13th May 2005. To be able to admit the named person under 65 years of age named in variation application no V000029387 dated 7th February 2006 29th June 2007 4. 5. 6. 7. 8. Date of last inspection Brief Description of the Service: Lucas Court is a care home providing personal and nursing care for up to 60 people. Currently Lucas Court provides care for older people, older people with dementia, older people with a mental disorder and people with a physical disability. Southern Cross Healthcare owns the home and it is located in the village of Moulton on the outskirts of Northampton. The village has some local shops and public houses and is on a bus route in to Northampton. The home is a two storey building with the first floor allocated for dementia care, and care for people with mental health needs. Fifty of the bedrooms are single rooms with forty-eight of these rooms having en-suite facilities. There are five double rooms in the home. The home has a passenger lift. There is an Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 5 enclosed well-maintained garden to the rear of the home, which is accessible to wheelchair users, and a car park. A scale of charges confirmed as being current at the time of the inspection states that fees are from £650.00 to £750.00 per week. The fees quoted are exclusive of any free nursing contribution, which is collected from the Primary Care Trust by Southern Cross Healthcare. Local Authorities who are funding people are charged at a set rate. These people will be asked for a ‘top up’ fee, which varies according to their ability to pay. The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. Information about the services provided including the complaints procedure is displayed in the foyer of the home. This includes the statement of purpose, a service user guide and a copy of the most recent Commission for Social Care inspection report. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the service, collating information received in surveys received from relatives, people who use the service and staff and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection (this is called a key inspection) took place in June 2007, however a Pharmacist Inspector carried out an inspection in September 2007, which focussed specifically on the management of peoples prescribed medication. Information from these inspections was taken into account as part of the planning. This unannounced inspection visit was carried out over a period of a day and a half. There were two inspectors on the first day and one on the morning of the second day. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. Because Lucas Court provide care for people with dementia and they are not always able to tell us about their experiences, we have used a formal way to observe people to help us understand their experiences. We call this method of observation a Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who use services for two hours and recording their experiences at regular intervals. This included their state of well-being, and how they interacted with staff members, other people who use services, and the environment. During the inspection questionnaires were given to a random selection of people to ascertain their views. People completed these and returned them to us at the end of the day. We assisted two people who use the service surveys with their completion. Seven surveys were received from relatives and six from Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 7 staff. Their views have been considered as part of the inspection and some comments incorporated within the report. The management of residents’ medication was checked through reviewing prescribed medication for a sample of people. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of people’s general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was given to the Registered Manager throughout the inspection and to the Operations Manager at the end of the inspection. What the service does well: What has improved since the last inspection? The management of medication on the first floor was found to be much better at this inspection. The Acting Manager in post at the time of the last inspection submitted an application for registration and is now the Registered Manager. This is important in that the person managing the service then has legal Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 8 responsibilities for the management of the service and care of people who use the service. What they could do better: In the surveys completed by relatives we asked what the service could do to improve. These are a sample of the responses: “On the whole staff are caring but some are slap dash in their approach to care”. “Give the support to ensure staffing numbers are met. Some comments from people who use the service include “see some people having to wait a long time to go to the toilet particularly at meal times”. While the majority of people who commented to us on the care were very positive, we had some concerns about the management and oversight of people’s health care needs. These were in the main people who were unable to express their own needs. One of our concerns related to people’s fluid intake as records checked for two people indicated that they were not receiving adequate fluid and were at risk of dehydration. Another concern related to the lack of systems in place to identify and act where someone becomes constipated. We made a safeguarding alert, as we could not be satisfied about the care of the site for someone’s PEG (Percutaneous Endoscopic Gastrostomy) feed tube. Some discrepancies were identified in the recording of medication administered and there had been delays in checking with the General Practitioner a medication brought in by a relative for a recently admitted person. The daily lives of people less able to instigate communication with staff could be improved with better staff awareness. This was highlighted during the SOFI observations. More training for staff is needed in several areas to ensure that they all have the appropriate knowledge and skills to meet the needs of people who use the service. People spoken with were happy with their rooms and pleased that they were able to bring personal belongings in. Several people were enjoying the sunshine in the enclosed garden. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 9 Although there appeared to be sufficient staff to meet people’s needs during the inspection, people told us that this is not always the case. Someone who uses the service told us that sometimes people have to wait a long time to go to the toilet. Staff told us that the problems arise mainly at weekends when people are sick and they have to cover other duties. The recruitment process is still not as rigorous as it needs to be to safeguard people who use the service. We found similar shortfalls at the previous inspection. The quality assurance process needs to be more effective in improving and maintaining standards of care for all people who use the service. 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. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 10 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 Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 11 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, 3, standard 6 was not assessed as intermediate care is not provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a thorough assessment process, which provides assurances that the needs of people admitted to the home can be met. EVIDENCE: Information is available to people considering using the service and their families in the form of a statement of purpose and service user guide. A copy of the documents and a copy of the most recent inspection report are also available in the foyer. The statement of purpose and service user guide, are corporate documents with some information specific to Lucas Court. As the documents are templates there is a risk, as appears to have happened in this case that information can be misleading. Underneath the section about inspection reports there are a series of statements, which appear as though they are from the report, which Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 12 they are not. It is important that people receive accurate information to help them make decisions. Advice was given at the last inspection to include more information about Lucas Court, for example the range of needs that can be met and the type of care provided. The Operations Manager advised that she intended to revise the documents, however has since left the company. The advice is repeated, as it is important that people who are considering using the service are able to make informed choices about their care. Information in surveys completed with two people who use the service identify that one person felt that they had received enough information to help them make a decision about moving in. The other said they were admitted in an emergency and “Matron visited at home”. It was confirmed that this was part of the assessment process. The statement of purpose identifies that an assessment of peoples needs is carried out prior to admission and this would involve visiting the person either at home or in hospital. This is important in helping to determine if people’s needs can be met. Review of the records for someone who had recently been admitted confirmed that an assessment had been carried out. A pre-admission care plan had been developed based on the information gathered during the assessment. A copy of the assessment carried out by social services had also been obtained. Information gathered included medical history, consideration of any risks such as developing pressure ulcers or falls. Information is also gathered about people’s social interests, religion and friends and families. It is important that information is gathered from all sources to help ensure that the required care and support can be provided. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 13 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, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The shortfalls in the monitoring and oversight of people’s health care needs have the potential to put them at risk. EVIDENCE: Two people who use the service and completed surveys with the inspector confirmed that they always get the care and support that they need. One said “there is always someone about”. Another person spoken with said they were “very happy with the home” and three others confirmed that they were also happy with the care that they receive. Eight surveys were completed by relatives of people who use the service. The responses to a question about whether their relative gets the care expected or agreed, were mainly positive with four people saying they always get the care, two usually and one sometimes. The additional comments indicate mixed experiences, with one relative saying, “Have no worries as she gets excellent Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 14 care”, while another said that there needed to be “better staff awareness of individual needs and expectations”. Care plans and care records were selected for two people on the dementia unit and two people on the ground floor. Care plans are considered to be important documents in guiding staff in the actions required to meet people’s needs and were in place for all of the people reviewed. Various assessments had also been completed which help highlight the particular needs and risks for the individual such as the risk of developing pressure ulcers and nutritional risk. The organisation has a comprehensive set of records designed to assess, plan and monitor the care provided. Some of the records are kept on people’s individual care files; some in handover records and then information such as elimination records and fluid intake records are kept separately. When piecing together the information we were concerned that in some cases there is a lack of overview and monitoring of individual’s health and well being. For example: Records relating to bowel care reviewed for one person were inadequate in that there were gaps in the records and staff were recording the information in different places making it difficult to track information. It was also of concern that lactulose a medication prescribed to reduce the risk of constipation was found in the medication trolley with a label showing that it had been dispensed for this person two months before they moved to Lucas Court. A nurse advised that a family member had brought this in, but it could not be clarified when this was or why the prescription and the need for this medication had not been checked with the General Practitioner. Records showed that the General Practitioner had visited ten days after admission and the reason for the visit