Inspection on 08/03/06 for Lugano

This inspection was carried out on 8th March 2006.

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

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

Other inspections for this house

Lugano 24/05/07

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 Ron Reeves Unannounced Inspection 8th March 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lugano DS0000017873.V285569.R01.S.doc Version 5.1 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.V285569.R01.S.doc Version 5.1 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 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.V285569.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8th September 2005 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. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out during the day of 8th March 2006 and lasted for 6 hours. The inspection process included a tour of the premises, discussions with the care manager and one of the proprietors/manager. The inspector spoke to several residents in their rooms and in the communal areas. In addition five visiting relatives and staff on duty were spoken to. The inspection also included examination of a random sample of care plans and a sample of policies and procedures and records. What the service does well: What has improved since the last inspection? What they could do better: The home should continue to investigate activities for residents with dementia. The home’s care planning system would benefit from greater clarity regarding risk assessments,daily records and evidencing resident/relative involvement. Protocols for medication prescribed “as and when required” (PRN) should be produced and medication storage monitored for excessive heat. The home needs to implement an approved quality assurance system. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 6 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. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 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.V285569.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2-5 The admission process is well managed and prospective residents and their families are invited to visit the home as many times as they like before making a decision. EVIDENCE: Care plans contained pre-admission assessments and prospective residents and their families are invited to visit the home as many times as they wish before making a decision. Visiting relatives spoke of how they looked at many homes in the area before choosing Lugano. The care manager informed that they had five prospective residents on the waiting list. Each resident is issued with a contract which includes the terms and conditions of residence. Staff spoken with demonstrated a sound knowledge of the residents needs and all felt they worked well together as a team. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 9 Visiting relatives expressed their satisfaction with the care manager and her team provided to the residents. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Residents’ personal and health care needs are consistently being met by the home. Residents are treated respectfully, maintaining their privacy and dignity. EVIDENCE: Care plans seen were generally found to be well documented and covered all residents’ assessed needs. The inspector discussed with the manager areas that would benefit from reviewing which included more detailed risk assessments,improvements to the daily recording and evidencing resident/relative involvement. Care plans evidenced that residents’ health care needs were being met. Medication administration was generally satisfactory with medication records appropriately completed. The home needs to produce protocols for medication administered “as and when” required (PRN) and to monitor the temperature of the medication storage to ensure it does not exceed 25ºC. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 11 Residents spoken with said the staff were very caring and always treated them respectfully. Staff observed throughout the day were seen to care for residents in a gentle and sensitive manner. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Daily routines were generally flexible with the home promoting independence and choice. Visiting arrangements were open and relaxed. Dietary needs of the residents were well catered for with a balanced and varied selection of food. EVIDENCE: From discussions with residents, visiting relatives and staff routines in the home were flexible and individual residents’ choices were generally accommodated. A list of activities displayed in the home showed a good variety of things to do, with outside entertainers visiting the home two or three times a week. Some of the residents spoken with said they do get opportunities to go out to a weekly luncheon club and to church every Sunday morning. Staff spoken with said they do get time to sit and talk with residents and encourage them to take part in activities. The home accommodates two residents who have dementia. The care manager said they are able to participate in the activities enjoyed by the other residents. However, the home should continue investigating activities for people with dementia. Visiting relatives said they are always made welcome and kept up to date with welfare of their residents. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 13 The home’s menus were seen to be varied and nourishing. All food is freshly cooked and purchased locally. Although there is only one meal available at lunchtime, staff do ask residents every day whether they would like a different meal. A wide range of choices is available for breakfast and tea. A new chef has recently been appointed who is keen to ensure residents continue to receive a good standard of food. It was noted that the home’s nutrition records were not being completed for several days. The home’s care manager and chef were reminded of the importance of maintaining accurate records of what residents actually eat. All residents spoken with were unanimous in praising the quality and choice of food provided. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Arrangements for protecting vulnerable residents and responding to their concerns is satisfactory. EVIDENCE: The home has an appropriate policies and procedures for dealing with residents concerns. No complaints have been received by the home since the last inspection. Visiting relatives and residents spoken with said that the managers and care manager are easy to approach and they are able to discuss any concerns with them. Many compliments were seen to have been received by the home. The home has policies, procedures and staff training in place to protect residents from abuse. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The home provides a good standard of accommodation which is safe, well maintained and meets the needs of the residents. EVIDENCE: Lugano is an elegant three storey Edwardian house that has been carefully converted to provide a high quality accommodation for twenty seven residents. The home is well furnished and decorated throughout. Communal space consists of an attractive dining room and lounge, both with views over the large and well maintained garden. The resident’s bedrooms were well furnished and personalised. Some have ensuite toilet facilities. The home has four bathrooms, two which have been fitted with electrical seat hoists. Thermostatically controlled taps have been fitted to all bathrooms and hot water temperatures regularly checked. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 16 Discussions took place with the manager regarding supplying paper towels to all communal toilets to minimise risk of infection. All the residents spoken with were very satisfied with their personal accommodation. On the day of the inspection the home was found to be clean, tidy and odour free. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Staff at the home are conscientious and provide a good standard of care for the residents. EVIDENCE: The home continues to maintain agreed staffing levels. The majority of staff have worked in the home for a considerable time. A wide range of training is available to staff with five staff qualified at NVQ level 2 and a further three staff awaiting to commence training. However, there was no evidence to support that the home’s staff induction programme met the standards set by “Skills for Care”! A recently appointed member of staff’s file evidence that robust staff recruitment procedures were in place. Residents and visiting relatives spoken with were very complimentary regarding the care and support provided by the staff. Comments included “staff are always helpful and do find time to sit and talk”. “Staff here are really lovely”. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33 & 35-38 The home continues to be well managed which enables the home to provide a consistent good quality of care. EVIDENCE: The home’s manager has achieved NVQ level 4. The home’s care manager is training to achieve NVQ level 4. Residents and staff spoken with were very complimentary regarding the managers and staff of the home and felt the home was well managed. The home sends out quality questionnaires to residents and their families. Discussions to place regarding the implementation of an appropriate quality assurance system. The home does not look after any residents’ personal money. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 19 Staff receive regular supervision from the care manager. A number of the home’s policies, procedures and records were examined and found to be appropriate. However policies and procedures would benefit from being reviewed on a more regular basis. Health and Safety in the home was not examined in detail on this occasion, however it was noted that two residents were being transported in wheelchairs without footrests. Both residents spoken with did not want footsteps on their wheelchairs. The risks were pointed out to the residents, but they were adamant that they did not want footrests. The situation was discussed with the care manager. If the residents continue to refuse footrests then the situation must be risk assessed and staff made aware of the risks and action required to reduce risks. Residents and their relatives must be given written details regarding the risks and written acceptance recorded. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 20 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. The home must produce protocols for medication prescribed “as and when required” (PRN). 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. The registered person must establish and maintain a system for reviewing and improving the quality of care provided by the home. The registered person must make suitable arrangements to provide a safe system for moving and handling service users. This includes the use of wheelchairs without footrests. Timescale for action 31/05/06 2. OP9 13 15/04/06 3. OP15 17 (2) Sch 4 15/04/06 4. OP33 24 31/05/06 5. OP38 13(5) 15/04/06 Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 22 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. Refer to Standard OP7OP4 OP30 OP26 Good Practice Recommendations Consider appropriate activities for people with dementia and to provide signs etc to orientate residents throughout the building. The homes induction programme should meet the “Skills for care” standard. The home should provide paper hand towels in all communal toilets in the home to reduce the risk of the spread of infection. Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lugano DS0000017873.V285569.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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