Inspection on 19/07/05 for Lukestone

This inspection was carried out on 19th 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 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 13/01/06

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 Announced 19 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. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lukestone Address 7 St Michaels Road Maidstone Kent ME16 8BS 01622 775821 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) Nellsar Limited Vacant CRH Care Home 44 Category(ies) of DE(E) Dementia over 65 (44) registration, with number of places Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: To accommodate service users over the age of 50 years. Date of last inspection 28 March 2005 Brief Description of the Service: Lukestone was puchased by Nellsar Ltd 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 off 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 large patio area with flower beds accessible to residents. Local shops and amenities are nearby and bus stops are located on the main road into Maidstone. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place from 9.30 am until 4.45pm.The inspectors, Debbie Sullivan and Paul Stibbons, spent time with Nellsar’s Operations manager and the Senior Sister/Acting Manager of the home, undertook a tour of the premises and spoke with residents. Due to the nature of the service much information in the report was gained from reading documentation, direct observation and speaking with visiting relatives and staff. The midday meal was partially observed. Comment cards were received before the inspection and comments from these and information from the pre inspection questionnaire completed by the home are included. At the time of the inspection the position of home manager was vacant; recruitment had taken place and it is planned the vacancy will be filled by the Autumn. There were also a number of vacancies for residents. The home was being well run by the Acting Manager and there were positive changes evidenced in some areas, particularly relating to documentation and staffing. What the service does well: What has improved since the last inspection? Staffing recruitment, training and supervision policies and procedures have been improved upon. The assessment of prospective residents has been more formalised and focussed on ensuring needs can be met. A new activities coordinator is in post. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 6 The hairdressing room has been relocated downstairs so it is more easily accessed. 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. Lukestone H56-H06 S52544 Lukestone V227495 190705 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 Lukestone H56-H06 S52544 Lukestone V227495 190705 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) !,2,3,4 and 5. Prospective residents and their relatives have access to information about the home to help them make an informed choice. Needs are fully assessed prior to admission and a place is only offered if they can be met. EVIDENCE: Prospective residents are assessed by the homes’ Senior Sister before a place is offered and comprehensive information is gained from relatives or professionals involved so that a thorough picture of needs is obtained. Most residents are admitted from hospital. The assessment process has been improved over recent months to ensure that inappropriate admissions are avoided. At the time of the inspection there were ten vacancies in the home, assessments of eight prospective residents was planned. The home had not rushed to fill vacancies to allow time for revised admissions procedures and staffing changes to settle. A clear statement of purpose and service users guide is available, relatives are also given a colour brochure summarising the facilities on offer and are encouraged to visit. One relative spoken with stated that “my (relative) is the most settled than for a long time and had been in previous homes”. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 9 Residents receive a written contract and statement of terms and conditions on admission. The home does not offer intermediate care. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10 and 11. Recording on care plans needs to be more thorough or clear in some sections to increase the safety of residents and accessibility of information. The systems for the administration of medication are good; improvement in the temperature of storage facilities will enhance the otherwise sound procedures. Residents are treated with dignity and privacy is respected. Preferences regarding terminal care are respected. EVIDENCE: Care plan documentation has been updated so that information is more easily accessible and comprehensive. There is still some room for improvement so that information can be easily found and a summary of needs at the front of the folders is recommended for staff new to or unfamiliar with the home. Recording under risk assessments has improved but on some plans still needs to be expanded upon to include more detailed information about measures taken and to be put in place to avoid risks. There was evidence that health needs are addressed and that a referral is made to health professionals if required. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 11 Discussion with staff evidenced that importance is given to maintaining good tissue viability and healing and avoiding any pressure areas through good care, monitoring and diet. No residents self medicate. Medication facilities and procedures were inspected and the lunchtime medication round observed. Medication is stored in a dedicated clinical room, cupboards were clearly labelled and the room in good order, there is a locked fridge and controlled drug cabinet. The room was above the recommended medication storage temperature and the drug fridge thermometer faulty so that correct readings were not being taken. An air conditioning unit will be placed in the room and a new thermometer purchased. Staff observed administering medication did so in accordance with policies and procedures. During the inspection nursing and care staff were seen to treat residents respectfully and be attentive to needs. A relative spoken with said that “the staff are very caring”. Each bedroom has en suite facilities and personal care is given in rooms or bathrooms situated on each floor. Evidence was seen on care plans of consultation with relatives about preferences regarding terminal illness and death, if a terminally ill resident wishes to spend their remaining time at the home and are in hospital, their wish to return is respected as long as needs can be met. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 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 standard(s) 12,13,14 and 15. Residents are able to exercise choice over their lives and maintain links with relatives and others. Meals are well cooked and presented with choice on offer. EVIDENCE: Residents are encouraged to exercise choice over their daily lives; evidence of this seen and discussed on the inspection was choice of activity, meals, how to spend personal money and times to get up and go to bed. Personal interests are acknowledged and local churches visit the home. Visitors are welcome at any time and a number were present at various times during the inspection. A room is available so that visitors can be received in private other than in bedrooms. One relative spoken with stated that they “visited at irregular times and are always made welcome”. A new activities coordinator, working 25 hours a week has recently been appointed; the coordinator was very enthusiastic and was hoping to increase the range of activities available following assessment of each residents’ interests and to introduce some therapeutic sessions. On the morning of the inspection a music session using newly purchased percussion instruments was in progress that a number of residents had chosen to attend. The home buys in fortnightly motivation sessions from a specialist provider, a session took place during the afternoon which involved memory and exercise. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 13 Some residents were clearly very engaged in the group and others present were assisted by staff. Time was spent talking to the cook and inspecting the kitchen; a high standard of cleanliness was evident. The cook was also enthusiastic about her role and committed to presenting good food with plenty of choice. Recording of temperatures and cleaning schedules were up to date and in order. The midday meal was partially observed, the meal was well presented, portions were appropriate and residents were seen to enjoy the food. Nutrition is taken seriously to help maintain general good health. A visitor said they regularly helped feed their relative who enjoyed the food and another that they were offered a meal if visiting at mealtimes. A comment from a resident was that “the food here is very nice”. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 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 standard(s) 16 and 18. A clear complaints procedure is in place. Complaints are acted upon and taken seriously. The home has worked hard to increase the awareness of staff regarding adult protection issues and the safety of residents has been enhanced. EVIDENCE: Lukestone has a copy of their complaints procedure mounted on the wall in the entrance hallway. The procedure is included in the statement of purpose and service user’s guide. The complaints recording book was inspected; complaints had been addressed in the given timescale of 28 days. A relative stated that they would know how to complain if necessary but had never needed to. Adult protection and POVA training is provided as part of induction training for staff and update training is provided. Evidence was provided on the inspection and in the pre inspection questionnaire of scheduled training on adult protection and a staff training record showing dates training had been attended. Since the last inspection there had been one adult protection alert that resulted in the home looking closely at communication, staff training and needs assessment issues. Evidence demonstrating that progress had been made in these areas was gathered through discussion with the Operations Manager, Senior Sister/Acting Manager, nursing staff, from observation and reading of documentation. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,23,24,25 and 26. Residents live in a well maintained, pleasantly decorated, safe and clean environment. Facilities throughout the home are available to meet specialist needs. EVIDENCE: Lukestone is attractively decorated and furnished; some residents’ rooms are personalised more than others, this reflects individual choice. A small number of rooms have limited natural light due to small windows, this is a restriction caused by the layout of the building. All but two bedrooms have en suite facilities and there are sufficient toilets and bathrooms throughout the premises. The home was cleaned to a high standard with no unpleasant odours; a relative who regularly visits commented that the home was odour free. The maintenance folder was inspected; checks were seen to have taken place at appropriate intervals. Fire alarms are tested weekly and the last fire drill held on 1.7.05. The outside patio area is safe and secure; the shed used by staff as a rest area had been left unlocked and could be a hazard. Staff will be reminded to lock it after use. