Inspection on 13/01/06 for Lukestone

This inspection was carried out on 13th January 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

Lukestone 28/10/08

Lukestone 31/10/06

Lukestone 19/07/05

Lukestone 28/03/05

Lukestone 19/07/04

Lukestone 24/02/04

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

CARE HOMES FOR OLDER PEOPLE Lukestone 7 St Michaels Road Maidstone Kent ME16 8BS Lead Inspector Debbie Sullivan Unannounced Inspection 12th January 2006 10.15 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 Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 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. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lukestone Address 7 St Michaels Road Maidstone Kent ME16 8BS 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) 01622 775821 Nellsar Limited Vacant Care Home 44 Category(ies) of Dementia - over 65 years of age (44) registration, with number of places Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate services users over the age of 50 years Date of last inspection 19th July 2005 Brief Description of the Service: Nellsar Ltd purchased Lukestone in 2004 and the premises were then extensively refurbished. The home is a large detached property in its own grounds situated approximately one mile from the centre of Maidstone, in a residential area a short distance from the main road. The home is registered for 44 residents; bedrooms are on three floors with access to upper levels via a shaft lift. The ground floor comprises of bedrooms, staff offices and a nursing station, dining and activities areas and a large lounge room. There is a secure patio area with flowerbeds accessible to residents. Local shops and amenities are nearby and bus stops are located on the main road into Maidstone. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 10.15 am until 4.05 pm. Time was spent with the homes’ manager and operations manager, care and nursing staff, the cook, activities coordinator, residents and visiting relatives. A tour of the premises took place and some documentation and records were read. Due to the nature of the service most of the observations in this report were gained from staff and relatives, direct observation and documentation. The manager started work at the home in September 2005 and has applied to become the registered manager. At the time of the inspection there was one vacancy for a member of nursing staff and four vacant beds, an admission took place that day. Throughout the day staff were friendly and helpful in supplying verbal and written information. The views of relatives spoken with were positive and included, “Very good staff here” “No complaints” “The new manager is good” “Standards of cleanliness are excellent” “The food is good” “My (relative) is very happy here” What the service does well: Prospective residents are assessed prior to admission and have access to comprehensive information about the service. Staffing levels are good and care and nursing staff are provided with plenty of service specific training. A programme of day activities is offered to meet a variety of interests. The environment is comfortable, clean and well furnished. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 6 There are opportunities for relatives to meet with senior staff and the suggestions that they make for improvement are taken forward. What has improved since the last inspection? What they could do better: Procedures for the safe administration of medication and the security of the medication trolley whilst in use need to be improved upon. The homeliness of resident’s bedrooms would be improved upon if the option of divan beds was available, and the location of the screening in a double room needs to be reconsidered. Menu options need to be available to residents in a clear accessible format. The health and safety of residents and staff could be improved upon in some respects such as the provision of rubbish bins with lids in ensuites. Fire records need to be properly dated and indexed and records and documentation available at all times for inspection. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 7 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. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 8 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 Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 9 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): 1,3,4 and 5. Prospective residents and their relatives have access to information about the home to enable them to make an informed choice. Needs are fully assessed prior to admission and a place only offered if they could be fully met. EVIDENCE: The home has a comprehensive statement of purpose and service user’s guide and a colour brochure giving information on the service. Prospective residents are assessed by the manager prior to admission, needs are recorded on a pre admission document and no one is admitted if needs cannot be fully met .The manager and operations manager gave examples of a situation where a referral to the home had been turned down as the individuals’ needs in terms of staffing and health were to extensive for them to manage. Just under half of the beds are block contracted by Social Services, so care management assessments are also undertaken prior to a referral to the home. Relatives spoken with said that they had been able to visit to view the facilities before their relative moved in and in one case had been able to choose from a Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 10 choice of rooms. One relative of a resident recently transferred from a residential home made positive comparisons, and all said that their relative was happy at the home and they were satisfied with the service. The home does not offer intermediate care. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 11 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): 7,8,9,10 and 11. Care plans have improved and contain information on health and personal care needs. Medication procedures need to be refined and staff retrained so that residents are fully protected by the systems in place for the safekeeping and administration of medication. Residents are treated with respect and dignity and wishes regarding terminal care recorded. EVIDENCE: Some care plans were read including those of very recently admitted residents. Care plans have been made more comprehensive and information in relation to risk assessments has been expanded upon. Care plans contain personal information, health monitoring documentation such as weight and Waterlow skin integrity charts, daily log sheets and evidence of reviews. There is a key worker system and key workers are responsible for tracking and undertaking reviews. Care plans contained evidence of input from other professionals such as dieticians and care managers, and of information on personal interests in some cases. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 12 Residents do not self medicate; medication is stored appropriately in a dedicated room which was kept in good order. The lunchtime medication round was partially observed, the member of staff administering medication was seen to give three residents water to drink after their doses from the same glass, not changing the water, and to leave the trolley, although locked, unmonitored by other staff whilst giving medication, the trolley was not tethered. The manager and operations manager said that immediate action would be taken regarding this and that the use of the same glass was not the homes’ practice. Throughout the inspection all staff were observed to attend to and speak with residents in a respectful and dignified manner, a relative spoken with was complimentary regarding the patient manner of the staff. The preferences of residents regarding terminal care and in the event of death are recorded on care plans if this information is available, and residents near the end of their lives are able to remain at the home as long as care and nursing needs can be met. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 13 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): 12,13,14 and 15. Residents are supported in maintaining links with friends and families and are able to make choices over aspects of their daily lives. Opportunities are offered to engage in daily activities at the home. Meals are well cooked and varied; information on meals needs to be made more accessible to residents. EVIDENCE: The home employs an activities coordinator; the programme of weekly activities includes, art and craft, music sessions, visits from a pianist, games and bingo and remembrance sessions. Some residents were engaged in an art session in the main lounge and others were in part of the dining room. The coordinator had a good understanding of individual interests and abilities. Residents are able to make choices in their daily lives in respect of ground floor area of the home to access in the daytime, meals, and activities to take part in. A hairdresser visits fortnightly. Since the last inspection the lounge area has been made more homely by the replacing of seating so that chairs are not in rows, and coffee table have been provided. During the inspection a number of visitors arrived at various times and were made welcome, the relatives of one resident said that in summer lunch could be taken outside on the patio. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 14 Meals are varied and well cooked, lunch was fish, chips and peas with sponge and custard for pudding. The food was well presented for those on normal and on pureed diets, and the mealtime unhurried with plenty of staff available to help those needing assistance with eating. One member of staff was feeding a resident whilst standing up which was not appropriate. Choice can be offered if a resident does not like the main meal, the menu is displayed in the dining room but needs to be in a format that is more easily accessible to the resident group. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 15 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 and 18. Residents and their relatives can feel confident that concerns and complaints will be taken seriously. Residents are protected from abuse by the homes’ adult protection procedures. EVIDENCE: The home has an established complaints procedure that is included in the statement of purpose and service user’s guide. No complaints had been received since the last inspection. A record of complaints is kept although a new complaints book is needed so that the security and confidentiality of information is ensured. Relatives spoken with said they would be happy to raise a concern or complaint with the manager or senior staff, and staff spoken with were aware of the complaints procedure. Staff receive adult protection training as part of their induction and updates are given, CRB and POVA checks are undertaken on new staff employed at the home and no member of the care staff works unsupervised until their CRB is through. There had been no adult protection alerts since the last inspection. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 16 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): 19,20,21,22,23,24,25 and 26. Residents live in a well maintained, pleasantly decorated, clean and comfortable environment. There are facilities throughout the home to aid independence. EVIDENCE: The home is well decorated, furnished and maintained. All areas of the home inspected were cleaned to a good standard, the only odour noticeable was in an en suite toilet which had yet to be cleaned that morning. Bedrooms and communal areas are appropriate to the needs of the client group and a there is a safe and secure garden and patio area that is used in fine weather. Bedrooms are located on all three floors with access via a shaft lift, each floor has an assisted bathroom and a shower room and there are plenty of toilets. There are grab rails in all corridors accessed by residents. The pedal bins in the toilets need to be replaced with bins that have lids to reduce the risk of cross infection. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 17 Bedrooms are equipped with call bell points, each resident is risk assessed as regards use of bells and leads in their rooms, and they are removed if any risk is present. Individual bedrooms are personalised to differing degrees, residents and relatives are encouraged to bring in personal items, and some rooms contained lots of ornaments and pictures. In rooms with less personal items or pictures the walls appeared bare, the addition of pictures provided by the home if a resident accepts these would enhance their personal environment. Each room is equipped with a hospital bed, where the needs of the resident are not such that one is required; it is recommended that residents and relatives be offered the option of providing a divan bed. There are two shared rooms; both were only occupied by one resident, fixed curtaining is in place, although in the double room inspected, the curtain rail was located so that if the room was fully occupied one resident, or staff in the room, would need to access the other’s personal space in order to reach the door. The laundry is located away from any food preparation areas and a permeable step has been repaired. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 18 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): 27,29 and 30. The home has a sufficient compliment and skill mix of staff that are well trained and aware of the needs of the resident group. Recruitment policies and procedures serve to protect residents. EVIDENCE: Lukestone employs carers and trained nurses who have qualified in this and other countries, as well as kitchen and housekeeping staff. Six carers and three nurses were on duty during the inspection, there was one nursing vacancy that was to be advertised. The number of nursing and care staff on duty allowed for residents to receive sufficient individual attention, and for carers to attend to needs on a one to one basis when necessary. All staff receive induction training and a programme of mandatory training and courses on subjects relating to the specific care needs of residents is arranged. The most up to date list of training was not accessible, the list of training provided in 2005 included challenging behaviour, continence, pressure care, care planning and nutrition and dementia. A sample of staff files were inspected, they included references, photographs, proof of identity, CRB and POVA checks, training certificates, an induction check list and in the case of staff from overseas work permits and any relevant communication regarding permit applications. The new manager has reviewed all staff files, information is now indexed and kept securely in folders. Care staff spoken with said that they have the opportunity to attend plenty of training and listed mandatory course updates attended recently. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 19 Relatives spoke well of staff and the patience given to residents. Due to the high number of overseas staff there had been occasions when there had been communication difficulties in respect of residents, although this has not recently been highlighted as a problem. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 20 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): 31,32,33,34,35,36,37 and 38. The home is well run in the best interests of residents and staff and staff are well supported. Improvements in safe working practices and procedures are needed to enhance the health and safety of residents and staff. EVIDENCE: The manager has been in post since 20th September 2005 and has applied to become the registered manager, the lines of accountability are clear with the senior sister being responsible for overseeing nursing tasks at the home. Nellsar’s operations manager who was present for part of the inspection supports the manager. The atmosphere was open and friendly and there had been positive changes in some areas of administration such as staff files and recruitment. Quality assurance questionnaires are circulated to relatives, the results of the 2005 survey were displayed in the entrance hall. Relatives spoken with said Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 21 that relatives meetings are held and that they welcome the opportunity to make suggestions, one suggestion that had been actioned was that staff and residents stop have a morning coffee break at the same time so that staff were on hand to help residents with their drinks. Staff receive documented supervision, although records could not be inspected as the administrator who held the key to the cabinet was not on duty. Staff spoken with confirmed that they receive regular supervision. Safe working practices and measures to protect residents from health and safety risks were observed and in place, with omissions in terms of a tray of cleaning materials left in an unattended bathroom, the need for lidded pedal bins in communal toilets and ensuites and a freezer without a working temperature gauge and in need of cleaning in the kitchen. A valid insurance certificate is on display. Fire records show that drills take place on a regular basis and smoke detectors, emergency lighting and tests on other safety equipment take place, although files with these records need to be more clearly labelled so they can be easily accessed. Staff evidenced verbally that drills take place both with and without warning. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 22 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 2 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 2 2 Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 23 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 OP9 Regulation 13.2 13.3 Requirement Timescale for action 17/03/06 2. OP15 12(1)(a) (4)(a) “ The registered person shall make arrangements for the recording, handling, safekeeping, safe administration, and disposal of medicines received into the care home and to prevent infection, toxic conditions and the spread of infection at the care home” In that the medication trolley must be tethered when used in the dining room, or overseen by a second member of staff whilst medication is being given. The same glass of water must not be given to more than one resident following their medication. The manager advised that immediate action would be taken regarding the use of water glasses. “ The registered person shall 17/03/06 ensure that the care home is conducted so as to promote and make proper provision for the care and welfare of service users, and is conducted in a manner which respects the privacy and dignity of service DS0000052544.V264354.R01.S.doc Version 5.0 Lukestone Page 24 3 OP26 13(3) 4 OP37 17(3)(b) 5 OP38 12(1)(a) users.” In that staff should not stand up to feed residents who need help with meals. “The registered person shall 17/03/06 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”. In that all freezers must be regularly defrosted and cleaned, and have working temperature gauges, and all open jars of food be labelled with the date of opening. “ The registered person shall 17/03/06 ensure that the records referred to in Schedule 4(6)(f) are at all times available for inspection in the care by any person authorised by the Commission to enter and inspect the care home” In that staff supervision records must be available for inspection at all times. “The registered person shall 17/03/06 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users”. In that cleaning materials should not be left unattended. All kitchen freezers have working temperature gauges and are regularly cleaned. Jars of food opened and refrigerated are labelled with the date of opening. Fire record folders be properly indexed and labelled so that evidence of all drills and checks can be easily identified. Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 25 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 OP1 Good Practice Recommendations It is strongly recommended that the statement of purpose and service user’s guide be amended as required to specify the correct number of beds and the name of the new manager. It is recommended that daily main meal options be displayed in a format more easily accessible to residents. It is strongly recommended that complaints and related documentation be filed more safely and securely in a dedicated book or folder. It is recommended that new residents be offered the option of providing a divan bed and additions to the decoration in the room if they do not bring many items from home or other previous accommodation. It is strongly recommended that where the location of fixed screening does not fully allow for privacy in shared rooms the use of the rooms for shared use or relocation of screens is reviewed. 2. 3. 4. OP15 OP16 OP24 5. OP24 Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Lukestone DS0000052544.V264354.R01.S.doc Version 5.0 Page 27 - 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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