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Inspection on 29/06/07 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 29th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

There is a relaxed atmosphere and observations confirmed that staff were aware of residents` individual needs and preferences. There is a thorough assessment process before people are admitted where detailed information about the needs of the individual is gathered, helping to ensure their needs can be met. Information is provided about fees and access to inspection reports. Residents` spoken with who were able to express a view about their care, were happy they were getting the care and support they needed. Observations carried out on both floors during the inspection indicated that residents` were receiving good care according to their needs. Staffing arrangements at meal times were very good. Observations on the dementia unit identified that the use of hostesses helped to ensure that there was someone with a good overview of what residents` had eaten. This also helped care staff to concentrate on supporting and assisting the more physically dependent residents`. Residents` were happy with the meals provided, which looked appetising on the day of inspection. Staff were very good at ensuring that all residents` including those with dementia were offered a choice of meal. These were offered appropriately at the time of service of the meal. Visitors are encouraged, visiting times are flexible and there is the opportunity for residents` to see visitors in privacy if they wish. Staff were happy to assist in transferring a resident to their room. Quality assurance systems are in place to monitor the standards of care provided and areas for improvement are identified and acted on.

What has improved since the last inspection?

The annual quality assurance assessment submitted by the manager identifies care planning as an area that has improved since the last inspection. The findings of the inspection would confirm that this is so with many of the care plans, which have been completed to a good standard. Documentation of complaints was identified as another area that has improved. Records relating to the management of complaints were found, during the inspection to be very clear, with details of the investigation and actions taken. A team of bank staff have been recruited which has meant that it is not necessary to use agency staff to cover staff absences. This helps to provide more consistent care to residents`.

What the care home could do better:

Care plans which support the care provided in some cases were very good and peoples care needs were reviewed regularly. However these good standard needs to be achieved for all care plans to ensure all residents` care needs are properly supported. Records relating to health professional visits and the advice given need to be consistently recorded to ensure that any changes in advice regarding treatment or changes of residents` medication are clear. The recruitment process needs to be more rigorous to ensure that residents` are protected as far as possible. For example applications need to be checked to ensure that a full employment history has been given and that references always include an employers reference rather than one from a colleague. The current manager has been in post for over two years, however an application for the registration of a manager has not yet been submitted to the Commission for Social Care Inspection. A registered manager has specific legal responsibilities, which include making proper provision for the health and welfare of residents`.

CARE HOMES FOR OLDER PEOPLE Lucas Court Nursing Home Northampton Lane North Moulton Northampton Northants NN3 7RQ Lead Inspector Kathy Jones Unannounced Inspection 29th June 2007 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.V339433.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.V339433.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.V339433.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 12th June 2006 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.V339433.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. The following fees were given as current at the time of this inspection: Local Authorities who are funding residents are charged at a set rate of £332.48 for nursing care plus any additional nursing contribution. For those requiring dementia nursing care the fee is £353.85 plus any additional nursing contribution. Residents funded by the local authority will be asked for a ‘top up’ fee, which varies according to their ability to pay. Privately funded residents are charged between £650 and £680, plus any additional nursing contributions. The actual fee is dependent on the resident’s assessed needs. 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, which as detailed in the body of this report is currently under review. A copy of the last inspection report is also available. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. 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 the information held by the Commission for Social Care Inspection as part of the pre-inspection planning and an unannounced inspection visit to the service. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls, letters, and details of any complaints and concerns received. The report from the last key inspection carried out on 12 June 2006 was reviewed and the findings taken into account when planning this inspection. Two unannounced inspection visits were made, the first of which covered the morning and afternoon of a weekday. A second visit was made to review staff files to check the adequacy of the recruitment process in protecting residents’. The files were not available for inspection on the first visit as the manager and administrator were on sick leave. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. Some of the residents’, particularly those with dementia were unable to express their views on the care provided, therefore observations were made of their general well being. The inspector also spoke with other residents’ who were not part of the case tracking process. An annual quality assurance assessment (self assessment) submitted by the manager was received and reviewed as part of the inspection process. Some views from residents’ and relatives were obtained during the inspection and have been taken into account as part of the inspection. As part of the information gathering process the Commission for Social Care Inspection, forward questionnaires for distribution to a selection of residents’ and their relatives. At the time of completion of the report no completed questionnaires had been received. Communal areas and a sample of residents’ bedrooms were viewed during the inspection and observations were made of residents’ daily routines. