CARE HOMES FOR OLDER PEOPLE
Lucas Court Nursing Home Northampton Lane North Moulton Northampton Northants NN3 7RQ Lead Inspector
Mrs Moira Mosley Unannounced Inspection 18th October 2005 10:00 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.V256698.R01.S.doc Version 5.0 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.V256698.R01.S.doc Version 5.0 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.V256698.R01.S.doc Version 5.0 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. 26th April 2005 4. 5. 6. 7. 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.The home is located in the village of Moulton on the outskirts of Northampton. The village has local shops and public houses and is on a bus route 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.V256698.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection by one inspector, two hours were spent gathering information and planning for the inspection and 3.5 hours were spent in the home. The care of four residents was reviewed to include care plans, risk assessments, medication and other records. In addition discussions were held with three residents, five members of staff and a visitor to the home and a period of observation on both floors undertaken. The CSCI visited the home on the 7th July 2005 to monitor compliance with the previous inspection and improvements had been made, all the requirements made on the 26/4/05 had been met and the home was undergoing extensive refurbishment and redecoration. What the service does well: What has improved since the last inspection?
At the monitoring visit in July 2005 all the requirements made at the inspection in April 2005 had been met. These included improvements to medication storage and discrepancies in stock management; a further requirement for a clear audit trail of medication in the home has been met. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 6 The temperature on the first floor has been improved with the fitting of an air conditioning system and the refurbishment and redecoration has created a very pleasant environment, which the residents appear to enjoy. Staff spoke about the good level of support they are receiving and the training that has taken place including dementia training. They said they have sufficient numbers of suitably experienced staff on duty to be able to meet the resident’s needs. The residents and staff were all very settled and there was evidence of positive interactions between them. 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. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 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 the following standard(s): 3 There is a good pre admission process to ensure resident needs can be identified and met. EVIDENCE: Detailed pre admission assessments are contained within resident files and show that the resident and their families are involved where possible in the process. The new care planning system includes a pre admission draft care plan which gives a clear overview of needs identified and direction for staff to provide care from the point of admission before more detailed care plans are developed as the resident settles into the home. Intermediate care is not offered at Lucas Court so standard 6 is not applicable. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 9 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 and 10 Pressure area assessments are not always being followed up with appropriate interaction and putting residents skincare at risk. Care plans are not being used as working documents and this compromises consistent care. EVIDENCE: Care plans are detailed with clear instructions on the interventions needed to meet resident needs. However discussions with care staff identified that although they received a handover about residents at the start of their duty they did not always review or use the care plans as working documents on a daily basis and relied on verbal information from the nurse in charge about any changes to care needs. Healthcare assessments are completed and there was evidence of input from other professionals, for example the GP, dietician and continence advisor where required. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 10 There were two residents within the dementia unit identified who had high risk pressure ulcer assessments, one had no care plan to address how this need would be met and the other had a detailed care plan which indicated the use of a pressure relieving mattress and cushion, the mattress was in situ, however there was no cushion being used. These issues were addressed at the time of the inspection. Residents looked clean and well groomed and the staff spoken to confirmed they supported residents to maintain privacy and dignity even when they were unable to express their needs. Observation showed positive and appropriate interactions between the staff and the residents. A monthly audit of medication procedures by the acting manager is leading to improvements in the management of medication. An audit trail has been introduced to ensure the stock and administration of medication is monitored. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The provision of activities, food provided and support given to residents to maintain contact with families and friends overall provides a good level of daily interest and stimulation. The lack of meaningful occupation specifically for residents with severe dementia is restricting their quality of life. EVIDENCE: A very comprehensive activity programme is offered within the home and the activity organiser is enthusiastic and works with residents on both a 1-1 and small group basis. The residents spoken to said there was lots of things going on and at the time of the inspection many were involved in a reminiscence session with an external entertainer, which they were observed to be enjoying. As part of the refurbishment the dementia unit has equipment to stimulate the residents including ‘touch boards’ in the corridors. Rummage boxes are now available but there were not seen at the time of the inspection. Within one of the dementia unit lounges there were 3 staff available but there was only 1 person in attendance with 9 residents who were either dozing or
Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 12 trying to stand up, the staff member was preoccupied with ensuring the safety of the residents and encouraging them to sit down with little evidence of any stimulation to occupy and redirect residents. Staff spoken to stated they had had dementia training but no specific direction in what to do to encourage positive interactions. A visitor spoken to confirmed he was always welcome in the home and residents notes showed evidence of regular contact with families and friends. There is information available around the home about advocacy services to provide support and help to the residents and their families. The residents spoke highly about the food and the kitchen was well organised with the necessary facilities and equipment to provide a well balanced diet. The Environmental Health Officer last visited in June 2005 and there were no issues of concern identified. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 There is an effective system in place to ensure the residents are protected from abuse. EVIDENCE: Staff confirmed they had received training about abuse and felt they would be able to raise any concerns within the management structure of the home. There are procedures in place for the reporting of and action required in the event of any protection of vulnerable adult concerns and the home has demonstrated an appropriate response when a concern was raised about the treatment of a resident, they reported it promptly to the relevant services and conducted a detailed investigation. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The home provides a safe and comfortable environment for the residents. EVIDENCE: The home has been refurbished and redecorated to a high standard with new décor throughout. The home was clean and tidy and the residents, staff and visitor spoken to were very happy with the environment. The fire system and maintenance programme is kept up to date with regular recorded checks and a system for addressing any health and safety concerns. The temperature concerns on the first floor have been addressed with the fitting of an air conditioning system to ensure a comfortable environment. Staff commented that since the environmental changes they feel that residents within the dementia unit have been much more settled, more relaxed and less agitation noted.
Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 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 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): These standards were not assessed on this inspection. EVIDENCE: Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 16 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 and 35 There are effective systems in place to ensure that residents’ views are sought about the service and that their financial interests are safeguarded. EVIDENCE: The Registered Managers’ position remains vacant although it is the intention of the current acting manager to apply for registration. The staff and residents all speak very highly about the acting manager and the many positive changes have been implemented under her guidance over the past 10 months. The home does not act as appointee to any resident and either they, their families or representatives have financial control. All monies given to the home for safekeeping is fully documented and receipted. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 17 There is a Quality Assurance system in place with both internal and external audits to ensure standards are maintained. Regular resident and family meetings are held to seek feedback about the care service in addition regular individual reviews are held with residents and their representatives and includes the opportunity to discuss issues about the home with a senior member of the team. The acting manager runs a weekly clinic, with an open door policy for staff; visitors or residents to discuss any concerns and questionnaires have been used to further assess views about the service received. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 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 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 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X X Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 19 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. 1 Standard OP8 Regulation 13(1)(b) Requirement Pressure ulcer assessments must be completed for all residents and evidence available of action required to minimise any risk identified. An application for the registration of a Manager at the home must be submitted to the CSCI. Timescale for action 30/11/05 2 OP31 8 30/11/05 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 Refer to Standard OP7 OP12 Good Practice Recommendations The care staff should be using the care plan documentation as a working tool to direct the care they provide. Care staff should be trained and supported to provide stimulation and occupation to resident with dementia outside of the planned activity timetable. Lucas Court Nursing Home DS0000012628.V256698.R01.S.doc Version 5.0 Page 20 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
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