Inspection on 21/11/07 for Lucerne House

This inspection was carried out on 21st November 2007.

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

Other inspections for this house

Lucerne House 21/10/08

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Lucerne House Chudleigh Road Alphington Exeter Devon EX2 8TU Lead Inspector Teresa Anderson Key Unannounced Inspection 09:30 21 and 22 November 2007 st nd X10029.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 Lucerne House DS0000069220.V355493.R03.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 and Care Homes for Adults 18 – 65*. 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. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lucerne House Address Chudleigh Road Alphington Exeter Devon EX2 8TU 01392 422905 01392 424636 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) Barchester Healthcare Homes Ltd ****Post Vacant**** Care Home 75 Category(ies) of Dementia - over 65 years of age (31), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (31), Old age, not falling within any other category (31), Physical disability (13) Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing (N) offering care to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia - over 65 years of age (DE(E)) - maximum 31 places Mental disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) - maximum 31 places Old age, not falling within any other category (OP) - maximum 31 places Physical disability (PD) - maximum 13 places The maximum number of service users who can be accommodated is 75. 4th July 2006 2. Date of last inspection Brief Description of the Service: Lucerne House Care Centre is a purpose built home which first opened in 1995. It is a large care home provided care, accommodation and nursing care for up to 75 people. The home is divided into three units, Shillingford, Ide and Alphinbrook. Shillingford is registered to provide care for up to 31 people with dementia. Ide is registered to provide care for up to 31 people who have needs relating to old age. Alphinbrook is registered to provide care for up to 13 younger adults who have physical disabilities. Although the units are separate from one another, they share some facilities and services. All units are entered via a large communal reception area. On the ground floor Shillingford, the dementia care unit, is entered via a door that is controlled by a keypad system. In here communal areas are made up of a large lounge, a dining room off and a small lounge. Corridors are wide and long, giving people who like to walk about ample room to do so. Ide, the older persons unit, is on the second floor and is accessed by staircase or the lift. Here, communal space is made up of a lounge and a dining room. Again the corridors are wide and long. Alphinbrook, the younger adults unit, is on both the ground and first floor. Here Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 5 there are a number of communal areas including a bar, a lounge, a dining room and a private room. The majority of bedrooms are for single occupancy, and all have ensuite facilities. Outside the home there is ample parking and a number of level access sitting areas with tables and chairs. The gardens and seating areas for those people who live in Shillingford are secure, for their safety. The home is situated in the heart of Alphington with access to the facilities there including a church, chemist and pub. There are good transport links. The home has its own mini bus. Further information about this service, including CSCI reports, can be obtained direct from the home. Current charges range from £496.00 to £1200 per week. Charges do not include items such as newspapers, toiletries, chiropody, hairdressing, taxis etc. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. Two inspectors undertook it over two days. During that time we looked at all communal and service areas of the home and at some bedrooms. We looked at records relating to assessment, care planning, medication, staff recruitment, training and general management. We looked closely at the care and services offered to three people living in each of the three units. This process of ‘case tracking’ helps us to judge the services and care offered generally and also helps to see if people’s diverse needs are being met and to see if issues of equality underpin this. We spoke to or observed the care offered to these people. We also spoke and observed the care of other people living here. We spoke with visitors and with staff and with the manager and deputy manager. Prior to the site visit we sent surveys to people asking for their comments. We sent 20 people who use the service and 10 were returned; we sent 11 to relatives and 4 were returned; we sent 9 to health and social care professionals and 3 were returned; 15 were sent to staff working at the home and 9 were returned. In addition the manager provided information about the home in a preinspection questionnaire, together with his assessment of what the home does well and what the plans are for improvements. These sources of information have been included in this report. What the service does well: People who consider coming to live at Lucerne House have lots of information about the home and services offered available to them. People are encouraged to come and have a look around the home, or have someone look on their behalf. People living here all have a plan of care that is well organised, easy to read and accessible to staff. Staff make referrals to other healthcare professionals as need to help ensure that healthcare needs are met. Visitors to the home are made welcome and always offered refreshments. Some choose to sometimes have