CARE HOMES FOR OLDER PEOPLE
Lymewood Court Nursing Home Piele Road Haydock St Helens Merseyside WA11 0JY Lead Inspector
Miss Diane Sharrock Key Unannounced Inspection 11th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lymewood Court Nursing Home DS0000005462.V332317.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. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 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.V332317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 46 OP, up to 46 PD(E) and up to 46 PD aged 55 years and over. Date of last inspection 10th February 2006 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 sResidents 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.V332317.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day. There has been no cause for any visits to the home since the last routine inspection. Inspections involve measuring a number of standards considered as important by the Commission. During the inspection discussions took place with 5 Staff and the Inspector met with approximately 4 Residents that were in the lounge and bedroom areas. A total of 8 comment cards have been submitted to CSCI and 3 letters submitted to CSCI from family members. Selections of Comment cards were also left in the home to offer people further opportunity to give their opinions. The Inspector completed this unannounced visit by looking at the homes records and undertaking a tour of the building. Feedback was given to the Manager at the end of this site visit. What the service does well:
The majority of the comment cards and interviews with Residents and Relatives were very positive about the Staff and offered complimentary comments about the care and the food. Some comments made are listed below. One Local Doctor stated, “We do a lot of visiting to the home and there is a high level of surveillance of the residence.” 3 Relatives wrote to the Commission about their experiences at the home, “ No matter what time we visited the home was always immaculate, clean and fresh.” “The Matron and the Sisters and all the Staff cannot be praised highly enough.” “The Matron and her wonderful Staff, Lymewood is excellent…..The home is cheerful, clean and exceptionally well run. The Staff are friendly, patient and very caring.” “The kitchen would grace a hotel and the food although I never tasted it always looked and smelled appetising.” 4 comment cards were received from Residents at the home all indicating they were generally happy at the home. One person indicated that “usually” activities were available and one other person indicated that they were “sometimes” available. Three people stated that Staff were “sometimes” available and Two Residents felt that the Staff were very busy and didn’t have time to chat to them or get to know them.
Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 6 The main lounges and dining room remain well maintained and attractively presented although there was an amount of storage of furniture in some communal lounges that made these areas look cluttered and spoiled the homely atmosphere previously achieved. The home continues to offer a group of staff who have worked at the home a long time offering great stability. Staff were very enthusiastic and observed to have a good rapport with Residents and Relatives and noted to be very respectful and caring towards Residents. 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. This inspection was able to evidence good management of a home that has a lot of positive feedback from Resident and Relatives about the care received. However the main issues listed below are regarding the company and management processes that have not been put in place to support the home in ongoing issues especially around the maintenance repair and refurbishment of the home and ongoing reviews of staffing levels at the home. The Commission will request an improvement plan from the Company so that they can demonstrate what actions they will take to fully meet these regulations and to ensure these ongoing concerns do not continue. 1) The Staff felt that staffing levels were not enough and did not meet the dependencies of residents needs. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 7 Some Residents said that the staff were very busy “and never seemed to have time to sit and chat and relax they were always on the go and worked very hard”, they felt sorry for them, they said the bells are going all the time. Staff felt it effected their standard of work and felt that the dependency of Residents had increasingly changed and that they noticed that the time they use to spend socially in the afternoons with Residents just doesn’t happen any more due to the workload. Staff were generally happy however they felt the main issue at the present was the dependency of the residents was “increased” and they are constantly on the go and don’t have any time to sit with the residents any more like they use to in the past, even though they have a reduced number of