Inspection on 08/09/05 for Lytham Court Care Home

This inspection was carried out on 8th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 01/06/06

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 Announced Inspection 8th September 2005 09:30 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.V249890.R02.S.doc Version 5.0 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.V249890.R02.S.doc Version 5.0 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 Care Home 31 Category(ies) of Dementia (31) registration, with number of places Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 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. 21/06/05 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 service users, 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 service users. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and started at 9.30am, took place over 8 hours and was carried out by two inspectors and the Commission for Social Care Pharmacy Inspector. The Inspectors spoke to the Registered person, the managing director, the newly appointed home manager, the company’s estates manager 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. The residents Comment cards were issued one was received back from a relative at the time of the report. Care records and staff files were examined. A tour of the premises was undertaken and the Pharmacy Inspector for the Commission for Social Care carried out a thorough audit of medication procedures with the Director of Nursing for the company. The Commission for Social Care Inspection assess all standards over the two required inspections per year. Standards assessed on this inspection were the ones outstanding from the previous inspection, however prior to this inspection a complaint was made covering several issues, some of which were upheld. These issues and the respective standards where included in this inspection. What the service does well: What has improved since the last inspection? The home has had some ongoing staffing problems, which the company have been trying hard to resolve. Several environmental health and safety concerns raised on the previous inspection have been dealt with swiftly and effectively. The company now has an estates manager in place, who has a team of maintenance staff to carry out maintenance and renewal for the home. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 6 The home now has a clear cleaning rota and the home is now looking cleaner and is free from odours. 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. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 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 the following standard(s): None of the above standards were inspected at this visit. EVIDENCE: Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 9 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 and10 Individual care plans are in place these require updating and reviewing. Health care needs are met and good communication generally maintained with medical professionals. Poor medication practices have placed residents at risk. The people at the home are treated with dignity and respect. EVIDENCE: The home is implementing a new care planning format, which is very thorough and covers all areas of care needed and includes a section on the person/relatives perception of care required. Some information has been transferred on to the new format however these remain incomplete for the majority, therefore staff are still referring to the old care plans, which set out in detail the action needed to be taken by care staff to ensure that all aspects of health, personal and social care needs of the service user are met. However these have not been consistently reviewed and reviews do not take place with the involvement of the service users or their relatives, the inspector advised that service users and their relatives should be encouraged to take an active part in the care planning process. Relevant risk assessments form part of these care plans however these also require updating. Rota’s viewed showed appropriate levels of qualified nursing staff. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 10 The care plans the inspector used in the tracking process gave evidence relating to the assessment and identification of those service users that were at risk of falling. Nutritional assessments and relevant interventions were documented. Fluid balance and turn charts were clear and completed accurately. Aids and equipment in respect of continence, pressure relief and moving and handling were sufficient and observed in use. Records showed that good communication is maintained with medical professionals. Two ladies who were bedfast were observed to receive appropriate attention throughout the day. One gentleman’s records on file showed that appropriate action was taken to transfer him to hospital when his health deteriorated. Residents were treated with respect and dignity and a comment card received from a relative stated that they were always able to visit their relative in private. Following on from medication issues previously identified by the pharmacist inspector a full medication-handling audit was carried out. Following this inspection a legal notice was issued in respect of the poor practice in this area and failure to meet previous requirements and recommendations. The specific findings of the pharmacist inspection are available in a separate report. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 11 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 Social activities are currently not planned and taking 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 a detailed past history and social interests. Previous inspections had shown that these interests had been continued in the home, however due to recent staffing difficulties activities in the home did not seemed to be planned or occurring on a regular basis. The snoozlem in the home did not appear to be in current use. 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 a comment card. The home’s policy on maintaining relatives and friends’ involvement with service users was seen in the Statement of Purpose/Service User Guide. Residents are supported and encouraged to manage their own financial affairs for as long as they wish to and as long as they are able to. However due to the Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 12 mental frailty of the service users accommodated most are unable to do so. In these circumstances relatives or a solicitor are asked to act in the best interest of the service user. 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. During the inspection the inspector spoke with the chef who advised that the main meal of the day was now 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. The chef has recently 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 it’s initial form. Residents who were previously served pureed meals now have these meals, which make the meal look more appetising. The chef also advised that he is notified on admission of any specialist diets likes and dislikes. The new care planning format has a catering action as a result of assessment section. There are signs around the home encouraging residents and relatives to contribute to the planning of a new menu. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 13 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): None of the above standards were inspected at this visit. EVIDENCE: Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 14 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): 19,20,22,23,24 and 26 Previously identified environmental health and safety concerns have been addressed. Some areas of the home look neglected and fail to provide residents with comfortable surroundings. EVIDENCE: During a recent complaint visit several arrears of concern were raised in respect of environmental health and safety. The home has reacted quickly to attend to these matters. One of the inspectors conducted a thorough tour of the building with the estates manger and a refurbishment plan for the home has now been produced for August to December to address any immediate issues, with a further maintenance and renewal programme to be drawn up for 2006. Water temperatures were found to be inconsistent and these are to be monitored on a regular basis. The laundry area within the home requires attention to ensure that the floor and walls are readily cleanable and impermeable. The television in the lounge area is to small and placed in an elevated position making it difficult to be viewed by residents. A nurse’s station, which had been situated in the dining area, has now been Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 15 removed to ensure each resident is afforded 4.1sq metres of communal space. Garden areas are well maintained with seating and are independently accessible to all residents through the provision of a ramped access. The estates manager has been liaising with the local fire service in respect of an open fire escape stairway to minimise the risk of residents attempting to climb this. The Home has a variety of aids to promote independent activity or aid assisted bathing in order to meet the needs of the service users accommodated. A passenger lift is installed to promote independence and freedom of movement. A call bell system with an accessible alarm facility is available in every room. Residents are encouraged to bring their own possessions into the home on admission to maintain a homely feel to their rooms. All bedroom doors are fitted with appropriate locks in addition each room has an item of lockable storage. The home is hygienically maintained. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 16 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 Staffing levels are satisfactory to meet the needs of the residents, however the use of agency staff does impact on residents care. EVIDENCE: The home has recently undergone many staff changes due to the resignation and dismissal of 13 staff between March and August 2005. The home is currently still using a high proportion of agency staff to supplement the rota. The management team acknowledge that this has an impact on resident care and have been liaising closely with the agencies to try to use staff that are familiar with the home. Recruitment is ongoing and new staff are currently being inducted to improve this situation. Rota’s were viewed; staffing levels provided at the home were noted to always be in accordance with the guidance issued by the previous registering authority. 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 previous complaint 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 inspectors sighted all C. R.B. and P.O.V.A. (Protection of Vulnerable Adults) checks, which were seen to be in order. Although the company has good training systems in place, which are coordinated by the quality and training manager, the inspectors were unable to ascertain the current situation in respect of training and qualifications held by staff in the home. Some certificates were seen on staff records. There was no Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 17 training matrix available and no pre inspection information had been provided there fore the inspector was unable to ascertain the current level of qualifications for staff. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 18 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): 31,35 and 38 The home has lacked clear leadership and management, which has placed residents at risk.It is important that the new manager provides clarity and purpose to the process of care delivery. EVIDENCE: The home currently has no registered manager and the newly appointed manager for the home had only been in post for a week at the time of the inspection. She has worked previously at the home through an agency. There are clear lines of accountability within the home and also with external management, however it is felt that this has proved ineffective in some areas over several months. This has been recognised and tighter monitoring has been put in place. Service users are supported and encouraged to manage their own money for as long as they are able and wish to. Should a service user be unable to manage their own affairs relatives or a solicitor will be asked to act in the best interest of the individual service user. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 19 The registered person maintains written records of charges and payments made by and on behalf of service users in respect to fees and a record of all pensions and benefits collected by the home on behalf of the service users. Records in respect of these transactions were maintained. Clear training records were not available in the home, however some records on staff files indicated that they had attended courses on moving and handling, fire safety, first aid and food hygiene, however staff needed to attend further training to ensure that their knowledge and skills are up to date and a training matrix needs to be in place to ensure the manager is clear of the current state of training. The home has information on the safe storage of hazardous substances. The estates manager provided information for the inspectors, which confirmed that all maintenance and servicing records are correct and up to date. The fire records showed that the alarms were tested every week, the last fire drill was noted as 18/08/05 and appliances were tested earlier that month. The registered provider has devised a written statement of the policy, organisation and arrangements for maintaining safe working practices. Risk assessments for all safe working practice topics and the significant findings of the risk has been recorded. The home had appropriate arrangements in place to record all accidents, injuries, and incidents of illness or communicable disease. The registered provider is aware of the obligation to notify the Commission for Social Care Inspection in writing of certain events and occurrences within the home under Regulation 37, of the Care Homes Regulations 2001. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 3 X 3 3 3 X 3 STAFFING Standard No Score 27 3 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X X 3 Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 21 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 OP12 Regulation 16(2)(m) Requirement Timescale for action 30/11/05 2 OP30 18(c)(i) 3 4 OP31 OP27 8 18 (b) The home must provide suitable activities that are reflective of individual’s needs and preferences. Care staff in the home must 30/11/05 receive appropriate training and clear records be maintained of qualifications held. The provider must register a 31/10/05 manager with the Commission for Social Care Inspection. The provider must ensure that 30/11/05 the home has a stable cohesive staff team by reducing the number of agency staff to ensure consistency of care. 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 Care plans should be reviewed and updated to give adequate information to care staff. DS0000006056.V249890.R02.S.doc Version 5.0 Page 22 Lytham Court Care Home 2 3 OP19 OP28 The home should have a yearly 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 by 2005. Lytham Court Care Home DS0000006056.V249890.R02.S.doc Version 5.0 Page 23 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.V249890.R02.S.doc Version 5.0 Page 24 - 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!