Inspection on 25/08/06 for Lymewood Nursing Home

This inspection was carried out on 25th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lymewood Nursing Home 26/03/10

Lymewood Nursing Home 04/02/09

Lymewood Nursing Home 06/03/08

Lymewood Nursing Home 09/02/06

Lymewood Nursing Home 05/08/05

Lymewood Nursing Home 10/02/05

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

CARE HOMES FOR OLDER PEOPLE Lymewood Nursing Home Lymewood Nursing Home Woodhouse Uplyme Lyme Regis Dorset DT7 3SQ Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 25th August 2006 10:15 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 Nursing Home DS0000061709.V302515.R02.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 Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lymewood Nursing Home Address Lymewood Nursing Home Woodhouse Uplyme Lyme Regis Dorset DT7 3SQ 01297 445444 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) Lymewood Care Limited Mrs Helen Mary Gray Care Home, with nursing 37 Category(ies) of Dementia - over 65 years of age (37), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (37) Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. You may admit up to five service users with Dementia (DE) aged over 55 years, subject to individual assessment by local care management teams. 9th February 2006 Date of last inspection Brief Description of the Service: The home provides accommodation and personal care (including nursing) for people over 65 years of age, who have needs that relate to dementia or a mental disorder. The home can also admit up to five people aged 55 – 65 years old with similar needs. A maximum of 37 residents can be accommodated. Lymewood Care Ltd. has owned Lymewood since November 2004, with Mr Paul Stratton acting as the Responsible Individual for the company. Set in a beautiful rural location about two miles from Lyme Regis, the easiest access to the home is via the centre of the village of Uplyme; the entrance drive off the Woodhouse road is less easily found. There is parking space around the home. Accommodation is provided on three floors, with all areas serviced by stair lifts, and a passenger lift between some areas. The manager therefore assesses the suitability of bedrooms for prospective resident, dependent on the room’s location and the resident’s level of mobility. Some double rooms are available, and a number of the single rooms have en suite facilities. There is a main lounge, a dining room, and a lounge-diner off the entrance hall to the home, with a small lounge in the newer extension from the main house. There is also a hairdressing room, with an adapted sink. Residents who would be at risk should they leave the grounds unescorted can be given a device that alerts staff if they go through the gate into the drive. Residents are thus able to have the freedom to enjoy the home’s extensive gardens, with support provided if they go further afield. In certain circumstances, new residents are able to bring existing pets with them, when they first move into the home. Weekly fees at the time of the inspection were £485 - £585. These did not include the cost of papers, toiletries, hairdressing, chiropody, or transport to hospital other than by ambulance - which are charged at cost price. Inspection reports produced by the Commission (CSCI) about the home are available directly outside the manager’s office. Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 36 residents at the home on the day of this unannounced inspection. Helen Gray, Home manager, had returned a CSCI pre-inspection questionnaire. Completed CSCI surveys or comment cards were returned from three residents or their families, six care staff (nurses and care assistants), and three community-based health or social care professionals. The inspector met at least 10 residents around the home, some individually and some who were sitting together. Not all were able to give their views in depth; most looked at ease, able to observe activities going on around them or move between rooms as they wished. The inspection incorporated ‘casetracking’ of four residents, including a bedbound resident, and new residents. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (preadmission assessments, medication sheets, etc.), talking with staff, and observation of care these residents received - especially where they were unable to give their views in depth. The inspectors also spoke with seven visiting relatives/friends, four members of the care and ancillary staff, and the manager, during the eight hours spent at the home. Other records seen included those relating to staff, health and safety, and quality assurance. A tour of the building included the kitchen and laundry. The inspector discussed her findings with Helen Gray on a later day (28 August 2006). Information gained from all these sources and from communication with the service since the last inspection is included in this report. The Commission has not received any concerns or complaints about the home since the last inspection. What the service does well: When asked this question, a resident said, “We’re well looked after”, and a visitor said, “They don’t miss the personal things”. Prospective residents’ needs are assessed well, helping ensure the home can meet the care needs of people who are admitted. Involvement of community-based professionals helps to ensure residents receive the health care they need. The home has good standards of hygiene, which protects their wellbeing. An enjoyed and nutritious diet is provided, promoting good health. Residents benefit from a well-kept, spacious and homely environment (although odour-control needs ongoing monitoring). Their privacy is respected, Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 6 and they are enabled to have choice and control of their lives where possible, promoting their dignity and rights. Links with families, friends and the local area ensure residents benefit from interesting and supportive contact with communities around the home. A variety of strategies help to ensure the home is run in the best interests of the residents. These include that the manager has the knowledge and experience to ensure the home is run well, there are systems that protect