residents in. Staff they felt they had no quality time to spend with the residents and that this was effecting them. They felt that in their opinion an increase in staffing levels in the morning was needed as they felt that breakfast time in particular was a struggle. The above points were discussed with the manager who agreed it was very busy at the moment and felt that the staff were very busy The company must demonstrate how they have calculated an acceptable staffing level that demonstrates it meets the needs and dependencies of Residents at the home. Residents and Staffs concerns and opinions must be reviewed to help provide an acceptable number of staff on duty. The process should be completely open and transparent. It is of concern that the company have not taken any steps to discuss these views and concerns with Residents, Relatives and Staff and have not tried to evidence how the current staffing levels are supposed to meet the Residents needs. 2) Some outstanding maintenance issues were in need of attention, especially actions needed to be taken as a matter of priority to the homes outstanding “repairs, Replacements and Refurbishment programme,” dated 15/1/07. i.e. rooms identified in need of new carpets and refurbishment replacement of carpet tiles, repairs and refurbishment to bathrooms and showers, flooring in sluices, non slip flooring needed for both dining rooms, replacement of identified storage heaters, a leak to the ceiling in one identified lounge, air bricks and window vents in the kitchen and laundry. Some maintenance work needed in the kitchen is due to be carried out but the manager does not yet have a starting date. Staff, residents and relatives all need information and a confirmed date of when the refurbishment programme will be complete. This should be an open and transparent process so that all parties can be involved in the developments to their home. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 8 This is an outstanding issue and it is of concern that such an amount of work already previously recognised has still not been planned by the company. Storage at the home must also be reviewed as there was a large amount of clutter seen in communal areas and corridors including, wheelchairs, hoists, linen skips, mattresses, boxes of new bedroom furniture. 3) There was an activities programme displayed in reception however some Residents were unaware if there was an activities programme. Activities should be reviewed so that Residents opinions and needs are taken into account. Further work should be undertaken to ensure Residents social and diverse needs are met. Two Residents said they would like to get involved with more activities other than bingo but didn’t like to ask. Care plans should identify how they will meet the Residents social needs giving staff the right information and resources as to how the support will be provided. 4) During this inspection one staff member was noted to continue practices in the home with limited insight to how this was disrespectful to Residents at the home, especially interrupting a private conversation and talking over Residents and discussing their personal care needs. This point was discussed with the Manager and it was agreed that this practice would be stopped and reviewed with Staff to ensure correct practices for Residents privacy, choice and rights are maintained at all times. 5) Finances should continue to be developed and actions taken to provide clear and accurate information for all Residents regarding the management of their monies, this will give Residents added safety in showing how their funds are managed in their best interest. Residents must be supported to have their own bank accounts or given informed choices and support in choosing how they want to manage their finances. Resident’s money must not be stored in the company account. Please contact the provider for advice of actions taken in response to this inspection. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 9 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. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 10 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.V332317.R01.S.doc Version 5.2 Page 11 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): 3 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. Residents needs are assessed before moving to the home in order to ensure their needs can be met prior to moving in. EVIDENCE: Residents who chatted to the inspectors stated they were happy at the home. All comment cards received reflected these views. Care plans were looked at during this inspection and one included a recently admitted resident to the home. Most plans had pre-assessments in their file which showed their needs had been assessed prior to moving in. 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 detailed and are part of the Southern Cross records. The Residents information booklet had information about the home kept in the reception area by the front door.
Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 12 One Resident said they had come in for respite and somebody had spoken to her and got her to sign something, she thought it was a brochure about the home and the lady that came to her promised to give her a copy but she has still not brought her one. These comments were shared with the manager who said she would arrange for the “service User guide” to be given and she thought it was probably her contract that she had signed and would arrange for this also, she explained they also leave welcome cards in the bedrooms for new residents, this was seen in this residents bedroom Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7/8/9/10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home did show they were adequately managing Residents health and personal care needs. EVIDENCE: Two care plans were reviewed as part of case tracking Residents care. Individual plans of care are available and identify relevant aspects of health, social and personal care. All care plan seen were detailed and gave a good account of the Residents needs and were able to demonstrate they can meet the diverse needs of Residents at the home. Some care plans gave good details how the Residents needs and choices could be met but some plans around social support were very basic with little detail how they Resident would be supported with their social needs. Residents and Relatives were generally were happy with the care provided at the home. One Resident said that they had help with a bath once a week, they said they were only allowed one a week but felt ok about that as they said the staff were very busy and probably couldn’t fit any more than one a week in. This
Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 14 was discussed with the Manager so that action could be taken to emphasise the managers view of offering support at any time during the week with no restrictions and giving Residents as much choice as possible. During interviews with Staff they were able to discuss the personal, nursing and social care needs and individual routines of Residents and explained how they gave that care and support Various positive interactions were observed with Staff supporting Residents throughout the day. However some interactions seen were discussed with the manager as they did not show good practice in respecting the Residents rights, privacy and dignity. One carer had an incontinence pad tucked into their apron as they felt it helped quicken the care needed to always have a pad available and at hand. This was an issue which had already been dealt with by the manager who agreed it did not show good practice in maintaining Residents dignity. This was raised as a training issue for Staff around the basic principles of care which needs to be evident in all care practices. A member of staff also interrupted residents speaking privately to the inspector talking over them about their personal care, again this is not a practice not condoned by the manager and identified a training issue in the basic principles in care. Another Carer was seen walking around the lounge areas with an apron and plastic gloves. The Manager agreed to review all care practices to make sure that Staff acknowledge they are working in the Residents home environment and must respect their dignity at all times. Some bathrooms were noted to not have any coverings to the frosted glass windows and a number of bedrooms still have frosted glass in the bedroom doors. Some Residents stated they felt ok about the bedroom doors and didn’t really mind. This is a longstanding issue that should be looked at by the company to show what they can do to promote a Residents privacy by providing basic facilities of coverings to windows. A sample of Medications and records and storage were viewed. These are stored within a separate locked room and minimal stock was kept and all cupboards viewed appeared tidy and organised showing a well-managed area. The home now has regular medication audits which shows regular checks and action plans are produced for any identified improvements needed to help provide ongoing safe practices at the home. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13/14/15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home did mainly provide adequate support to some Residents to meet their social needs, but others are at risk of being socialy isolated. Visitors are welcomed and included in the home at any time. EVIDENCE: There was a poster of activities displayed in reception, covering, bingo, visiting entertainers, nail painting, and foot spa, quiz afternoon, dominos and discussion however some residents were unaware whether there were any activities on offer. Activities are organised by the new activities organiser who has been at the home for seven months and works 15 hours a week. The activities organiser felt it was difficult to organise activities as a lot of residents didn’t want to do anything. She stated she was trying to build up the Residents confidences in activities. The organiser said she had been to another home to pick up some points about activities and she was awaiting going on a company training course for activities. Some Residents said the staff never have time to talk, they felt the staff were very busy and never seemed to have time to sit and chat and relax they were always on the go and worked very hard, they felt sorry for them, they said the
Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 16 bells are going all the time. One Resident said they liked watching television and talking to her friend but when she goes into the lounge Staff sit her in a corner that doesn’t face the television and she has never liked to ask about that. This was discussed with the Manager who agreed to review this with the Resident. Developments in activities should include ongoing Residents needs and requests and how they will be supported with their social care and support. Residents sat in the dining room agreed to sit and have a chat with the inspector. The room was empty but it was noisy from the kitchen, nurse call bells and people shouting to each other, dining room doors and kitchen doors all open. The Residents agreed it was too noisy and agreed for the doors to be closed to help make it a bit quieter and give some privacy. Both Residents stated they got used to the noise. This point was discussed with the manager who agreed to review the dining room noise and take actions to minimise noise and disruption to this area especially during meal times. The Cook currently caters for different dietary needs e.g. diabetic diets and liquidised meals Lunch served during this visit looked appetising and was well presented. Several residents stated they were very happy with the food and menus offered. The manager had also developed a new tool for the kitchen called “nutmeg” which will help them eventually to plan menus. Kitchen audits are also carried out by the manager, one seen dated 28/4/07 and 15/3/07, detailed and covering all areas. The kitchen area was clean and tidy, well organised and well stocked with food, especially a large stock of dry stores. Some stores of dry food packets were left open and not put into sealed containers. Sealed containers must be provided to improve the current storage of dry stores especially in a room that is awaiting maintenance and repair for signs of damp and dark patches. It was noted that there was some outstanding maintenance work needed in the kitchen but staff were unaware of what date it would be repaired. The Manager confirmed the Company had agreed to it being repaired and was awaiting decorators to commence the work. 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.V332317.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16/18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place for dealing with complaints and Residents know how to make a complaint. Systems are in place to protect Residents. 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 is displayed at the reception so that everyone has access to all necessary details and guidance in this booklet. The home has a complaints procedure, which is time scaled appropriately and includes contact details for the Commission. A copy of the complaints procedure is available to Residents. The pre inspection questionnaire gave details of one complaint over the past 12 months and the homes complaints records were seen during this inspection. These records showed that the companies’ complaints policy is well managed and carried out to try to address a persons concerns. However it was of concern that one complaint was about a maintenance issue regarding the repair needed for a bedroom ceiling, especially as the home has a build up of maintenance issues. During Staff interviews, Staff had attended some of the mandatory training and were happy with the training on offer. They had received Abuse awareness
Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 18 training. Staff are fully trained and experienced to support and protect Residents. One Staff member was still awaiting this training but the Manager had an ongoing training plan covering all mandatory training. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 19 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): 19/26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is generally adequately managed and provides a pleasant environment for Residents to live in however outstanding work has had an overall cluttering effect on the home. EVIDENCE: A sample of areas throughout the home were seen during this key inspection. Some improvements seen included bedrooms redecorated some with new furniture and curtains, corridors redecorated and carpets replaced in some areas. A sample of bedrooms seen showed personalised rooms with various personal belongings. One Resident suggested that she would like a mirror in her bedroom, this comment was passed to the manager who agreed to supply this as soon as possible. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 20 Storage at the home must also be reviewed as there was a large amount of clutter seen in communal areas and corridors including, wheelchairs, hoists, linen skips, mattresses, boxes of new bedroom furniture. Some outstanding maintenance work was still needed and had already been identified by the Manager and reviewed 15/1/07 highlighting outstanding work needed in, Eg. bedrooms identified in need of new carpets and refurbishment replacement of carpet tiles, repairs and refurbishment to bathrooms and showers, flooring in sluices, non slip flooring needed for both dining rooms, replacement of identified storage heaters, a leak to the ceiling in one identified lounge, air bricks and window vents in the kitchen and laundry. Some maintenance work needed in the kitchen is due to be carried out but the manager does not yet have a starting date. 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. Staff and Residents did not know when the work would start or be completed and some Staff acknowledged they had waited along time for repairs and refurbishment and they felt it was a shame as they tried to make the home a nice place to live. In reviewing risk assessments it was noted several risks assessments have previously identified necessary action should be taken to reduce risks with e.g. static baths and low lying beds and outstanding maintenance work as listed above. The Company must take appropriate action to reduce all identified risks and provide an overall plan to ensure the health and safety of everyone at the home. The homes pre inspection questionnaire gave details of all maintenance checks in the home. A sample of these were seen during this visit and appeared to be up to date and showed that the home is safely maintained in these particular areas. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27/28/29/30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by appropriately qualified Staff. EVIDENCE: There is a large Staff team who were observed to have a genuinely caring attitude towards Residents. Everyone in the lounge areas was seen to be helped to feel comfortable. Relatives and Residents were also very positive about the Staff and all comment cards sent to the Commission offered good comments about the Staff. Case tracking of three Staff files took place and these files showed good recruitment procedures which helps to safeguard Residents at the home and shows good practice in supporting and training Staff. 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. Some individual training records had not been updated but interviews with Staff and training development plans for the home showed that training had taken place and included a wide range of courses to help Staff support Residents diverse needs. A sample of course seen and discussed with Staff included Abuse awareness, moving and handling, fire safety, abuse awareness,
Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 22 national care award training,(NVQ) Some staff said that due to the changing needs of Residents that they would benefit from further training in dementia. Currently the Manager advises that 70 of Staff have already achieved this qualification and a number of staff have already started this course which shows were the home have exceeded the minimum guideline of having at least 50 of the workforce with this qualification. Staff felt they worked really well as a team and didn’t really have much movement. This investment to improving the training needs of staff showed that Staff are competent and trained to do their job and carry out the care and support that Residents need on each unit. 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 staff at all times. This is a repeated issue that comes up on the homes inspections and both Residents and Staff made comments about staffing levels not being appropriate. Staff said that some staff had worked at the home for many years and discussed how they felt about the home. They were generally happy however they felt the main issue at the present was the dependency of the residents being very difficult, and they are constantly on the go and don’t have any time to sit with the residents any more like they use to in the past in the afternoon even though they have a reduced number of residents in. Staff felt they had no quality time to spend with the residents and that this was affecting them. They felt that in their opinion an increase in staffing levels in the morning was needed as they felt that breakfast time in particular was a struggle. During interviews with Staff some asked what the staffing levels should be. This was discussed with Staff and the Manager. Staff, Residents and Relatives should have a clear rationale from the company as to how the staffing levels are assessed and how they are reviewed so the staff can always meet the Residents needs, especially if there are any changes to the residents dependencies. The above points were discussed with the manager who agreed it was very busy at the moment and felt that the staff were very busy, she stated that she had arranged for care manager reviews for 2 residents to assess their needs as they may need other facilities. The Manager acknowledged that they did not have any calculation to work out staffing levels and have never been able to increase them, this was an outstanding issue from previous inspections and yet the Company had not taken steps to evidence how the staffing levels are calculated or show they are able to give the care needed and reflect the resident dependencies. From positive comments made by Relatives, Residents and Local doctors its clear that the manager and staff work hard to try to give good care. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 23 This report highlights the lack of evidence by the company to communicate how to make sure the staffing levels are right for the home and to meet the Residents needs. Staffing levels should be evidenced by the Company that they are appropriate for the resident’s current dependencies and should be in the best interests of the residents. All concerns and comments raised by Residents and Staff must be reviewed and appropriate action taken by the company. Any changes should not only be clear and evidenced but also updated in the homes Statement of Purpose. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 24 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): 31/33/35/38/Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, welfare and safety of Residents and Staff is mainly promoted and protected. Residents finances are not always managed in their best interests regarding current management policies. EVIDENCE: The Manager had organised regular Staff meetings. This should ensure that Staff members have a regular forum to discuss issues that may effect the service provided to Residents and the implementation of polices, procedures and practices within the home. The minutes of these meeting showed good details around all topics at the home including policies procedures. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 25 Staff commented during interviews that they felt they could bring any subject up at meetings and felt supported in airing their views but felt that staffing levels was a point that never seemed to get an acceptable outcome. Three Residents finances that were case tracked showed that personal allowance money for one Resident had been stored at head office for 3 months. The administrator stated it was unusual for the money to be kept in head office for 3 months but usually each month they send a cheque for each persons personal allowance money. She said she wasn’t sure why they had stored the money for so long this time but thinks it might be something to do with head office moving. The Residents personal allowance money is kept in a pooled account named as a “Residents personal allowance account”, She stated all of the residents personal allowances were paid into this account and the interest from this account was then transferred