was recorded as “review medication especially for constipation”. Following discussion with the Registered Manager about the above concerns, she met with staff on duty and a more detailed system for recording of bowel care was immediately implemented. A similar example of where recording systems are in place but are not used effectively was identified in relation to fluid intake. Records of fluid intake were checked for two people with dementia for the 01/07/08. As these people were unable to communicate their experiences, observations were made during the morning and the records checked against what was observed during this period. The fluid records dated 01/07/08 for the same people were looked at again on the morning of the 02/07/08 to check the adequacy of the fluid intake over the twenty four hour period. No records could be found of either of them receiving any fluids from 5-50pm on the 01/07/08 until breakfast the following morning. An assessment for one of the above people stated that they should have a minimum daily fluid intake of 100ml. Records from 31/12/07 show that the Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 15 minimum level had not achieved and there was no evidence of any action taken. The Registered Manager confirmed that they would urgently review how fluid intakes are monitored to reduce the risk of people becoming dehydrated. Care records for the management and care of the site for someone’s PEG (Percutaneous Endoscopic Gastrostomy) feed tube were poor. A care plan dated almost two weeks prior to the inspection indicated some concerns about the condition of the site where the feed tube is inserted, however there were no records to show the current condition or of any care being given. Due to the concerns and risks associated with people not receiving appropriate care in this area a safeguarding alert was made by the Commission for Social Care Inspection. An investigation is to be undertaken through the safeguarding adults procedures to check that appropriate care is being provided. A sample check of the management of people’s prescribed medication was carried out. On the first floor, the storage and administration records appeared satisfactory with records of medication being booked in and of returns. A sample check of medication on the ground floor identified some discrepancies. A check of the tablets in stock and the signatures indicated that in some cases according to the prescription, the number of tablets received and in stock, the medication may have been given and not signed as given. A medication prescribed to be given once a day, where the time of the dose had changed was found to have been signed as given twice in one day. The number of tablets in stock indicates again that this was a recording error. Advice was given to the nurse that the record must not be altered; however it was suggested that an explanation with the date the error was found could be added to the reverse of the medication record. It is important that accurate records are in place to confirm that people have had their medication as prescribed. No date of opening was found on some of the eye drops, which have, a short shelf life once opened. Advice was given to ensure that this is added in all cases to ensure that medication administered is safe and effective. Advice was given about the need for care plans relating to medication management. One example discussed was pain management for people who are not able to communicate easily either as a result of their medical condition or because English is not their first language. Following discussion a care plan was developed for one person and was being reviewed by the Registered Manager. Staff were heard to speak respectfully to people who use the service. People’s dignity was preserved in that all personal care was provided within the privacy of people’s rooms and people were clean and well groomed. A relative responded in a survey that they felt that choice, respect and dignity and Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 16 individuality are sometimes forgotten. Observations on the dementia unit supported the view that more could be done in this area in terms of some staff being more aware of how to interact and engage appropriately with people with dementia. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Visitors are encouraged and welcomed and people who use the service are happy with the quality of food provided. The daily lives of people less able to instigate communication with staff could be improved with better staff awareness. EVIDENCE: People spoken with during the inspection who were able to express their views confirmed that activities are provided and that they were satisfied with the daily routines. One said they choose not to join in the activities but they are available. Another said that “the activities people are good” and said that various things are provided such as bingo, scrabble, countdown, flower arranging and now and again a ‘happy hour’. A relative stated, “The recreation/activity/exercise staff are excellent. There is a pleasant enclosed garden at the rear of Lucas Court, which had a gazebo providing some shade. Staff had assisted some people outside, as it was a hot sunny day. The garden has level entry access, which enables Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 18 wheelchair users who can mobilise independently to go in and out as they wish. Surveys from relatives of people identified that four of the seven felt they were always kept up to date with important issues, two usually and one sometimes. On the first day of inspection a coffee morning was taking place. Relatives and friends and some people from another nursing home had been invited. There was a relaxed and pleasant atmosphere and relationships between staff and visitors appeared to be good; visitors were acknowledged and welcomed by staff. This is important in encouraging people to visit which helps to enhance the daily lives of people who use the service. In addition to talking to people who are able to express their views we carried out some observations of the support given to people who are less able to communicate their needs and wishes. This was done on an informal basis throughout the inspection and also included a dedicated period of observation on the dementia unit over two hours covering the breakfast time period in the dining rooms and lounges. The observations