residents’ financial affairs, and good recruitment procedures that help ensure only suitable people are employed. Suggestions and concerns are listened to, and used to improve the service that residents receive. Staff numbers and the variety of roles are sufficient to meet residents’ needs. Training and support for staff ensures they have the knowledge and skills to safely provide necessary care. What has improved since the last inspection? What they could do better: One visiting relative who was asked this said there was nothing. A staff suggestion was for better staffing levels. The introduction of a new care planning system needs to be completed promptly, to ensure staff have clear, complete information about residents’ care needs and how to meet them. Information from reviews of care should be better used to update care plans, thus ensuring they reflect changing needs. Some aspects of medication management must be addressed, to ensure medication is administered as safely as possible. Residents enjoy a balanced and varied diet; however, dining arrangements could be improved for some residents, to add to the enjoyment of mealtimes. Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 7 Various activities and events are organised, but some residents would benefit from other opportunities for recreation. Current safeguarding policies and practices help to protect residents from abuse; however, one improvement would help to protect them more fully. There are systems in place that ensure most health and safety matters are attended to, but - to further protect residents and staff - action must be taken to address a matter raised by the fire authority. 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 Nursing Home DS0000061709.V302515.R02.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 Lymewood Nursing Home DS0000061709.V302515.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not offer intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good admission practices, which ensure that the home can meet the needs of those who go to live there. EVIDENCE: Residents’ surveys said they had enough information before moving in, to help them decide if they might like living at the home. Senior staff met prospective residents to carry out wide-ranging assessments of their care needs; the manager had recently taken steps to ensure people get written confirmation, before admission, that the home could meet these needs. Some assessments seen were not very detailed in parts – for example, ‘likes TV’ being noted but not what types of programmes; one didn’t have the person’s social history, which can be very significant when caring for someone with dementia. However, care notes for a new resident were very detailed for their first days at the home, adding information to the initial pre-admission assessment of their needs. A new resident said they felt very welcomed when they first moved in, and was positive about the home. Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care needs are adequately identified, but care-planning systems should be improved to ensure staff meet all care needs, including changing ones. There is good multidisciplinary working, ensuring residents receive good health care. Management of medication is adequate, but some aspects must be addressed to ensure safe administration. There is good respect for residents’ privacy and dignity, with promotion of their rights. EVIDENCE: Surveys from community-based professionals said staff showed clear understanding of residents’ needs; one felt an “excellent level of care” was provided, with staff “following comprehensive care plans, in a most Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 11 professional manner”. However, the home had begun using a new comprehensive care recording system a few weeks before the inspection; transfer of information from old records had not been completed, with information about some residents being stored in two different places. Information and observations in daily care notes were not always used to further develop existing care plans. Both of these points could lead to staff not being aware of some care needs or required care. For example, where daily notes showed a resident had developed a new skin problem, this was not shown in the accompanying care plan nor cross-referenced to a care plan for wounds - which was kept elsewhere with an updated risk assessment for pressure damage. Other daily notes suggested a particular routine for a resident, regarding meals, but this was not in their care plan. Staff, however, seemed to know residents well, giving examples of likes/dislikes and preferences regarding personal care; one said they learnt about residents’ social needs from care plans, or were told about them very soon after the person came to live at the home. Care records reflected input from GPs, Community Psychiatric Nurses, and the physiotherapist employed by the home for fortnightly visits, to help meet residents’ various health needs. The manager said they also had support from consultant psychiatrists. Residents said they were weighed regularly; records seen in care notes, with nutritional risk assessments, showed weights generally remained stable. Pressure-relieving equipment was seen in use for a relatively immobile resident with wounds, to help promote healing. Most visiting relatives felt staff attended to health needs well; and they said residents always looked well cared for, were dressed appropriately, etc. whenever they visited. There were appropriate systems for recording medication and other prescribed items received by the home, using individual record sheets for each resident. Appropriate systems were also in place for disposal of unwanted medication, including two staff signing as witnesses when this was done. The manager said she would ensure two signatures were always recorded, where a few handwritten entries on medication charts had only one signature as confirmation of the entry’s accuracy. No controlled drugs were currently used, although secure storage was available if necessary. A short course of a medicine requiring cold storage was kept in the food fridge; the manager said that a medication fridge would be obtained if there were greater use of medicines requiring cold storage in future. Staff took medications in individually named containers to residents around the home, carrying them on a tray; thus there was no immediate way of leaving them safely if the nurse had to put the tray down in an emergency, etc. The manager agreed to review this, to ensure safer transportation. One resident’s allergies were noted in their care records but not on their medication sheet; writing them on the latter would help ensure prescribing errors were avoided. Guidance on use of over-the-counter preparations was dated 2002, and not all GPs providing a service to residents had been consulted about it; this might result in inappropriate use of ‘homely remedies’. Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 12 Residents felt their privacy was respected. A resident who wanted to remain in their own room was able to do so. En suite facilities had privacy locks, and locks are provided for bedroom doors if requested by residents, subject to risk assessments. Double rooms had movable screens and each resident had their own set of furniture (wardrobe, etc.), providing private space for each resident and their possessions. One visitor said they were pleased that staff showed affection towards residents, in a kindly, appropriate way - putting their arms round them to comfort and reassure them. Lymewood Nursing Home DS0000061709.V302515.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is adequate provision for fulfilment, but some residents would have a better quality of life if more recreational opportunities were offered to them. Good links with residents’ families, friends and the community around the home ensure residents benefit from supportive and interesting relationships. There are good practices that promote residents’ choice and control in their lives where possible, promoting their rights. Catering arrangements are adequate, with residents enjoying a balanced and varied diet, but with one area needing some improvement. EVIDENCE: A visitor said staff seemed to know individuals’ interest, providing appropriate music or books, for example. The television was seen to be used selectively, as also noted by some visitors and a resident, who said staff ensured the television was on for the resident’s favourite programmes. Music was playing in one lounge; musical entertainers also visited during the afternoon, and some Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 14 residents did jigsaws with a carer. Visitors said staff took residents out for walks, and the home has a minibus, the manager confirming there is no charge for this transport; recent outings were to a donkey sanctuary, and a ‘pickyour-own’ strawberry farm prior to ‘Strawberry Day’ at the home. Some residents said they didn’t get bored. However, one with poor mobility said they would like to go out more, and another in their room said they would like a television or access to music there. Residents’ surveys reflected there were not always sufficient activities they could take part in. A senior carer has taken a lead on organising activities, etc. since the last inspection. She had had some training for this role, but was soon to attend some specific to caring for people with dementia. Action is being taken to get games more suited to residents’ needs – musical items, large versions of popular games, etc. – with some help from the Relatives’ Support group. Residents said their visitors were made welcome and visitors spoken with felt well supported and appropriately informed by the staff; some said staff brought visitors a tray of tea if they were sitting in the garden. One commented that it was nice to see children visiting, observing that residents enjoyed seeing them about and that the home had a family atmosphere. There were outings to local places, and the home sponsors a donkey from the local sanctuary. The home holds fund-raising events; half of the money is for the Residents’ Fund, and the other half goes to a charity nominated by residents and their families. Staff used residents’ preferred name or form of address, which was seen recorded in care notes. When the inspector asked whether staff were willing to fit individuals’ preferences or requests into daily routines, one resident said, “You could do just as you liked, if you wanted to”, adding they felt “treated very well as an individual”. Another felt staff listened and did as they, the resident, wished. A visitor said their relative had a lie-in when they wanted one. Residents had their own possessions in their bedrooms, helping to personalise the rooms. Residents spoken with liked the food provided, as reflected in the residents’ surveys, and said they were given enough to eat and drink. Others were seen enjoying the lunch provided during the inspection. Visitors said residents were sometimes offered pieces of fruit or cheese mid-afternoon, besides a cup of tea and biscuits. Fresh fruit and vegetables are delivered twice a week to the home. And the manager said sandwiches are offered during the evening, in addition to the earlier evening meal. It was noted that in one dining room, pureed main meals were served to residents in bowls at lunchtime, and that the dining tables did not have tablecloths, mats, etc. The manager said she is trying to obtain more appropriate crockery, and other ways of improving these dining facilities were also discussed. Lymewood Nursing Home DS0000061709.V302515.R02.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 inspected at least once during a 12 month period. 