Inspection on 28/10/08 for Lukestone

This inspection was carried out on 28th October 2008.

CSCI found this care home to be providing an Excellent service.

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 31/10/06

Lukestone 13/01/06

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lukestone 7 St Michaels Road Maidstone Kent ME16 8BS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paul Stibbons     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Lukestone 7 St Michaels Road Maidstone Kent ME16 8BS 01622755821 01622675432 Lukestone@nellsar.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Nellsar Ltd Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 44. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 27 Over 65 0 44 Brief description of the care home Maidstone. The fees range from 463.20 pounds to 699.45 pounds per week. Social services have a block contract for services. Extra charges are made for: - Chiropody 13.50 pounds, Hairdresser 9.50 pounds to 23.50 pounds. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 31st October 2006. This unannounced inspection visit was conducted over a period of four hours on 28th October 2008. A completed AQAA (Annual Quality Assurance Assessment) was returned to the commission prior to the visit. A tour of the premises was conducted and a variety of records and documents were examined during the visit. Discussions were held with the manager, Director of operations, Residents, Relatives and care staff. Observation of practice informs some judgments. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: There are no requirements arising from this inspection. The home should continue to enroll staff on to NVQ in care and dementia courses to Care Homes for Older People Page 8 of 27 maintain the excellent outcomes for residents the home is currently providing. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have sufficient information on which to make an informed decision as to whether the home can meet their needs. Prospective residents benefit from a trial period and full assessment of needs before a permanent placement and written contract of terms and conditions is offered. Evidence: Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. The home has a company website and information pack. Photographs of staff members are displayed on the notice board as are newsletters and activities calendar. The home has developed a comprehensive statement of purpose and service users Care Homes for Older People Page 11 of 27 Evidence: guide that is kept updated. A comprehensive health and social care assessment is undertaken with the resident and family/representative before admission. The service is highly efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. For individuals whom are self funding, the assessment is undertaken by a highly qualified member of staff. Individuals are supported and encouraged to be involved in the assessment process. Information is gathered from a range of sources including other relevant professionals, and with the individuals agreement. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs, at which point the prospective resident will be sent a letter confirming the placement. Prospective residents are given the opportunity to spend time in the home prior to admission and then have one months trial period to ensure the placement is suitable. Residents have a named nurse and a key worker who liaise with their family and work directly with them to ensure they have a personalised service. All residents receive a contract to which they have agreed and it gives clear information about fees and extra charges which is reviewed and kept up to date. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have an individual plan of care that sets out how their health, personal and social care needs will be fully met. People living in the home are protected by the homes policies and procedures for dealing with medication. People living in the home are treated with respect and their right to privacy is upheld. Evidence: Residents have an individual care plan that is drawn from all of the collated assessments and receive effective personal and health care support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. There is a named nurse system in place for each individual who ensures that care plans are kept up to date and regularly reviewed and record peoples preferences and have expert knowledge about individual personal needs when providing support. Care Homes for Older People Page 13 of 27 Evidence: Staff members were observed during the visit to respond appropriately and sensitively in all situations involving personal care, ensuring that it is conducted in private and at a time and pace directed by the person receiving the care. The home arranges training on health care topics that relate to the health care needs of the residents, for example, dementia, first aid and NVQ qualifications. The home works closely with external professionals and specialists for advice and support to help the resident, for example, continence adviser, diabetic nurse, tissue viability nurse, dietitian and speech and language therapists. The home has developed efficient medication policy, procedure and practice guidance and staff members all have access to this written information and understand their role and responsibilities. Following a requirement made at the last inspection the home has implemented procedures for managing PRN (as required) medication. Monthly quality assurance visits by the Quality assurance manager ensures policy is put into practice. Positive written feedback from a consultant pharmacist audit of managing medication was viewed during the visit. The service is highly efficient when caring for residents who are terminally ill or dying and have implemented End of Life care plans. The wishes of individuals about dying and terminal care and the arrangements they want after death are openly and sensitively discussed during the development of a person centred plan of care. Care staff work to a very high standard and constantly monitor pain, distress and other symptoms to ensure individuals receive the care they need. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have the opportunity to participate in a range of activities that meet their social, spiritual and recreational interests and needs. People living in the home enjoy a healthy and varied diet that is of their choosing. Evidence: Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents by collecting information about individuals life histories and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. The home employs an activities coordinator who works directly with residents and staff in supporting leisure and recreation, for example, daily lunch clubs, games, arts and crafts, singing groups, pat dog therapy and trips out, recent trips include Leeds castle and boat trips on the Medway. The AQAA states that the home caters for a range of religious interests and has contact with Church of England, Roman Catholic and Baptist ministers. Menus viewed indicate meals are very well balanced and highly nutritional and cater Care Homes for Older People Page 15 of 27 Evidence: for varying cultural and dietary needs of residents. The home has developed pictorial menus to enable residents to make choices. The home has an Environmental Health 5 star rating for kitchen cleanliness and record keeping. Staff members were observed assisting those individuals who needed support during mealtimes, including those who have difficulty swallowing or chewing. They were discrete and sensitive to the feelings of both the person they are helping and also to others present. Mealtimes are flexible and relaxed, staff are patient and helpful, and allow individuals the time they needed to finish their meal comfortably Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their views will be listened to, taken seriously and acted upon. People living in the home are protected from abuse. Evidence: The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is supplied to everyone living at the home and is displayed in the entrance lobby of the service. Residents/representatives and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The AQAA states that no complaints have been received by the home in the last 12 months. Visitors and residents spoken with during the inspection said they were happy with the service and had no complaints. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. All staff members have received training around safeguarding issues. Staff working at the service know when incidents need external input and who to refer the incident to. Care Homes for Older People Page 17 of 27 Evidence: Equipment that may be used to restrain individuals such as bed rails, are only used when necessary and reviewed every 3 months. People are involved in the decision making process about any limitations to their choice in this area. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, well-maintained environment with ample personal and communal space to meet their needs. People living in the home benefit from having the specialist equipment they require to maximise their independence. Evidence: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who live there. The living environment is appropriate for the particular needs of the residents and is homely, clean, safe and comfortable. Residents are encouraged to see the home as their own and it is a very well maintained, attractive home and has very good access to community facilities and services. It has a wide range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service, for example, hoists, lifts and pressure relieving mattresses. There are 40 single bedrooms that are all en-suite and 2 double bedrooms with ensuite facilities. Bedrooms viewed had personal possessions on display that reflected the interests of the individual, and all bedrooms have a photograph of the user on the doors to aid orientation. Care Homes for Older People Page 19 of 27 Evidence: A relative spoken with during the inspection states they viewed several homes in the area and Lukestone was the best by far. There is an external patio area with seating and a sensory garden for the enjoyment of the residents. The management has a proactive infection control policy and they work closely with their own staff and external specialists to ensure that infections are minimised. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are in safe hands at all times supported by a trained staff team in adequate numbers. People living in the home are protected by robust recruitment policies and procedures. Evidence: Rotas viewed showed that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Staff members undertake external qualifications beyond the basic requirements and over 50 of staff have NVQ level 2 or higher in care. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. All staff have relevant training that is focused on delivering improved outcomes for residents, this includes health and safety, fire awareness, first aid, manual handling and dementia. There is a good recruitment procedure that clearly defines the process to be followed and includes references, POVA and CRB checks. There are additional checks and guidance for recruiting overseas staff. Personnel files viewed confirm this procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Care Homes for Older People Page 21 of 27 Evidence: Evidence was viewed that confirms staff meetings and supervision sessions take place regularly. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home that is run by a competent manager and the ethos, leadership and management approach of the home. The home is run in the best interests of the residents and their health, safety and welfare is promoted and protected. Evidence: The registered manager has the required qualifications and experience and is highly competent to run the home and meets its stated aims and objectives. The manager communicates a clear sense of direction and demonstrates a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. There is strong evidence through discussion with staff and residents that the ethos of the home is open and transparent and the views of both people who use the service Care Homes for Older People Page 23 of 27 Evidence: and staff are listened to, and valued. The AQAA contains excellent information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to residents. The home demonstrates a high level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed the ways in which they are planning to do this. The home has as appropriate, effective and regular support from the parent organisation through a named line manager and there are clear lines of accountability. The manager states that the home does not act as appointee for residents this role is undertaken by relatives or representatives. Insurance certificate displayed confirms that the home or corporate body are fully insured to meet any loss or legal liabilities. Record keeping is of a consistently high standard and records are kept securely. The home has a comprehensive range of policies and procedures to promote and protect residents and employees health and safety. There is full and clearly written recording of all safety checks and accidents and there is no evidence of a failure to comply with statutory reporting requirements and other relevant legislation. The manager, senior team, and staff at all levels have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. The manager ensures that staff members are trained in health and safety matters as evidenced by individual training records viewed. There is evidence of organisational monitoring by corporate providers. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!