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Inspection on 02/05/06 for Lydfords Care Home

Also see our care home review for Lydfords Care Home for more information

This inspection was carried out on 2nd May 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The comprehensive Statement of Purpose and Service Users Guide give prospective residents the information required to enable them to make an informed choice about where they live. One resident said " I refer to it when I need to, I find it very helpful" another did not recognise the term. The atmosphere in the home was comfortable and relaxed. All parts of the home were clean and comfortable. The quality and choice of meals remain good and all residents spoken with confirmed this. " the food is delicious, I have to be careful not to put on weight" "they really went to town at Christmas time, it was a wonderful spread" " desserts are wonderful" "I would like fresh rather than frozen vegetables" Systems are in place to regularly consult with residents via service users meetings and surveys. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard service users finances. Residents are supported and protected by robust recruitment practices.

What has improved since the last inspection?

The home has undergone a major refurbishment since the last inspection, and the home was found clean, welcoming and comfortable. The bedrooms on Firs are being slowly upgraded, and divan beds have been replaced for those residents receiving nursing care. "they have spent lots of money and it looks really nice", The paintings in the corridor are bright and interesting","not to my choice, but it looks clean and tidy". The care plans viewed demonstrated that they have been maintained to an acceptable standard, with evidence of monthly review and clear directions for staff to follow ensuring that the health needs of residents are met. The health and safety of residents are being protected by staff receiving regular training and following the good practice guidelines in place. "we receive training in a wide range of topics, I have learnt a lot". The standard of cleaning was seen to be much improved and the majority of feedback received from the residents and staff confirmed this. "the home is much cleaner", "I like living here it is my home"

What the care home could do better:

Whilst care tracking specific residents, it was found that the reason one residents admission diagnosis was depression and dementia, the staff need to be aware of the registration categories of the home and also be able to demonstrate that they can manage to meet the complex needs before admission. This has been identified before as a requirement and remains outstanding. Staffing levels need to be monitored carefully on a daily basis to ensure that they are sufficient to meet the changing needs of the residents. Whilst they were seen to be sufficient on the day of the inspection, feedback gathered from a range of different sources indicated that the staffing levels were not always sufficient and affected the care given. "we are short of staff, especially at weekends" "sometimes I find that there aren`t any staff around when I visit" It is still a concern, previously identified as a requirement and remains outstanding, that the less abled residents are not involved in the activities, and do not receive much stimulation or company. There was no evidence to demonstrate how residents are encouraged to participate in activities. During the inspection process it was proven how much certain residents enjoy participating, whilst others were seen just sitting in one of the lounge areas or their bedrooms, with little interaction. "activities are fun, but I don`t go all the time" "the co-ordinator is wonderful" "I can take part in activities, although the activities are not intellectually stimulating, I realise the Activity co-ordinator has to cater for a wide range of interests, she is very caring".

CARE HOMES FOR OLDER PEOPLE Lydfords Care Home 23 High Street East Hoathly Lewes East Sussex BN8 6DR Lead Inspector Debbie Calveley Key Unannounced Inspection 2nd May 2006 07:30 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 Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 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. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lydfords Care Home Address 23 High Street East Hoathly Lewes East Sussex BN8 6DR 01825-840259 01825-840997 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) Tamaris (South East) Limited (a wholly owned subsidiary of Four Seasons Health Care Limited) Ms Karen Waddington Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is fifty (50). That service users should be aged sixty five (65) or over on admission. 16th November 2005 Date of last inspection Brief Description of the Service: Lyford’s Care Centre was originally a Victorian private family home that has been extended and adapted with two purpose built extensions. It is a home registered to provide both nursing and social care for fifty residents, and is situated in a village location in a semi rural position. The accomodation is divided in to two units, Firs and Orchard and is on two floors with level access provided by a lift and a chair stair lift. There are four double rooms without an ensuite facility and forty-two single rooms, twentyfour of which have an ensuite bathroom. There is ample communal space consisting of a large dining room, two lounge areas and an activity room which are on the ground floor and central in the home. On the first floor and on Orchard unit, there is a comfortable quiet lounge, also on Orchard unit there are two areas with comfortable chairs which are used by families and residents. The gardens are natural, large and are to the side and rear of the proprerty. There are car parking facilities to the front of the home for approximately fifteen cars. The village shops are 200 yards away and there is also a public house and church in close proximity to the home. A local bus service runs through the village and Uckfield town centre is approximately five miles away. Fees charged as from 1 April 2006 range from £497 to £695, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over 8 hours on the 02 May 2006. There were forty-one residents in residence on the day, of which seven were case tracked and spoken with. During the tour of the premises ten other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including