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. There are good systems in place to ensure complaints are heard and used to improve the service residents receive. There is an adequate range of safeguarding policies and practices in use, to try to protect residents from abuse. However, one improvement is needed to fully protect people. EVIDENCE: Residents and visitors spoken with felt able to raise concerns or make complaints, as reflected in residents’ surveys. Neither the home nor the Commission for Social Care Inspection (CSCI) has received any complaints or concerns about the home since the last inspection; none were raised during this inspection. The written complaints procedure was in the entrance hall, in a helpful format. Although the home ideally should be approached first about any concerns and complaints, the manager agreed to include that CSCI could be contacted at any point (rather than only when other options had been tried, as the current information might imply). Residents’ surveys said they had received a contract, which helps protect their rights. Visitors said they had never seen any residents being treated improperly. One staff felt it was one of the home’s strengths that residents were “never taken advantage of”, despite their incapacities. Some staff had Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 16 had training or updates on safeguarding since the last inspection, with further sessions planned. Staff spoken with felt guidance seen in care plans, on dealing with aggression, was clear and helpful; they described appropriate strategies, and said there were two staff allocated to be in the main lounge during the day to diffuse any difficult situations if they arose. Some visitors said they had been informed that their relative, a resident, was being given a personal device that would alert staff if they went out unescorted. The family were happy with how staff engaged with residents who put themselves at risk by leaving the grounds on their own, having seen them act respectfully in a friendly manner. However, there was limited multidisciplinary discussion before use of these devices. Full involvement of others in such decision-making helps ensure that peoples’ rights - to liberty, etc. - are protected and upheld as much as possible. Lymewood Nursing Home DS0000061709.V302515.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a good standard of accommodation that is clean and generally well maintained, although other solutions may be needed to ensure odours are controlled. EVIDENCE: Visitors appreciated the amount of refurbishment being carried out by the new owners, as did one of the staff, and said they had been asked for suggestions on improving the home. The exterior was being painted during the inspection, and there was a good standard of décor internally. The manager said extra lighting would be put in when the main lounge is refurbished later this year. The Residents’ comfort fund had been used to buy a gazebo (a decision made by the residents and their families), so people can sit in the garden in shade. Basic adaptations such as grab rails and handrails were seen, which promote physical independence. Residents were making use of the ample space they enjoy, having several day rooms as well as access to their bedrooms and the Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 18 garden. The great majority of residents seemed at ease in their environment, although there was little else in the way of specialist design or adaptations specifically to help people who have dementia. This was discussed briefly with the manager. Residents spoken with were satisfied with the usual standards of cleanliness at the home, as were visitors. Residents’ surveys varied from ‘always’ to ‘sometimes’ when asked if the home was fresh and clean. Two areas were noted to have an enduring odour during the inspection; the manager said carpets are steam-cleaned regularly, but additional action may be necessary to address the underlying problem. Wheelchairs in use were dust-free and clean. There is a clear written procedure for handling of laundry, which staff were able to describe, to thoroughly clean linen and control the risk of infection. They said there was always plenty of disposable protective clothing, seen around the home, for staff - describing appropriate usage, to reduce risks of cross-infection. Lymewood Nursing Home DS0000061709.V302515.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers and the skill mix are good, helping to ensure residents’ needs can be met. The staff team has a good level of basic knowledge and skills to guide practice and ensure residents’ safety. Residents are protected by the home’s good recruitment policies and practices. Training and support for staff is good, helping them to provide the care residents need. EVIDENCE: Residents described staff as ‘helpful’, ‘they go out of their way to help others’; they felt they were interested in their work. Two said they could always get help and that staff were always about, as reflected by residents’ surveys; another in their bedroom said they didn’t feel neglected and that staff popped in to see them. Visitors said staff were very caring, always smiling or cheerful, they always seemed to have time for the residents, and they had necessary skills to care for the residents. Agency staff are rarely employed, with visitors saying they saw the same faces when they visited and the pre-inspection questionnaire confirming there is a low turnover of staff. There were eight care staff - including the manager, another nurse and a senior carer - and a general Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 20 assistant/bedmaker on duty on the day of the inspection, for 36 residents. A cook and the handyman were also on duty, with administration support staff based elsewhere. A rostered third nurse, the domestic and laundry staff were absent due to holiday leave or sickness. Staff said staffing was insufficient occasionally, due to sickness or vacancies, but that residents’ care was always maintained; two staff surveys said having more staff would improve matters. During the inspection, staff worked continually, but without rushing and in a cheerful manner – giving time to residents when with them. Staff spoken with had a recognised care or nursing qualification, were working towards one, or had several years of experience. The pre-inspection questionnaire indicated nearly two-thirds of the care assistants have a recognised care qualification. Rotas confirmed there is always at least one nurse on duty, to supervise care. There is an out-of-hours ‘on-call’ rota of senior staff - including the deputy manager, a Registered Mental Nurse available to provide advice. Staff felt newly recruited staff were suited to the care role they were employed to do. Files for two new staff were checked. Required information had been obtained, including timely police checks - helping to ensure they were fit to work there. Both had some relevant experience. Staff confirmed new staff worked with senior carers initially; a record was kept of their induction, which was of variable length according to their training needs. Files for two new staff showed they had already received some training relevant to residents’ mental health needs. Visitors thought staff were adequately supervised, and appeared well organised. Formal supervision for staff had begun, being ‘cascaded’ down through the staff team. A carer spoken with had had some dementia care training recently and was booked to attend more in the near future, as was a senior carer. Staff appeared to know residents well and how to meet their individual needs, including their mental health needs. Lymewood Nursing Home DS0000061709.V302515.