Inspection on 06/11/07 for Lulworth Residential Home

This inspection was carried out on 6th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 30/06/06

Lulworth Residential Home 26/10/05

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 Mrs Sue Gaskell Key Unannounced Inspection 6th November 2007 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.V352615.R01.S.doc Version 5.2 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.V352615.R01.S.doc Version 5.2 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 Mrs Mary Frances Lyons Care Home 42 Category(ies) of Dementia - over 65 years of age (42) registration, with number of places Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 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 Date of last inspection 30th June 2006 Brief Description of the Service: Lulworth Residential Home occupies a large detached property located in a quiet residential area of Maidstone within easy reach of the main road into the town and the M20 motorway. Local shops are nearby and the centre of Maidstone is approximately one mile away. Accommodation is provided on three levels with two shaft lifts giving access to upper floors. The home has a garden surrounding the property with a patio area. Four of the bedrooms are equipped with en suite facilities. There are two lounge areas, a sun lounge and dining room all located on the ground floor. The home was substantially renovated and extended in 2003 when a new wing was added. The Home has a registered manager, deputy manager, and a team of carers. The Home also employs an activities co-ordinator, kitchen and domestic staff an administrator and a maintenance man. The current fees range from £401.26 to £525.00 per week. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 6th November between 10.00am and 4.00pm. There are currently 38 residents living in the home. Some residents have limited communication and therefore I sat with residents whilst they were having lunch in order to see whether they appeared relaxed and comfortable. I spoke with the registered manager, operations manager, deputy manager, senior carer and chef. I also spoke with a District Nurse who was visiting residents and a relative who was visiting her mother. I toured the building and looked at bedrooms and all communal areas. The inspection process also consisted of information collected before and during the visit to the home, and feedback from care managers. The annual quality assurance assessment required by the CSCI was completed in a satisfactory manner. Other information seen included general assessments, risk assessments and care plans, medication records and the duty rota. There were no outstanding requirements from the previous inspection and just one requirement, concerning the central heating, made following this inspection. What the service does well: The home prepares care plans, which assists staff in providing consistent and appropriate care. The food is varied, nutritious and well presented. Staff are caring, friendly and well supported. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 6 The home provides a homely, safe, clean environment. What has improved since the last inspection? What they could do better: Risk assessments could be extended. Ensure that the heating system allows residents to control the heating in their bedrooms. Please contact the provider for advice of actions taken in response to this Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 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 Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use the service experience excellent outcomes in this area. The statement of purpose and service user guide says what service will be offered. Prospective residents can be confident that their needs can be met This judgement has been made using available evidence including a visit to this service. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home’s Statement of Purpose and Service User Guide are reviewed and amended on a regular basis. They provide residents, prospective residents and their relatives with all necessary information about the home. Copies of these two documents can be made available in large print or Braille if required and are also on a compact disc. New residents are provided with a Statement of Terms and Conditions/Contract; this sets out in detail what is included in the fee, and what they may be charged extra for. Of the six care plan files I examined, three referred to residents who have been admitted recently. All files inspected include comprehensive preadmission assessments carried out by the home, some with supporting information from health care professionals or care managers. This assessment of prospective resident’s needs is carried out by the registered manager, either in the resident’s home or in hospital. Residents are encouraged to visit the home prior to their admission and/or to stay for a trial period. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience excellent outcomes in this area. Residents’ care plans are reviewed and their health care needs are met. Residents are protected by the home’s policies and procedures for dealing with their medication. Residents are treated with respect. This judgement has been made using available evidence including a visit to this service. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 12 EVIDENCE: All files include reference to all various aspects of daily living including where appropriate, mobility, nutrition, behavioural, emotional and sexual needs. The care plans were seen to be reviewed recently and include risk assessments and guidelines on how best to assist residents and details of their condition and any allergies. A key worker system is in place so that the staff who have most contact with residents now have an input into the care plans and reviews. The daily records are clear and contain enough detail to monitor residents’ health and well being. There is further evidence in the care plan of monitoring residents’ health care needs and general well being, egg there are records to show where residents receive extra checks during the night or where they require particular attention because of their behaviours. These records include risk assessments and guidelines for