identified that although staff talked to people who use the service there was little in the way of conversation with them. For example people were told what they were being given for breakfast but there was no conversation or discussion about any alternatives. The observations highlighted the varying skills of staff in conversing with people with dementia. While all staff were observed to speak calmly and appropriately to people who use the service, more opportunities could have been taken to include people in conversations. Two people, who were more able to interact with staff, appeared to receive more attention. Interactions and conversation are important aspects of people’s daily lives and it was unfortunate that even when someone who used the service tried to instigate a conversation with a staff member, they were cut off with a fairly abrupt response. A different staff member was observed to calmly and tactfully divert someone away from a situation following an outburst of frustration. This indicated a better understanding of peoples needs. Visiting arrangements are flexible and visitors are made welcome. Social events such as the coffee morning held on the day of the inspection are organised to encourage friends and relatives to visit. Discussion with three people who use the service identified that they felt that they have choices in daily lives and routines. Examples given were times for getting up and going to bed and a choice of meals. People were happy with the meals provided and one person said that there is always a choice of two main meals but if you don’t like them you are always offered something else. A relative/carer/advocate survey stated, “Provision of meals is excellent, range of varied diet/choice”. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 19 The meals looked appetising and people were observed to be receiving appropriate support. However review of a sample of care plans identified that these had not in all cases been updated as peoples needs change. As detailed in the health and personal care section there was some concern about the monitoring of peoples fluid intakes. There was particular concern about what happens during the evening and overnight, as there was no evidence that the two people randomly selected had eaten or drunk anything between 5-50pm and 8-30am. Both of these people needed staff to ensure they received enough food and fluid. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 20 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, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are satisfied that any concerns will be listened to and acted on. More staff training is needed in dealing with complaints and safeguarding vulnerable adults procedures to ensure that people are safeguarded. EVIDENCE: There is a complaint procedure, which is detailed in the statement of purpose and available in the foyer. Responses received in surveys, two from people who use the service and seven from relatives and friends confirmed that the majority of people either knew how to make a complaint or were satisfied that they could access the information if needed. The Commission for Social Care Inspection have been given information about three complaints since the last inspection which people have referred directly to Lucas Court for investigation under their complaint procedure. Two of the complaints related to standards of care and the third to the management of medication. Two of the complaints referred to similar concerns having arisen previously. Discussion with someone during the inspection identified that the Registered Manager listens to peoples concerns and acts on them appropriately, there are improvements in practice for a while but this is not always sustained. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 21 Three people who use the service said that they felt confident that someone would listen to them if they had any concerns. A survey completed by a relative stated ““At any time that I had a question or a problem, all I had to do was have a word with Lynn (manager) and all were sorted out”. There were indications from staff surveys and training statistics that more training and awareness of safeguarding and complaints is needed to adequately protect people. Two out of six surveys received from staff said that they did not know what to do if someone had concerns. The training statistics for Lucas Court printed on 1st July 2008 identify that only 41 of staff have received safeguarding vulnerable adult training. Following two complaints which were investigated under safeguarding adult procedures by social services, reviews were being carried out by social services and the primary care trust in to the care being received by people to help ensure that people are properly safeguarded. The Registered Manager was cooperating and helping to facilitate this process. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 22 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, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment provides a comfortable and safe place for people to live. Deep cleaning and where appropriate replacement of some carpets will improve the environment for people who live there and their visitors. EVIDENCE: Shared areas of the home such as lounges and dining rooms and a sample of residents’ bedrooms were seen during the inspection. People on the first floor, which is the dementia unit, are able to, where mobility allows wander freely. Efforts have been made to reduce the confusion for people and assist them with independently finding their room or the bathroom. People’s rooms are clearly identifiable; the doors are painted different colours and have a picture that they can relate to, such as a pet or something of interest to them. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 23 Signage on bathrooms and toilets was clear with a large picture to identify the room. People are encouraged to personalise their bedrooms with pictures and family photographs and other objects of familiarity. One person spoken with said they were very happy with their room and were pleased that they had been able to bring in their own belongings. On entering the dementia unit there was a strong odour in the corridor, which appeared to be coming from the carpets. The carpets in the lounges were also quite stained. The Registered Manager advised that quotes were being obtained to replace some of the carpets, which would include part of the corridor on the dementia unit. There is an enclosed garden with patio and lawned areas. A gazebo had been erected to provide some shade for people. Several people had been assisted to sit outside. There is also an aviary in the garden, which adds some interest. There is level entry access to the garden, which allows people in wheelchairs to either be assisted outside, or where independent to go in and out as they wish. Some measures were observed to be in place to reduce the risk of infection. For example disposable gloves and aprons were available and staff were observed to be using them. It is important that staff have a thorough understanding of infection control, as older people can be particularly vulnerable. Training records identify that only 43 of staff have received training in infection control and it is therefore recommended that all staff receive this training to help reduce the risk. Lucas Court Nursing Home DS0000012628.V368746.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): 27, 28, 29, 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing arrangements which include keeping under review staffing levels, providing more staff training and improving recruitment procedures are needed to meet the needs and safeguard people who use the service. EVIDENCE: The majority of comments received about the staff team from people who use the service and relatives were positive. These included “They look after the elderly with care and compassion, they are always very kind and go out of their way to provide the best service and are always friendly”. One of the comments in the survey indicated that not all staff operate to the same standards as it stated that some staff were “slap dash in their approach to care”. It is not clear if this comment is linked to staffing levels, staff training, staff attitude or a mixture. Three people spoken with who use the service said that they get the care and support they need from staff and observations on the day of inspection supported this. However feedback from staff and relatives indicates that this is not always peoples experience and said that problems arise mainly when staff are off sick and at weekends when they are asked to cover other duties such Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 25 as cleaning and ‘hostess’ duties. The survey completed by relatives asks, “How do you think the service can improve”. One relative responded, “Give the support to ensure that staffing numbers are met”. Another “but they always seem short staffed”. A comment received from someone who uses the service “see some people having to wait a long time to go to the toilet particularly at meal times”. Surveys from two out of six staff who completed surveys said that their induction covered everything they needed to know very well and four others said it mostly did. One member of staff said they were short staffed when they started but that there was always someone to ask. Some staff training was taking place at the time of the inspection, however training statistics identify that a significant amount of training is required to ensure that staff have received training appropriate to their roles and to meeting the needs of people who use the service. Staff identified in the surveys that they receive training appropriate to their role. One member of staff particularly highlighted the need for more dementia care training to give them a better understanding of the needs of people with dementia. Some staff were receiving this training at the time of the inspection, however it was of concern that up to this point in time only a small number of staff have received training in this area. There are some important areas where the training statistics indicate that staff have received no training. These are nutrition and pressure area care. Both of these are considered important areas of training in the care of older people. Staff confirmed in surveys that checks such as criminal record bureau checks and references were made before they started work. One staff member said that they “are strict on that and had to wait two months to start”. A sample check of two staff files confirmed that criminal record bureau clearances are obtained prior to staff starting work. The file for one staff member showed that a full employment history and two references had also been obtained. The second showed gaps in the employment history with no evidence of the reasons being explored and only one reference, which was from an e-mail address and had not been verified. Similar findings were identified at the last inspection and a requirement was made. These checks are important in helping to protect people who use the service. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager works in the best interests of people who use the service, however quality assurance systems need to be more effective in improving and maintaining the quality of care. EVIDENCE: There is a Registered Manager who is suitably qualified and experienced. A staff member said that she is approachable and observations and discussion with relatives indicated that good relationships have been developed between the manager and people’s families. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 27 As feedback was given to the Registered Manager throughout the inspection she acted promptly to address some of the concerns raised. For example to review and revise a pain management care plan and also to meet with staff and change recording practices in relation to monitoring the risk of constipation. The last inspection in June 2007, while identifying some areas where improvement was required, found that the outcomes for people who use the service were good. This inspection has identified that although some people are very happy with the care in some cases the outcomes for people are poor in some areas. We are aware that the Registered Manager has had some periods of sick leave since the last inspection, however the expectation is that appropriate management arrangements are in place and the quality of care is overseen and maintained by the organisation. Southern Cross Healthcare has a range of quality assurance tools and audits to help measure the quality of care; for example Operations Managers carry out monthly unannounced visits to look at the quality of care provided. These unannounced visits are a requirement of the Care Homes Regulations 