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 7 Some verbal feedback on the inspection findings was given to the Deputy Manager during the inspection and an overview of the findings was given to the Operations Manager who was present at the end of the inspection. What the service does well: What has improved since the last inspection? The annual quality assurance assessment submitted by the manager identifies care planning as an area that has improved since the last inspection. The findings of the inspection would confirm that this is so with many of the care plans, which have been completed to a good standard. Documentation of complaints was identified as another area that has improved. Records relating to the management of complaints were found, during the inspection to be very clear, with details of the investigation and actions taken. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 8 A team of bank staff have been recruited which has meant that it is not necessary to use agency staff to cover staff absences. This helps to provide more consistent care to 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. The summary of this inspection report can be made available in other formats on request. Lucas Court Nursing Home DS0000012628.V339433.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.V339433.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, standard 6 is not applicable 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 available to prospective residents’ and their families was reviewed to see what information is available to help them make a decision about choosing a care home. The statement of purpose and service user guide, are corporate documents with some information specific to Lucas Court. The Operations Manager has advised that the documents will be reviewed and that more information about the range of needs and the type of care provided at Lucas Court will be included. The Manager has added some additional information within a letter added to the pack, which includes some information about fees and also directs people Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 11 to the inspection reports produced by CSCI. This helps people to make informed choices. Advice was given to ensure that all information contained in the documents is correct and not misleading. The current statement of purpose names the manager as being the ‘registered manager’. This term is used to describe a manager who has been registered by the Commission for Social Care Inspection (CSCI) and has specific legal responsibilities under the Care Standards Act 2000 for the conduct of the care home. At the time of the inspection there was no registered manager and an application for registration had been received by CSCI. Records for a recently admitted resident were reviewed to check the adequacy of the assessment process in determining if their needs would be met. The preadmission assessment was thorough and incorporated the resident’s physical, mental health and social care needs. Information about the residents’ preferred routines, past history, likes, dislikes, personal, social, religious and cultural needs had been gathered as part of the assessment. The information gathered as part of the assessment was then incorporated into a pre admission draft care plan. The plan gave staff a good overview of key needs and 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. Lucas Court Nursing Home DS0000012628.V339433.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall care provided appears to be good and some care plans and records support and guide the care provided very well. However more care needs to be taken to ensure that all care records are completed to this good standard to reduce the risk of residents’ needs not being met. EVIDENCE: Residents’ spoken with who were able to express a view about their care, were happy they were getting the care and support they needed. Observations carried out on both floors during the inspection indicated that residents’ were receiving good care according to their needs. A sample check of residents’ care plan identified that the standard of recording was variable. Care plans are considered to be important documents in guiding staff in the actions required to meet residents’ needs. Some of the residents’ plans were completed to a good standard, were reflective of residents’ needs Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 13 and were sufficiently detailed to enable a new member of staff to provide consistent and appropriate care to meet their individual needs. These care plans were found to have been reviewed regularly and updated where a resident’s needs had changed. However review of one resident’s care file, identified that the numbers of the care plans did not correspond to those in the care plan index, making it difficult to find relevant information. Review of one plan identified that there was no evidence of review or evaluation of the plan to support the changes that had been made to the care provided. Review of records for a resident admitted with a pressure ulcer identified that advice was being sought from the tissue viability nurse and that a record of the treatment and condition of the wound were being kept to monitor improvements. In this case there was evidence of regular review and evaluation of the care provided. Records show that advice and where necessary treatment is sought on behalf of residents’ from other medical and health professionals. For example General Practitioner, Dentist and Optician. However the records of the visits by professionals need to be kept up to date to ensure that it is clear what the current advice is. Records for a resident identified that the General Practitioner had stopped a particular medication at the end of March 2007, however medication administration records showed that this medication was being administered at the time of the inspection. Staff advised that the General Practitioner had later re-commenced this medication but staff had not recorded this in the professional visit record. The Deputy Manager confirmed that she would review other corresponding records and verify the current medication with the General Practitioner. The management of residents’ medication was reviewed through a sample check of records and medication for residents’ on each floor. Medication was securely stored, well organised and generally well managed. Residents’ prescribed medication was available and records were clear about what medication had been administered to residents’. A stock check of the controlled drugs held confirmed that these were clearly and accurately recorded. There were no discrepancies between the stock and the records. Staff were observed to treat and speak to residents in a respectful manner. This was supported by comments received from residents and their relatives. Lucas Court Nursing Home DS0000012628.V339433.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. 