staff. Residents’ eating preferences are recorded and they are weighed regularly. Residents have access to local health care services and are referred for specialist care when necessary. The local District Nurses call regularly. All residents have access to G.P.’s, dentists, opticians and other community services. A District Nurse who was present at the time of the inspection said that there have been various improvements in the delivery of care at the home and there are no current issues. A care manager who visits one particular client regularly said that he has been pleased with the care of that person. The home has a comprehensive medication policy which has been reviewed recently. Staff confirmed that they do not administer medication unless they have received training, been judged as being competent, and feel confident. There are appropriate records for the receipt, administration and disposal of medication. Separate records are kept for particular types of medication which require special attention. Medication is safely and securely stored in a lockable medication trolley in a locked purpose built room. The room also contains a lockable fridge and a special cabinet for specific medication. There is reference to residents storing and administering their own medication but there are currently no residents where this would be appropriate. One resident’s daughter said that the staff are always very kind and helpful and she is kept fully informed of any changes in the care of her mother. She confirmed that support with personal issues is provided in a sensitive manner that respects residents’ choice and dignity. All staff interviewed spoke of the need to treat residents with respect and to consider dignity when delivering personal care. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 People who use the service experience excellent outcomes in this area. Residents’ lifestyle preferences and expectations are generally met. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. This judgement has been made using available evidence including a visit to this service. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 14 EVIDENCE: The care plans contain a list of residents’ needs, likes and dislikes and preferences. There was evidence in the residents’ daily records to show that families, and other visitors are encouraged and welcomed. I also spoke with one resident’s relative who visits on a very regular basis. She said that she is always made to feel welcome and offered refreshments and meals. Residents may take meals in the dining room or in their own rooms. The food served on the day of the inspection appeared appetising and wholesome and the residents said that it tasted good. Staff said that there is always an alternative to the main midday meal and a wider choice for breakfast and the evening meal. Staff complete a record of whether residents have eaten and enjoyed their meals. One resident’s relatives said that the chef takes great care to prepare food that residents will enjoy. The store cupboard contained a wide range of food including fresh fruit and vegetables. The home employs an activities co-ordinator who keeps a record of the activities offered, including cooking, arts and crafts, games and exercise. The home now has a range of sensory equipment and is waiting for it to be installed where the residents can make best use of it. There are regular visiting entertainers. The residents have the use of a secure garden and there are regular events and outings to which residents’ relatives are also invited. The home keeps records of any involvement in residents’ finances, with appropriate receipts and records kept. Staff signatures are required for monies taken out either to purchase something on residents’ behalf or when residents spend money on social activities such as going on outings. There are no residents at present with different ethnic or cultural needs but the manager gave examples of where residents have been assisted in following their religious beliefs, The manager said that residents would be supported with personal relationships whatever their gender or choice of lifestyle. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience excellent outcomes in this area. Residents and/or their representatives can be confident complaints will be listened to and dealt with appropriately and that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 16 EVIDENCE: The service user guide includes the home’s complaints procedure. Although it was not possible to confirm this with the residents, one resident’s relative confirmed that she would feel comfortable in mentioning any complaints to the management or staff and confident that any concerns would be resolved. Staff confirmed that they are provided with initial training on safe guarding adults and are issued with a copy of the company’s “whistle blowing” procedures during their induction period. The staff interviewed all showed an awareness of the complaints procedure and of all of the issues concerning safe guarding adults. The home has a copy of the Kent and Medway Safeguarding Adults Procedures. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 People who use the service experience good outcomes in this area. Residents live in a comfortable, safe, clean environment. This judgement has been made using available evidence including a visit to this service. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 18 EVIDENCE: The building is on two levels and there is a lift and an alarm call system. The home is suitable for people with impaired mobility. Most of the residents are in single room accommodation, some of which have en-suite facilities. Shared rooms are provided with curtain style screens to afford some privacy. There has been a refurbishment of the home recently which has included redecoration, the painting of bathroom and WC doors to make them more identifiable, and the provision of new furniture. All of the completed bedrooms and living areas are furnished and decorated to a good standard, and contained the type of furniture and equipment necessary to provide a homely environment. Current residents have had some choice in the colour scheme of their rooms. There is a range of individual aids and adaptations to assist resident’s mobility and independence, including specialist baths, raised toilet seats, walking aids, hoists, ramps and grab rails. Some bedroom doors have locks which are not usable as they would not enable staff to gain access in the event of an emergency. All windows have been fitted with restrictors or other means of reducing risk and all radiators are either covered or will be covered in the near future. At the time of the inspection there were some areas in the home, including residents’ bedrooms, which were uncomfortably hot, and some areas which were noticeably cool. The manager said that the heating system has been checked recently but there has been an on-going problem of not being able to adjust the temperatures in some of the bedrooms. There is a secure well-maintained garden and patio with garden furniture which is used by the residents. The current refurbishment has included relandscaping the garden to make it more level and improve the access and security. All areas of the home are clean. Although there are some areas with a noticeable odour, the District Nurse observed that these areas are always being cleaned. There are some areas of older floor covering in this area, which may be the problem. There is separate laundry room with a commercial washer and a drier. Staff showed a good awareness of health and safety issues. There are disposable hand drying towels and pump soap dispensers in communal WC’s Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 19 and shower rooms to reduce the risks of cross infection. Disposable wipes are used for personal care. There are appropriate foot operated bins for particular waste products and staff confirmed that personal items are disposed of appropriately. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good outcomes in this area. Staffing numbers are adequate to meet the daily needs of the residents. Residents are protected and supported by the home’s recruitment and induction training procedures. Residents benefit from a well trained and supported staff team. This judgement has been made using available evidence including a visit to this service. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 21 EVIDENCE: The staff rota showed that there are generally one deputy manager and/or senior carer and four care staff on duty, in addition to the registered manager and activities co-ordinator. There are adequate kitchen and domestic staff, an administrator, and full time gardening and maintenance staff. Night staffing comprises 3 awake staff and there is an emergency on call system covered by the manager and deputy manager. Five staff files were examined and all contained evidence of sound employment, recruitment and supervision practices. The staff interviewed confirmed that they had to complete application forms, and that the home applied for their references, CRB checks and evidence of identity. Approximately 50 of staff have now completed or are shortly to complete NVQ2 training and two staff are currently working towards their NVQ4. Refresher training has also been provided in areas such as infection control, COSHH, moving and handling, first aid, fire safety, safeguarding adults and health and safety. Staff said that there is regular supervision and they also commented on the good working atmosphere and high level of support provided by the manager. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use the service experience excellent outcomes in this area. The current management arrangements ensure that the home is being run in a way which benefits residents and staff. The record keeping, and health and safety systems are sufficient to safeguard residents’ welfare, rights and best interests. This judgement has been made using available evidence including a visit to this service. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has extensive experience and nursing and management qualifications. The management of the home and completion of records are generally of a good standard with daily records regularly checked by the registered manager. There are further checks by the operations manager as part of the monthly regulation 26 visits. Staff said that the residents are regularly asked for their views and feelings about activities, meals and how things are done. This is either through talking to individual clients or through questionnaires for residents, and/or their families. The questionnaires include questions on satisfaction with personal support, the quality and quantity of the meals, staff attitudes, complaints and the comfort and cleanliness of the environment. The manager said that policies and procedures are reviewed continuously as issues arise, and several new systems have been put in place since the last inspection to ensure good practice. This includes health and safety and care checklists for staff to use to night and questionnaires issued to care managers to ensure a good flow of communication. Other quality assurance methods include the weekly senior management staff meetings and an annual business plan. Staff said that the manager and managing team are supportive and that staff morale is good. The manager was very ready to praise the staff team. There were no obvious hazards around the home and there was evidence to show that health and safety issues are taken seriously egg staff ensuring that personal items were appropriately disposed of and warning signs in place for wet floors. The fire alarm and emergency lighting are tested regularly. The maintenance file contains current certificates to show that regular checks egg gas, electricity, are carried out. Whilst there are adequate risk assessments on the environment, and for activities involving residents, these would benefit from more detail. Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 24 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 X X 4 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 25 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 OP25 Regulation 23 Requirement Ensure that the heating in all areas is adjustable according to resident’s needs and wishes. Timescale for action 28/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lulworth Residential Home DS0000024085.V352615.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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