CARE HOMES FOR OLDER PEOPLE
Lympstone House Strawberry Hill Lympstone Exmouth, Devon EX8 5JZ Lead Inspector
Vivien Stephens Announced 13 September 2005
th 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 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. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Lympstone House Address Strawberry Hill, Lympstone, Exmouth, Devon, EX8 5JZ 01395 270004 01395 264504 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Elizabeth Sylvester Ms Jacqueline Lee Care Home providing Personal Care 25 Category(ies) of OP - Old Age (25) registration, with number PD - Physical Disability (25) of places Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 08/04/2005 Brief Description of the Service: Lympstone House is a detached period property set in large gardens close to the centre of Lympstone village and within easy walking distance of all local amenities. There is on-site parking and attractive gardens surrounding the house. The home is registered to provide accommodation and personal care for up to 25 older people. The home is privately owned. There are two lounges, a dining room, conservatory and central courtyards. Two purpose built wings on the ground floor provide bedroom accommodation, and the bedrooms on the first floor of the main building are reached by either a passenger lift or a stairway. Assisted bathing facilities are provided. All residents are admitted initially for a one month trial period during which either party may give the other 24 hours notice of any termination without giving reason for termination. This is clearly stated in the home’s contract of residence. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection began at 10.30am and finished at 5.30pm. During the day the inspector toured the home, looked at records, spoke to residents, staff, visitors and the owners and manager. The inspector saw the lunchtime medicines being given out and talked and saw residents eating their midday meal. Pre-inspection information was provided by the home. Five comment cards were completed by residents and one comment card was completed by a relative. At the time of this inspection 17 residents were accommodated at the home. What the service does well:
New residents are given good information about the home including a copy of the contract of residence, and short stays and visits to the home are encouraged. Residents talked about life at Lympstone House and said they felt their needs were well met. They praised the staff, and said the staff are always kind and helpful. Residents’ health and personal care needs are well met. Staff take good care to ensure that medication is stored and administered safely. The menus are balanced and nutritious and served in attractive surroundings. Residents can choose where they want to eat their meals. Residents interviewed during the inspection said the meals are always tasty, well cooked, and to their liking. The home has a satisfactory complaints procedure. Residents are safeguarded from abuse. The home is comfortable, attractively decorated and furnished throughout. Risk assessments have been carried out, and actions taken where necessary to minimise the risk of accidents. The home is suitably equipped to help those who are unable to move around easily. The residents are safeguarded by sufficient numbers of staff. Recruitment procedures are satisfactory. The home is well managed. There is an open and friendly atmosphere. Records have been well maintained.
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 6 Residents are safeguarded by well-trained staff and a safe environment. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5, 6 Assessment procedures were found to be satisfactory. New residents are given good information about the home including a copy of the contract of residence. Residents have good opportunity to visit and get to know the home before they decide to move in permanently. EVIDENCE: Each bedroom has a folder containing information about the home. This includes all information required by regulations 4 and 5 and schedule 1. The manager, Jacky Lee, visits all prospective new residents to carry out an assessment and to ensure they have all of the information they need before they make a decision to move in. A copy of the Contract of Residence is included in the information pack. A new assessment form has been introduced in recent months. This covers all relevant aspects of care needs. Jacky Lee said she was satisfied this form prompted her to ask all of the relevant questions to help her get to know the prospective resident and to determine whether the home will be able to meet
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 9 their needs. Residents talked about how they chose Lympstone House. For many residents it was their families who chose the home on their behalf. All residents are admitted initially for one month on a trial period during which either party may give the other 24 hours notice of any termination without giving reason for termination. This is clearly stated in the home’s contract of residence. Prospective new residents must be prepared to return to their own homes or to move to alternative accommodation at short notice during the first month if the home find they are unable to meet the resident’s needs. Residents talked about daily life at Lympstone House and how their needs are met. They particularly praised the staff, and said that the staff are always kind and willing to help whenever requested. The home provides both long and short stay accommodation. Some of the long stay residents initially had one or more short stay at the home before deciding to move in permanently. Others talked about how their friends or relatives had looked around at different homes before choosing Lympstone House The home does not provide intermediate care. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 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 standard(s) 7, 8, 9 The recently introduced care planning system provides good information to staff about how the residents’ needs are to be met. Health and personal care needs are well met. Staff take care to ensure that medication is stored and administered safely. EVIDENCE: New care plans have been introduced in recent months. These cover all relevant areas of care needs, including health and personal care. Residents and relatives have been involved in the drawing up of the care plans. Jacky Lee has used the information gained from the care plans to draw up task lists for staff. Some of these have daily tick boxes that staff must tick to show they have carried out the tasks. In this way the management are able to ensure that all care tasks have been carried out, and no-one has been missed. The home has also introduced a keyworker system to ensure that tasks such as checking that drawers and cupboards are tidy, and clothing is in good repair, are carried out regularly. Keyworker notes showed that the staff have spent time sitting and talking to the residents, getting to know them, and making sure that any extra help needed is given. The notes provided evidence of care given that was ‘above and beyond’ the normal staff duties and demonstrated
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 11 how staff had taken extra effort to make sure that residents were happy and contented. During the morning visits to the home were made by various health professionals. Care plans include a range of assessment and monitoring forms to help the staff keep a careful check on the residents’ health. Daily reports showed that the home has acted promptly to bring in the relevant health care professionals at an early stage when ill health is suspected. The home uses the Boots Monitored Dosage System. The pharmacist visits the home regularly to give advice and support – during the inspection the pharmacist telephoned to arrange the next visit. The drug cupboard was neat and tidy. Controlled drugs are stored securely and careful records are kept. Records of receipt, administration and disposal of unwanted medicines have been well maintained. Only senior or experienced staff give out medicines. Staff have attended a training course on the care of medicines. Policies and procedures are in place. A drug round was overseen during the inspection and was found to be satisfactory. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The level of organised activities provided is low. For most residents the level of activities provided is satisfactory. . Residents are able to keep in touch with friends and families. Residents are able to make choices about all aspects of their daily lives. The menus are balanced and nutritious and served in attractive surroundings. Residents can choose where they want to eat their meals. EVIDENCE: Jacky Lee said they have tried to introduce regular group activities but found these have not been popular with the residents. However, car outings to Exmouth seafront or Woodbury Common have been well attended. Some residents have a daily newspaper, and some enjoy crosswords, reading books or cassette tapes. Holy Communion is held regularly at the home. During the warmer weather residents have enjoyed sitting outside in the garden, and one resident talked about how accommodating the staff have been to let them have meals outside if they wish. Information gathered from questionnaires showed that most residents were happy with the level of activities provided, but a small number said they would like more.
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 13 Jacky Lee plans to find out more about residents’ interests when she next reviews the care plans. She said she would like to build up community links, for instance with Age Concern and local schools in order to gradually increase the range of activities provided. Several relatives and friends were visiting the home on the day of the inspection. They were made welcome by the staff. The care plans gave evidence of how residents are able to exercise choice over their daily lives. Residents’ preferences over daily routines have been recorded, and the key worker system has also helped to identify further instances of individual requests and choices. Residents talked about how much they enjoy the meals. The daily menu is displayed in the dining room. Individual likes and dislikes and nutritional needs are identified at the initial assessment and this information has been transferred to the kitchen to ensure that the cook provides meals to suit each individual resident. The dining room has been attractively decorated and furnished. Residents can choose where they want to eat their meals. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 14 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 standard(s) 16, 18 The home has a satisfactory complaints procedure. Residents are safeguarded from abuse. EVIDENCE: The complaints procedure is set out in the residents’ handbook and covers all stages set out in standard 16. Since the last inspection one complaint has been received by the Commission. This related to a married couple being given notice to leave the home, causing distress to the couple and their family. The home did not carry out their own assessment prior to admission but relied on information given by Social Services and the family. Since their admission a manager has been employed at the home who is responsible for assessing prospective new residents to ensure the home can meet their needs. Admission procedures are now more robust. The home is also careful to ensure that prospective new residents fully understand that they are admitted on a one month trial basis in the first instance, and that either party may give 24 hour notice within that period with no reason given. Policies and procedures are in place to protect residents from all forms of abuse. Staff are given instruction on the protection of vulnerable adults during their induction. Staff are due to attend a course on Abuse Awareness on 26th October 2005.