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. There is a relaxed atmosphere in the home. Visitors are encouraged and welcomed, arrangements for the service of meals is very good and residents’ are very happy with the quality of food provided. EVIDENCE: The assessment carried out before a resident is admitted to the home includes information about prospective residents’ routines and history which helps staff to understand and support residents with their preferred routines. This is particularly important for residents’ with dementia who are less able to express themselves. For example the assessment for one resident identified that much of their life had been spent on a farm, which helped staff to understand why the resident often got up and wandered at a time that may be considered to many as ‘night time’. Discussion with staff confirmed that they were aware of and respected residents’ individual routines. Discussion with residents’ and staff confirmed that activities are provided and residents’ spoken with were happy with what is provided. They gave some Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 15 examples of activities which included bingo and dominos. Two residents’ were enjoying a tennis match at Wimbledon on the television. There is a relaxed and comfortable atmoshere in the home and observations during the inspection identified that some care staff and housekeeping staff are very good at stimulating and conversing with residents’, including those with dementia. However other staff while meeting residents’ physical care needs appropriatley did not take opportunities to involve residents’ in activities including conversation. The annual quality assurance assessment submitted by the manager identifies plans for improvements which will enhance residents’ daily lives. This includes ensuring that all staff are aware that activities are not just the responsibility of the activities staff. Additional training is to be provided for the dementia activities co-ordinator and they hope to access more activities within the community of the village over the next twelve months. Visiting arrangements are flexible, a relative said that they can visit as and when they wish and confirmed that staff are welcoming. Residents’ are able to see visitors in private if they wish and staff assist this where necessary. Positive comments were received from residents’ and relatives about the food provided. A resident said that they were looking forward to the fish and chips which were planned for lunch. There is a four week rotating menu and choices are provided. Residents’ including those with dementia were all offerred a choice of meal and drink. Assistance was given with making choices where appropriate. Observations of the service of part of the breakfast meal and part of the lunch time meal on the demetia unit identified that the use of hostesses, who are employed specifically to serve and support residents’ with their meals works very well. The hostess had developed a good knowledge of residents’ likes and dislikes and was aware of those residents’ who required support and assistance with their meals and those who may wander off or may need prompting. The hostess who is based in the dining room was also more easily able to monitor individual food intake than a carer who may be assisting other residents’ with washing and dressing. This reduces the risk of residents’ not receiving adequate food and fluid intake. Meals were served hot and looked appetising. Where residents’ want a cooked breakfast these are ordered and freshly cooked once the resident is up and washed and dressed. Toast and hot drinks are freshly made by the hostess in the dining room ensuring that these are served fresh and hot. Lucas Court Nursing Home DS0000012628.V339433.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures for dealing with concerns and complaints which residents and relatives are aware of and staff are aware of their responsibilities for protecting the people in their care. EVIDENCE: Complaints received by the Commission for Social Care Inspection (CSCI) included several telephone calls in August and September 2006 raising concerns about the call bell system and the system, which operates the fire doors being out of action. These systems had been affected by a lightening strike, which hit the building. CSCI and the fire officer had been appropriately notified of the event and the actions taken to reduce the risk to residents until the problem was resolved. A further four complaints have been received by CSCI since the last inspection in June 2006. These complaints were referred back to the organisation to investigate under their complaint procedure. CSCI were provided with the findings of two of the complaints, which were unfounded. These related to staff recruitment and the care of a resident. The other two were still being investigated at the time of the inspection. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 17 Complaint records held at Lucas Court were reviewed and these demonstrated that complaints are taken seriously and investigated thoroughly. Where shortfalls are identified these are acknowledged and information found for staff in the office on the first floor confirmed that they are also acted on. Relatives and residents’ spoken with were aware of how to make a complaint. A resident said that the manager is nice and if there is a problem they can talk to her and she will sort it out. The training records show that some, though not all staff have received training in safeguarding vulnerable adults and this is an area that should be reviewed to ensure residents’ are properly protected. However staff spoken with were clear about their responsibilities for protecting the vulnerable adults in their care. Relatives, residents’ and staff spoken with also had no concerns about how residents’ are spoken to or treated. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is generally good providing service users with a homely and safe place to live. EVIDENCE: Shared areas of the home such as lounges and dining rooms and a sample of residents’ bedrooms were seen during the inspection. Residents’ 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 residents’ and assist them with independently finding their room or the bathroom. Residents’ rooms are clearly identifiable; the doors are painted different colours and have a picture that they can relate to, such as a pet. Signage on bathrooms and toilets was Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 19 clear with a large picture to identify the room. Residents’ are encouraged to personalise their bedrooms with pictures and family photographs and other objects of familiarity. The annual quality assurance assessment submitted by the Manager identifies that relevant maintenance checks have been carried out. These include the lift, electrical appliances, hoists and emergency call equipment. Maintenance staff confirmed that the checks were up to date and no concerns were identified about the safety of equipment during the inspection. Discussion with staff confirmed that there is a programme of redecoration, with the shared areas on the ground floor being the next area to be decorated. Plans for improvement identified by the Manager in the annual quality assurance assessment include “Vinyl flooring in the ground floor dining room. Replacement programme for carpets. The garden to be more user friendly. Overgrown shrubs to be cut back. Sensory garden to be maintained better and the summer house to be errected.” A resident said that they are able to and do access the garden when the weather is good, however there were heavy showers on the day of inspection. All areas appeared to be comfortable and most areas clean and fresh. There was a malodour in one area of the dementia unit and the manager has identified within the quality assurance document that efforts are being made to address this. Residents’ bedrooms, en-suites and bedding were all clean. However the carpet in the small lounge on the dementia unit was sticky and at the start of the day was stained with various spillages. 