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 16 The laundry has steps leading to an ironing room, one of which was in need of repair as it is permeable and could be dangerous. Communal areas indoors are spacious and comfortable. Specialist equipment was seen throughout the home and signage to aid recognition of rooms and areas is to be improved. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 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 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) 27,28,29, and 30. Recruitment, and staff training and supervision procedures have improved. Staff feel well supported and are confident in their work. Staffing policies and procedures can be further refined but there is noticeable progress since the last inspection. EVIDENCE: Lukestone employs trained nurses, who have qualified in this and other countries. Most of the staff are registered nurses awaiting adaptation training. Staff training has improved and the Senior Sister/Acting Manager has devised a post adaptation support programme for nursing staff. A relative who returned a comment card prior to the inspection expressed concern that staff were often unable to adequately communicate with residents due to language difficulties. The management of the home were aware this has been a problem that is being resolved by more local recruitment, training and the home being more established. Recruitment procedures were discussed and evidenced and staff files were sampled. The administrator processes applications and work permits and takes up CRB checks here and abroad; two references are requested and one is followed up verbally. Staffing rotas were seen; these need to include the full names and designation of staff. Staff spoken with individually during the inspection felt well supported; supervision is given to care and nursing staff monthly and recorded and minutes of bi monthly well attended staff meetings were read. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 18 During the inspection care, nursing and other staff were observed to be confident and to relate well with residents. Comments from a relative spoken with were “the nurses are very caring” and “everyone is friendly”. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 19 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) 31,32,33,34,36,37 and 38. The home is being run in the best interests of residents by the current management arrangements. There is a clear commitment to providing a service in the best interests of residents and supporting staff in their work. EVIDENCE: The post of home manager was vacant at the time of the inspection. Following a recent recruitment drive, it is hoped it will be filled by the Autumn by an experienced manager. At the time of the inspection the Senior Sister was Acting Manager and the home was being well run with evidence of positive changes being implemented. A relatives’ feedback survey recently completed was evidenced; comments were mainly positive and matters of dissatisfaction taken seriously. An example was a relative of a resident stating the resident had been dressed uncomfortably; staff have been made aware that garments should be checked when dressing residents to ensure they are not creased up. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 20 The atmosphere in the home was friendly and open and residents and visitors were seen to approach staff confidently and be attended to swiftly. The policies and procedures documentation was sampled and records were kept safely in either the administration office or nursing stations. Standard 35 was not fully inspected, although the home does not manage residents’ finances; families or other advocates undertake this. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 21 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 2 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 Standard No 16 17 18 Score 3 x 3 2 3 3 x 3 3 3 3 Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 22 No 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 9.1 Regulation 13.(2) Requirement The registered person shall make arrangements for the recording,handling,safekeeping,s afe administration and disposal of medicines received into the care home. In that medicines should be stored at the correct temperature and temperatures in the clionical room and drug fridge be correct and monitired correctly. Timescale for action A cooling system was available for immediate use.Action plan regarding future monitoring to be received by the end of August 2005. Action plan to be received by the end of August 2005. 2. 26.4 13.(3) The registered person shall make suitable arrangements to prevent infection,toxic conditions and the spread of infection at the care home.In that repair must be made to the laundry step. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Lukestone Refer to Good Practice Recommendations H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 23 1. 2. 3. 4. 5. 6. Standard 7.2 7 19.3 27.2 37.3 38.2 Care plans need to record in more detail action taken in respect of risk assessment especially where measures are in place to minimise risk to a resident. Care plan folders would benefit from the inclusion of a front one page summary to assist staff unfamiliar with a resident. The garden shed adjoining the patio accessed by residents must be locked when not in use as items in it could cause injury to residents. The staff rota should include the full names of staff not just surnames. Staff records should be maintained in more confidential folders as records could become misplaced with the current format. Bins in en suite facilities need replacing with lidded pedal bins to reduce risk of cross infection. Lukestone H56-H06 S52544 Lukestone V227495 190705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent, 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. 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