CARE HOMES FOR OLDER PEOPLE
Lucas Court Nursing Home Northampton Lane North Moulton Northampton Northants NN3 7RQ Lead Inspector
Mrs Moira Mosley Unannounced Inspection 12th June 2006 09:00 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.V298995.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.V298995.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 Vacant 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.V298995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 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 18th October 2005 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 enclosed well-maintained garden to the rear of the home, which is accessible to wheelchair users, and a car park.
Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 5 The current weekly fees for the home range from £560 - £580 per week. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection by one inspector. The inspection process included the collation of information and pre-inspection planning to gather information and then six hours were spent in the home. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents and their views of the service provided. This is achieved primarily through the process of ‘case tracking’ which involves reviewing the care of specific residents including looking at their records, talking to them and their families or representatives where possible and talking with the care staff who provide the personal care to those selected residents. The care of six residents was reviewed on this inspection to include care plans, risk assessments, medication and other records. In addition seven residents were spoken to and several others met. Discussions were also held with five staff members and a period of observation undertaken. What the service does well:
The residents spoken to were positive about the home comments included “the staff are very helpful” “its fine here, I like being able to go outside” and “we do lots of things that I enjoy”. The pre admission assessment is good and residents and their relatives are encouraged to be involved in the initial assessment. There is a core of consistent and stable staff who demonstrated a good understanding of the individual needs of the residents and it was evident they use a variety of methods to aid communication. Care plans are completed to a high standard with good levels of information to ensure a consistent approach and they work well with other care professionals to ensure needs are identified and addressed. Healthcare assessments, for example pressure ulcer and nutritional assessments along with risk assessments are good with good clear directions and links to the care plans to ensure needs are fully identified and met. Social, cultural and religious needs are assessed with plans in place to meet those needs, for example access to church services. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 7 There is a good activity programme for residents with outside entertainers, regular trips out into the community and daily in house activities including ball games, quizzes, cards, arts and crafts. The manager has set up procedures to assess if the home is meeting needs with regular audits of processes and questionnaires being sent to regularly to assess others views of the home, this along with regular meetings for residents, staff and relatives and a clear complaints process is helping to ensure the home is constantly looking to make improvements and address any issues raised. What has improved since the last inspection? What they could do better:
At the last inspection a recommendation was made for staff to be trained and supported to provide stimulation and occupation to residents with dementia outside of the planned activity timetable, this has not been implemented. Residents were observed to have their basic care needs met and staff were pleasant and polite but there was no positive interaction or stimulation, residents were observed to be sat mainly in the lounge dozing, some occasionally wandered or spoke out but staff who were sat in the lounge did not appear to know how to encourage activity. There were no pictures, ornaments, rummage boxes or anything else to stimulate, the television was on with no sound and any movement of person or furniture was discouraged. Residents with dementia were not always offered choice about where they went or informed about what happened next or why. Things happened with no explanation, which could only add to the already confused state. Even small choices could assist residents in having some control over their lives. The first floor was very hot and uncomfortable and temperature recordings are being taken, the owners are reviewing the systems in place to maintain a safe working temperature and try to make it a more comfortable environment for the residents who live in the home. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 8 The acting manager has been at this home for over a year and although was registered by the Commission as the registered manager at her previous home, no application has yet been made for this home. 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. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 9 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.V298995.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s are being fully assessed to ensure their needs can be met prior to moving in to the home. EVIDENCE: Two of the residents whose care was tracked have moved in to the home over the past few months. Their pre admission assessment was detailed with evidence of an assessment by the manager of the home including a visit to the prospective person, liaison with the resident, their families and professionals involved in their care to ensure needs could be met. A pre admission draft care plan is written to give an overview of key needs and give staff direction on what is required prior to the resident moving in and during the initial settling in period, before the more detailed care plans are developed as the resident settles into the home. All residents have a physical and social assessment usually completed with their family that includes their past history, likes, dislikes, personal, social, religious and cultural needs.
Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 11 The residents spoken to said they liked the home and had been given information about it before they moved in. Intermediate care is not offered at Lucas Court so standard 6 is not applicable. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system ensures residents’ needs are met and medication procedures were good. EVIDENCE: The care plans for the six residents whose care was tracked were viewed; these contained comprehensive information and gave clear directions for staff to meet most needs. Care plans are regularly reviewed and updated and staff spoken to confirmed they use the plans as a working tool and are involved in their development and updating. Regular reviews are held with the residents an their families attending, comments within these documents included “feel like he [resident] lives in a safe friendly environment” and “we are very happy with the home”. The care plans are reviewed at this time and the resident or their representative signs agreement to the current plan of care. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 13 Healthcare needs are fully assessed including pressure ulcer and nutritional assessments. These are cross-referenced to care plans where needs are identified. There were also falls and manual handling assessments in place again with reference to care plans when indicated. There is evidence of input from a range of healthcare professionals including the GP, physiotherapy, tissue viability nurse, dental, optical and chiropody services. There are medication procedures in place for the safe ordering, storage, administration and disposal of medication. The medication administration records were cross-referenced to the medication stored for three residents and a spot check of all tablets in the monitored dosage system was undertaken. Overall there was a good system in place and the audit of medication demonstrated that residents are receiving their medication as prescribed. Observations showed staff interacting positively with residents and showing care to maintain their privacy and dignity especially when involved in providing personal care needs. The residents spoken to stated that they liked living in this home and felt the staff were very nice to them. One resident spoke about how she now feels safe and well cared for. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The daily life for people on the dementia unit could be improved to provide more stimulation and encourage them to participate in making choices. EVIDENCE: Within the care plans residents have records of their past history, interests and likes along with what activities they would enjoy. There are two activity organisers employed, one for each floor. There are regular events planned including in house activities and outings. The residents spoke about a boat trip planned for next week and an entertainer who had been in last week. On the dementia unit although regular daily activities are supported, the time when the activity person is not present there is no additional stimulation or positive interaction. The staff observed were very pleasant and polite and saw to the basic care needs of the residents, however there was no positive stimulation or encouragement for interaction, most residents were dozing in their chairs and those that were talking or wandering got no response.
Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 15 One resident had a newspaper, which he put on a small table and then tried to move the table, he was stopped and encourage to sit down, once sitting he was left and proceeded to doze. Staff confirmed that training has been provided about dementia but this does not include ideas and equipment that could be used to engage the residents. Residents spoken to confirmed they have regular visits from family and friends and enjoyed outings into the local community. They said they were able to make choices about how they spend their time. The residents on the ground floor said they could make choices on a daily basis, what time to get up, go to bed and how they spent their day. Again on the first floor dementia unit, choice was not positively encouraged or explained. One resident was observed to be asleep as lunchtime approached, the staff woke him and used a stand aid to transfer him to a chair and took him to the dining room, and at no time did they explain what was happening. Another resident in the dining room stated she did not like the ‘bibs’ and asked did she have to have one, there was no response and she complied while staff put it on her. The lunchtime meal was observed and the residents spoken to stated the food was very good and a choice of menu was offered on a daily basis. Staff were seen to assist residents who required help with eating and there are hostess staff that assist with managing the dining room and serving residents. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective system for the home to respond appropriately to complaints made and residents are protected from abuse with their views listened to. EVIDENCE: The complaints procedure was available on the notice board and staff spoken to were aware of the complaints process. The residents spoken to stated they would speak to the staff or to the manager if they had concerns. There have been six complaints since the last inspection; these included missing items, staff not attending to needs quickly enough, a resident going to hospital with insufficient information, lack of chiropodists and complaints about lumpy soup. All are fully documented and investigated by the manager with the outcomes clearly fed back to the complainant and all have been fully resolved. Staff demonstrated a good understanding of abuse and training records demonstrated they have received training on how to recognise and report any concerns. There have been no allegations made since the last inspection. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good providing service users with a homely and safe place to live. EVIDENCE: A tour of all communal areas showed the home to be clean and well maintained. The programme of redecoration and refurbishment has continued and all areas were pleasant, the residents spoken to said they were happy with the environment and liked the facilities on offer. Residents were observed to be using the gardens, which are secure and accessible to wheelchairs. A maintenance person is employed for the general upkeep of the building and records demonstrated adequate checks and routine maintenance including fire records. The environmental health officer visited last week and there were no issues of concern.
Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 18 Three resident bedrooms were seen and the residents spoken to said they had all the equipment and furnishings they needed and that they liked their bedrooms. It was a hot day and the temperature on the first floor was very high. Last year air conditioning was fitted to the main lounge area and treatment room and both these areas were cool, however the main corridors and other areas were extremely uncomfortable despite a number of fans. The temperatures are being recorded on a daily basis and the inspector was informed the company are considering the fitting of more air conditioning units to address the problem. Infection control procedures are in place and staff confirmed they have access to gloves and aprons and that laundry processes are well organised to meet the needs of the residents. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified and trained staff are provided in adequate numbers to ensure resident needs can be met. EVIDENCE: Staff training records demonstrate that staff have received the training needed in order to perform effectively within their roles. All staff are currently up to date with statutory training. There are a number of planned training events over the coming months and these are advertised on staff notice boards. Staff spoken to said that moral is currently quite good and staff were being supported in their roles. Staffing levels are maintained and both staff and residents spoken to said they felt there were sufficient care staff around to meet most needs. Some of the staff spoken to have achieved their National Vocational Qualifications (NVQ) at level 2 and they said that the manager was arranging for further people to commence this training. The recruitment procedures are good with evidence in staff files of a comprehensive system including references and Criminal record Bureau (CRB) checks prior to commencement of employment to ensure they are suitable to work in care.
Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective system in place to address issues identified and residents’ views are being sought with working practices in place to ensure that the health and safety of residents is promoted and protected. EVIDENCE: The acting manager has been in this home for over a year although an application for registration with the Commission has not been made. She was previously the registered manager of another home owned by the same company and has many years of experience both as a manager and working within this client group. There is an effective system in place for the management of residents’ money with clear audit trails and balances available. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 21 There are regular meetings with residents, staff and relatives with the residents being supported and encouraged to be involved in the running of the home as far as possible. There is a Quality Assurance system including a monthly audit of all areas of the home with action plan identified for any shortcomings noted. There are questionnaires sent out to families and friends of the home including some stakeholders, these are then be collated and a development plan developed for any issues identified. Policies and procedures are regularly updated and staff receive a company handbook outlining key policies. Manual handling plans were available in care handling procedures showed appropriate use required. Staff confirmed they have received including manual handling, food hygiene and plans and observations of manual of equipment and aids as statutory training in all areas fire. Fire records showed regular checks and maintenance of the systems and regular fire drills. A first aid qualified staff member is available on all shifts. A maintenance person oversees all regular maintenance and compliance with health and safety legislation. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation 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 2. 2. 3. Refer to Standard OP12 OP14 OP25 OP31 Good Practice Recommendations Care staff should be trained and equipment or resources provided to stimulate and occupy the residents with dementia outside of the planned activities. Staff should be trained and evidence maintained of supporting residents with dementia to make choices in their daily lives. Consideration should be made to reduce the temperature on the first floor. An application should be made for the acting manager to be registered with the Commission. Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lucas Court Nursing Home DS0000012628.V298995.R01.S.doc Version 5.2 Page 25 - 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!