care plans, medication records and recruitment files. Six members of care staff, two trained nurses, hairdresser and the cook & kitchen assistant were spoken with in addition to discussion with the Registered Manager. Comment cards received from nine residents and two relatives were generally positive and that both groups were satisfied with the services provided. Other social and healthcare professionals surveys have been sent, but not received back at the time of completing the report. What the service does well: What has improved since the last inspection? The home has undergone a major refurbishment since the last inspection, and the home was found clean, welcoming and comfortable. The bedrooms on Firs are being slowly upgraded, and divan beds have been replaced for those residents receiving nursing care. “they have spent lots of money and it looks really nice”, The paintings in the corridor are bright and interesting”,“not to my choice, but it looks clean and tidy”. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 6 The care plans viewed demonstrated that they have been maintained to an acceptable standard, with evidence of monthly review and clear directions for staff to follow ensuring that the health needs of residents are met. The health and safety of residents are being protected by staff receiving regular training and following the good practice guidelines in place. “we receive training in a wide range of topics, I have learnt a lot”. The standard of cleaning was seen to be much improved and the majority of feedback received from the residents and staff confirmed this. “the home is much cleaner”, “I like living here it is my home” 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. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 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 Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 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, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission procedure is followed giving prospective residents sufficient information to make an informed choice as to whether or not Lydfords Care Home can meet their needs. EVIDENCE: The Statement of Purpose and Service Users Guide were on display in the home and were viewed, it was found to be up to date and contained information that prospective residents need to make an informed choice of where to live. All residents spoken with were aware of the Service Users Guide and two residents retrieved their copy from their drawer to refer to whilst chatting. There is a comprehensive written contract/statement of terms and conditions that all residents receive on admission to the home. This contract is confirmation of the room booked, the type of admission, either respite or permanent and the fees to be paid. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 9 Four Seasons Health Care have an assessment tool, which covers all the needs as defined in standard 3.3. Six pre-admission assessments were viewed, five of which were found fully completed and informative. The assessment takes place at the prospective residents’ place of residence; either hospital or home and the home manager involve the relatives whenever possible and input from other relevant professionals is sought when required. Five residents spoken with were able to confirm that they had been seen by a member of the staff before admission to the home. Two relatives said that they had not been involved in this process, but said that they had been informed of the imminent discharge from hospital. Self-funding residents are invited for a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. The placing authority review their residents after six weeks to ensure that the placement is successful. One resident confirmed that she had been there for a holiday before permanently moving in. On viewing one resident’s care file, it was found that they had a diagnosis of dementia as a reason for admission, this needs to be fully explored as the home is not registered specifically for caring for residents with dementia. There is a need to ensure that these needs are recognised and documented to ensure that the home can meet these needs and staff receive the appropriate training. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 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, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All aspects of resident’s health, social and care are identified and planned for, which direct staff in the delivery of appropriate care. EVIDENCE: Seven care plans were tracked from the pre-admission assessment to the delivery of care. The improvement seen over the last year has been maintained. There was evidence of regular review and the physical needs of the residents were clearly identified. Social histories of residents had been completed; there was evidence of families being involved in completing these documents. Risk assessments were in place, and are reviewed on a regular basis, two were found to be non- informative regarding changes to the skin integrity despite a change to the risk assessment. Residents are weighed monthly and any weight loss or gain is recorded, evidence was seen of action taken by staff, one new resident though had a weight loss of 2 kgs in two weeks, but there was little recorded regarding what action was taken by staff, and how they were encouraging her to eat. The staff Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 11 when spoken to were clearly aware of the difficulties and of what was being done, and this needs to be reflected in the daily records and care plan. Details regarding residents’ religious preferences and sexuality were documented in the care plans of those residents care tracked. The clinical rooms were clean and tidy, the equipment well maintained. There are policies and procedures in place for the storing, administrating, disposal and receipt of medication. The temperature of the fridge and room are recorded daily and of an acceptable temperature to maintain dressings and medications. All medications that have a short life from the day of opening need to be dated to ensure that they are not used when out of date. e.g. Calogen and eye drops. The Medication Administration Records (MAR) were found correctly completed, however the signatures on the MAR do not match the example signatures of staff. All staff need to ensure that their signatures match and are traceable