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Inspection on 07/11/08 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 7th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 focus of this inspection was to check compliance with requirements that had not been met, however managers and staff were co-operative with the inspection process and continued to express a commitment to making improvements. Staff were heard to speak to people who use the service in a respectful manner.

What the care home could do better:

Improvements continue to be needed in respect of the management of people`s medication and their healthcare needs. Enforcement action is currently being considered as a means of obtaining improvements and reducing risk for people.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Lucas Court Nursing Home Northampton Lane North Moulton Northampton NN3 7RQ The quality rating for this care home is: The rating was made on: zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Kathy Jones Date: 0 7 1 1 2 0 0 8 Information about the care home Name of care home: Address: Lucas Court Nursing Home Northampton Lane North Moulton Northampton NN3 7RQ (01604)493233 01604493234 lucascourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Healthcare Services Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability 0 0 0 6 Over 65 28 1 60 6 Conditions of registration: 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 Care Homes for Older People Page 2 of 11 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 Date of last inspection Brief description of the care home Lucas Court is a care home providing personal and nursing care for up to 60 people. Currently Lucas Court provides care for older people, older people with dementia, older people with a mental disorder and people with a physical disability. Southern Cross Healthcare owns the home and it is located in the village of Moulton on the outskirts of Northampton. The village has some local shops and public houses and is on a bus route in to Northampton. The home is a two storey building with the first floor allocated for dementia care, and care for people with mental health needs. Fifty of the bedrooms are single rooms with forty-eight of these rooms having en-suite facilities. There are five double rooms in the home. The home has a passenger lift. There is an enclosed well-maintained garden to the rear of the home, which is accessible to wheelchair users, and a car park. A scale of charges confirmed as being current at the time of the inspection in July 2008 states that fees are from 650 pounds to 750 pounds perr week. The fees quoted are exclusive of any free nursing contribution, which is collected from the Primary Care Trust by Southern Cross Healthcare. Local Authorities who are funding people are charged at a set rate. These people will be asked for a top up fee, which varies according to their ability to pay. The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. Information about the services provided including the complaints procedure is displayed in the foyer of the home. This includes the statement of purpose, a service user guide and a copy of the most recent Commission for Social Care inspection report. Care Homes for Older People Page 3 of 11 What we found: The inspection was unannounced and conducted by three inspectors and a regulation manager. This inspection was carried out as a result of information about ongoing concerns. The purpose was to look at outcomes for people who use the service and to check if there is continuing non compliance with regulations. Three random inspections have already taken place since the key inspection in July 2008 and evidence has been collected and collated and is being considered for possible enforcement action. The main focus of this inspection was again on the management of medication and health care. Other requirements will be checked at inspections in the near future. During the inspection there were indications of further breaches of regulations. We served a Code B notice prior to continuing our search for, and seizure of evidence. This notice is issued in accordance with the Police and Criminal Evidence Act 1984 and explains powers and rights. Records were copied and seized during the inspection and this evidence will be reviewed and considered in relation to possible enforcement action. A temporary manager who is a registered manager in another Southern Cross Care home was managing Lucas Court at the time of the inspection with support from a project manager. The operations manager for the area was also present at Lucas Court for part of the inspection. Managers and staff were co-operative with the inspection process. We were told that there continued to be a voluntary embargo on admissions as agreed between Southern Cross and Northamptonshire County Council and at the time of the inspection there were 49 people living at Lucas Court. We looked at care records including medication records for a sample of people. For some of these people we explored in more depth particular aspects of their care. We spoke with people and to some of the staff who provide their care. We reported following our last inspection on 21st October 2008 that efforts were being made to obtain an occupational therapy assessment to advise on specialist seating for someone who uses the service. We had concerns about movement and handling risks relating to the person being nursed on a mattress on the floor. This issue has not yet been resolved as indicated in a copy of a letter dated 5th November 2008 to the General Practitioner from the occupational therapy department. The letter advises that they are unable to give advice re seating and the letter provides details of how to contact suppliers of these products. Review of a sample of peoples care records indicated that while care plans were in place there was evidence that they are not always followed. Examples identified were - someone with a pressure ulcer not being turned as regularly as the care plan requires. We saw from the records that the tissue viability nurse had visited the day before the inspection and advised that a foam wedge be used as there was evidence of pressure damage to the toes. We found that the wedge was not in place, however the manager later confirmed that this had now Care Homes for Older People Page 4 of 11 been done. We also found some discrepancies in information, for example an entry in someones care plan stated that medication for oral thrush had been discontinued. However the Acting Manager advised that this was being used as there had been a recurrence of the condition. Following the inspection on 21st October 2008 we received information from the temporary manager confirming that people had been weighed and a full review of their nutritional