Inspection on 01/06/06 for Lytham Court Care Home

This inspection was carried out on 1st June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lytham Court Care Home 02/08/07

Lytham Court Care Home 08/09/05

Lytham Court Care Home 10/03/05

Lytham Court Care Home 02/08/04

Lytham Court Care Home 27/02/04

Lytham Court Care Home 12/08/02

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

CARE HOMES FOR OLDER PEOPLE Lytham Court Care Home 2 Lowther Terrace Lytham St Annes Lancashire FY8 5QG Lead Inspector Mrs Lynne Lynch Unannounced Inspection 1st June 2006 09:15 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 Lytham Court Care Home DS0000006056.V287499.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. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lytham Court Care Home Address 2 Lowther Terrace Lytham St Annes Lancashire FY8 5QG 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) 01253 735216 Century Healthcare Limited Mrs Catherine Angela Scally Care Home 31 Category(ies) of Dementia (31) registration, with number of places Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 31 service users to include: Up to 31 service users in the category of DE (Dementia) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 8th September 2005 Date of last inspection Brief Description of the Service: Lowther View Care Home has recently been renamed and is now called Lytham Court. The home offers care and nursing to a maximum of 31 residents, with dementia, aged 50 years and over. The Home is situated opposite Lowther Gardens, near to the sea front. It is within walking distance of Lytham. Close by are churches of various denominations and a bus stop serving both Preston and Blackpool. The Home is a converted Victorian detached dwelling with a purpose built extension to the rear. The accommodation includes, in addition to lounge and dining areas, a sensory room for residents. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 1st June 2006 and started at 9.15 am. The inspector spoke with the registered manager of the home, the companies managing director and the Director of Nursing for Century Healthcare. It was not possible to speak to the residents due to their health and communication needs, however observations were made throughout the day and general conversation was held with residents and staff. Records were examined in relation to staff training and recruitment, resident’s care, medication, health and safety and financial transactions. A partial tour of the premises was undertaken. The Commission for Social Care Inspection assess all standards during this key visit. Prior to this inspection, resident and relative comment cards provided by the Commission For Social Care Inspection were sent to the home for completion. At the time of writing this report three relative comment cards had been returned. The registered provider has appointed a manager of the home, who has recently registered with the Commission for Social Care Inspection. What the service does well: The home has a newly registered manager and a consistent staff team now in place. It was generally felt that the new manager is good and she is beginning to improve the way the home is run. There is a detailed assessment format in place, which provides opportunity to gather adequate information prior to admitting a new resident. The company have a refurbishment plan for the home and improvements to the furnishings and décor have been noted. The manager has addressed and improved relationships with medical and social care professionals. The home now has good communication with these outside agencies. The medication practices within the home are now satisfactory and staff are working hard to maintain good practice in this area. Feedback from relatives was positive, with a relative commenting on the personal qualities of the staff saying, “I feel the staff are brilliant and trust that they in turn, get cared for, supported and encouraged.” Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 6 The aromatherapist gave positive feedback regarding the caring nature and helpfulness of staff. What has improved since the last inspection? What they could do better: Care staff in the home must receive appropriate training in respect of managing challenging behaviour. The home should develop suitable activities that are reflective of individual’s needs and preferences. Records maintained in respect of accidents and incidents should be kept in line with data protection guidance. Clear records of specialist dietary requirements should be maintained in the kitchen via the catering action form. Risk management strategies must be developed for individuals who display challenging behaviour giving clear guidance for members of staff. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 7 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. Lytham Court Care Home DS0000006056.V287499.R01.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 Lytham Court Care Home DS0000006056.V287499.R01.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 and 6 Quality in this outcome group was good. The home carries out a thorough assessment of each resident and gathers relevant information from other professionals. EVIDENCE: Three residents files were viewed during the visit. There is a detailed assessment format in place, which provides opportunity to gather adequate information prior to admitting a new resident. Assessments were seen on each file and had been carried out by a staff member qualified to do so. The model used is based on daily living activities. All areas of the assessment were generally completed giving good information on which to base a care plan. Additional care management assessments were also on file and specific specialist medical assessments had been received providing information in respect of mental health needs. Staff need to ensure that all forms are completed fully as some of the health assessments had only a total score without indicating how this had been obtained and therefore clearly identifying the area of need. Files need to be consistently constructed to enable access for all staff. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 10 The majority of the residents in the home have well developed dementia making conversation difficult however most of the residents were observed throughout the day and appeared comfortable, happy and relaxed with staff. Staff when spoken to showed a good knowledge of the residents needs. The home does not provide intermediate care. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 11 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): 7,8,9 and 10 Quality in this outcome group was adequate. The medication practices within the home continue to safeguard the welfare of residents. Resident plans are in place and accurately reflect resident needs and the staff support required. The lack of risk management strategies for residents who challenge, places other residents and staff at risk. EVIDENCE: Three residents were cased tracked files for these residents’ contained relevant details. The new manager has updated all the resident plans. Those care plans which have been updated highlighted the need to respect the privacy and dignity of residents, and to encourage independence. Each resident has a named key worker who is responsible for the review, and completes a monthly written overview. Checklists have been used for example to assess the risk from lack of nutrition and susceptibility to pressure sores, where these are used it is important that all elements are completed to ensure that all staff reading the assessment understand the outcome of the assessment and the actions they must follow to maintain the residents wellbeing. The care plans for all residents are reviewed monthly. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 12 There was evidence of the involvement of health personnel where applicable, referrals had been made for dietetic and community psychiatric services. The Speech and Language Therapist is being contacted to provide guidance to ensure safe eating and drinking for a resident with swallowing problems. The medication practices are now very thorough and regularly audited by the manager of the home. All records viewed were satisfactory. Care files were noted to have general risk assessments in place and risk assessments pertaining to the use of bed rails. It was noted that there was no guidance in respect of residents who display challenging behaviour both verbal and physical and during the visit one resident displayed quite challenging behaviour towards a member of staff. This area was discussed with the manager and she was advised to develop risk management strategies for such individuals giving clear guidance for members of staff and to ensure that all staff access training in this area. Staff were observed to treat residents with respect. One member of staff was observed straightening a ladies clothing, as she had become a little dishevelled. Relatives confirmed via comment cards that they were able to visit their relatives in private if they so wish. Lytham Court Care Home DS0000006056.V287499.R01.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): 12,13,14 and 15 Quality in this outcome group was good. A social activities programme is now in place. Residents are able to receive visitors in private. Meals are varied and a nutritionally balanced diet is provided to residents. EVIDENCE: Care plan documentation included some information regarding past history and social interests. The company now has an activity co-ordinator who attends the home once a week and ensures activities in the home are planned. The home also has a designated member of staff who ensures the activities are implemented. The snoozlem in the home is now being used for some activities. The activities programme should be further developed with peoples specific interests in mind. Good records for each individual were maintained. Evidence gathered from documentation and observation of residents and staff indicated that routines in the home were flexible and were primarily designed to meet the needs and choices of the residents. Residents are able to receive visitors in private and this has been observed in practice during inspections and was confirmed by the information returned on comment cards. The home’s policy on maintaining relatives and friends’ involvement with residents is in the Statement of Purpose/Service User Guide. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 14 The residents at Lytham Court all have a diagnosis of dementia resulting in various degrees of cognitive impairment. A relative will usually take responsibility for financial affairs and make any necessary decisions on their behalf. Feedback from relatives indicates that they are kept informed of important matters. Records of money held in the home on behalf of residents were maintained. Residents are encouraged to bring in personal possessions on admission and this practice was evident on a tour of the building. The main meal of the day is served at Lunchtime with the residents who needed staff assistance being served first. Copies of the four weekly menus were provided for the inspector the meals appeared to be nutritionally sound and the chef had a good knowledge of specialist dietary requirements, however clear records of these should be maintained in the kitchen via the catering action form which forms part of the new care planning format. The chef has had training in preparing meals with the “thick and easy supplement “ and presents the food after it is pureed reconstituted, in moulds to reshape it into its initial form. He also spoke about further training requirements that had been discussed with the manager. There are signs around the home encouraging residents and relatives to contribute to the planning of a new menu. Lytham Court Care Home DS0000006056.V287499.R01.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 and 18 Quality in this outcome group was good. Arrangements for handling complaints are in place and concerns are responded to appropriately. The home has a suitable vulnerable adults procedure. EVIDENCE: The home has only received one complaint from a relative regarding a bedroom environment and this is being addressed. The home has received several letters of compliment from relatives of residents. Feedback from relatives comment cards confirmed an awareness of the complaints procedure. Quality monitoring questionnaires are sent to relatives, which also give opportunity for raising issues or expressing concerns. These are returned direct to the company office and any issues then passed to the manager of the home. The home has a policy in respect of avoidance of abuse. No referrals have been made to social services in respect of abuse in the home. The Commission for Social Care Inspection has received no complaints since the last inspection. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome group was adequate The home provides a safe, comfortable and clean environment, which meets the needs of the people living there. EVIDENCE: Following the last inspection a complete refurbishment programme for 2006 was forwarded to the Commission for Social Care Inspection. A partial tour of the home was undertaken and it was pleasing to note that work had been carried out in several areas of the home. Further work identified is reflected in the refurbishment plan. An estates manager is employed by Century Health Care, he is responsible for making regular inspections that ensures the home meets with all relevant Legislation. The home on the day of the inspection was warm and clean and domestic staff were observed in their duty. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 17 The laundry is sited away from food storage and preparation areas. The laundry room floor and walls are impermeable and easily cleaned. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 18 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): 27,28,29 and 30 Quality in this outcome group was adequate The home is showing improvement and the management team has improved staffing and training. This capacity to improve should result in better outcomes for people using the service. EVIDENCE: The rota showed that there were sufficient staff on duty. The use of agency staff is greatly reduced and they are only used to cover when sickness and annual leave caused staff shortages. Staff spoken with felt they were very busy, but still had time to spend with residents. Resident’s basic needs are met; there are still areas that can be improved upon to ensure that staff are able to respond to the individual needs of residents. A relative said via a comment card “I feel the staff are brilliant and trust that they in turn, get cared for, supported and encouraged” There is a new induction programme that ensures new staff members are given the right information to be able to do their jobs well. A training plan has been developed and should ensure that training is provided to staff throughout the year. This training will include ‘safeguarding adults’ and ‘dementia care’ as well as the mandatory training to meet resident’s basic needs, such as manual handling and health and safety. The manager was advised that all staff should complete training in challenging behaviour to ensure safe handling of residents who challenge the service. Staff were clear about their role and knew what was expected from them. The manager showed a good understanding of the actions she needed to take to meet and promote equality and diversity. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 19 The home has an employment and recruitment policy that indicates the importance of obtaining a full employment history and satisfactory references from the last employer, however during the visit it was noted that this had not been rigorously adhered to due to one member of staff being employed with poor references and no further investigation into this. The inspector sighted all C. R.B. and P.O.V.A. (Protection of Vulnerable Adults) checks, which were seen to be in order. The Human resources manager was advised that staff should only commence employment on a POVA First clearance in exceptional circumstances where there is pressure to recruit staff quickly and not as a matter of course. The company has shown good management commitment to improving the service and providing training and were feeling optimistic about the future. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome group was Good New management arrangements are meeting the needs of the service, and the quality of the service is improving. EVIDENCE: The manager has been in post for nine months and is registered with the CSCI. The manager is experienced in the field of nursing. The registered provider does not manage the home and is therefore required to carry out monthly monitoring visits and make a record of the findings. Copies of these monthly reports have been sent to the CSCI office on a regular basis. Relatives via comment cards indicated they knew the management structure of the home. Staff and residents felt the new manager was good and was beginning to improve the way the home is run. Most of the residents in the home have cognitive impairment and are therefore unable to be fully consulted regarding improvements in the quality of the service. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 21 Staff appreciated the new management style, and felt it had made the working environment more comfortable, which meant that there was a better atmosphere for residents. For the majority of people living at the home, a relative will take responsibility for finances. A personal allowance record sheet is kept on behalf of each person living at the home. This shows expenditure such as hairdressing costs, which would then be paid by the relative on behalf of the individual. The registered provider, acts as appointee for one resident. A safe is available, should any valuables need to be kept. A supervision/appraisal system is being introduced. Staff members spoken to confirmed they had had such sessions. The manager is aware that the frequency of supervisions should be planned to ensure six supervisions for each individual throughout the year. New staff work alongside a more experienced member of the team and this is highlighted on staff rotas. The core-training programme includes training in safe working practices and records show that most staff have completed these courses. Any gaps need to be addressed. The pre inspection questionnaire completed by the manager confirmed certain safety checks taking place such as the checking of fire systems, external health and safety visit, water temperature check for compliance with Legionella and approved electrical certificate. The quality assurance systems are effective and the manager is proactive in addressing quality issues within the home. The views of residents, staff members, relatives and professionals visiting the home are sought on how the service can be improved. The homes Residential Domiciliary Benchmarking inspection was occurring at the time of the visit and the companies managing director advised that the company was considering the Investors in People quality assurance system. The manager was committed to promoting equality and diversity in the service and meeting resident’s individual needs. This should form an integral part of the business plan to try and improve how the care is planned and delivered to meet the diverse needs of the people who use it. Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 22 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 23 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 13(6) Requirement Risk management strategies must be developed for individuals who display challenging behaviour giving clear guidance for members of staff. The home must develop suitable activities that are reflective of individual’s needs and preferences. Care staff in the home must receive appropriate challenging behaviour training. Timescale for action 30/06/06 2. OP12 16(2)(m) 30/09/06 3. OP30 18(c)(i) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations Clear records of specialist dietary requirements should be maintained in the kitchen via the catering action form. DS0000006056.V287499.R01.S.doc Version 5.2 Page 24 Lytham Court Care Home 2. 3. OP26 OP28 The home should continue to implement it’s maintenance and renewal programme, to ensure a homely, comfortable environment is maintained. The home should have 50 of it’s care staffed trained to level 2 NVQ. The manager should achieve the Registered Managers Award. Records maintained in respect of accidents and incidents should be kept in line with data protection guidance. 4. 5. OP37 OP38 Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Lytham Court Care Home DS0000006056.V287499.R01.S.doc Version 5.2 Page 26 - 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. 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