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Inspection on 26/04/05 for Lucas Court Nursing Home

Also see our care home review for Lucas Court Nursing Home for more information

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service is always co-operative with the inspection process and responds to requirements with the development of action plans.

What has improved since the last inspection?

There has been an improvement in the premises with a refurbishment programme. This has included redecoration to communal areas and new carpets being fitted to provide a more homely and pleasant environment for the residents. Record keeping has improved with more detailed and accurate care plans being used to ensure resident needs can be met. The recruitment of staff procedures have improved to ensure that staff employed have all the necessary checks, training and experience to provide care to the residents in the home. The provision of activities has also improved with the employment of two activity co-ordinators who provide daily stimulus to both groups and individual residents.

What the care home could do better:

The storage of medication when being returned to the pharmacy needs to be managed in a safe way to prevent residents being at risk of accessing unsecured medication. The stock levels of medication need to be carefully recorded and monitored to account for all medication received in to the home. The safety of residents during work by contractors needs to be managed in a safe manner to protect the residents from any potential harm. The temperature on the first floor needs to be monitored and reviewed to ensure residents are comfortable and to provide acceptable working conditions. Staffing levels need to be reviewed to ensure that there are sufficient staff to meet all the needs of the residents in a safe and manageable manner.

CARE HOMES FOR OLDER PEOPLE Lucas Court Nursing Home Northampton Lane North Moulton Northampton NN3 7RQ Lead Inspector Moira Mosley Unannounced 26 April 2005 10.30 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lucas Court Nursing Home Address Northampton Lane North Moulton Northampton Northants NN3 7RQ 01604 493233 01604 493234 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Serices Limited Vacant Care Home with Nursing 60 Category(ies) of PD(E) Physical Disability - Over 65 (6) registration, with number MD(E) Mental Disorder - Over 65 (28) of places DE(E) Dementia - Over 65 (1) OP Older Persons (60) PD Physical Disability (6) Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users in the category of DE(E) must be accommodated on the first floor. 2. Two named female service users may be accommodated in the category of Mental Disorder, until such time as they leave the home. 3. 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 4. 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 5. 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) Date of last inspection 1st February 2005 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 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 DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection by two inspectors over 6 hours. The care of four residents was reviewed including their care records and medication. Discussions were held with those residents and a further four residents to find out how they felt about living in the home. In addition, a resident’s relative, a Community Psychiatric Nurse, and five members of staff gave comments about the home. We have visited the home on a number of occasions since the last inspection in September 2004 due to the number of concerns that have been raised during a complaint investigation and subsequent visits to monitor the homes compliance with requirements made. This has included additional visits by a pharmacy inspector from the Commission for Social Care Inspection. The management of the home have undertaken steps to rectify issues identified on the complaint investigation and subsequent issues of concern. Action plans have been submitted to address any identified shortfalls in care. The manager vacancy has been addressed with an experienced manager from another of this companies homes transferring and taking the acting managers post in Lucas court from January 2005. What the service does well: What has improved since the last inspection? There has been an improvement in the premises with a refurbishment programme. This has included redecoration to communal areas and new carpets being fitted to provide a more homely and pleasant environment for the residents. Record keeping has improved with more detailed and accurate care plans being used to ensure resident needs can be met. The recruitment of staff procedures have improved to ensure that staff employed have all the necessary checks, training and experience to provide care to the residents in the home. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 6 The provision of activities has also improved with the employment of two activity co-ordinators who provide daily stimulus to both groups and individual residents. 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 DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 There is a good pre admission procedure and assessment to ensure that residents needs can be identified and met. EVIDENCE: One resident’s assessment identified complex nursing needs and there was evidence that the necessary skills and equipment were in place before admission. The resident and his relative spoke of being very happy with the information they were given before moving into the home and felt that all needs had been met. Discussion with staff identified that they had received information about care needs before admission and were supported to ensure that the care provided was manageable by the staff team. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 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 standard(s) 7, 8 and 9 A proactive management strategy is in place to address the needs of the residents through care plans and healthcare assessments. The management of medication must be improved to ensure that it is securely stored and carefully audited to reduce the risk of medication errors. EVIDENCE: Following previous requirements the content and detail of the care plans has improved. One resident with complex nursing needs had detailed plans for all assessed needs which clearly outlined the action to be taken to ensure all staff were aware of how to meet his care needs. The resident indicated that he was happy with the care he was receiving and his relative confirmed this. Staff spoken to confirmed that the records are being maintained and they receive clear direction of what action is needed to respond to identified needs. There was evidence of liaison with the GP and other healthcare specialists in response to areas of concern including weight loss. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 10 Pressure area care has improved with evidence of assessment and detailed care plans in place. The evaluations did not always contain information about the condition of the pressure ulcer to indicate response to treatment. A resident on the first floor was displaying difficult to mange behaviours and the care plans gave clear guidelines on how best to manage these. However, it was evident that she had a risk of falls due to her climbing out of and over furniture including her bed. The use of bed rails was identified as a potential risk and an urgent review was recommended for her safety. An audit of medication showed that overall the procedures for ensuring the safe storage, administration, recording and disposal of medication including controlled drugs has improved since the last Commission for Social Care Inspection pharmacist visit when a number of requirements were made. An unlocked and unsupervised trolley containing medication was seen in the communal hallway, it contained bottles and strips of medication that were being collected for disposal by the pharmacist. There was a risk that the residents in that area could have taken medication from that trolley undetected. An immediate requirement was made. An audit of medication on the first floor found a discrepancy in the amount of Promazine liquid in stock for two residents, with a total of 170 mls missing. An immediate requirement was made for an investigation into the shortfall of medication. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 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 standard(s) 12 and 15 Interactions and activities are well managed to provide daily variation, stimulus, and interest for all the residents. EVIDENCE: There were activity co-ordinators on both floors encouraging and supporting residents to participate in activities. One resident with complex needs was included in activity and effort was made to engage all residents. Staff were observed to interact positively with the residents throughout the inspection. Lunch was served during the inspection 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 although there were several residents having to wait for available staff. This is further addressed in National Minimum Standard 27 (staffing levels). The arrangements for serving the meal on the first floor was of concern due to the presence of decorators and the manager was asked to intervene to prevent residents becoming agitated and potential moving and handling risks. This is further addressed in National Minimum Standard 19 (environment). Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There is a proactive management process in place to respond to complaints effectively and ensure residents’ needs are addressed. EVIDENCE: There was one complaint made to us in November 2004 about pressure ulcer care. Following investigation this was upheld and requirements were made. During the complaint investigation inspection a number of serious concerns were identified about the care of residents with healthcare needs that were not being addressed by a GP, pressure ulcer assessment and intervention; nutrition and weight loss and manual handling practices seen. Requirements were made and a visit by the Commission for Social Care Inspection pharmacy inspector in January 2005 raised further issues of serious concern about the medication procedures with requirement s being made. We have continued to regularly visit the home since this time to monitor the progress of compliance. The management of the home have been fully cooperative with the investigation and subsequent visits and have submitted action plans to address the shortfalls identified. At this inspection, the requirements made since November 2004 have been reviewed and all have been met. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25 and 26 The lack of a management plan evident to ensure the safety of residents during the refurbishment and redecoration process placed them at risk in an unsafe environment. The raised temperature on the first floor needs to be reviewed to prevent the risk of dehydration and increased agitation and discomfort for the residents. EVIDENCE: There was a programme of refurbishment and redecoration in progress with new carpets being laid to the main entrance and the first floor being redecorated with new flooring to be laid. The residents spoken to on the ground floor said they were happy with the facilities, décor, and furnishings in the home. The decorators present in the home continued to wallpaper the dining room during the residents’ meal. Residents were seen to be getting agitated and manoeuvrability of residents and wheelchairs were restricted. This was only Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 14 addressed when we raised concern and this was not a safe environment at that time. Three resident bedrooms were seen; two were in good order and showed personalisation for the residents. One had a very stained carpet, but this was due to be renewed very shortly. The home was clean and tidy and it was evident that procedures were in place to minimise any risk of cross contamination and infection from residents who had diagnosed infectious conditions. This included awareness by staff of residents with, for example MRSA and the provision of necessary equipment and facilities. The communal areas on the first floor were very hot, despite several fans and both staff and residents were feeling uncomfortable. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Staffing levels are insufficient to meet all the identified needs of the residents. Staff recruitment and training is good and provides safeguards to offer protection to the residents being cared for in the home. EVIDENCE: The high dependency and level of nursing needs on the ground floor were such that the one registered nurse on duty was unable to oversee and direct care staff. For example, a new residents medication was not booked in due to a GP visit and a resident needing nursing care. This then affected the administration of the lunchtime medication. This resulted in the needs of residents not being met. Care staff were observed to assist resident at lunch time, there were two staff allocated for 14 residents present in the dining room, of which 6 were seen to need feeding in addition to others who were eating in their own rooms and staff stated some of which also needed feeding. On the first floor there were 2 members of staff allocated to care for 13 residents in the lounge, 7 of which needed 2 staff for moving and handling. When staff went for a break, a resident asked to be taken to the toilet and this relied on another staff member passing by chance being summoned to help. When two staff were assisting the one resident there was no lounge cover. Discussions with staff and records seen indicated there has been an increase in the number of falls in the home. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 16 The staff spoken to confirmed they had received recent training in statutory areas including moving and handling and fire. Staff training records confirmed this and the home currently have 3 staff with a National Vocational Qualification at level 2, with a further 6 staff working towards this. A sample of three staff members’ files showed that a thorough recruitment process is in place with staff having the necessary checks including Criminal records Bureau clearance before commencing employment. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 38 The management of the home is effective and provides staff with leadership, guidance, and support. There is a proactive approach to the management of safe working practices with training provided to staff. EVIDENCE: The staff spoken to stated that the management of the home has improved and they receive good levels of support and direction. The residents and visitors in the home along with the staff said they were very clear about who to speak to if there were any problems and felt they were aware of things that were happening in the home. Manual handling assessments and care plans were up to date and gave clear guidelines for staff. There was a range of manual handling equipment available to ensure the safe transfers of residents. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 18 There are staff trained in first aid and the manager states that a first aider is on all shifts. Staff training files showed that all staff are up to date with statutory training in fire, manual handling, Control of Substances Hazardous to health (COSHH) and food hygiene training. Staff spoken to confirmed the training they had received and there were regular planned training sessions available to them. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x 3 2 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 x x x x x 3 Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 12(1(a)(b ) and 13(2) Requirement An investigation must be undertaken to assess the discrepancies in the stock balance of the Promazine and a written response made to the Commission for Social Care Inspection. (this was an immediate requirement) Medication must always be securely stored (this was an immediate requirement) Timescale for action 28/4/05 2. 9 3. 19 4. 25 5. 27 12(1)(a)( b), 13(2) and 13(4)(a)(c ) 13(4)(a)( There must be a risk assessed b)(c) plan in place to ensure residents have a safe environment during all refurbishment and redecoration. 13(4)(c) The temperature on the first and floor must be monitored and 23(2)(p) systems to ensure a safe working temperature reviewed. 18(1)(a) Dependency levels of residents must form the basis of calculating staffing levels and ensuring resident needs can be met. A copy of the calculation to be submitted to the Commission for Social Care Inspection. 26/4/05 30/5/05 30/6/05 30/6/05 Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 21 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 8 28 Good Practice Recommendations The evaluation of pressure area care should include details about the size and condition of the wound. The home should continue to work towards the 50 of staff with a National Vocational Qualification at level 2. Lucas Court Nursing Home DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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 DC51 C08 S12628 Lucas Court V223135 260405 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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