for legal reasons. A self-administering policy is in place, but there were no residents at this time self-administering their medication. Positive interaction between staff and residents was observed throughout the inspection. Resident’s comments regarding staff are “absolutely super”, “carers are very nice” “staff are excellent, delightful” “ communication is sometimes difficult, due to the language”, “no complaints, but staff never have time to just sit and chat, always rushing about”. Two relatives said that they “found the staff very caring, that they seemed happy in their work” “staff are very approachable”. “Don’t think there is enough staff all the time, mum sometimes says that she has to wait for someone to come back to her”. There are policies and procedures in place regarding death and dying, the staff were aware of the policies and how to access them. They were aware of differing religions, but said that most of the residents were “Church of England”. Amongst the complimentary letters, there were letters from families thanking the staff for their support and for looking after their relative so well during this time. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 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 &15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Meals remain good in respect of both quality and variety that meets resident’s tastes and choice. The lifestyle experience by residents does not always match their expectations, choice or preferences. EVIDENCE: Activities remain an important part of life in Lydfords, for those that are able to attend, fifty-five hours are provided weekly. The activities change according to the seasons and trips out are arranged depending on the funds available. There are fund raising events held throughout the year whose profits are used for the activities. The shopping trolley from which residents can buy cards, toiletries, chocolates and stationary remains popular with residents as it gives them a sense of independence and choice, there is also a card stand in the reception area that residents can purchase cards from. On the day of the inspection the activity co-ordinator was not available due to sickness, and a carer had taken over the responsibility of the activities. The activity room has been refurnished and is a pleasant room with good lighting and plenty of storage areas. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 13 New flat screen televisions and music centres have been purchased since the last inspection. The morning session was attended by only seven residents and the mood was quiet and little interaction was seen at this time (possibly due to the coordinator not being there). After lunch there was a more involved and stimulating session. It was again noted that the residents that do not have the capacity to attend or make the decision not to attend are quite isolated. The care plans available did not state how residents are encouraged to participate in activities or what was planned for those that do not have the capacity to choose. Many were found in the lounge and their bedrooms with little stimulation available. Comments regarding activities was in the main positive, “I enjoy the activities, I have made many friends, and enjoy helping those that are not as well as me” “I love amateur acting, dressing up and acting, I don’t go very often as I found the chairs very uncomfortable, no support for my back, I do enjoy the colouring and drawing”. Two residents were discussing the choice of books, and one other declined to comment on activities or on her decision not to attend. One resident said he got bored and would like to go out more trips. Another said that “activities are not for her, as it makes her feel like she has to ‘perform’. Three residents were outside enjoying the sunshine on the patio, with their visitors for most of the afternoon. It was found from talking to the residents and some visiting relatives, that they are able to choose the way they spend their time and are offered choice and flexibility on a daily basis. Two residents said that one area that they would like more choice was bath days and times of their bath. One gentleman said he would like more than one bath, another said she would rather have her bath in the morning as she finds it exhausting in the afternoon. This was discussed with the manager, and would be rescheduled in agreement with the resident. It would be beneficial to ask all residents their preference when reviewing their care plan as they might appreciate a change to their routine. The residents whilst appreciative of the improvements in décor, the majority said it was not to their taste, especially the art pieces, and it was said that they were not consulted. Lydfords promotes an “open door” policy during the day. Residents spoke of visitors they had received and the home maintains a record of the contact each resident has with relatives and friends. Four relatives visiting said that “whatever time they visited they felt welcomed, and were offered refreshments”, security has improved with an alarm system on all doors and windows, but feedback regarding the front door access at weekends was differing, two surveys from family and friends mentioned that they were able to enter without seeing a member of staff, whilst two relatives said that they rung the bell for admittance. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 14 The kitchen was found clean and well stocked. The full time cook was on Annual leave and her replacement was knowledgeable about the resident’s likes and dislikes and says the budget was sufficient to produce good quality food and choice. The dining area is large and attractively set out with tables and chairs. The new tables are high enough to allow wheelchairs to fit underneath, and encourages residents to get themselves to the table without having to wait for staff. Residents are encouraged to use the dining area to encourage interaction with other residents. The midday meal observed was attractively presented and enjoyed by the majority of the residents, the sweet trolley was offered to all residents so they could choose which they wanted. Also served was the pureed meal of their choice. The feedback regarding the food at Lydfords was complimentary from both residents and relatives. One resident said the “food is always good with plenty of choice”. Another said “there is always a choice, so if you change your mind you can always have something else”, “the food is so good that I have put on loads of weight”. The one area that received negative feedback was the evening meal, this was discussed with the manager who was aware that this, the evening meal service will reviewed. There was no record seen of resident’s intake seen following the midday meal, of whom ate well or whom did not, this needs to be implemented so as to be forewarned early of any potential eating disorder. Staff were seen assisting residents unable to feed themselves discreetly and with dignity. The menu demonstrated choice, variety and nutritionally valuable food. Again one resident said, “the staff cut up my food, I could do it myself”. This appears to be an on-going problem and staff need to be aware that it is important to allow and encourage residents to be as independent as possible. It was confirmed by relatives that they could eat with their relative for a moderate charge. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints system with evidence that service users felt confident their views would be listened to. Staff have been trained in the protection of adults, improvements need to be made to ensure they remain familiar with procedures so that service users are not at risk of harm or abuse. EVIDENCE: The home has detailed policies and procedures on complaints. No complaints have been received since the last inspection and residents repeatedly told the inspector that they ‘had no complaints at all’. Five residents spoken with said they would be happy to talk to staff or the manager if they had a problem. Comment cards received from service users and relatives all stated that they knew who to complain to. One resident said when she has complained it has been taken seriously and dealt with. Two relatives said that they would not hesitate to approach the staff if they were not happy with the care seen. The home has detailed policies and procedures on adult protection and all staff have been trained in adult protection. From information gathered there is still some uncertainty regarding the procedures to follow in the event of an abuse concern being raised internally. All senior staff taking responsibility of the home when the manager is off duty needs to have a complete understanding of the Adult Protection Procedures in place, and be aware of the problems occurred when there is a delay in reporting an incident. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a clean, safe and well maintained environment. EVIDENCE: Lydfords is a large property, which has four double rooms and thirty-six single rooms, twenty-one of which have an ensuite facility. Extensive refurbishment has been undertaken at Lydfords Care Home over the past four months, the lounge areas, reception and activity room have been tastefully and creatively decorated and furnished with good quality furniture. Firs unit bedrooms are still in the process of being upgraded, with new adjustable height beds and furniture. When visiting residents in their bedroom during the inspection, rooms have been personalised by families. The windows on firs unit are under review. On Orchard unit the resident’s bedrooms were homely and comfortable and many of the residents have personalised their rooms with items from home. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 17 The gardens are large and unspoiled, and there is a patio area to the rear. Some of the residents spoken with have definite ideas regarding future plans for the gardens, which are being discussed at present. The feedback from residents and relatives is that the gardens have not been utilised to its full advantage. There are adequate bathrooms and toilet facilities for the needs of the residents, with the equipment necessary for the physically frail. Maintenance issues previously identified have been attended to, window blinds are now provided to ensure a feeling of privacy. There is specialist equipment available, which includes hoists, air mattresses and cushions. Divan beds are being replaced for the residents with nursing needs. An area that requires constant review is the monitoring of those residents that are not able to use a call bell, ensuring that they are visited by staff on a regular basis to ensure their comfort and safety. Random hot water temperatures were tested and were of the recommended temperature 43 Celsius, regular testing of the hot water outlets are recorded. The temperature of the home was comfortable and all radiators were found with appropriate guards. The standard of cleaning at Lydfords was found to be much improved and all areas of the home were found clean and tidy. Feedback from residents and families confirmed that the cleaning was much better, however two surveys received said that that their bedrooms were never dusted or polished. The equipment in use was found to be clean and maintained to an acceptable level. The sluice areas were found clean with appropriate equipment ready for use. The laundry remains small to cope with fifty residents, but staff working in the laundry are well organised and cope well with the levels of laundry activated in the home. The staff were seen wearing gloves and aprons and they are freely available throughout the home. The use of gloves when serving tea and coffee is not usually considered necessary, unless there is a medical condition as some residents’ find it offensive. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 18 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. Staff training has improved, and residents are also protected by robust recruitment practices. EVIDENCE: On the day of the inspection, there were sufficient staff to support the health and social needs of the service users as detailed in the care plans. Staff interviewed confirmed that the staffing levels were adequate at this time to meet the needs of the residents. Call bells were answered promptly. Residents’ spoken with commented that staff were caring and that they were helpful and always willing to assist, when they had time. Written and verbal feedback from residents and their families indicated that staffing levels were not always seen as sufficient to cope with the needs of the residents and this needs to be monitored by the management team. Surveys and verbal feedback state that there are still residents and families that are struggling with the language barrier with oversea staff, mainly carers and domestic staff. It has caused miscommunication when requesting assistance and two surveys received stated that the residents felt that their needs were not met and they had to wait for another staff member to interpretate. This is something that needs to be further discussed at resident and staff meetings. English lessons have been provided in the past, and this may be something that can be reintroduced. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 19 The recruitment files of five members of staff were examined and were found to have all the necessary information required. All the files contain details of employment, study sessions and supervisions. All staff have a Criminal Record Bureau check before commencement of employment. Over the past six months there has been training sessions arranged to ensure that staff have appropriate training to perform their jobs. The training files were examined and indicated that training was on-going and that all new staff complete an induction training that is in line with the National Training Organisation. Staff interviewed were able to discuss the training opportunities available within the home, and discuss training that they found helpful to perform their job competently. One senior staff member said that he was really happy working at the home because he felt that the training he was receiving was also giving him the opportunity to develop new skills. Five other members of staff also confirmed that they had completed an NVQ qualification in care. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 20 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, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall management of this home is good with effective systems in place to protect service users. EVIDENCE: The management structure of the home is stable, with a registered manager, supported by two senior trained nurses who are both ‘acting up’ as her deputy and receiving management training. The residents and staff spoken to commented they felt supported by the management team in place. The relatives visiting were aware of the manager and felt able to approach her with any concerns. The manager maintains a visible presence and staff and residents confirmed that she was often seen at weekends and out of hours. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 21 Regular resident and staff meetings are held and residents feel that their views are taken seriously by the manager. The formal quality assurance and quality monitoring systems enable the management to objectively evaluate the service and ensure it is run in service users best interests. There are suitable systems in place to safeguard the resident’s finances. Resident’s are responsible for their own finances if appropriate; the administrator works full time in the home and is knowledgeable regarding the residents financial status and endeavours to ensure that the policies and procedures in place are adhered to. Policies and procedures regarding gifts and money rewards have all been issued to staff. Documents used for recording items held by the home were viewed and found to be satisfactory with receipts provided for all items handed over for safekeeping. Records were available to demonstrate that fire alarms, water temperatures and emergency lighting systems are regularly tested and fire drills undertaken. Testing of portable electrical appliances has been carried out. Certificates to demonstrate that bath hoists, gas appliances, electrical systems and appliances are safe are available for inspection. Formal supervision of staff has commenced and is on-going, however there is evidence that it is not regular for all staff yet. The training records evidence that all staff have received the mandatory training in moving and handling, infection control and fire safety therefore safety for residents and staff is maintained. A risk assessment of the grounds and premises in respect of all safe working practices has been undertaken to enable the provider to identify areas of risk. Good practice was observed throughout the inspection in respect of health and safety: safe moving and handling techniques were seen used and all equipment was found to be in working order. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 3 3 Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes. 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 OP4 Regulation 12(1a&b) 14(1)(d) Requirement That the residents admitted meet the registration category of the home, and the home demonstrate that they can meet the assessed needs of the residents. (Previous timescale of 16/11/05 not met) That the example signatures of staff responsible for administering medication are the same as they use on MAR sheets. That the provision of social and cultural activities are appropriate to the circumstances of all residents and with regard to any disability of residents. That residents are consulted about the programme of activities and are enabled to attend the activities on a regular basis. That all residents are enabled to exercise autonomy and choice. (Previous timescale of 01/02/06 not met) Timescale for action 02/05/06 2. OP9 14(2) 02/05/06 3. OP12 16(2)(m) 02/08/06 Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 24 4. OP18 5. OP38 5. OP22 6. OP27 7. OP36 18 (c) (1) That all senior staff are aware of the correct procedures to follow when they are in receipt of an AP alert. 13(4)(c) That those residents that do not 23(2)(n) have the ability to summon help have an appropriate system in place to ensure their safety and comfort. 13(4)(c) That those residents that do not 23(2)(n) have the ability to summon help have an appropriate system in place to ensure their safety and comfort. 18(1) (a) That staffing levels are appropriate to the assessed needs of the residents, the size, layout, and purpose of the home at all times. (Previous timescale of 16/11/05 not met) 18 (2) That all staff receive formal supervision at least six times a year. 02/05/06 02/06/06 02/06/06 02/06/06 02/08/06 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 OP8 OP15 OP26 Good Practice Recommendations That staff follow through with an action plan when risk assessments denote a change. That a more formal way of recording individual residents dietary intake is implemented. That staff use gloves appropriately. Lydfords Care Home DS0000014016.V291150.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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