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has good knowledge, skills and experience to ensure the home is run well. There are a good variety of strategies in place to ensure the home is run in the best interests of the residents. Good systems and practices used by the home protect residents’ financial affairs. There is adequate attention to health and safety matters, but one matter must be addressed to fully protect everyone at the home. EVIDENCE: Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 22 The manager is a Registered General Nurse, who as obtained additional management qualifications, and who has 13 years experience in the post. She is trained to teach safe moving and handling skills to staff, and since the last inspection has had updates in relevant aspects of care (continence, etc.). One person said the manager was “the right person for the job” because she was able to diffuse difficult situations (between residents, for example) without being ‘bossy’. People said she was always available, including that she works weekends. The atmosphere was described as ‘open’. Staff felt well supported, even when reporting concerns; they also said they had sufficient stocks, equipment, etc. to give care as expected. A relative said minutes were sent to them if they were unable to attend the relatives’ monthly meeting. These were also seen pinned on the noticeboard in the entrance hall, with minutes from the residents’ meeting and staff meeting. Other visitors said they had completed a ‘quality of care’ survey recently, for the home, with one saying results were usually shared at their meetings. Staff said CSCI inspection reports were discussed with them. Staff sickness was monitored. The home does not hold personal monies for residents, but bills them in arrears for any expenses they incur. Relevant monthly records for three residents were seen; receipts were available for entries checked. The home does not act as appointee for any residents, leaving control of residents’ financial affairs to those chosen by or for the residents. Visitors and staff felt it was a safe place, free of tripping hazards, etc.; some confirmed they had heard fire bells being tested. Staff spoken with had had recent updates for various health and safety topics. A record was seen of checks relating to control of Legionella, fire safety and repairs. The maintenance staff also confirmed he carries out monthly checks on window restrictors, ensuring they are still effective. The pre-inspection questionnaire confirmed that home’s electrical wiring was checked in December 2006. A positive report was seen from an Environmental Health Officer’s inspection of the kitchen in May 2006; the area was clean and organised on the day of this inspection, with steps being taken to comply with new food legislation. The manager said the fire risk assessment was still to be updated as requested by the local fire authority in February 2006. Mr Stratton (Responsible Individual) has since confirmed he will do this by 30 September 2006, and that some other action requested by the fire officer has been addressed. He was aware that the fire risk assessment would need reviewing in line with new fire regulations effective from October 2006. Lymewood Nursing Home DS0000061709.V302515.R02.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 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 3 X 3 X 3 X X 2 Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 31/10/06 arrangements for the safekeeping and safe administration of medicines in the home. This is regarding provision of safe delivery/transport systems for medication administered to residents, noting allergies on medication sheets, & regular review of medication policies. Requirement Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 25 2. OP38 13(4)(b)& (c) & 23(4) 13(4) The registered person shall 30/09/06 ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. 23(4) The registered person shall after consultation with the local fire and rescue authority (b) provide adequate means of escape. This is regarding the home’s fire risk assessment, which must be updated in accordance with the letter received by Mr P Stratton (Responsible Individual), sent from Devon & Fire Rescue Service in February 2006. 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 OP7 Good Practice Recommendations It is recommended that a) Transfer of information to the new care planning/recording documentation is completed as quickly as possible to ensure care needs are appropriately identified and met; b) Information and observations in daily care notes are better used to develop existing care plans, to ensure changing needs are met. It is recommended that further work be done to provide stimulation or occupation for residents that reflects their interests and capacity to take part, to increase their wellbeing. 2. OP12 Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 26 3. 4. OP15 OP18 It is recommended that dining arrangements are further developed to ensure all residents have an equal opportunity to enjoy pleasant dining facilities. It is recommended that multidisciplinary decisions are evidenced where potential restraint / restriction of liberty issues are involved, to ensure residents’ rights are protected. Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lymewood Nursing Home DS0000061709.V302515.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!