needs carried out. We were advised that an investigation was being carried out into failures to monitor peoples weights and nutritional needs. Review of someones care plan identified that a nutritional care plan had been developed on 3rd November 2008, however we were concerned that there were discrepancies in records relating to nutritional supplements and indications that they were not being given as prescribed. We also found that records showed that fluids were not offered and given as often as required resulting in low fluid intake. We spoke with a member of the care staff on the first floor about the process for monitoring peoples fluid intake. Her understanding was that these were taken into the office and the information collated by the nurses. With the assistance of the nurse on duty we found fluid intake charts on a clipboard containing a mixture of charts for different people containing different dates, with no evidence of collation of the information. Although care staff were completing the documents there was no system in place to collate the information and use it to ensure people were getting the care that they need. Similar issues have been identified on previous inspections. This was brought to the attention of the operations manager during the inspection who confirmed that this would be addressed. We spoke with someone during the inspection on 21st October 2008 who had not been referred to a podiatrist and to the General Practitioner in a timely manner. During this inspection they told us that they had received treatment from a chiropodist, been seen by the General Practitioner who prescribed medication for a fungal infection and had an appointment to see a podiatrist. We saw a member of staff about to give someone a pureed meal which had been left standing for some time, gone cold with a skin formed on the surface. We had to ask them to bring a fresh meal. Records copied at the inspection on 21st October 2008 identified that someone who uses the service had missed some doses of two of their prescribed medications due to them not being in stock. We looked at this persons records again and found that one of the medications had again run out leaving the person without four doses of this medication, with the fifth given late. Staff told us that there is often a problem obtaining supplies of this medication as it has a short shelf life and not held in stock by the pharmacist, therefore difficult to get at short notice. Given that this is a regular prescribed medication, our expectation would be that arrangements would be made with the pharmacist to ensure that new supplies would be ordered in time. We found, for someone else who uses the service that a General Practitioner had visited on 31st October and prescribed medication, which had not been received at the time of the inspection. The project manager contacted the surgery and the pharmacist and arranged for it to be delivered that evening. However we were concerned that it had been necessary for inspectors to prompt this. Care Homes for Older People Page 5 of 11 We received a complaint about staffing levels following our last inspection which we have referred to the Responsible Individual for investigation under Southern Cross complaint procedures. We were told that there had been staff short on the morning of inspection but additional staff had been brought in to cover. We discussed staffing, and the Acting Manager advised that there were currently four full time and four part time vacancies and efforts were being made to fill these vacancies. A new nurse was due to start on Monday and appropriate documents were awaited prior to appointing another nurse. In the interim a nurse from another Southern Cross home was helping out. We emphasized again the need to establish systems for working out staffing needs and to monitor the sufficiency of staff throughout the twenty four hour period and the need to look at this from the perspective of whether peoples needs are being met. We provided some verbal feedback and left details of the evidence seized during the inspection with managers and advised that this would be collated and reviewed prior to consideration of enforcement action. No further requirements were made as a result of this inspection. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 8 12 (1) (a & b), Where it is assessed that it is 11/09/2008 necessary to monitor peoples fluid intakes, records must be checked daily and reasons for people receiving insufficient fluids investigated. This requirement with a timescale for compliance of 25/08/08 has not been met. Evidence of non compliance has been seized and enforcement action is being considered. 2 8 12 (1) (a & Peoples health and well 11/09/2008 b), 13 (1) (b) being must be monitored with prompt action/referral to healthcare professionals as appropriate. This must include the risk of constipation for those people unable to express a problem. This requirement with a timescale for compliance of 25/08/08 has not been met. Evidence of non compliance has been seized and enforcement action is being considered. 3 9 13 (2) Accurate, complete and up to 11/09/2008 date medication records Care Homes for Older People Page 7 of 11 must be kept to ensure that medication is administered correctly, safely and as intended by the prescriber to manage individual health needs. This requirement with a timescale for compliance of 26/11/07 & 25/8/08 has not been met. Evidence of non compliance was seized and enforcement action is being considered. 4 18 13 (6) All staff must receive safeguarding adults training to help protect people who use the service. Compliance with this requirement was not checked at this inspection. 30/10/2008 5 19 23 (2) (d) Carpets must be kept clean 30/09/2008 and free from odour and replaced as required to ensure people have a pleasant environment to live in. Compliance with this requirement was not checked at this inspection. 6 27 18 (1) (a) Staffing levels must be 30/09/2008 reviewed and monitored in consultation with people who use the service and sufficient staff provided to meet their needs. Compliance with this requirement was not checked at this inspection. Care Homes for Older People Page 8 of 11 7 30 18 (1) (c) (i) Staff training should be 30/10/2008 implemented to address gaps identified in the staff training matrix to ensure that all staff have up to date training to meet residents needs. Compliance with this requirement was not checked at this inspection. 8 33 24 (1) (a & b) Quality assurance systems must be effective in improving and maintaining the quality of care provided to people who use the service. Compliance with this requirement was not checked at this inspection. 30/09/2008 Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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