Random inspection report
Care homes for older people
Name: Address: Lyons Court Care Home Stones End Evenwood Bishop Auckland County Durham DL14 9RE two star good service 30/01/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Andrea Goodall Date: 1 3 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Lyons Court Care Home Stones End Evenwood Bishop Auckland County Durham DL14 9RE 01388834516 01388832327 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Durham Careline Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 50 Number of places (if applicable): Under 65 Over 65 0 50 dementia old age, not falling within any other category Conditions of registration: 50 0 The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 50 Dementia Code DE, maximum number of places 50 Date of last inspection 3 0 0 1 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home The home is well designed and has pleasantly landscaped surroundings. It shares a site with its sister home, Bowes Court. There is ample parking space and views of the surrounding countryside. The home has three floors and all are accessible by lift. The home has very generous communal and circulatory space and it has been designed to enhance the experience of the service users and to make operation easier for the staff. There is a generous amount of storage space in the home. This design and build is an example of good practice. There is a good standard of equipment such as mobile and fixed hoists, and specialist beds. A suitable call system has been installed. The scale of charges is between 454.71 and 476.44 Pounds per week depending on whether nursing care is required or not. Care Homes for Older People Page 3 of 10 What we found:
A random inspection was carried out on 13th July 2010. The inspection visit was carried out by one Compliance Assessor over 5 hours. The reason for this inspection was to check whether the provider had complied with the timescales for four of the ten requirements made at the last key inspection on 6th May 2010. At the last key inspection the homes rating was reduced from Good to Poor. On 2nd June 2010 we sent a Warning Letter to the provider about its failure to meet the regulations that apply to the ten requirements. There has been a suspension of placements to the home by Durham County Council since April 2010 following safeguarding adults concerns. The home is working to an action plan produced by the Safeguarding Adults Team, and to the action plan following the key inspection. Since the last key inspection a new manager has been appointed and she is to apply for registration as the manager under the Care Standards Act 2000. The home has not had a registered manager in post since October 2009. The provider has also appointed an Interim Compliance Manager to support the home to meet the improvement and action plans. During this inspection visit we spoke with the new manager and the new Compliance Manager. We looked at records the home keeps about how to care for people, for example care plans and risk assessments. We spoke with catering staff and looked at information about peoples dietary needs. We looked at the reports that the provider has to make about the operations of the home (these are called Regulation 26 reports). We looked at the care files for four people who live here. Care plans are records that are used by all care services to show how each person needs support with their individual needs, for example mobility, personal hygiene, and nutrition. Since the last inspection new care plans have been put in place for every resident. These are based on the current activities of living needs of the people who live here. Care plans are now clearer and provide more guidance for staff about how to support people. (At this time monthly evaluations about peoples needs are still being written next to old care plans, not the new care plans. The manager stated that the nursing and senior staff will be taking responsibility for the new care plans this week and that old care plans are to be archived.) There are new care plans in place for people who need support with their eating or nutritional health. For example one person is at risk of choking due to the speed of their eating. The new care plans describes how this person requires a normal diet cut into small manageable pieces, and needs observations and prompts from staff to slow down their eating. We also looked at care assessments about peoples nutritional health care needs. New nutritional assessments are now in place (called MUST assessments) and weight records show any changes in peoples nutritional well-being. At this time there are two sets of nutritional assessments in the care files, some dated up to March 2010 and new assessments dated from June 2010. The manager needs to make it clear to staff which
Care Homes for Older People Page 4 of 10 nutritional assessments are to be used. Since the last inspection there is now written information for catering staff about the dietary needs of the people who live here. This is kept in the kitchen so cooks know whether people have special or fortified diets, and where each person prefers to dine (for example some people choose to dine in their bedrooms). One cook has previously attended Focus on Food training (about nutrition and healthy eating) and there are plans for the other cook to attend this in the future. In this way there have been improvements to the way that the home supports the dietary needs of the people who live here. At this time people are still asked for their menu choices the day before the main meal. Many people who live here would not remember their choice the next day, and some people may not be able to make a choice without a visual prompt. However the manager and cook commented that this is just to get an idea of how many people may choose either dish, but that people are offered the alternative dish if they prefer when they sit down to their meal. There are written menus in the dining rooms and the Compliance Manager stated that picture menus are being developed to support people when making choices about meals. At the last inspection a requirement was made about risk assessments for peoples health needs being kept up-to-date and reviewed. During this inspection we looked at the care files for four people, and found evidence of the same shortfalls because risk assessments are still not completed correctly. For example one persons manual handling risk assessment still states that they are independent but further in the assessment then states that they require support of one care staff. The assessment is not complete and does not show whether the person needs any specific methods or equipment for transfers, standing or mobilising. In this way the assessment is contradictory and incomplete, and this would be confusing for new or agency staff. This means that the person may not be supported in a safe way. The care files were examined for four people who have some mobility needs. There was no manual handling risk assessment for one person who has an unsteady gait, uses a walking stick and is at high risk of falls. There were manual handling risk assessments for the other three people, but none were dated so it is not possible to know if they are current assessments. None of the manual handling risk assessments were signed so it not known who the assessor was and whether they were trained to carry out the assessment. The new manager was not aware whether any of the staff or management team are trained as moving & assisting assessors. One persons continence assessment was not completed other than a heading doubly incontinent for seven years. Several assessment documents are headed with the name of another provider, rather than Durham Careline limited, which suggests that the provider does not have its own corporate assessment forms. Recently one person became entrapped in the sides of bedrails (as the pressure mattress had deflated) and a safeguarding adults referral was made. Despite that incident the risk assessment for use of the bedrails has not been fully completed. There is no information about who fitted the bedrails and what training they had to do so, there is no signature of consent by next of kin, and the date of informing the persons GP is not completed. The care files state that the person has advanced dementia care needs, but there is no indication that nursing services or care managers were involved in the decision to use
Care Homes for Older People Page 5 of 10 bedrails. During discussions with the new manager it was clear that significant efforts have been made over the past few weeks to improve care plans and care practices, and it was evident that the care plans are now more detailed about peoples care needs. However there continue to be shortfalls in the risk assessments and this matter is under further investigation. There has been an improvement in the management of the service. A new manager has been appointed (subject to registration). Also an Interim Compliance Manager has been appointed on a temporary basis to support the service to meet the previous requirements, and to set up management systems for continuing future compliance. The Compliance Manager is also carrying out monthly reports of the operations of the home (called regulation 26 reports). The aim is that monthly reports should identify any shortfalls and show how these will be actioned by the provider. The home has held a Residents/Relatives meeting to gain peoples views and introduce the new manager. The manager and Compliance Manager commented that it was favourable meeting. Quality assurance surveys have also been given to residents and relatives to gain their views of the service. Also an Activities Co-ordinator has been appointed who is spending time with residents and relatives, and completing life histories and social care preferences. It is then intended that a social activities programme will be put into place. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2.
Care Homes for Older People Page 6 of 10 Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 13 Ensure that individual service 09/08/2010 users risk assessments are in place and are reviewed and updated to reflect their changing needs. (This is an outstanding requirement from the last inspection.) This is to ensure service users are protected from risk of harm. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 3 4 5 7 7 8 8 30 Nursing and senior staff should take responsibility for care plans and evaluations. Old care plans should be archived to the back of care files. Care records should not be headed with the name of another provider. All parts of risk assessments should be fully completed. At least one staff should be trained as a moving & assisting assessor in order to carry out moving & assisting assessments.
Page 9 of 10 Care Homes for Older People Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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!