to a social fund account managed by the manager. There was no evidence of Residents agreement for their money to be paid into this account or for their interest generated on their money to be paid into the social fund account. The administrator keeps ongoing balance sheets for each of the resident’s monies managed by her and receipts were seen kept for any outgoings from their personal allowance monies. Records were much more organised and improved with clear, accurate records. The development of managing Resident finances has been longstanding with previous company responses stating they are reviewing the policies for this area. The management of finances must be clear and accurate and show that they are managed in the best interest of Residents. Permission must be obtained to manage their money and interest generated for any transfer to a company Social fund account for the home. Resident’s monies must not be stored in a company account. The manager had organised various quality assurance systems in place. Various audits were seen, dated 5/2/07, some covered medications which showed regular checks on the storage and management of medications. The audits also covered human resources, maintenance and staff supervision and communication and activities, moving and handling. The company have a measuring tool were the manager will give a percentage to each area which will give an overall percentage rating each month which helps to show which areas have improved and developed and which need further input and review. A recent company survey dated 11/6/06 was carried out with residents and their relatives, these copies were seen and were very positive, the overall results had not yet been summarised and published as yet. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 26 The home had also commenced a cross referenced tool for measuring against the National minimum standards with some documents kept in the file to show how the company meet some parts of these standards. Regulation 26 reports were also seen dated 22/3/07 which showed evidence of regional manager checks on finances, maintenance books, care plans and activities. These documents showed good evidence in how the home is being managed. It showed what actions are taken to consistently show the home tries to maintain the national minimum standards and its own policies and procedures. The company have various procedures and health safety records in place to show how the home is being managed e.g. the inspector looked at a sample of maintenance certificates, fire safety checks, risk assessments, accident records which showed what actions were taken to ensure the safety of everyone at the home. 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. The Company 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.V332317.R01.S.doc Version 5.2 Page 27 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 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 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 X 2 X X 2 Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 12 4)a) 18 1) a)b) Requirement To make sure all staff are updated and trained in the basic principles of care so that Residents are supported with choice, rights privacy and dignity. The Provider must conduct regular health and safety inspections of the home. They must show how they will make the home safe for Residents. All actions identified in the homes risk assessments to reduce all risks to persons at Lymewood Court must be carried out. (this is a repeated concern) To review all residents and staff concerns around low staffing levels and to demonstrate they have suitable numbers of qualified and competently trained staff at all times. (this is a repeated concern) To carry out all identified maintenance, decorating and refurbishment to the home. To provide an open and transparent communication with everyone at
DS0000005462.V332317.R01.S.doc Timescale for action 05/07/07 2. OP38 13 4)a)c) 05/07/07 3. OP27 18 1)a) 21 1) 24 1)2)3) 05/07/07 4. OP19 23 1)2) 02/08/07 Lymewood Court Nursing Home Version 5.2 Page 29 5. OP35 20 1)a b the home so they are aware of the company commitments regarding what actions they will take to maintain the Residents home. The management of finances must be clear and accurate and show that they are managed in the best interest of Residents. Residents monies must not be stored in a company account 05/07/07 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 OP12 Good Practice Recommendations To ensure activities are provided for residents and take appropriate actions to consult Residents about what activities they would like and make arrangements to support Residents with their social needs. To develop regular minuted Residents/Relative meetings. To provide sealed containers for any opened food stuffs stored in the pantry areas. To review noise levels in dining areas and take actions to enhance a more relaxed environment for Residents dining there at meal times. To ensure the maintenance and decorating plan includes all areas noted during the inspection and provide an open and transparent communication with everyone at the home. To share maintenance decorating and refurbishment programme with Residents, Staff and Visitors. To provide appropriate storage to prevent cluttering in communal areas. To provide coverings to bathroom and bedroom door windows to enhance Residents privacy. To review all care practices and update staff in training of basic principles of care covering, privacy, dignity and choice. The Staffing levels should be kept under review in order to make sure that Staffing levels are appropriate to the needs of the Residents .To publish the homes commitment
DS0000005462.V332317.R01.S.doc Version 5.2 Page 30 2 OP15 3 OP19 4 5 OP10 OP27 Lymewood Court Nursing Home to a minimum Staffing numbers for each day in the statement of purpose. Lymewood Court Nursing Home DS0000005462.V332317.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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