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 15 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 The home is comfortable, attractively decorated and furnished throughout. Risk assessments have been carried out, and residents are safeguarded from avoidable accidents. The home is suitably equipped to help those who are unable to move around easily. EVIDENCE: The home is situated close to the centre of Lympstone village. It is a period style house set in large gardens. There is ample on-site parking. There are 2 lounges, a conservatory and a dining room. The gardens have various patio chairs, tables and benches where residents can sit. There are 19 single bedrooms and 3 double bedrooms all with en suite facilities. There are 3 bathrooms that have been suitably equipped to enable residents to get in and out of the bath safely. Many of the bedrooms are situated on the ground floor and have level access to all areas. There is a passenger lift to the first floor.
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 16 In a tour of the home all bedrooms appeared clean and in good order. Residents have been able to bring pictures and personal effects in order to make their rooms feel homely. Risk assessments have been carried out on the environment and actions have been taken where necessary to minimise or eliminate risks. Radiators have low surface temperature covers and hot taps on the baths are thermostatically controlled to prevent the risk of burns and scalds. A cleaner has recently been employed. The home has suitable laundry equipment. The home also has sluicing facilities. All areas were bright, well ventilated and free from any unpleasant odours. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The residents are safeguarded by sufficient numbers of staff. The level of staff training has improved significantly in the last year. Recruitment procedures are satisfactory. EVIDENCE: At the time of this inspection there were 17 residents accommodated with low to medium care needs. Staff rotas seen showed that the staffing levels are as followsJacky Lee, manager – Mon Tues Thurs Fri 8am to 5pm Morning shift Afternoon shift Evening shift Night shift – 8am to 1pm - 3 care staff 1pm to 5pm - 2 care staff 5 pm to 9pm – 3 care staff 9pm to 8am - 1 waking and 1 sleeping care staff The home also employs a cook each day, plus a cleaner every afternoon Mon to Fri The owners, Mr and Mrs Sylvester, live on the premises and are fully involved in the management and maintenance of the home. Residents, staff and visitors said they were fully satisfied with the number of staff employed.
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 18 Staff files were seen for those staff recently employed. These showed that all relevant checks and references had been taken up. New staff receive both inhouse induction and an external 1 day induction course. 6 staff are currently undertaking NVQs. 2 staff have NVQ 3 and some staff also have nursing qualifications. All staff have recently undertaken Manual Handling, Food Hygiene, fire training, and care of medicines. Courses booked for the near future include first aid, health and safety and abuse awareness. Residents and visitors praised the caring manner of the staff. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37, 38 The home is well managed. There is an open and friendly atmosphere. Staff are well supervised, although would benefit from regular staff meetings. Jacky Lee has worked hard to implement a good Quality Assurance system and is in the process of collating the information and taking action where necessary. Records have been well maintained. Residents are safeguarded by well-trained staff and a safe environment. EVIDENCE: Jacky Lee has had a number of years of relevant experience. She Holds NVQ level 3 and is currently undertaking NVQ level 4 and the registered managers’ Award. She has also attended a number of relevant short courses. Staff,
Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 20 residents and visitors expressed satisfaction in the way the home is currently managed. Staff have received regular supervision and appraisal. Jacky Lee hopes to set up regular staff meetings, although these have not been held regularly to date. Questionnaires have been given out to residents and relatives recently as part of the home’s quality assurance system. When all of the questionnaires are received the results should be collated, actions taken where necessary, and the results and outcomes should be circulated to those who participated. Records seen during the inspection include Assessments, care plans, individual risk assessments and daily reports Administration of medicines Fire log book Staff rotas Staff files Policies and procedures These records were found to be well recorded. Staff have received induction and training on a range of health and safety related topics. Further training has been booked for the near future to ensure staff are regularly updated. Policies and procedures are in place on health and safety subjects. Risk assessments are in place for the environment. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 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 Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 3 3 Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 22 no 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP33 Good Practice Recommendations Care plans should include details of residents social needs and interests, and plans drawn up to show how these needs will be met on a regular basis. Questionnaires completed by residents and relatives should be collated, actions taken where necessary, and the residents and relatives should be informed of the outcomes. 3. Lympstone House D54-D06 S21972 Lympstone House V241700 130905 Stage 2.doc Version 1.40 Page 23 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road Exeter, EX4 3AY Tel: 01392 474350 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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