Inspection on 24/05/07 for Lugano

This inspection was carried out on 24th May 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

Lugano 08/03/06

Lugano 08/09/05

Lugano 17/03/05

Lugano 22/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lugano 3 Powell Road Buckhurst Hill Essex IG9 5RD Lead Inspector Sarah Buckle Unannounced Inspection 24th May 2007 11.30 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 Lugano DS0000017873.V336292.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. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lugano Address 3 Powell Road Buckhurst Hill Essex IG9 5RD 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) 020 8505 2695 020 8506 0754 Mr David Pearce Mr M Brook Mr David Pearce Mr Michael John Brook Care Home 27 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (27) of places Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide accommodation and care to three service users with dementia (whose identity is known to the CSCI). 8th March 2006 Date of last inspection Brief Description of the Service: Lugano is a care home providing personal care for twenty-seven older people. It is situated in Buckhurst Hill, near to the station and local shops. The home is a three-storey Edwardian house with lovely views of the local countryside. The home has been extended with some of the original features maintained. There are three double and twenty-one single bedrooms. Four rooms have en suite facilities and two have direct access to a pleasant terrace area. The home is in good decorative order and well maintained. There is a large lounge and a separate dining area. A shaft lift provides access to all floors. Both the lounge and dining area open out onto a terrace and there is a large, well-kept garden to the rear of the property. The registered providers have installed a summerhouse in the garden although access to the garden is limited for some service users. There is room for some parking to the front of the home and street parking. No information regarding fees was available at the time of the key inspection. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine key unannounced inspection. The inspection included a visit to the service on 24th May 2007. This site visit lasted for six hours. During the course of the inspection information was gathered using surveys from four staff members, the care manager, nine residents and four health care professionals. The findings of these surveys are reflected in the body of this report. The registered manager completed an Annual Quality Assurance Assessment (AQAA) and returned this to the Commission. Some of the information contained within the AQAA is also incorporated into the report. During the site visit, a tour of the premises was undertaken, residents and staff were observed and spoken with and relevant records and documents were examined. What the service does well: What has improved since the last inspection? Risk assessments have been introduced regarding residents who choose not to use footplates on their wheelchairs, and family members or representatives are involved in these if necessary. Hand towels have been introduced in all bathrooms to reduce the risk of cross infection. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 6 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. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been carried out. Prospective residents are given the opportunity to spend time at the home before making a decision to stay. EVIDENCE: Two care plans were examined during the site visit to Lugano in relation to initial assessment. Both of these contained thorough information, which including a summary of assessment from the care management services placing the resident. One file examined contained an “Overview Community Care Assessment” from Waltham Forest Social Services, and this was a detailed account which contained information specific to the person concerned i.e. requires social stimulation as they are an open and chatty person, risk of falls, hip Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 9 replacement, risk of wandering, probable dementia, visual hallucinations etc. Support needs were also clearly identified. Alongside this assessment the home had completed an information sheet, which detailed such areas as the person’s name, preferred name, GP, next of kin and general medical history. Nine surveys were completed by residents at the home and returned to the Commission and all of these stated that they received enough information about the home before moving in. Comments included, “I was recommended by a residents son and after visiting, I was very impressed by the care and attention given by the staff”, and “Very suitable”. Eight of the surveys said that they had received a contract and one said they had not. Eight of the surveys completed stated that they always receive the care and support they need and one said that they usually do. Comments received include, “I am delighted with the level of care and support given by the home”, and “The care and support I receive is excellent”. The care manager stated that as part of the admission procedure to the home, the prospective resident is visited at home or hospital and all their details, needs and requirements are discussed, as is what the home can provide. The service user guide and home brochure are also given to the prospective resident at this time. The care manager said that the family or representative are advised to bring the prospective resident in to visit the home and meet the other residents and staff. There is a one-month trail period before a decision to reside permanently is made. One relative comment stated, “My (relative) suffers from dementia and I went to see approximately 40 different homes before I picked this one for my (relative). I have nothing but praise for this wonderful and caring home”. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans at Lugano contain basic information necessary to adequately deliver the resident’s care, but they do not detail information specific to the needs of the resident and are not sufficiently person centred. Risk assessments are completed but are basic and mainly focused on keeping the resident safe. Residents have appropriate access to healthcare services and the health care needs of residents unable to leave the home are managed by visits from local health care services. Medication is, in the main part well managed. EVIDENCE: Two care plans were sampled during the course of this inspection. Both documents were well organised into A4 files. One care plan was examined in detail. Support plans were completed for the resident in relation to personal hygiene, mobility, continence and skin integrity. Personal hygiene stated ‘ full assistance, mouth and eye care, cut and clean fingernails, bath once a week’ Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 11 etc. It did not break this information down further to explain what full assistance would mean to this specific resident. This was true of all the support plans seen, for example, a section on continence states ‘ensure (the resident) wears pads and pants at all times, follow regular toileting pattern’, but there was no further information to explain what this toileting pattern was. A Waterlow pressure sore assessment was completed, which rated the resident as very high risk. The skin integrity support plan did identify ways of managing this i.e. by ‘regular turning, repositioning, dressing of wound regularly and high protein diet’. However, it did not state how frequently the resident should be turned during the day or night, or how they would need to be re-positioned, nor did it specify who would be responsible for dressing the wound, although there was evidence within the care plan of district nurse intervention. The resident’s dietary needs plan stated ‘Encourage to eat and drink. Monitor and record (their) food intake. If there are any changes with (their) appetite refer accordingly – weight at least 2 x a month to monitor weight loss’. There was a food and drink monitoring chart contained within the care plan, however this had only been completed on 18/05/07. There were no weight records for this resident but their weight chart did state, “Unable to weigh, frightened to stand up” and “unable to weight bear – non-weight bearing needs 2 to stand”. A support plan for mobility stated that the resident should be assisted during transfers and be encouraged to do leg exercises. There was no detail to explain how this should be done in relation to the residents’ specific needs. A risk assessment was completed for falls prevention, and although the factors influencing the likelihood of falls was completed in detail i.e. history of falls, use of sedatives, continence problems etc, the action to be taken to limit the possibility of a fall was scant. It said, “Use wheel chair, needs lots of prompting and encouragement to stand up. Very reluctant to mobilise”. Daily care notes were examined and these were completed in detail. The resident concerned had had two falls where an injury had been sustained however, the home did not notify the Commission of these accidents as required by Regulation 37 of the Care Home Regulations. The handling assessment contained within the care plan had not been completed. There were no care or support plans in place for this resident in relation to dementia, wandering, challenging behaviour, visual hallucinations or depression. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 12 Nine of the resident surveys completed stated that the staff listen and act on what they say, and eight stated that staff members are always available when needed. One survey stated that they usually/sometimes are. All of the staff surveys completed stated that they are always given up to date information about the needs of the people they support or care for. One comment stated “We always have a handover before and after the shift and any changes to residents we always document it in their care plan. We also have a log book for daily report”. The AQAA stated that over the last 12 months the home has made amendments to record keeping and increased the service users participation in care planning. It was clear from the care plan that the health care needs of residents were being met. The daily notes demonstrated that district nurses were intervening and that GP’s and emergency services were called when appropriate. On the day of the inspection site visit an optician was undertaking eye tests on residents. Four health care professionals completed surveys and all of these had positive responses to the home i.e. an example of what the home does well stated, “Prompt response to patients requests. Provision of private examination area for visiting doctor. Courtesy and friendliness of staff”, another stated “Do their best and look after clients needs whether physical or psychological”. The mediation file was examined. It was positive to note that changes in medication need were identified in the daily notes within the care plan sampled. There were a number of omissions on the medication records. One resident did not have a signature to suggest their Senna had been administered on the 21/22 and 23 May 2007. There was no reason recorded for this omission. Two further omissions were noted on 23rd May 2007 at 5pm. One signature was not in place for Diazepam syrup and one for a nasal spray. The medication file did not contain photographs of residents and handwritten medication profiles were not double-signed by a witness. The AQAA received by the Commission from Lugano does state that over the last twelve months ‘as and when’ medication protocols have been introduced. All of the four staff surveys returned state that they are confident that they have enough training and information about care, health care and handling medication. One comment received states, “I was given enough training and so thankful about it and I’m so confident for everything I do because of my relevant knowledge which I’ve learned from my previous experience and especially here in my present job”. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 13 Seven of the resident surveys stated that they always receive the medical support they need, one said that they sometimes did and one did not complete this section. Lugano DS0000017873.V336292.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lugano has a strong commitment to enabling people to maintain their quality of life, including socially, emotionally and in terms of making independent choices where appropriate. Family links are positively encouraged and meals are balanced and nutritional. EVIDENCE: A whiteboard in the hallway at Lugano lists activities and outside entertainers. Daily care notes examined demonstrate that residents are engaged in activities throughout the week and that family members are welcome to visit. For example, one resident was visited by their daughter on 02/05/07, and on 04/05/07, had their hairdresser appointment on 05/05/07, was visited by a family member on 06/05/07, enjoyed listening to entertainers and was visited by their daughter on 07/05/07, played ball games with staff members on 08/05/07, partook in an exercise activity and was visited by family on 09/05/07, visited by family on 09/05/07, played a game of bean bags and joined in a sing a long on 10/05/07. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 15 A montage of photographs showing the residents and staff enjoying themselves during various social occasions was hung in the hallway of the home. During the site visit to Lugano residents were observed within the lounge reading newspapers, chatting and dozing. Some residents were involved in a game of ball with staff members. One resident was reading quietly in their room and another resident had decided to have a lie down. Staff members interacted with residents in a respectful and supportive manner. Information received on the completed AQAA states, “Routines (within Lugano) are flexible and the home promotes independence and choice and visiting arrangements are open and relaxed”. Visitors were observed sitting with residents in the lounge, talking and joining in. The ‘what we could do better section’ states, “..try to be more persuasive in encouraging service users to engage in activities without them feeling forced to do so and at the same time respecting their freedom of choice”. Five resident surveys stated that there are always activities arranged by the home for them to take part in, two said that there usually are and one person did not compete this section of the survey. The dining area within the home is a large and pleasant room overlooking the garden. The home uses a four weekly menu and this was varied and balanced. Nutrition records are kept for the residents within the home; however, these are not completed on a daily basis. For example, the breakfast records, which were contained within a file in the kitchen, had been completed on 08/09/10/12/20/22 May 2007, and the lunch records had been completed on 09/15/16/20 and 22 May 2007. One resident who stated that they were vegetarian had steamed fish, ham and chicken and ham recorded as food they had eaten. The care manager stated that there was a list of specified food for this resident, however, this was not reflected in their nutrition records. Six of the resident surveys completed stated that they always liked the meals at the home. Comments included, “Wonderful” and “The meals are very varied and extremely good”, two people said that they usually like the meals and one person said that they sometimes did, commenting that the “Food is not always hot enough”. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 16 The AQAA stated under ‘what we do well’, that, “Our menus are varied and nourishing. Our food is freshly cooked and purchased locally. Choice is available for residents who do not wish to have the menu of the day”. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lugano has an open culture, which allows residents to express their views and concerns in an understanding environment. Residents and others within the home are appropriately supported to make complaints. There is clear understanding within the home regarding procedures for Safeguarding Adults. EVIDENCE: There have been no complaints received by Lugano; however there have been many compliments and these are all contained within a file. All of the surveys completed by residents stated that they knew who to speak to if they were unhappy and that they know how to make a complaint. The Commission has received one anonymous complaint regarding Lugano. The accident book was examined during the site visit and it was positive to note that both of the falls detailed in the daily care notes of the care plan sampled were recorded thoroughly. The care manager stated that approximately ten staff members have completed POVA training, and a letter received from the registered manager since the site visit states that further POVA training is booked for 21/06/07 and lifting and handling training has also been booked for 14/06/07. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 18 The care manager said that all but the newest staff members have completed training in dementia. One member of staff spoken with was able to clearly outline the procedure to be taken of an incident of abuse were suspected within the home. Safeguarding vulnerable adults information was observed within the office. The AQAA states under ‘what we could do better’, “Continue to increase an awareness and openness amongst service users and their families and staff to ensure that there is no breach in our commitment to provide a happy and secure environment and an atmosphere of free expression”. The ‘how we have improved in the last 12 months section states’, “The care manager holds meetings but also meets with service users on an individual basis to discuss how they are and to allow them to express their views or discuss matters that may concern or trouble them freely and with confidence. Care staff are reminded to be watchful of service users and to observe any small changes in their behaviour which may indicate if they are anxious or troubled about anything and report it to the care manager”. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lugano provides a physical environment that is appropriate to the needs of the people who live there. The environment is well maintained and is a pleasant place to live. The home is well lit, clean and tidy and smells fresh. EVIDENCE: A tour of the premises was undertaken as part of the site visit to Lugano. The home is an elegant three storey Edwardian house that has been converted to provide high quality accommodation. All of the bedrooms have been personalised to reflect the taste of the person living in the room. Some bedrooms had just a few photographs, whereas others were covered in posters and photos. Some bedrooms have en-suite Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 20 bathrooms. There is one double bedroom and a screen is in place for purposes of privacy and dignity. One resident survey stated, “Would like a ground floor room when available. Have to be taken to top floor, where my room is when my colostomy bag needs changing. Also it is very noisy at nigh. Due to self closing fire doors left to bang shut and my room also backs onto toilet and bathroom”. The communal space within the home consists of a large, pleasant dining room and a lounge, both of which look over an attractive and well-maintained garden. There is a terrace for residents to sit out at and a ramp or stairs to access the garden. There are four bathrooms at Lugano, two of which have been fitted with electrical seat hoists. Thermostatically controlled taps have been fitted to all bathrooms. Paper towels and hand soap have now been fitted in all bathrooms to minimise the risk of infection. The larder was well stocked, and the fridge and freezer temperatures recorded daily. The laundry room was well organised and clean. Each resident has a box for his or her laundry and there is a twenty-four hour turn a round. On the day of the site visit, all of the beds were made and windows were open for ventilation. Eight of the resident surveys completed stated that the home is always fresh and clean, one said that it usually is. Comments received include, “Always spotless, both personal care and cleanliness in the building itself”, and “The home is spotless”. Information received in the AQAA said that a programme of redecoration and refurbishment had been carried out and that this is on going. On the day of the site visit, the home was clean, tidy and there were no odours. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough qualified, competent and experienced staff to meet the health and welfare needs of people living in the home. There are significant shortfalls in the recruitment procedure within Lugano. Lugano does recognise the importance of training for the staff team, however there are gaps in this area. EVIDENCE: Three staff files were examined in relation to recruitment. It was positive to note that all of these contained a completed application form with full employment history. Two of the files contained two references, however the third file did not have nay evidence of references being received. The care manager stated that these had been applied for two weeks ago. Two of the files had proof of identity contained within them, whereas one file did not. All of the files had CRB checks completed, however, all of these were from a previous employer and not undertaken by Lugano. The care manager stated that she did not realise that CRB checks are not transferable. Induction files were requested for three new members of staff, however, the care manager was not able to locate these during the time of the inspection. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 22 The AQAA states in the outcome area regarding staffing, that Lugano “provide a staff team that is experienced kind, considerate and conscientious in their work and we provide a high standard of care”. Comments received from residents surveys reiterate that the staff team are of a high calibre, i.e. “The staff are particularly caring”, “Lovely caring home”, “I am very happy and contented here – everybody is very kind to me”, “The home and staff is excellent” and “ In residence here nearly 18 months and quite content and appreciative of all the staff that work very hard”. The AQAA also states that Lugano “will review our recruitment procedures and induction training for staff”, and “Review our staff training needs……..and institute more staff training”. According to the AQAA ten staff members currently have NVQ2 or above and four further staff members are currently undertaking this training. All of the kitchen staff members have completed infection control training and further training in this area is booked. One staff file examined had evidence of training in POVA 05/08/076, health and safety 12/08/06, pressure area care 05/08/06, manual handling 22/07/06, medication administration 22/07/06, reporting and record keeping 12/08/06, 1st Aid 12/08/06 and fire safety 12/08/06. A second file had evidence of food hygiene 26/01/06, which was valid until 25/01/07, dementia 15/01/07, health and safety 26/01/06, valid until 25/01/07 and manual handling 03/01/07. The third file had no evidence of training. The care manager stated that this as this staff member worked part time they had never been available for training. She also stated that as they have no manual handling training she demonstrates how to move and handle and they learn by this example. The care manager explained that six staff members are currently undertaking a course in the administration of medication at Hackney College. She said that only seniors and the care manager administer medication except at night when senior carers do. All of the staff surveys completed and returned to the Commission stated that they have completed training in all the specified areas. One comment received stated that, “The staff team is highly motivated, well trained and committed to providing a high level of care”. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care manager has a more hands on approach within Lugano that the registered manager. She is achieving the required qualifications and has the experience and competence to run the home. Policies and procedures are not adequately up dated and a formal quality assurance system has not yet been implemented. Supervision is not regular or recorded. EVIDENCE: The registered manager at Lugano has achieved NVQ4 and the care manager has one unit left until she completes this qualification. All of the staff surveys received stated that they were regularly given enough support from their line manager. Comments received included, “Our manager has always been Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 24 supportive and very good to us. She always makes sure that every thing goes smoothly. We always have staff meetings at least once a week or even more if she has something important to tell the staff”. The AQAA states, “We believe that we do well in achieving our aim in providing good care to the satisfaction of service users and their families which is evidenced in our reports and in the numerous letters of thanks and praise that we have received which are available for inspection”. The AQAA does however acknowledge that Lugano has to accept the fact that record keeping is an area that they could do better, “Acceptance that an overriding important factor in caring for the elderly is record keeping, general paper work and keeping abreast of regulations and changes affecting this service business and finding time for all these whilst not allowing it to impinge on the basic job of caring and giving time to service users”. The home does not handle resident’s money. A requirement was made at the last inspection regarding a system of reviewing the quality of the service provided. Although he home does receive many compliments a formalised system for improvement needs to be implemented. The AQAA recognises this as something that has to be done over the next twelve months and states that Lugano will be “Seeking views of service users and their families in a more formal way as to the service provided and what changes they might suggest and considering whether such may be implemented”. A general review of policies and procedures is also due to be undertaken in the next twelve months. Although there was evidence that supervision of staff had been planned, none had been undertaken during 2007. Risk assessments have been completed regarding residents who wish to use wheelchairs without the footrests. Various health and safety certificates were examined and these were in date. Fire risk assessments were completed. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 4 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X N/A 1 X 3 Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15 Requirement The home must continue to develop the care planning system to ensure residents involvement is recorded, and daily recordings and risk assessments are all fully detailed. This is in relation to care plans that do not detail the specific support needs of residents, do not have support plans for all identified needs and to risk assessments needing further information regarding how risks are to be managed. (This is a repeat requirement with the previous timescale 31/05/06 not met) 2. OP15 17 (2) Sch 4 Records of food provided to service users must be maintained in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. This is in relation to nutrition records being completed in an erratic manner and not on a daily basis. (This is a repeat requirement Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 27 Timescale for action 30/09/07 15/08/07 with the previous timescale 15/04/06 not met) 3. OP29 19(1)(b) & Sch 2 The registered person must ensure that the recruitment procedure within the home is robust in order to safeguard the residents. This is in relation to staff files not containing photographs, one file having no evidence of I.D., one file having no evidence of references and to all three files examined having CBR checks from a previous employer. 15/08/07 4. OP30 18(1)(c) (i) The registered person must 30/09/07 ensure that all persons employed by the care home receive training appropriate to the work they are to perform, including a structured induction. This is in relation induction packs not being available for three new staff members and to one member of staff having received no formal manual handling training. The registered person must establish and maintain a system for reviewing and improving the quality of care provided by the home. (This is a repeat requirement with the previous timescale 31/05/06 not met). 30/09/07 5. OP33 24 5. OP36 18 (2)(a) The registered person must make suitable arrangements to ensure that people working at the home are appropriately supervised. This is in relation to no evidence being seen of supervision during 2007. 31/08/07 Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 28 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. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that for the purposes of good practice, current photographs of residents are placed within the MAR file, and that all handwritten medication profiles are double signed for safety purposes. Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Lugano DS0000017873.V336292.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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