Inspection on 29/04/08 for Lyme Regis Nursing Home

This inspection was carried out on 29th April 2008.

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

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

Other inspections for this house

Lyme Regis Nursing Home 09/07/07

Lyme Regis Nursing Home 02/05/06

Lyme Regis Nursing Home 17/11/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Lyme Regis Nursing Home Pound Road Lyme Regis Dorset DT7 3HX Lead Inspector Lesley Jones Unannounced Inspection 29th April 2008 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 Lyme Regis Nursing Home DS0000063737.V361478.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. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyme Regis Nursing Home Address Pound Road Lyme Regis Dorset DT7 3HX 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) 01297 442322 01297 444851 Magna Care Centre Limited Vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th July 2007 Brief Description of the Service: Lyme Regis Care Home is established in premises originally built as a cottage hospital. The home is on a hill above Lyme Regis and thereby parts of the ground and lower ground floors have direct and level access to the gardens and car park. During early 2005 the home became owned by Magna Care Centre Limited and managed by PS Care Home Management. It is registered to provide nursing care for a maximum of 27 service users requiring nursing care in a total of 23 single and 2 double bedrooms. The home has a locally contracted agreement to provide five Lyme Community PMS (Primary Medical Service) nursing beds. There is a communal lounge on the first floor and a smaller lounge/dining room at lower ground level. A passenger lift enables level access throughout the home. There is a level car park to the front of the home and an additional parking area at one side of the building. There is a large paved area and a landscaped garden to the rear of the house. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good outcomes. For the purpose of this inspection we have taken into account all the information we hold about this service. This includes our previous inspection report September 2007 and information provided in our annual quality assurance questionnaire (AQAA) completed by the home. We used case tracking as part of our methodology. This involved the random sampling of four people, whose care and service provision was more closely examined. We spoke with people about the care and services they receive and looked at the written care plans and associated health/care records. We also inspected the private and communal accommodation of those people case tracked. We spoke with staff and management about the arrangements for their recruitment, induction, training and deployment, supervision and support. We examined related records and observed some staff interactions and approaches with people during our visit to the home. We spoke with the deputy/acting manager about their role and responsibilities and about the management and monitoring arrangements for the home. What the service does well: People are well supported during their admission to the home. Their needs are suitably accounted for and are met, in a manner, which accords with their rights and preferences. People are enabled to maintain their social, recreational, cultural, and religious interests and receive wholesome and appealing food, which accord with their wishes and needs. Peoples’ rights to complain are upheld and they are safeguarded from harm and abuse. Staff are effectively recruited, trained, and deployed. The home is being well managed and run in peoples’ best interests. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Ensure further improvements and the refurbishment plans come to fruition as soon as practical. To maximise the safety of both residents and staff, the home’s hot water system must be investigated by a qualified engineer to ensure a regulated and consistent temperature of water is available in all parts of the home. A suitably qualified and competent Manager must be recruited and submit an application for their registration under the Care Standards Act, 2000 to the Commission. Amend the home’s complaints procedures to provide accurate contact details for the Commission. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Lyme Regis Nursing Home DS0000063737.V361478.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 Lyme Regis Nursing Home DS0000063737.V361478.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 and 3 Quality in this outcome area is good. Residents and their representatives are provided with information to make an informed choice about living at the Home. The Statement of Purpose, which incorporates the Service User Guide, was prominently displayed in the entrance hall, additionally each resident is provided with his or her own copy. People’s needs are suitably accounted for and overall they are well supported during the admission process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 10 A senior representative from the home generally visits prospective residents in their current place of occupation prior to a decision of admission being made. At that time the prospective resident or their representative would be give information about the home. Where practical, prospective residents visit the home, however, where this is not possible relatives or advocates are invited to visit on their behalf. The information gathered at these visits is recorded. People’s care needs are well recorded, and include specific risk assessment information and known personal and lifestyle preferences and choices. People say they that their needs are discussed with them and staff confirmed that they are usually given sufficient information. The records of two recently admitted residents were read and both contained comprehensive pre-admission assessments. Each offered practical and detailed information concerning the person’s daily needs and preferences. The assessments had been signed by the representatives of the residents. Lyme Regis Nursing Home DS0000063737.V361478.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 and 10 Quality in this outcome area is good. Residents care plans demonstrate how residents’ needs are met. The plans are detailed, and clearly illustrate how their needs are met. Residents’ medicines are stored securely and records indicate that medicines are given as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spoke with people about the care they receive, including their medical and health care need and also their medicines arrangements. We looked at the written care plans, the arrangements for the management, storage and administration of their medicines and made general observations of staff approaches with people during our visit to the home. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 12 Peoples written care plans are person centred, reflective of recognised practice with the care of older people and are up to date, having regularly recorded reviews. There are clear and sensitive instructions for staff for example, “Give C sufficient time and ensure patience is demonstrated when communicating with him as C likes to think about this answers” Inputs from and access for people to outside healthcare professionals are also well accounted for. People spoken with said they usually receive the care and support they need and that staff treat them with respect. Many comments were received, which are positive and include: “The staff are lovely, nothing is too much trouble” “The nursing staff are excellent” The procedures and systems in place for administration, storage, and disposal of medication are checked monthly to audit good medication practises. Medicines are supplied by a local pharmacy and the deputy manager said that they have good support from the pharmacy to help them manage medication safely. The management company are considering transferring the current system to the MDS Monitored Dosage System and staff from Boots the pharmacist are due to run an advisory training session for all staff and management. The medication administration charts were inspected and were up to date, legible and in order. The staff had signed for medication administrated, or recorded the reasons for any omissions. There was a photograph of the person maintained with each record. This should ensure medication is administered correctly to the person named on the chart. Lyme Regis Nursing Home DS0000063737.V361478.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 and 15 Quality in this outcome area is good. People are enabled to maintain their social, recreational, cultural, and religious interests and receive wholesome and appealing food in accordance with their known preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A member of the care staff dedicates up to twenty hours per week to organising a variety of activities for residents. They encourage people to join in a variety of social and therapeutic activities such as bingo, arts and crafts, watching old films, and trips to the town of Lyme Regis, and the sea front. The activities organiser is sensitive to the needs of people who choose to remain in their bedrooms and they regularly spend individually with them reading and quietly talking reminiscing. This shows that the social needs of those residents are not forgotten. Visitors are welcome at any time and refreshments are always offered. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 14 The deputy Manager confirmed that the home endeavours to have an informal and relaxed policy for receiving visitors. The visitors’ book illustrated that the home has regular visitors and residents confirmed this. Arrangements are made for residents to celebrate special occasions at the home with family and friends. During the inspection residents told us that they are consulted by the chef about their menu preferences. Several residents commented how much they like this contact, this is good practice. The chef also services the main meal and checks with residents if they have enjoyed it or if there was anything they would have preferred. The menus are displayed in the main entrance and demonstrated ample choice and a daily vegetarian option. The menus offered people plenty of choice and variety. The mid-day meal was observed, it was well presented, looked appetising and where residents required assistant this was done discreetly by staff that sat down beside the resident. Residents spoken with indicated their meals were good and that staff are aware of their likes and dislikes. Lyme Regis Nursing Home DS0000063737.V361478.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 and 18 Quality in this outcome area is good. Peoples’ rights to complain are upheld and they are safeguarded from harm and abuse. Complaints about the service are listened to and acted upon wherever possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a copy of the complaints procedure on display in the main reception area, for the public’s ease of use. At this inspection we looked at the home’s complaint record and discussed complaints recorded during 2007 with the deputy manager. We asked people if they knew who to speak to if they were not happy and if they knew how to complain. People spoken with said that they always knew who to speak with if unhappy and that they knew how to complain. The complaints procedure is incorporated in the Service User Guide which each person is provided with a copy in their own room. The complaints record and showed that there have been three complaints received, and all of the complaints had been dealt with promptly and thoroughly. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 16 Staff spoken with were conversant with their roles and responsibilities with regard to dealing with complaints and ensuring people are protected from harm and abuse. The home has appropriate policies and procedures in place concerning the safeguarding and protection of vulnerable adults. Staff spoken to confirmed that they had received awareness training in this area and evidence was also seen on individual training records. The deputy manager agreed to revise the complaints procedure to provide correct contact details for the Commission, given some of our recent office closures/changes. Lyme Regis Nursing Home DS0000063737.V361478.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 and 26 Quality in this outcome area is adequate. Residents live in an environment that is adequate to meet residents’ needs, and is clean and adequately maintained. The home is furnished and equipped and suits people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lyme Regis Nursing Home is a large property that was previously the town hospital. The Home is built over two floors, which can be accessed by stairs or lift. The Home is a five-minute car ride away from Lyme Regis town Centre. There are local shops, library, churches, pubs, and sea front promenade. