CARE HOMES FOR OLDER PEOPLE
Lunesdale House Lunesdale House Hale Milnethorpe Cumbria LA7 7BN Lead Inspector
Marian Whittam Unannounced Inspection 9th October 2006 10:20a 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 Lunesdale House DS0000062846.V308618.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. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lunesdale House Address Lunesdale House Hale Milnethorpe Cumbria LA7 7BN 015395 63293 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) Mr Christopher David Green Mr Christopher David Green Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 18 service users to include: Up to 18 service users in the category of OP ( Old age, not falling into any other category) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 23rd March 2006 Date of last inspection Brief Description of the Service: Lunesdale House is a residential care home providing personal care and accommodation for older people. The home is a large detached, older property with modern extensions that have been purpose-built to provide additional bedrooms with en-suite facilities, a large reception area and a large communal lounge. The home is on the A6 approximately two miles south of the town of Milnthorpe, a market town in the southern Lake District. The home is set back from the main road and is surrounded by attractive gardens that are easily accessible, with a car park at the front for visitors. There are extensive views over the surrounding hills and countryside from most rooms in the home. There is a stair lift for easy access to the first floor. All bedrooms have en-suite facilities and are for single occupancy only. In addition to the new extensions the home has been refurbished throughout. Fees payable at the home range from £385.00 to £410.00 a week as at 9th October 2006. There are additional charges for hairdressing and private chiropody. The home makes information about its services available through its brochures, service user guide and statement of purpose. These are available in the home. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on 9th October 2006. The inspector looked around the home and spoke with the manager, residents, visitors to the home and staff members. Staff recruitment records, training records, medication handling and records and care plans were examined and a selection of records required by regulation. The provider had supplied information about the home and services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection took place. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activity. What the service does well: What has improved since the last inspection?
Since the last inspection the home has started a more formal programme of staff supervision and senior staff oversee this. This should ensure that staff are appropriately supervised and follow the homes policies and procedures to promote residents welfare. Work continues, following completion of the extensions to the home, to improve and upgrade the environment for residents living there. Many of the improvements made are unseen such as new heating systems, electrical rewiring and new septic tank, other improvements can be seen in the new call
Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 6 bell system, larger car park and ongoing redecoration and refurbishment of residents bedrooms. Overall major environmental improvements have been made to the home to give residents a safe, comfortable and well maintained home to live in. 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. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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): 1,2,3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose, Service User Guide and terms and conditions of residency provide information to promote making informed choices about living in the home. EVIDENCE: Information about the services the home provides is available in the statement of purpose and service users guide. These are available and provided for all residents and families. There are copies of social services contracts for care kept securely on file. Individual care plans record that new residents needs are being assessed by senior staff before and at the time of admission to the home. Individual and ongoing care plans have been developed from this. Information from other agencies is obtained to try to ensure that the home will be able to meet residents’ needs when they come to live there. During the visit the Macmillan Nurse was visiting a resident to provide specialist advice and support.
Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 9 Where appropriate families, other specialised care agencies and professionals are involved in providing information on the health and personal needs to be met. The home encourages trial visits and there were some prospective residents and families looking around the home and talking with staff and other residents on the day of the visit. One resident has a phased introduction into living in the home, as they made the transition from their own home, and staff are supporting them to do this. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning and assessment system in place to provide information for staff to meet resident’s individual health, personal and social care needs. EVIDENCE: This home has care plans recording a range of information about the residents’ social, health and personal care needs, daily routines and preferences, including residents’ expectations and wishes after their death. Care plans are reviewed and updated. Referrals to doctors and other health care and specialised services are being done and working relationships with other agencies are good. Visits to specialised services are recorded and residents say they see doctors, dentists and opticians as they need to. The home uses a monitored dose system for medicines and records quantities of medicines received from pharmacy and those disposed of. Storage facilities for medicines are satisfactory. However some medication practices need reviewing to promote good practice. Where a medication chart is written out by hand it should to be checked, signed and dated by another staff member as a safeguard for promoting accuracy. Also where a dose of a medicine varies
Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 11 the quantity given each time should always be recorded on the chart. The home does not have many medicines that need refrigeration but when prescribed for residents they should be stored separately and securely. Residents who choose to keep their own medicines are supported to do so and a risk assessment is undertaken. Observation during the inspection, records of care planning and conversations with residents and relatives suggests that resident’s are treated very much as individuals with their dignity, independence and choice promoted by staff. Some residents spoken with had lived there many years, one said it “truly was their home from home”. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14,and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A varied and nutritious menu is provided and a programme of organised activities is in place taking into account resident’s individual preferences, choices, capabilities and cultural and religious expectations. EVIDENCE: There is a resident centred programme of social events as well as individual and group activities. There are regular outings to places that residents help choose. Some trips are in small groups or as residents needs dictate. Links are in place with local churches to give access to different religious needs and so offer a variety of religious services and pastoral support. Residents spoke highly of the social activities, of a recent visit to see gospel singers and attending a local flower festival. One resident especially liked playing cards with staff in the evenings and another had enjoyed a barbeque during the warm weather. Some residents spoke of doing crafts, which they participated in according to their abilities. The home offers physiotherapy and exercise sessions twice weekly. Some residents go out with their families and friends on a regular basis, one has their own laptop computer to help them keep in touch with family and friends. Relatives spoken with say they are made welcome in the home, always given a cup of tea and made to feel “involved in everything”.
Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 13 The home is in a small rural community and several residents are local. They are supported in keeping links with friends and with the local area not just by trips out into it but through inviting local churches and clergy into the home. Menus indicate a choice of food that is wholesome and varied and alternatives to the main menu are available. Lunchtime was observed to be a relaxed and calm time with staff assisting residents in the attractive dining room. The meal was well presented and took into account particular needs for special and softer diets. Residents spoken with said they could always choose what they want to eat and one said that that the meals are “ exceptionally good and home made”. When observing and overhearing staff assisting residents they are supportive and sensitive to residents needs. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaint procedure and tracking system that is followed to make sure complaints are dealt with promptly. Adult protection procedures and staff training help safeguard residents from abuse. EVIDENCE: The home has a satisfactory complaint procedure and this is displayed and available in the home. There have not been any complaints recorded since the last inspection. Information on advocacy and individual rights is available in the home and this service can be arranged should anyone need it. Staff have had training on recognising and responding to abuse as part of their NVQ course. The manager is aware of the need to update this periodically and has information on training from Social services. The home has procedures in place to protect vulnerable adults and for whistle blowing and multi agency guidance. Resident’s families and representatives assist them with their financial affairs. The home does not handle any resident’s monies or financial affairs. Residents know whom they would complain to if they were unhappy, although all residents and relatives spoken with said there had been no reason to do so. All spoken with said they were sure the manager would listen to them and take action if they were unhappy. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 22, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a well furnished, clean, safe and comfortable environment for residents to live in with the equipment they need to promote mobility and physical independence. EVIDENCE: There is regular, planned maintenance of the home and grounds. There are up to date maintenance records for the testing of emergency equipment, call bells, boilers, call systems and water temperatures. Due to the extensive refurbishment that has taken place in the home and grounds many items of equipment are still under guarantee. The home is clean, tidy and creates a homely environment for residents. The communal rooms are well lit, well decorated and furnished to a high standard. Several residents spoken with in the lounge were sat in informal groups chatting together. One resident said they often sat in there with their coffee having a chat with other residents. The residents spoken with said they
Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 16 enjoyed the views from the windows in the dining room and the new lounge that overlooks the garden and local countryside. Several bedrooms have recently been redecorated to a high standard and new soft furnishings provided to improve the environment for residents. Other bedrooms, in need of improving, are scheduled to be done, as occupancy and resident’s wishes permit. Many residents have their own possessions in their bedrooms making them more personal and familiar for them. The home’s laundry is small but well organised and clean. The home has infection control procedures. There are adaptations and equipment in the home to help residents make the most of their physical independence and to get about the home safely. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and deployment of staff on duty, and on duty rotas, is sufficient to be able to meet resident’s needs. EVIDENCE: Staff rotas and observation during the visit indicate that the home had a stable staff group providing continuity of care for residents. The duty rotas show in what capacity staff are working and that there are enough staff with appropriate skills to provide personal care to residents. There is also sufficient domestic cover to maintain a clean home and the home has a full time cook. Relatives spoken with say that the staff are a friendly group and one resident said that “Staff are always asking me what I want” and another that they are” very flexible and ask me what I need”. Staff observed have a good rapport with residents. The home supports staff to undertake training and develop their practice and has a high percentage of staff with NVQ Level 2 in care with some staff doing Level 3 as well. The home’s recruitment procedures are in general satisfactory, however there are some weaknesses seen with more recent recruitment. The manager could not find the evidence of a Criminal Records Bureau (CRB) check or Protection of Vulnerable Adults (POVA) register check for one new staff member. Staff files examined for 2 new members of staff did not have adequate references. The staff have worked for the owner before and had made a professional
Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 18 assessment of them from that, however 2 references must always be obtained for any person working in the home. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 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, 33, 35, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in the best interests of resident’s health, safety and welfare. EVIDENCE: The manager is experienced, qualified and communicates a clear sense of direction to staff relatives and residents. Resident’s families and friends are asked for their views and opinions using surveys, however the home is of a size whereby residents and families put forward ideas in an informal way. This informal approach was confirmed by residents and relatives spoken with who said they told the manager whatever they “thought about things” when they saw him each day. One resident said, “ I know I am listened to” and another that “staff are always there to listen and talk”. Relative’s commented they “feel involved with everything” and that the staff “communicate well” keeping them informed about any changes.
Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 20 Policies and procedures are in place for staff to follow and are reviewed. The home does not handle any resident’s monies or hold cash for them. All expenses incurred by residents are invoiced to the resident or their representatives. The home has implemented a more formal programme of staff supervision and senior staff oversee this. Records of maintenance indicate that the home has fire training and servicing and testing practices to promote resident health and safety. There is evidence that appropriate testing and servicing of equipment is being carried out and that the home tests water temperatures. Some equipment and installations are relatively new and still under their guarantee period. The home keeps records of any accidents and incidents occurring in the home that affect residents. However these events have not always been notified to the Commission for Social Care Inspection (CSCI) as they should be. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 X 3 X 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 X 3 3 2 3 Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 22 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 OP29 Regulation 19 (1) Schedule 2 19 (4) Schedule 2 37 (1) (2) Requirement Evidence must be provided to CSCI that CRB and POVA checks have been done for a new member of staff identified at the inspection. Evidence must be provided to CSCI that all staff employed have 2 references obtained before taking up their post. The home must give notice to CSCI, without delay, all relevant events under this regulation. Timescale for action 01/11/06 2. OP29 01/11/06 3. OP37 01/11/06 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. 3. Refer to Standard OP9 OP9 OP9 Good Practice Recommendations When medicine charts are handwritten they should routinely be checked for accuracy by another staff member and signed. Where a dose of a medicine varies the dose given should always be recorded on the administration chart. When medicines needing refrigeration are in use they
DS0000062846.V308618.R01.S.doc Version 5.2 Page 23 Lunesdale House should be stored separately and securely. Lunesdale House DS0000062846.V308618.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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