CARE HOMES FOR OLDER PEOPLE
Lymewood Court Nursing Home Piele Road Haydock St Helens Merseyside WA11 0JY Lead Inspector
Miss Diane Sharrock Unannounced Inspection 10th February 2006 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 Lymewood Court Nursing Home DS0000005462.V284922.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. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lymewood Court Nursing Home Address Piele Road Haydock St Helens Merseyside WA11 0JY 01942 270548 01942 271083 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) Southern Cross Care Management Limited Mrs Christine Corsair Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (46), Physical disability of places over 65 years of age (46) Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 46 OP, up to 46 PD(E) and up to 46 PD aged 55 years and over. The Service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 12th August 2005 Date of last inspection Brief Description of the Service: Lymewood Court Nursing Home is registered for 46 beds for elderly/physically disabled over the age of 65 years, however, the Home has been granted a condition of registration by the (Previous Area Manager) to admit service users over 55 years. The Home is purpose built in design on a single level for residential services. The Home is situated close to local amenities in Haydock. The Home is privately owned and managed by Southern Cross Care Management Ltd. The Homes Registered Manager is Mrs Chris Corsair. Lymewood Court Nursing Home DS0000005462.V284922.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 to the home and was carried out as part of the regulatory requirement for Care Homes to be inspected twice a year. There has been no cause for any visits to the home since the last routine inspection. A review of care records, general discussions with staff and residents and a review of some areas of the environment took place. A selection of comment cards were also left during this visit. What the service does well: What has improved since the last inspection? What they could do better:
Full feedback was given to the manager at the end of this inspection including written feedback. Some areas were noted to need further review and action to be taken by the company to evidence the standards in full. 1) The company had changed staffing levels but had not demonstrated a rationale or evidenced the levels met the dependencies of residents needs. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 6 The company must contact CSCI with a proposed staffing level and provide appropriate evidence that the proposal is in the best interests of the residents. The process should be completely open and transparent and include the opinions of all parties i.e. staff, residents and relatives. 2) Two care plans were noted to be in need of some parts being updated to address individual requests and use of equipment and staff for moving and handling. Some maintenance issues were in need of attention, some wheelchairs were noted not to have footrests, one tyre was flat, one lap strap was broken, most wheelchairs were “dirty” and in need of cleaning. Some maintenance work is needed in the kitchen and risk assessments. Staff, residents and relatives all need information and a confirmed date of when the refurbishment programme will start again and be complete. This should be an open and transparent process so that all parties can be involved in the developments to their home. 4) There was no activities programme displayed and some Residents were unaware if there was an activities programme. Staff explained the previous organiser left in December 2005. Further work should be undertaken to ensure this standard will be met. During this inspection some Staff were noted to be transferring residents with two staff. This point was discussed with the Manager and it was agreed that this practice and training should be reviewed so that only updated Moving and Handling techniques in line with current legislation are practised. 3) 5) 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. Lymewood Court Nursing Home DS0000005462.V284922.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 Lymewood Court Nursing Home DS0000005462.V284922.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, 3. 1 - Statement of purpose currently being developed and updated. 3 - Staff carry out assessments to residents prior to moving into the home. EVIDENCE: Standard 1 was not measured in full, however, the Manager explained they had recently updated this booklet and were hoping to display it soon, once they had instructions from head office. Staff carry out pre-assessments to any new resident prior to admission so that they can assess whether they can accommodate all of the residents needs. These documents are very detailed and are part of the Southern Cross records. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 There continues to be progress made within care plans. EVIDENCE: Residents were happy with the care provided at the home. The care plans seen offered a lot of detail and information to assist staff in supporting residents. Two care plans were noted to be in need of further review and update, specifically for one residents personal request to their personal needs and one residents needs for moving and handling. The company have their own internal audit form for checking care plans, which identify any actions needed to improve the care plan. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 10 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 12 – Not measured in full but not met on this occasion. 13 – Menus looked appetising, there were lots of compliments about the food. EVIDENCE: Previously the home showed evidence to meeting this standard, however, the organiser had left in December 2005. There was no programme of activities organised or displayed and some residents were unaware whether there were any activities on offer. This should be reviewed as a matter of priority as the home and residents were noted to have greatly missed the benefits of an activities organiser. Lunch served during this visit looked appetising and was well presented. Several residents stated they were very happy with the food and menus offered. It was noted that there was some outstanding maintenance work needed in the kitchen but staff were unaware of when it would be addressed. This should be reviewed with planned action taken and communicated to staff so they are involved in the developments of the home, especially necessary repairs and maintenance. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 11 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 The home has a complaints policy in place accessible to all parties. EVIDENCE: The home now has a new Southern Cross Complaints Record Book, this was seen during the inspection and the manager still offers the facility of a “grumble book” located in reception. The Statement of Purpose should be finalised and displayed as soon as possible so that everyone has access to all necessary details and guidance in that booklet. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 12 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 Some areas of maintenance and repair were noted to be in need of attention as a matter of priority. EVIDENCE: The home was noted to be clean and tidy in most areas, but some areas were noted to be in need of attention. Wheelchairs’ were in need of immediate repair and cleaning. Dining room and lounge windows were in need of cleaning. Some outstanding maintenance work was needed in the kitchen area. A maintenance and decorating plan for 2006 was seen but there was still no confirmed date to the original capex of 2003/05. The company must provide an open and transparent form of communication to all parties so they are aware of the company’s intentions and enable people’s opinions to be expressed to the developments of their home.
Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 13 In reviewing risk assessments it was noted several risks assessments have previously identified necessary action should be taken to reduce risks with e.g. broken bedroom furniture, static baths and low lying beds. The Responsible Person must take appropriate action to reduce all identified risks. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 14 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, 29, 30. 27 – Staff rotas reflected some shortfalls on occasions. 29 – Personnel files were detailed and met this standard. 30 – Staff training was very organised and covered all mandatory training. EVIDENCE: Staff rotas showed some shortfalls on occasions with a reduced occupancy of residents. Staffing levels were discussed with the Manager as it was made clear at the last inspection the Companies legal responsibility with the Care Home Regulations to always provide suitable numbers of qualified and competently trained staff at all times. Any proposed changes should be in consultation with everyone at the home in an open and transparent process. The proposed staffing levels should be evidenced by the Company that they are appropriate for the residents current dependencies and rationale should be in the best interests of the residents. Any changes should not only be clear and evidenced but also updated in the homes Statement of Purpose. Personnel files seen were noted to be well organised and contained all necessary records as detailed in the Regulations. The Manager organises a training matrix and showed recent training events attended by staff, some still advertised and offered to staff. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 15 The home is also accessing specialised training offered by the PCT’s. Some individual training records were in need of updating just to reflect their attendance at recent training. The home also have the benefits of their own training room located on site. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 16 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): 35, 38 35 – Not measured in full as administrator new in place so will inspect in full at next inspection. 38 – Detailed records in place for health and safety which have identified some risk assessments that have not been actioned by the Company. EVIDENCE: The home has various health and safety records kept to ensure the ongoing maintenance and safety of the home, including a maintenance file, fire book, bed rail inspections, accidents records and risk assessments. In reviewing the environmental risk assessment it was of concern that previously kept records which had identified risks had not had the actions taken by the Company to reduce the risks as listed in the homes risk assessments. The Responsible Person must address this as a matter of priority and take all appropriate actions to ensure the health and safety of everyone at Lymewood Court.
Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 18 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 OP19 Regulation 16(2)(C) Requirement Timescale for action 20/04/06 2. OP38 13 3. OP27 18 4. OP12 16 2 m For the Responsible Person to ensure the maintenance and decorating plan includes all areas noted during the inspection including the kitchen, wheelchairs, cleaning and capex programme and provide an open and transparent communication with everyone at the home. For the Responsible Person to 20/04/06 take all actions identified in Company risk assessments to reduce all risks to persons at Lymewood Court. To submit an action plan to CSCI stating what actions will be taken to meet this requirement. 04/05/06 For the Responsible Person to demonstrate they have suitable numbers of qualified and competently trained staff at all times and submit an action plan to CSCI stating what actions they are taking to evidence they are meeting this Regulation. For the Responsible Person to 04/05/06 ensure activities are provided for residents and take appropriate action to meet this Regulation.
DS0000005462.V284922.R01.S.doc Version 5.1 Lymewood Court Nursing Home Page 19 5. OP38 18,13 For the Responsible Person to provide suitable Moving and Handling training for all staff and ensure they carry out up to date techniques in line with current legislation. 20/04/06 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. Refer to Standard 7 Good Practice Recommendations To update and review care plans specific to residents’ needs and requests. Lymewood Court Nursing Home DS0000005462.V284922.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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