their meals with the person they are visiting. People generally like the food served at Lucerne House, which is nutritious, healthy and provides a balanced diet. Lucerne House is very well maintained and is decorated to a high standard. There is a large reception with seating area and doors and corridors are wide so that those with mobility problems can get around more easily. The majority of toilets are accessible and there is lots of equipment and adaptations so that Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 7 people with mobility problems and disabilities can be more independent. The home is clean and hygienic throughout. It has a large and well organised kitchen and laundry. Staff are described as ‘excellent’, ‘lovely’ and ‘efficient’. One person said ‘they are always willing to help, have a smile and are pleasant to every client’. They get lots of training to help them do their jobs and the majority hold a National Vocational Qualification (NVQ) in care. Staff are recruited using robust procedures to help keep people safe. They are employed in sufficient numbers to meet people’s needs. Each unit always has a Registered Nurse on duty. This home is well managed. It has many corporate management systems that work well. These include maintenance and safety checks, fire safety, training programmes and systems for managing peoples personal allowances. The home has a manager (not yet registered with the commission) whom staff say is competent and approachable. What has improved since the last inspection? What they could do better: Everyone has a care plan, however these are not always written in sufficient detail to ensure that needs can be met to a consistently high standard. Care plans are not always person centred. Reviews take place frequently but rarely result in a change to the care plan, which staff recordings indicate might be appropriate. Some peoples mental health needs are not being met and there is evidence that the management of some peoples skin care and nutrition could be improved. The younger adults who live here are not helped to develop goals and are not always given their care in a way they prefer. Medicines are generally well managed, but record keeping and some practices could be improved for the safety of people living here. In particular some medications prescribed to be given when needed, are routinely given and care plans do not include reasons why as needed medicines have been given, or their effects. We will carry out a random inspection to check that this has improved. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 8 The range and amount of activities offered are not always meeting the diverse range of needs of the people living here. Formal complaints are well managed, but some people are not being heard or their wishes acted upon when they make informal complaints. Not all staff have all the skills needed to understand that some behaviours are a form of ‘complaint’ and therefore do not act upon these. Some staff are not always respectful and some people living here have their freedom to move around restricted by the use of chairs or beds. This may be appropriate, however the reasons behind this have not been fully justified or documented. Staff have very recently received training in the Mental Capacity Act, which will help them to do this, but have yet to put this into practice. The home has quality assurance processes in place. These include residents and relatives meetings. However, people feel they are not as productive as they might be because all three units meet together and people feel each unit has different issues. 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. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Older people standards 1, 2 and 3 (the home does not provide intermediate care). Adults 18 – 65 years standards 1, 2, 3, 4 and 5. Quality in this outcome area is good. People have the information they need to help them make an informed decision about where to live and each person has a contract. People who live here have their needs assessed to ensure the home can meet those needs. This judgement has been made using available evidence including a visit to this service. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 11 EVIDENCE: All units. In surveys the majority of people say they have a contract and had enough information about the home prior to moving in. In surveys and in conversations people were very positive about the information supplied. One person said ‘I was impressed with the clarity and thoroughness in covering all areas of service provision’, another said ‘the staff could not have been more informative or helpful’, another ‘the information we received led us to expect certain things and our expectations have been met’. People who helped their relatives to choose a home say that they were able to look around the home at their leisure and were given lots of information. When we looked at some contracts we found that these do not always specify the bedroom people are contracting to occupy, as they should. We also found that terms and conditions of occupancy are not always included in the contract. The manager assures us that these are given to people in a separate statement. Assessments to determine peoples’ needs are carried out. The format used covers important issues and the assessments we saw had been completed comprehensively with detailed information. There is evidence that assessments include information from other health care professionals and from carers. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 13 Older people standards 7, 8, 9 and 10. Adults 18 – 65 years standards 6, 9, 16, 18, 19, 20 and 21. Quality in this outcome area is adequate. Whilst some care plans are well written and understood by staff, some people’s care plans lack detail and are not always meaningfully reviewed. Physical health care needs are met, although the mental health needs of some people are not being met. People’s medication needs are generally well met although some improvements are needed on Shillingford unit. People’s right to have their privacy and dignity protected are not always protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All units. In surveys people say that they always or usually receive the care and support they need. Healthcare professionals say that people’s healthcare needs are met and that the home seeks advice appropriately and that they put this advice into action. Relatives (in surveys) say that people’s needs are always or usually met and that people usually or always get the care expected or agreed upon. One person commented that they could not praise staff enough for the nursing care given. We looked at care plans in all three units. We found them all to be well organised, accessible and easy to read. People in all units have access to specialist equipment depending on their needs. The home provides hoists, specialist nursing beds and some people have personally adapted electric wheelchairs. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 14 Ide We looked at the care plans of three people who live in Ide. We found that, in general, they were written in enough detail to ensure peoples’ needs are met and that they are met in a way that each person prefers. No one living here has a pressure sore. One person told us they sometimes have a sore and this had been a problem on and off for some time. When we checked we found that this person has a recurring sore, which heals and breaks. This person told us that their skin had broken again that morning. Staff did not consider it to be a pressure sore because it is not in a place usually associated with pressure. However, when we checked we found that pressure from this person’s toilet causes their skin to break. Although the care plan gives staff instructions to observe for breaks in the skin, it did not give staff instructions on how to prevent such skin breaks. We bought to the attention of the nurse in charge at the time of the inspection who told us this would be dealt with. People’s nutritional needs are assessed and people’s weights are recorded. However, we found that some people have been losing weight. This had been recorded but the care plan regarding how to meet their nutritional needs, and how to help them to stop losing weight, had not been changed. We found that people’s food preferences are not recorded in the care plans or in the kitchen, meaning that if someone has lost their appetite, staff may not have the information needed to tempt them to eat. Care plans contain information on how people should be moved and there is plenty of equipment to help staff to do this. We observed some staff using good techniques to support people to move, however we saw some staff using a technique that resulted in the persons feet dragging on the floor. Care plans show that health care professionals are contacted when needed. This has included psychiatric nurses and tissue viability nurses. We looked at how the medications of three people living in Ide are managed. In general there is a safe and tidy system. However, when we counted some medications we found that they did not all match with records. We found that staff are not signing to say when a prescribed cream has been applied and we found that some medications had not been signed as being received into the home. People told us that staff help to protect their dignity by for example ensuring they have care in private and by knocking on doors. Visiting healthcare professionals say that they are always helped to see people in private. However, one visitor told us that they had seen a person being pushed in a wheelchair in a very undignified way and that they had overheard a carer tell someone off for being incontinent. We saw variable practice in relation to caring for people with respect. For example, we saw one carer move a person Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 15 in their wheelchair without looking or speaking with them. We saw another carer get down on their bended knee to get eye contact with a person to ask them if they were hungry and if would they like to go into lunch. Shillingford We looked at the care plans of three people who live in Shillingford. We found that people’s physical health care needs are generally well met with staff making referrals to healthcare professionals. We could see that staff have spent a lot of time developing these plans, however their completion is insufficient to meet peoples’ needs. For example we found that in one care plan it was recorded that a person had fallen out of bed. The care plan told staff to change the position of the bed but did not specify what this position should be. The care plan includes records that demonstrate that this person has been gradually losing weight since July this year and daily entries record that they are agitated especially during meals. The care plan has been reviewed monthly but there has been no change to the plan of care, staff are asked to continue to monitor. We observed this person during lunch. They continually left the table and wandered around other tables, giving their food away. Staff repeatedly put this person back at their table but did not make a record as to how much this person ate. We observed that they ate very little. This care plan also states that an aim of care is to maintain this persons current mental state. There is no