2001 as it is considered important that organisations are overseeing the quality of care provided to people using the service. Reports of visits in January 2008, March 2008 and May 2008 were seen and all had positive findings with no concerns being identified. In addition Lucas Court have set up a quality assurance group, which involves people who use the service. Views have been gathered so far about the staff team, activities, hairdressing and residents meetings. People have also been involved in a survey about a proposal to set up a mobile shop. Although the group is in its early stages it is positive that people who use the service are being encouraged to participate in the quality group. Some people leave small amounts of money for safekeeping to assist with paying for services such as hairdressing and chiropody. This kept in a central bank account, which accrues interest and is added to each individual account. Records are kept of all transactions and receipts kept to verify these. This helps to safeguard people. The necessary forms and templates are in place to help ensure that records required by regulations are in place. The records are not in all cases completed to a good standard or used effectively to support the care of people who use the service. Some examples of this were identified through a sample check of the accident/incident records. For example: One record just states “at time of observation no injury or bruise”, there is no information to indicate what the accident was or why the record was completed. Some records show the time last seen and time of accident as the same, indicating that the accident was witnessed, however it does not say who Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 28 saw it and the descriptions of what happened are minimal. The dates on the forms and the order of the forms in the book in two cases show that the records had been completed at least three days after the event. Accident records are considered to be an important tool in monitoring the health and safety of people who use the service, which cannot be effectively done unless they contain complete and accurate information. Observations during the inspection were that staff were carrying out safe practice in relation to the movement and handling of people who needed assistance. Training records identify that staff do receive training in safe working practices, however some updates are now required to help ensure that staff have the necessary knowledge and skills to reduce the risk for people who use the service. Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 29 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 12 (1) (a & b), 13 (1) (b) Requirement People’s health and well being must be monitored with prompt action/referral to healthcare professionals as appropriate. This must include the risk of constipation for those people unable to express a problem. Where it is assessed that it is necessary to monitor people’s fluid intakes, records must be checked daily and reasons for people receiving insufficient fluids investigated. Where People have a PEG (Percutaneous Endoscopic Gastrostomy) feed tube fitted, up to date care records must be in place to show the current condition of the site and any care provided. Prescribed medication must be checked on admission and any additional medication brought in must be checked without delay with the General Practitioner. This is to ensure people receive all of their prescribed medication. Accurate, complete and up to DS0000012628.V368746.R01.S.doc Timescale for action 25/08/08 2. OP8 12 (1) (a & b), 25/08/08 3. OP8 12 (1) (a & b), 25/08/08 4. OP9 13 (2) 25/08/08 5. OP9 13 (2) 25/08/08 Page 31 Lucas Court Nursing Home Version 5.2 date medication records must be kept to ensure that medication is administered correctly, safely and as intended by the prescriber to manage individual health needs. This requirement with a timescale for compliance of 26/11/07 has not been met. 6. OP18 13 (6) All staff must receive safeguarding adults training to help protect people who use the service. Carpets must be kept clean and free from odour and replaced as required to ensure people have a pleasant environment to live in. Staffing levels must be reviewed and monitored in consultation with people who use the service and sufficient staff provided to meet their needs. The recruitment procedure must include obtaining a full employment history and ensuring that employment references have been obtained to protect residents’. This requirement with an original timescale for action of 15/08/07 has not been met. 10. OP30 18 (1) (c) (i) Staff training should be implemented to address gaps identified in the staff training matrix to ensure that all staff have up to date training to meet residents’ needs. Quality assurance systems must be effective in improving and maintaining the quality of care provided to people who use the service. DS0000012628.V368746.R01.S.doc 30/10/08 7. OP19 23 (2) (d) 30/09/08 8. OP27 18 (1) (a) 30/09/08 9. OP29 19 25/08/08 30/10/08 11. OP33 24 (1) (a & b) 30/09/08 Lucas Court Nursing Home Version 5.2 Page 32 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 OP1 Good Practice Recommendations The statement of purpose should include more information about the range of needs that can be met and the type of care provided. The information should be checked to ensure that information is accurate and not misleading. Dates of opening should be recorded on medication with a short expiry date when opened to ensure that the medication remains effective. Pain management care plans should be implemented where appropriate and particularly in cases where people are not able to verbally communicate to staff that they are in pain. All staff working with people with dementia should be aware of how to interact and communicate with them. Checks should be made to ensure that the controlled drugs cabinet in the nursing unit complies with legal requirements. This recommendation was made following an inspection by a pharmacist inspector in November 2007. The action taken was not checked at this inspection and will be checked at the next. Care records should be organised, completed and kept in a manner, which supports people’s care. 2. 3. OP9 OP7 4. 5. OP12 OP9 6. OP37 Lucas Court Nursing Home DS0000012628.V368746.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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