Inspection on 11/07/05 for Luke Senior

This inspection was carried out on 11th July 2005.

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

Other inspections for this house

Luke Senior 11/03/09

Luke Senior 19/02/07

Luke Senior 22/09/05

Luke Senior 16/11/04

Luke Senior 29/06/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Luke Senior Park Lane Guisborough TS14 6ER Lead Inspector Katherine Acheson Unannounced 11 July 2005 09:30 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 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. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Luke Senior Address Park Lane Guisborough TS14 6ER Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01287 632378 Redcar & Cleveland Borough Council Mrs Sarah Jane Brunton Care Home (CRH) 41 Category(ies) of Old Age (31) registration, with number Dementia over 65 (10) of places Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16/11/04 Brief Description of the Service: Luke Senior is registered to provide care to thirty one older people and ten older people with dementia. The home is owned by Redcar and Cleveland Borough Council. Luke Senior is situated in Park Lane, Guisborough, and is close to local shops and ameneties. It is a two storey, purpose built facility offering single room accomodation to residents. Not all bedrooms in the home enironment meet spacial requirements of National Minimum Standards. Bedrooms contain a hand wash basin. The dementia unit is situated on the ground floor of the home, this unit has a separate lounge and dining room facilities. There are a number of other lounges situated on the ground and first floor of the building, there is also a large communal dining area situated on the ground floor for residents residing on the elderly frail unit. There is a passenger lift giving access to the upper floor. The Home also provides day care for 3 additional older people. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 9.30am and lasted for almost five hours. During the inspection five service users were spoken to, four as a group and one individually, four staff members were spoken to, two of which were spoken to as a group. Numerous records including care plans, policies/procedures maintenance and staff records were examined. A brief tour of the premises was carried out. The Manager was not present at the home during the inspection, however, staff should be complimented on their efficiency throughout the inspection process. What the service does well: What has improved since the last inspection? It was highlighted at the last inspection that the Manager must review the home’s system for managing resident’s money; this had been carried out effectively and ensures that resident’s finances are safeguarded. The home’s internal policies and procedures have been reviewed and updated Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 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. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 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 standard(s) 2, 3 Assessments of needs are carried out to ensure that the home can meet the needs of the individual person. EVIDENCE: The Assistant Unit Manager who was in charge of the home during the inspection said that the home do not carry out their own pre-admission assessment of residents, however, an assessment is carried out by a Social Worker, and the home receive a copy of this assessment before the person is admitted to the home. Records were available on files examined during this inspection to confirm that this is the case. A statement of terms and conditions/contract was available on those files sampled during the inspection. The home does not provide intermediate care. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8, 10 The home plans well for and is good at meeting the health, personal and social care needs of the people who live there. EVIDENCE: The home’s care planning system is comprehensive and the records viewed contained detailed information about the care provided. During the visit the inspector spoke to five residents all of who said that they are well cared for. One resident said, “The staff are wonderful, I am very satisfied”, another resident who was receiving respite care said, “It’s excellent, I have been to other places and this is by far the best”. Residents’ views and preferences are recorded in their plans of care and the signatures of residents were seen in plans. Residents spoken to said that they are treated with respect and provided with dignity. It was highlighted at the last inspection that care plans for residents with a medical condition required further development. Records examined showed that medical conditions of the residents had been highlighted along with details of care that is required, however, this was done in the form of a risk assessment as opposed to a plan of care; a discussion took place with staff at the home in respect of this. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 10 Files examined contained a record of visits carried out by chiropodists, GP’s, Opticians and dentists. Records were viewed to confirm that staff at the home carry out an audit of the home’s accident record on a regular basis. Standard 9, medication, was not inspected in full during this inspection, however requirements highlighted at the last inspection were re-visited. The medication trolley when not in use is now chained to the wall, however, reviewing of the home’s medication policy is yet to be addressed. Standard 9, medication, was not inspected in full during this inspection, however a requirement highlighted at the last inspection was re-visited and was found to have been addressed. A group discussion with residents in the conservatory highlighted that on occasions residents had waited some time before they had been taken to the toilet. Residents spoken to made it clear that it was not because staff were unwilling to help, but due to the fact that the conservatory does not contain a call system to summon the help of staff. It was felt by all present that if a call system were to be fitted to the conservatory then this would further enhance the care that was received. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13, 14 Resident’s lives are enhanced by the social activities provided by the home and by the welcome it extends to visitors. EVIDENCE: Staff spoken to during the inspection said that the home provides activities, entertainment and outings for residents on a regular basis. On my arrival to the home residents were observed to be enjoying the morning sunshine in the seating area at the front entrance of the home. One resident said, “I like to read my book out here, whilst I watch the goings on” Residents spoken to spoke of many activities including bingo, crafts, many entertainers and outings. One resident said, “I’m perfectly happy and content, I play bingo every night” the same resident said, “I am looking forward to the trip to Whitby” Residents spoke of the staff’s enthusiasm in providing activities. Residents said that they were looking forward to the home’s summer fayre at the weekend, but hoped that the weather stayed fair, as it had rained last year. In direct observation showed that relationships between staff and residents were very good, the atmosphere within the home was relaxed and staff were respectful when attending to residents. One resident was heard to be singing beautifully as he sat in his room. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 12 Residents spoken to during the inspection said that contact with family and friends is encouraged and that visitors are made to feel welcome at any time. One resident said, “My husband visits me every day” another said “I have lots of visitors”. Residents spoken to said that they were able to exercise freedom of choice and that routines were flexible. Staff said that the home support residents to practice their religion and that visits from clergy are available to the home, residents spoken to confirmed that this was the case. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18 Staff receive appropriate training in respect of adult protection to ensure an appropriate response to any allegation EVIDENCE: A policy/procedure was in place in respect of adult protection, this contained details of the action that staff should take if abuse is suspected. Residents spoken to during the inspection said that they felt safe living at the home. Staff spoken to during the inspection were able to give a clear account of action that should be taken if abuse is suspected. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 14 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 standard(s) EVIDENCE: The above standards were not inspected, however requirements highlighted at the last inspection were re-visited, the majority of which were observed to have been addressed, however hot water pipes in the showers and hairdressing room had not been boxed in to ensure safety of residents. The Person in charge of the home during the inspection said that she would address this and work would be carried out within a month. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: The above standards were not inspected, however a requirement highlighted at previous inspections in respect of staff records being stored in the care home has been addressed. It has been agreed by the Commission for Social Care Inspection that staff records can be held centrally at Redcar & Cleveland Borough Council Offices, and that the CSCI will view records on an annual basis at the Council offices. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 38 Staff receive training relevant to the job that they do, however, fire training is not adequate to ensure safety and protection of staff and residents. Systems are in place to ensure resident’s money is managed appropriately. EVIDENCE: The home operates a rolling programme of servicing appliances and equipment. Records examined at random confirmed that the homes fire extinguishers, fire alarm, gas boilers and emergency lighting are serviced on a regular basis. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 17 Records were available to confirm that staff receive regular training in respect of moving and handling, first aid and other training relevant to the working environment. Records were available to confirm that staff receive fire training, however, this training is provided to staff by them watching a video and then answering questions. A discussion took place regarding the suitability and effectiveness of the video. The home operates an effective system in which they look after the personal allowance of a number of residents. Accurate records of transactions and receipts were available for examination. Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x 3 x x 2 Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 19 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 OP21 Regulation 13 Requirement The hot water pipes in the showers and hairdressing rooms must be boxed in to ensure safety of residents (Previous timescal for action 30th December 2004 not addressed) Care plans must be developed for residents with mediacl conditions A call system which enables residents to summon the help of staff must be fitted to the conservatory A regular and suitable program of fire training must be provided to all staff working at the home Timescale for action 11th August 2005 2. 3. OP7 OP7 14, 15 13 30th September 2005 30th September 2005 Immediate 4. OP38 13, 23 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 OP19 OP19 OP20 Good Practice Recommendations The external wood work should be painted The corridor on the first floor would benefit from redecoration The carpet in the lounge designated for those residents who wish to smoke should be replaced B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 20 Luke Senior 4. OP31 The Manager must continue to work towards achieving her NVQ level 4 in care by 2005 Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit B, Advance St Marks Court Teesdale, Stockton-on-Tees TS17 6QX 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 Luke Senior B51 B01S31344 Luke Senior V237535 110705 Stage 4.doc Version 1.40 Page 22 - 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. 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