description of what their current abilities are or how staff are to maintain them. This person is described as aggressive and disruptive. There are repeated entries in the daily notes stating this. The care plan has been reviewed monthly. However, there are no records to show what interventions, other than medication reviews, have been tried. The care plan of another person shows that when they were admitted seven months ago they were usually continent of both urine and faeces. However, the care plan does not provide staff with instructions on how this ability might be maintained. This person is now doubly incontinent. In a survey one person thought that daily teeth cleaning or dental hygiene could be improved. We found that whilst the majority of people had clean teeth and fresh breath, some had dirty teeth. A visitor says they think that people who are incontinent should be bathed more frequently. When we checked we found that everyone on this unit tends to have a bath or shower once a week. Although staff say they always wash people when they change their pad, we noticed that some people smelt of urine. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 16 The third care plan we looked at showed that this person used to walk around a lot and had fallen on many occasions. The care plan shows, and staff confirm, that in order to prevent this person from falling and hurting themselves, they get up at about 9.00 am and go back to bed at about 10.30am. They remain there for the majority or all of the day and night without opportunity for exercise or to be stimulated. We looked at how medications are managed. We found that they are kept safely and securely and that records are generally up to date. However, when we audited some medicines by counting the stock and comparing this with records, we found a discrepancy in one person’s tablets. We also found that one person who should be receiving a medication when it is needed, receives this every night. The care plan or medicine administration record does not say why this happens. We found that staff are recording the temperature of the fridge where some medicines are kept every day. However, they are recording that this is running below the temperature it should run at. We also found that staff are checking the minimum and maximum temperatures that the fridge is running at over a 24 hour period. We found that they are recording temperatures in excess of 40°C, and do not know what this means. We observed staff interacting with the people who live in Shillingford. We saw some staff being respectful and helping to protect peoples’ dignity. In particular we heard one carer skilfully following the conversation of one person with dementia in a way that was respectful, helpful and which showed an understanding of helping people to maintain their wellbeing. However, we also saw staff talking over people and ignoring people who were calling out in what appeared to be distress. We saw one bedroom door open and the person inside was wearing a T-shirt and an incontinence pad. We saw, on two occasions, two carers walking with a person at a pace that was far too quick for this person. Alphinbrook We looked at three care plans here and found that they were written in detail, that staff understood them and that they have been reviewed recently. Where appropriate families have been involved in developing the care plan. However, one survey that a visitor completed suggested that staff could involve the family more in care, especially where that person had been the main carer for a long time. Care plans are not however generally written in a way which helps people to explore and develop life ambitions and goals and do not help people to work out how their goals might be achieved. People’s preferences about how they like their care delivered are recorded and people say staff usually follow these preferences. One person said that they like to get up at 08.30 but that the home cannot always accommodate this. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 17 People living in Alphinbrook told us that their healthcare needs are well met. They told us that a General Practitioner visits the home every week, but is called in between if needed. Records confirm that referrals are made to healthcare specialists when needed and that preventative healthcare such as visits by the dentist and chiropodist take place. The home employs a physiotherapist who says she mainly works in Alphinbrook. She writes plans of care which she says are followed. On the day of the site visit, a reflexologist was working with one person. One person, in a survey, said that they wished staff would be more vigilant about checking if someone who cannot communicate easily is, for example, in pain. When we looked in care plans, staff had not recorded what this persons behaviours might indicate or what staff might do in response. Comprehensive risk assessments are in place relating to the environment and the impact on people. However, there was no evidence that people are supported to take risks in their everyday lives. People spoken with say that their physical disabilities prevent them from taking such risks. People say that they receive their mail unopened, that staff knock before entering, that they use their preferred form of address and that people choose if they join in with things or not. We saw staff knocking on doors and observed staff chatting with the people who live in Alphinbrook and not with each other. Medications are managed safely and records are up to date. Storage facilities are safe. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 19 Older people standards 12, 13, 14 and 15. Adults 18 – 65 years standards 12, 13, 15 and 17 Quality in this outcome area is adequate. People are generally supported to make choices and remain independent. People’s social needs are not always being met as the programme of activities does not reflect the varied needs and abilities of the people living in different units. People generally enjoy the meals that are nutritious, healthy and balanced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All units. Each week the home produces a programme of activities and an in house magazine that includes articles and quizzes. We saw the programme for the week in which we visited. Some people described this as ‘bland’ and others commented that it can arrive late. The manager told us that on this particular week, two activities co-ordinators were away from the home receiving additional training. This programme showed that on three days there were no activities and other days included staff training, a relatives meeting and 30 minutes of ‘tranquil moments’. On one day a music therapist visits Shillingford unit and is very engaging. The programme also advertised a theatre trip and individual trips. Whilst this is good practice, a very limited number of people are able to go on each occasion and no alternative activities are advertised for the people who do not go out. Feedback about activities from people and visitors was mixed. Some people told us that whilst staff care for their physical needs well, their social needs are often neglected. Some visitors say that there is usually more going on than was advertised on the week we visited. In surveys the majority of people say there are usually activities arranged which that they can take part in. The home employs four activities co-ordinators and has a mini bus. All visitors say they are made welcome, always offered a tray of tea and biscuits and some choose to have their meals with their relatives. The trainee chef is undertaking a ‘Master Chef’ course and the home are part of the ‘Cooking with Care’ initiative. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 20 People are helped to make choices such as what to eat, what to wear and when to get up and go to bed. Ide and Shillingford We spoke to some visitors on Ide about activities. They say that these tend to happen in Shillingford and that many people living in Ide do not want to go there. Two visitors say they wish that staff could spend more time chatting with their relatives. Some people are less able to join in with organised activities. However, staff and visitors report that people usually respond well to the music sessions. We observed this and heard some people singing along and saw others showing signs of relaxation and well being during this time. This session tends to happen once weekly. Staff report that people who live in Shillingford benefit from ‘one to one’ interactions. We observed some staff skilfully engaging with people and following each person’s conversation. However, we also saw staff talking amongst themselves and watching the television. When we looked in people’s care plans we saw that, in general, staff are recording people’s previous interests and occupations. However, care plans do not provide a plan of care that might help to meet these interests. For example one person is described as liking ‘to fiddle’. We observed them touching people, pulling at their clothes and examining a fire extinguisher. However, the care plan did not give staff instructions on things that might be more appropriate for them to engage with and although we observed for a number of hours, we did not see staff offer this person any alternative ways of being engaged with an activity. Each month this care plan has been reviewed, but there have been no changes to the plan of care despite entries that describe the behaviour as agitated, disruptive, destructive and aggressive. The manager reports that the home is planning to introduce forms of engagement and activities based on best practice in meeting the social needs of people with dementia. This will involve everyone being trained in how to achieve this. So far the manager and some of the activity co-ordinators have received training. People say the food is nice, there is variety and that they get the help they need. Comments in surveys and conversations included ‘too much pasta’ and ‘there should be more food that older people like such as stews’. One person says the food is ‘institutionalised’, although we were not able to clarify what this meant. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 21 We saw people being supported to eat by staff. We observed lunchtime in Shillingford. The food served was hot and looked nutritious and well presented. Those who could comment said it was lovely. However, during lunch one person called out continually and two people wandered between tables moving plates and cutlery. Some people found this distressing and one person became angry. Staff repeatedly sat those people who were walking about down in their chairs and ignored the person who was calling out. This made lunchtime quite a noisy and anxious time and did not feel like a pleasant social occasion. Alphinbrook People who live in Alphinbrook have complex and diverse needs. Because of their physical disabilities they rely heavily on staff to support them physically so that their social needs can be met, and to support them to be occupied and be socially included. Some people think staff do this well. These people tend to like their own company and prefer a quieter environment. However, others feel that more could be done to meet their social needs. Examples given were for the books to be appropriate to their age and interests and to be changed more frequently. Another was that it would help if the video boxes contained the right video. Some people have been assisted to attend the theatre and clubs of their choosing. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Older peoples standards 16 and 18. Adults 18 – 65 years standards 22 and 23. Quality in this outcome area is adequate. The home has a robust complaints procedure that is adhered to. However, people who communicate complaints, requests or grumbles outside this formal procedure are not always heard. People are protected from harm. However, some staff are sometimes less than respectful and it is not clear in all instances why some people have their freedom of movement restricted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All units This service received one formal complaint directly since the last inspection, which was dealt with within the timescale set. This complaint related to respite care. When we spoke with staff they said that the respite service had been below standard because of the number of people receiving respite at one time. They say it takes a long time to get to know someone’s needs and to meet Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 23 them in a way that each person prefers. Staff feel that now they have less people admitted for respite that the standard of service has improved. In addition the commission undertook an additional inspection in March 2007 as a result of a complaint received. The majority of that complaint was not upheld. However, recommendations were made that staff should be more respectful and people’s privacy could be better protected. In surveys the majority of people say they know who to speak with if they are not happy, they know how to make a complaint and staff listen and act on what they say. When we spoke with people, one said that staff do not always listen to them and another that staff are more likely to listen to their family, but not them. This person asked us to pass a request on to the manager as no one else had dealt with it. One person said they had repeated a request to different staff over a four week period and nothing had been done until a professional had become involved. During lunch we heard people living at the home complaining about other people’s behaviour. Staff did not respond to this. We also saw people exhibiting behaviour which might indicate a form of ‘complaint’ or a form of declining to do something. For example, two people pushed their food away and staff pushed it back in front of them. One person kept leaving the table and staff put them back at the table repeatedly. One person hit out at another person who kept coming to their table. In care records some people are described as ‘disruptive’ and ‘destructive’. However, records did not indicate that any investigation or discussion had taken place to determine if this was a type of complaint or how this might be dealt with. Staff have all received training in safeguarding people. We spoke with some about this and their knowledge of what is abusive practice and what to do about this is good. However, one visitor told us she has heard a member of staff being verbally rude and being disrespectful to two separate people. We observed a member of staff being annoyed with someone who could not communicate as they do. We also observed that staff are using bed rails and reclining chairs to prevent people having free movement. This form of ‘restraint’ may be for their own protection but records do not show how these decisions have been made or who had been involved in the decision-making. It is therefore not possible to determine that these are the right decisions or that they are made in the best interests of that person. In one care plan, the decision to use a lap belt and bed rails contradicted what staff had written in the care plan. Although the organisation is planning to help staff to understand the issues of capacity, Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 24 consent and restraint through the provision of training relating to the Mental Capacity Act and the Code of Practice, this has yet to be put into practice. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Older people standards 19 and 26. Adults 18 – 65 years standards 24 and 30. Quality in this outcome area is good. People living here benefit from an environment that is both homely and designed to meet diverse needs. It is clean, safe and enjoyed by all. This judgement has been made using available evidence including a visit to this service. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 26 EVIDENCE: All units. Lucerne house is a purpose built home that has been extended and refurbished over the years. It is furnished and maintained to a very high standard and is clean and odour free throughout. People living and visiting here say the home is always or usually clean and that it meets their needs. Corridors and doorways are wide meaning that people with mobility problems and those who use wheelchairs can get through them easily. The majority of toilets are accessible for people with disabilities. A bar has been created in Alphinbrook and a new dining / private meeting room have been created. Bathrooms are well equipped and warm. People’s bedrooms are personalised with pieces of their own furniture, pictures and photographs. Lucerne is set in its own grounds which are mostly paved for easy and level access. There are numerous seating areas with raised beds. The home has an ongoing programme of refurbishment and redecoration and there is a designated health and safety officer and hotel services manager who is in charge of the gardens, catering and maintenance. All fire checks are carried out and any faults found are dealt with immediately. People who can use a call bell have one in easy reach and other people like to keep their bedrooms open to attract staff. This is done safely with magnetic door holders, which are linked to the fire alarm system. The laundry is tidy, clean and well organised. There are appropriate hand washing facilities throughout the home and staff say they have plenty of gloves and protective clothing for their use. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Older peoples standards 27, 28, 29 and 30. Adults 18 – 65 years standards 32, 34 and 35. Quality in this outcome area is good. People living here benefit from a staff group who are employed in sufficient numbers, who are well trained and who are recruited in a way that helps to ensure peoples safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All units In surveys people say that staff are always or usually available when needed. Some people told us how lovely and kind staff are. One person in a survey said ‘I cannot give enough praise to the nursing staff in this home’ another said Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 28 ‘staff are helpful and approachable’. Others said ‘sometimes the junior staff find it difficult to communicate with X but they are always pleasant’ and another said ‘sometimes the bell rings for a long time or when they come they are hurried’. Another person said ‘staff are better than good and more like friends’. A number of relatives of people living here told us that the staff and their care are excellent. We looked at the duty rotas to see how many people are on each shift. We found that each unit has at least one Registered General Nurse on each shift. Shillingford unit also has a number of Registered Mental Health nurses. All staff receive mandatory training and additional training to help them to meet the needs of the people who live here. In the information provided by the manager, he reports that the home has a designated trainer and training includes induction training, caring for people with challenging behaviour, communicating effectively with people who have had a stroke or have dementia and good record keeping. The manager reports that 49 of the 53 (92 ) carers working at the home have successfully completed a National Vocational Qualification (NVQ) in care and another carer is working towards this. This is commendable as the standard expected is for 50 of staff to have achieved this. The manager reports that there is a stable workforce. He also reports that he considers not only the number of people on duty at any one time but also the mix of skills of those people. In addition to the nursing and care staff, the home has a manager, deputy manager, administrator, catering services manager, cooks, kitchen assistants, cleaners, laundress and a gardener. The home also employs a physiotherapist who works mainly with the younger adults. They say this is an excellent service which has made a big difference to their lives. The current physiotherapist is due to leave shortly and the manager reports that the recruitment process for a replacement has started. We checked the recruitment records of three staff who had started work recently. We found that robust checks, including police checks and written references, had been undertaken to help prevent the employment of unsuitable people. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 30 Older peoples standards 31, 33, 35 and 38. Adults 18 – 65 years standards 37, 39 and 42. Quality in this outcome area is good. People benefit from living in a home that is well managed and where there are good systems in place to keep them safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All units. Barchester Healthcare Homes Ltd owns Lucerne House. This is a large company with established corporate systems for managing care services. There are well-established quality assurance systems in place, with a survey currently being undertaken. Each month the home is visited unannounced by a person designated by Barchester Healthcare to do this. This person looks at the quality of care provided and makes any recommendations needed. The manager reports that regular staff meetings take place and residents/relatives meetings have started relatively recently. However, some visitors think that having combined meetings for all three units is not appropriate as there are different issues affecting each unit. Records show that the majority of people living here who attend, live in the younger adults unit. Numbers of relatives attending are low. Some people thought this might be because it is always held in the afternoon when many people are working. The manager has been in post since May 2006. Staff report he spends approximately 50 of his time at another of Barchester Healthcare’s Homes and that this does not cause a problem. They say he is always contactable by phone or email and that he can return to the home quickly if needed. They also report that he is helpful and approachable. Because the manager has not yet applied to the commission to become the registered manager, this home has been without a registered manager for 18 months. The manager completed a preinspection questionnaire prior to this inspection. This provided comprehensive information about the services offered and what he considers the home does well and what needs to be improved upon. He identifies that the home is committed to providing person centred care and to improving the social lives of people living here, especially those with dementia type illnesses. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 31 We looked at maintenance records which show that maintenance and necessary checks are well organised and are up to date. All gas, electrical, fire and environmental checks have taken place with any necessary minor actions being taken quickly. Records show that all staff receive mandatory training, including first aid, moving and handling and infection control. We looked in the kitchen that is large and well equipped. The cook reports he has all the equipment he needs and that the kitchen is easy to keep clean. All food is stored appropriately, labelled and dated. We looked at the how people’s personal allowances are managed and found that there is a well organised system in place. The home runs ‘debit accounts’ for people and keep good records and receipts of all monies spent on people’s behalf. People who look after their own monies say they are supported to do this. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 32 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 3 2 3 3 3 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 17 x 18 1 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 3 34 x 35 3 36 x 37 x 38 3 Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 33 Yes 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 YA6 OP7 Regulation 15 (1) Requirement People who have dementia must have their care planned in a way that is person centred, identifying all their needs and detailing how these needs should be met. Younger people who have physical disabilities must have their care planned in a way that helps to set and attain life goals. Care given must be reviewed in a way that helps the care planner to make a judgement about whether the planned care is meeting that persons needs. People must have their healthcare needs met and care to meet these needs should be appropriate. This includes ensuring that peoples’ nutritional, tissue viability and mental health needs are met. Timescale for action 30/04/08 2. OP8 12 (1) (a) (b) 31/01/08 Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 34 3. OP9 13 People living here must be assured that their medicines are handled safely and securely. Those medications prescribed to be given ‘when needed’ should not be given routinely. The reason for giving ‘when needed’ medications should be recorded as should the effects the medication has. Previous timescales of 30/09/05, 14/05/06, 04/09/06 and 21/05/07 not met. All medications received into the home must be checked by two people and records kept of what was received. Staff must sign to say they have given any and all prescribed medicines. This includes the application of prescribed creams. Staff must be sure that all medicines which require refrigeration are kept at the temperature recommended by the manufacturer. 31/01/08 3. OP10 12 (4) (a) People who live here must be 30/01/08 treated with respect and have their privacy promoted. This includes ensuring that people who are in a state of undress cannot be seen by passers by; that people are not ignored; that staff are not rude to people living here and that staff walk and work with people at a pace that is appropriate to them. Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 35 4. OP12 YA14 16 (m) Each person living here must be 31/03/08 consulted about their social interests and arrangements must be made to meet those interests in a way that takes into account their needs, abilities and preferences. 5. OP16 6. OP18 YA23 7. OP18 YA23 8. OP18 YA23 9. OP31 YA37 Previous timescale of 4/10/06 not met. 22 (2) People living at Lucerne should all be supported to have their complaints heard and acted upon. This is particularly important for people who cannot directly communicate their complaints. 13 (7) People living at Lucerne should not be restrained unless this is the only practical means of securing their welfare and there are exceptional circumstances. 17 (1) (a) Where restraint is used staff Schedule 3 must keep a record of this and records must include the reasons for this. 13 (6) People must be further protected from potential harm by providing staff with training in the Mental Capacity Act and the associated Code of Practice. 8 (1) An application must be made to the commission to register a manager for this service. 28/02/08 31/01/08 31/01/08 31/03/08 31/12/07 Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 36 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 OP8 OP8 OP8 YA9 Good Practice Recommendations People living here must be supported to maintain their oral and personal hygiene. Each person living here should be helped to remain continent for as long as possible. People living at this home should be helped to exercise and to be physically active. People living in Alphinbrook should be supported to take risks as part of their life. This may involve ensuring they have appropriate information and offering support and encouragement for them to be more independent. People living in Shillingford should be able to take their meals in relaxed surroundings at a time that is convenient to them. Each person living at Lucerne must have their personal preferences for how their care is delivered taken into account and where possible respected by staff. People who live in here must feel that their views are listened to and acted upon. Staff and the manager should help people to voice their concerns and encourage discussion to prevent issues developing into problems. People living at Lucerne, or relatives of those people, have suggested that consideration be given to the arrangements made for organising the residents/relatives meetings in order that these might be more meaningful and useful. 5. 6. 7. OP15 YA18 YA22 8. OP33 YA39 Lucerne House DS0000069220.V355493.R03.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI. 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