Inspection on 26/10/05 for Lulworth Residential Home

This inspection was carried out on 26th October 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

Lulworth Residential Home 06/11/07

Lulworth Residential Home 30/06/06

Lulworth Residential Home 30/08/05

Lulworth Residential Home 05/01/05

Lulworth Residential Home 14/04/04

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

CARE HOMES FOR OLDER PEOPLE Lulworth Residential Home Lulworth House Queens Avenue Maidstone Kent ME16 0EN Lead Inspector Debbie Sullivan Unannounced Inspection 26th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lulworth Residential Home DS0000024085.V260625.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. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lulworth Residential Home Address Lulworth House Queens Avenue Maidstone Kent ME16 0EN 01622 683231 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) Nellsar Limited Care Home 42 Category(ies) of Dementia - over 65 years of age (42) registration, with number of places Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Services users between 60 and 65 years of age that have a diagnosis of dementia may be admitted to the home. The home may provide service to two persons with the category of MD whose dates of birth are 06/07/1926 and 29/11/1934. 30th August 2005 Date of last inspection Brief Description of the Service: Lulworth Residential Home occupies a large detached property located in a quiet residential area of Maidstone. It is in easy reach of the main road into the town and the M20 motorway. There are local shops nearby and the centre of Maidstone is approximately one mile away. Accommodation is provided on three levels, two shaft lifts provide access to upper floors. A garden and patio area surrounds the property. Four bedrooms are equipped with en suite facilities. There are two lounge areas, a conservatory and dining room on the ground floor. The home was substantially renovated and extended in 2003. Lulworth Residential Home DS0000024085.V260625.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 over five hours. Due to the nature of the service most of the evidence was gained from discussion with the homes’ manager and other members of staff. No residents had visitors during the inspection, so unfortunately it was not possible to gain views from relatives or friends. The homeowners were present for some of the time and were given feedback on findings prior to the inspection being completed. A tour of the premises took place, documentation was read and lunch observed, lunchtime medication round and the general daily routines of the home were observed. What the service does well: What has improved since the last inspection? A new expanded care plan has been devised which is thorough and allows for information to be easily accessed, completion of the new plans for each resident is underway. Space available has been improved in a shared bedroom. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 6 Plans have been agreed for improvements to the internal and external environment that will improve accessibility to some areas and reduce any hazards. The lighting in the dining room has been changed so that it is more suitable for the resident group. Some new furniture has been provided in the lounge. A new staff handbook has been compiled. Recording of fire procedures has improved with the introduction of a document to log staff fire training and practice and to update when staff leave or join. 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. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4, and 5. Prospective residents and their relatives have access to information to help them make an informed choice before moving into the home. EVIDENCE: Standards 1 and 2 were not fully inspected, on the last inspection on 30th August 2005 they were fully met, both the service users’ guide and statement of purpose had been updated. Following referral to the home the manager undertakes an assessment of need by visiting the prospective resident at home or in hospital, when there is a deputy manager in post this responsibility will be shared. Prospective residents and their families are able to visit to view the service before making a decision on taking a place. Relatives are invited to provide a written history and up to date information so that a full picture of the resident can be gained. One care plan read included a very full and helpful history provided by a relative. The home does not offer intermediate care. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 and 10. Care plan recording is improving to include more comprehensive and accessible information. Medication procedures need to be improved upon. Residents are treated with respect and health care needs are well met. EVIDENCE: Care plans have been updated, this work is continuing and a new format has been devised which allows for information to be recorded more clearly and easily and to be more accessible. Care plans in the existing format contain sectioned and comprehensive information although it was not always easy to find. The new care plans include sections dedicated to the recording of GP and District Nurse input. Care plans and other documents read included evidence of liaison with health professionals and of specialist needs being met, for example contact with a Parkinson’s’ disease nurse and details of hospital appointments, the manager explained that a visit from a consultant for one resident had been arranged to reassess the need for a medication. If the needs of a resident can no longer be met by the home a reassessment takes place and an appropriate alternative service is sought. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 10 No residents self medicate. The medication room was in good order and medication was stored correctly. The Nomad system is now well established, medication to be returned to the pharmacy was kept in the room. The lunchtime medication round was partially observed, at one point the carer left the trolley unattended whilst giving medication in the lounge. The manager addressed this during the inspection. Residents requiring assistance with their personal care were attended to in privacy and care plans provided information on personal care preferences. One downstairs double room has very limited space for personal care to be given discreetly. It was a recommendation of the last inspection that net curtains be fitted at the windows; the manager and homeowner advised they will imminently be fitted. It remains a requirement that the use of this room for shared use be reviewed. Double rooms allow for space to be personalised. Systems are in place to ensure that laundered clothes are returned to the correct resident, the home is to purchase a new labelling system that will attach labels more securely to garments so that there is even less chance for clothes to be mislaid. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 and 15. Residents are well supported in maintaining links with friends, family and the community and are able to exercise choice over their daily lives. Importance is placed on maintaining good nutrition; meals are well cooked and varied. EVIDENCE: The home has a programme of activities arranged by the activities coordinator who is employed four days a week. The weekly activities are displayed on a notice board; the coordinator sends a questionnaire to residents’ relatives asking for information on interests and ideas for suitable activities. Activities are flexible in terms of duration and the resident group. Events and outings take place such as trips to the coast and barbeques in good weather and in recognition of special dates such as a VJ day celebration and a forthcoming bonfire night party. A letter was displayed from a relative thanking the home for a birthday celebration. Although no visitors were at the home, during the last inspection a number were present and said they could visit at any time and were made welcome. A dedicated room visitor’s room is available. Residents are able to exercise choice in their daily lives, bedrooms are personalised, there is daily choice of meals and residents can move safely and freely around the home. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 12 Menus are on a four weekly rotation and include a good variety of meals that are both traditional and more imaginative to provide a range of tastes and textures. The cook was spoken with in the kitchen and places importance on providing freshly cooked and varied meals. Additional snacks, drinks, food supplements and a high energy drink that the home has developed in liaison with the district nurse are available in between meals to keep up residents’ nutritional intake as a number are very active for most of the day. Special diets are catered for. The dining room lighting had been changed and is now more appropriate for the resident group. A menu boarding the dining room is updated daily, as well as information on meals it contained misleading information for residents regarding the weather, the manager immediately addressed this. Those eating in the dining room enjoyed their meal; some residents who needed assistance with eating had lunch in the lounge. The meal was unrushed although some carers were standing up to feed residents; again this was immediately addressed. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 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 the following standard(s): 16,17 and 18. Residents and relatives can be sure that complaints will be listened to and acted upon. Adult protection procedures are in place. EVIDENCE: Standard 16 was partially inspected. The home has a complaints procedure that was displayed in the entrance to the home and on a notice board. There had been no complaints since the last inspection; complaints procedures seen then had been correctly adhered to. Some residents are registered to vote, the manager had sought advice as to how to proceed if they were unable to make an informed choice. Staff receive adult protection training and CRB and POVA checks are made on applicants. This documentation was not available in respect of a member of the ancillary staff recently recruited via an agency; the manager was making efforts to gain this information. No other staff recruited or employed by an agency were working at the home. Records in relation to residents’ financial transactions were not available as the administrator was not on duty. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 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 the following standard(s): 19,20,21,22,23,24,25 and 26. Residents live in a clean, comfortable and well-maintained home. Improvements to indoor and outdoor space will improve the quality and accessibility of the environment. EVIDENCE: Improvements have been made to the environment. Some seating has-been replaced in the lounge. A shared bedroom has been altered to allow for more individual space although it’s use needs to continue to be reviewed and net curtains must be fitted as the room overlooks the drive. Dining room lights have been replaced. Further improvements planned will increase the safety and accessibility of some outside areas and brighten up the stairway and lounge. Environmental risk assessments now include outside and all communal areas. All parts of the home seen were clean and well maintained, a slight odour in one room was quickly dealt with. Three residents smoke in the conservatory at times when no other residents are present. The conservatory is used for activities and there was a strong smell of smoke lingering, discussion took place with the manager as to how to protect other residents and staff from smoke. Risk assessments and Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 15 consultation will be undertaken in respect of residents who are not in shared rooms, as to the viability of smoking in their individual accommodation and no residents who smoke will be admitted in future. Individual bedrooms vary in size and décor; all included varying amounts of personal items and furniture. Some were very personalised and attractive. Shared rooms are equipped with curtains for privacy. Window restrictors had been broken in two rooms, these were to be mended by the maintenance man. Equipment to aid and maintain independence was in evidence throughout the home; some wheelchairs and other equipment were stored in an alcove leading off the main lounge and intruding into it, this reduced space available to residents and was not appropriate in a sitting area. The laundry is located in an outbuilding next to the main house and has been equipped with a new ozone laundry system. The laundry was clean and clothes returned to baskets for each resident. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 16 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): 27,28,29 and 30. An appropriate mix of staff that has good awareness of their needs supports residents. Direct recruitment practices are thorough; procedures for the employment of agency staff need to be improved upon. EVIDENCE: An appropriate number and skill mix of staff were present; the post of deputy manager was vacant with recruitment due to take place. Care staff were very much in evidence and were seen to be talking with residents as well as helping with social and personal care needs. All staff went about their work competently and residents related to them well. Care staff recognised individual preferences and friendships and those spoken with liked working with the resident group. Staff receive induction and update training on topics such as manual handling, fire safety and service specific training regarding dementia. Recruitment procedures and practices are good, staff files read were well presented and up to date and information was easy to find. Evidence was in place of both verbal and written references, CRB and POVA checks and induction and training, although no documentation was available for a member of ancillary staff employed via an agency who had recently commenced working at the home. One staff member spoken with confirmed that their recruitment had been thorough. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 17 Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,36,37 and 38. The home is well run and improvements have increased the quality of the service. Staff are well supported and records kept securely. EVIDENCE: The home manager has applied to become the registered manager and has completed the Registered Managers’ award. The manager continues to progress improvements to the home and standards have risen substantially during 2005. The atmosphere in the home was open and friendly a comment from a staff member spoken with was “ It was welcoming when I first came here”. Consultation takes place with residents and relatives and regular relatives meetings are held. A group of relatives has become very involved and recently started helping with gardening at the home. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 19 Financial investment is being made in the home with a programme of improvements planned. Regular supervision is given by the manager, staff spoken with felt well supported and that the manager was helpful and approachable. Staff meetings take place on a regular basis. One staff member commented that the manager is very involved in arranging social activities for residents. Records are kept safely, care plans are kept locked in the care staff office when not in use, staffing information and other confidential records are in the managers’ office. Financial records are located in the administrator’s office and could not be accessed. Standard 38 was not thoroughly inspected although safe working practices were observed during the inspection and procedures and records to ensure safety in the event of fire have been improved upon. Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 2 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X 3 3 3 Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 9 Regulation 13(2) Requirement “ The registered person shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home” In that the medication trolley must not be left unattended and unlocked at any time. “The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the dignity and privacy of service users.” In that re review of the front downstairsshared bedroom be undertaken as there is insufficient space in the area provided around the washbasin for personal care to take place in privacy. Net curtains must be fitted as a priority. “ The registered person shall 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 residents who require assistance with feeding DS0000024085.V260625.R01.S.doc Timescale for action 20/12/05 2 10 12(4)(a) 20/12/05 3 15 12(1)(a) 20/12/05 Lulworth Residential Home Version 5.0 Page 22 4 22 23(2)(l) 5 29 18(1)(a) 19(1)(b) 6 35 17(3)(b) 4(8) 7 38 12(1)(a) 13(4)(c) receive this in an appropriate and dignified manner. “ The registered person shall ensure that suitable provision is, made for storage for the purposes of the care home.” In that a storage area must be provided for wheelchairs and other equipment that does not limit or intrude upon communal living space. “ The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home” and, “ The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person information and documents specified in Schedule 2 paragraphs 1-6.” In that evidence must be provided that any agency staff have relevant qualifications and training, CRB and POVA checks and other specified documentation be provided, before they are employed at the home. “The registered person shall ensure that a record of the care homes’ charges to service users are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home” In that all financial records must be accessible for inspection. “ The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users” and, “ any unnecessary risks to the health and safety of service users are identified and DS0000024085.V260625.R01.S.doc 20/12/05 20/12/05 20/12/05 20/12/05 Lulworth Residential Home Version 5.0 Page 23 so far as possible eliminated” In that smoking must be eliminated from a communal area as far as is possible” 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 Refer to Standard 22 32 Good Practice Recommendations It is recommended that incontinence pads and plastic gloves used on the top floor be stored more discreetly. It is strongly recommended that misleading information for residents must not be written on the menu board Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 24 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 Lulworth Residential Home DS0000024085.V260625.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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