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.V339433.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were meeting the needs of residents’, however a more thorough recruitment process is needed to provide better safeguards for residents. EVIDENCE: Observations during the inspection identified that there were enough staff on duty to meet residents’ needs. Particular pressure times for staff are mornings when residents’ need assistance with washing and dressing and also need breakfast, with many needing assistance or support with their meal. The use of hostesses at meal times helped to ensure that residents’ got the assistance they needed. Lucas Court have recruited their own bank staff and report that currently they do not need to use agency staff. This helps to maintain consistency of care. Staff were sensitive and caring in their approach to residents’ and were aware of their individual needs. This was confirmed by discussions with visitors and residents. Information received in the annual quality assurance assessment identifies that eleven of the twenty six care staff have achieved a National Vocational Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 21 Qualification (NVQ) at level 2 or above and a further eight are working towards it. The National Minimum Standards recommend that at least 50 of the staff team are qualified to the equivalent of NVQ 2. The NVQ provides staff with a basic understanding of care practices to assist them in meeting residents’ needs. Review of the staff training matrix identified that there are currently some shortfalls in training identified as core training for staff. A letter on a staff members file confirms that action is taken where staff do not attend mandatory training. Training and regular training updates are important in ensuring that staff have the necessary knowledge and skills to meet residents’ needs. A sample check of staff files identified that references and criminal record bureau clearances are obtained as part of the recruitment process. It was however identified that more care needs to be taken to review and verify information received as part of applications to fully protect residents. For example two applications did not contain a full employment history. References are not in all cases requested from an employer as they are being requested from colleagues at private addresses. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 22 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): 33, 33, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in the best interests of residents. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. At the time of the inspection there was no registered manager in post and had not been one for some time, therefore this standard was not inspected as such. However it is considered from the perspective of the adequacy of the management arrangements, as this is considered a key aspect of ensuring that residents receive appropriate care. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 23 It was identified at the inspection carried out in June 2006 that the acting manager had been at Lucas Court for over a year and an application for registration with the Commission had not been made. No concerns have been identified through inspection about the management of the home, however it is of concern that an application has still not been submitted. The manager 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. The organisation has comprehensive quality assurance processes in place to monitor the quality of care provided. Audits are carried out monthly by the manager and a validation audit is carried out every two months by the Operations Manager. The audits were not available at the time of the inspection however staff confirmed that these take place. Methods of obtaining views on the care provided include meetings with staff, residents and relatives to gather their views. Notices for staff indicated that action is taken to address any negative feedback. An annual quality assurance assessment (self assessment) submitted by the manager demonstrates proper consideration of outcomes for residents’ and identifies where improvements can be made. There is a system whereby small amounts of money are held for safekeeping for residents’ to assist them with paying for services such as hairdressing and chiropody. The records were not available at the time of the inspection, however no concerns have been raised about these arrangements, which are audited by the organisation. The last inspection identified that there was an effective system in place for the management of residents’ money with clear audit trails and balances available. No health and safety concerns were identified during the inspection. Staff spoken with had received appropriate training in safe working practices and appropriate movement and handling methods were being used reducing the risk to residents’. However review of the training records indicated the need to monitor staff training in safe working practices to ensure that all relevant training updates have been undertaken keep residents’ safe. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 24 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 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.V339433.R01.S.doc Version 5.2 Page 25 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 OP29 Regulation 19 Requirement The recruitment procedure must include obtaining a full employment history and ensuring that employment references have been obtained to protect residents’. Timescale for action 15/08/07 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. 3. 4. Refer to Standard OP1 OP7 OP30 OP31 Good Practice Recommendations As part of the planned review of the statement of purpose the information should be checked to ensure that information is accurate and not misleading. Care plans should be reviewed and systems put in place to ensure that information is easily accessed and all residents’ care is evaluated regularly. 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. An application for registration of a manager should be submitted to the Commission for Social Care Inspection. Lucas Court Nursing Home DS0000012628.V339433.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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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