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 18 The main lounge and dining area and a number of bedrooms benefit from sea views and several people voiced their appreciation of these views. People were observed sitting in communal areas looking relaxed and comfortable. There is a range of specialist equipment and adaptations in place throughout the Home, to assist people who may have reduced mobility. The majority of bedrooms and all the communal areas were viewed. Most bedrooms are for single occupancy, however there are two double rooms. Bedrooms had been personalised by residents, with small items of furniture, televisions, personal possessions, and some residents have their own phone line. The majority of bedrooms have en suite facilities, and on all floors there are bathrooms and toilets located within close proximity to rooms. There are suitable adaptations in toilets and bathrooms to assist residents with reduced mobility there is also lift access to the basement. On the day of the inspection the home was clean and tidy throughout. Domestic staff were observed working hard cleaning the Home. We also asked people if the home was kept clean and fresh and all said that it usually was and comments were received commending the work of the domestic staff. Communal areas were comfortably furnished and decorated. Since the last inspection there has been new carpeting in the lounge, some corridors and bedrooms. The new management company are continuing to upgrade the environment and particular areas which require attention are the kitchen, laundry and lower ground floor bedrooms and bathrooms. Plans are in hand to improve the exterior appearance and gardens as well as the kitchen and bathroom area. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 19 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, and 30 Quality in this outcome area is good. Residents’ benefit from sufficient number of staff that have done some training to meet their needs. Residents are protected by the Homes recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The May duty rota for both nursing and care staff was looked to find out if residents benefit from a sufficient number of staff to meet their needs. There is a minimum of one registered nurse on duty at all times and three care assistants throughout the day. In addition there are catering, domestic, and laundry staff employed. At night two waking staff are on duty. To find out if residents are protected by the Homes recruitment practises a sample of staff files were viewed. These demonstrated that necessary recruitment practices are followed with clear interview records and written references obtained and Criminal Record Bureau checks. These checks are a safeguard for vulnerable people, as they should help employers recruit suitable staff to work with residents. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 20 Staff training records were looked at and demonstrated a wide range of training programmes for staff, which were clearly linked with the National Minimum Care Standards. Basic mandatory care courses in such areas as moving and handling and food hygiene were arranged on a regular basis. Other areas such as working with dementia, infection control were also covered and NVQ training actively promoted. Feedback from staff was positive regarding the extent of training opportunities. A number of the care staff have completed the National Vocational Qualification in care award programme to level 2 and level 3. This qualification helps to demonstrate how competent staff are at their work. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is good. Health and safety systems and procedures adequately protect the health and safety of residents, staff, and visitors. At the time of this inspection the deputy manager is “acting manager” and is ensuring the best interests of people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered manager for the home has recently left and the management company are actively recruiting for a suitably qualified and experienced person. The deputy/acting manager is very competent and is managing the home on a day-to-day basis very effectively. Discussions with staff confirmed that the Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 22 management of the home is viewed as open, accessible and supportive. There are regular established communication systems in place that include regular meetings with residents and staff meetings. The management company has put in place appropriate management cover during the interim period of the home not having a registered manager. The operations manager is currently visiting 3 times a week and the deputy/acting manager is being given some supernumerary shifts to ensure management procedures are maintained. The management company have four weekly meetings with managers which may additionally include a training session e.g. customer service, medication administration. The environment looked safe in all areas that were viewed. The maintenance employees carry out regular health and safety tests and specialist equipment e.g. bed rails, hoists. The fire log showed fire alarm tests are completed and fire drills carried out on a regular basis to help protect the health and safety of residents and staff. Fridge and freezer temperatures are maintained, to ensure they are operating within food safety guidance levels. There were also records to demonstrate that `high risk’ foods are temperature probed before serving to ensure the food has reached above minimum required temperature. However there is a problem in the kitchen as one freezer requires defrosting but the other freezer recently supplied is small and would not contain all the frozen food. It is therefore recommended the management company invest in a freezer, which is sufficient to the needs of the home. Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 3 Lyme Regis Nursing Home DS0000063737.V361478.R01.S.doc Version 5.2 Page 24 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 OP16 Regulation 22 Sch 4 (11) Requirement The home must update the complaints procedure to reflect the new management company and correct details of the Commission. The home must ensure that the recommendations and requirements made by the Environmental Health Officer on her last visit in relation to the kitchen are met. Timescale for action 31/08/08 2. OP19 23 (2) 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The planned upgrading of the home continues. 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