CARE HOMES FOR OLDER PEOPLE
Lyttleton House 1 Ormond Road Frankley Birmingham B45 0JD Lead Inspector
Monica Heaselgrave Unannounced Inspection 12th 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 Lyttleton House DS0000033561.V254252.R01.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. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lyttleton House Address 1 Ormond Road Frankley Birmingham B45 0JD 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) 0121 460 1150 0121 457 7726 Birmingham City Council (S) Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. That the home is registered to accommodate 29 people over 65 years who are in need of care for reasons of old age which may include mild dementia. Registration category will be 29 (OP) That minimum staffing levels are maintained at 4 care staff throughout the waking day of 14.5 hours. That an application for registration of a manager is submitted by end May 2005 The home must adhere to a laundry policy which ensures that soiled laundry is not transported through dining areas when meals are served or consumed. That additional to above minimum staffing levels there must be two waking night care staff. Date of last inspection Brief Description of the Service: Lyttleton House is owned and managed by Birmingham City Council and is registered to provide care for 29 older adults who may have mild dementia. The building is a bungalow construction and divided into three separate units, each with their own dining area, kitchen and lounge. Facilities briefly include 29 single bedrooms, the majority of which are less than 10 square metres and therefore cannot contain all the items of furniture specified in the standards. Each bedroom has a call system. There is a large communal area in which service users can socialise, this is equipped with a TV, video and music system. The home is situated on a corner plot in a cul-de-sac it has a beautiful open plan frontage with lawn, shrubs and flowers. There is level access to the front door and parking to the front and side of the property. Lyttleton House is located close to local shops and facilities, including public transport. On the day of the inspection 10 service users were going on holiday to Paignton. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 09:30 a.m. and 2:30 p.m. on a weekday. On the morning of the inspection, 10 service users and a group of staff were preparing to go on a week’s holiday to Paignton. The inspector met briefly with a Registered Manager, who was going away with the service users, two senior carers, and two care assistants. The inspector had the pleasure of meeting the majority of service users, some briefly before their holiday. A tour of the building was undertaken, and a number of records were inspected which include: rotas, care plans, risk assessment, case files, daily notes, communication book, staff records, medication records and records pertaining to the maintenance of gas, electric and far equipment. The inspector had the opportunity to observe care practices, on two of the three units which included the lunchtime period. What the service does well: What has improved since the last inspection?
All staff have completed adult protection training. This will equip staff to recognise the potential for abuse, and help protect people from abuse. Since the last inspection in March 2005, a new medication room has been created, which enable staff to secure medicines safely. The office area has been developed into an open plan office creating improved accessibility. There were noted improvements in looking after service users personal toiletries, and ensuring these are not left in bathrooms for communal use. The Acting Manager has improved staff files, these have been restructured and now
Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 6 contain records of training undertaken. The recruitment procedures have been tightened up, staff files now have information relating to police checks, references and full work histories. Improvements are a positive step towards ensuring that service users are cared for by staff who have undergone the necessary checks. The Acting Manager has recently achieved her Registered Managers award. Following a lapse in formal staff supervision, it was noted that several staff have recently had a formal supervision. 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. Lyttleton House DS0000033561.V254252.R01.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 Lyttleton House DS0000033561.V254252.R01.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): 1, 2, 3 The information provided to prospective service users needs to be updated, to enable informed choice about living in the home. The needs of service users are known, and follow appropriate assessment procedures. There is good consideration of service users specific needs such as dementia. EVIDENCE: A copy of the Service User Guide was provided. This required amending to include the name of the current manager, the correct name and address of the Commission for Social Care and Inspection and a list of those bedrooms which do not meet spatial standards. The Statement of Purpose was not fully checked at this visit, but was required to be amended at the last inspection visit to the home. The previous inspection report was on display in the office, but not in the homes foyer where other information such as the complaints procedure was prominently displayed. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 9 Each service users had a contract on their file, stating the terms and conditions of residence and the fees payable. This provides information as to what to expect from the staff. Six service user files were sampled and showed that assessment of need is undertaken, prior to moving into the home. Each service users had an up-todate individual service statement. These were well written and comprehensive, providing very good detail as how individual needs were to be met. One entry read under the heading of heard and consulted, “The service user, is not confused, just cant hear. Encourage the use of hearing aid. Another entry concerning food read I would like to be by my friends at all times, staff show me where to sit, and tell me enjoy my food. Staff will supervise my eating, so I do not feel I need to hide my food. The individual service statement reflected that a good degree of consideration is given to meeting the needs of those service users who are suffering a degree of confusion all dementia. While some service users were not able to articulate their experiences, some advised the inspector that the home lived up to their expectations and that staff know my needs and how I like things done. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 There are good systems in place to ensure service users health and care needs are met. Care planning is linked into assessment information and incidents of changing needs. In this way, the well-being of service users is promoted. EVIDENCE: Care plans are current, comprehensive and regularly reviewed. They ensure all aspects of health and care needs are identified and planned for. Difficulties with eating, weight loss and the risk of falling was seen to be identified and planned for. Observation of the practice confirmed that where specific health or eating concerns were evident, staff were aware, and vigilant in their supervision. Care staff demonstrated a good understanding of how to meet the needs of service users who were confused or suffered with dementia. One staff member was observed encouraging and monitoring food intake of a service user. Staff described good awareness of mental health needs and potential conflict between individuals and how this was to be managed. Care plans reflected good direction of the staff in seeking ways to meet specific needs. Two service users confirmed that they have been consulted about how they would like their needs to be met. One stated I like the help when I have
Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 11 a bath, staff are good, and help me see to my personal care. I dont go out much, but thats my choice. I have my own key and the food is lovely. Other service users spoken to were able to describe care needs that have been recorded in their care plan. It was particularly positive that each of the three units service users reside on, have a folder with copies of individual service statements. This ensures that staff can clearly say how needs are to be met. There is a good level of written communication, which ensures consistency of care for service users. The arrangements for personal care ensure that the privacy and dignity of service users is protected. Service users have access to a telephone, and have their own bedrooms. Staff were observed to support individuals with accessing toilet areas. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 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 the following standard(s): 12, 14, 15 The routines of daily living are flexible and suit the needs of the service users. Service users have meals that are varied, wholesome and balanced which they enjoy. EVIDENCE: The daily routines reflected a relaxed and caring response to service users, particularly those who were frail or confused. Staff members were observed to be responsive and caring in their interactions. Support and assistance at mealtimes was positive, discreet and encouraging, particularly towards individuals who have known difficulties with foods. Care plans provided good direction to staff members on how to assist individuals, and these are their preferences in relation to aspects of daily living. Some service users commented that routines are flexible and they can choose when they go to bed, get up or what they like to eat. Some stated that they can bath or shower when they wish, with assistance from staff. The manager has ensured that service users are actively consulted about choices that are important to them. This was evident in service users meetings minutes. One service user confirmed they received support to manage their own medication which is kept in a locked cabinet. Other service users confirmed they are offered daily menu choices.
Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 13 There is an activity programme which is displayed in the foyer. Service users stated that they can opt in or out of these. Individual service statements reflected that the social and recreational interests of service users are explored and opportunities planned for them. This included religious preferences one entry stated service user is a Jehovahs Witness. Does not want to celebrate Christmas. Does not eat black pudding. Another stated, Service user wants to continue going to the centre, to enable this, staff to get codes and support to minibus. It was positive to note that service users as with dementia had their preferences, capabilities and level of support required, specified in their care plans. The inspector was informed that activities are reviewed/evaluated as part of the management review process. Several service users commented upon the good quality of meals. One lady said, the food is very good and you get plenty of it. Another stated, I do get a choice and they are nice meals. Food intake is monitored that those with difficulties and this is well documented. Menu showed choice and an alternative is always unavailable. The inspector observed a degree of flexibility in the time in service users at their meal, and that staff were on hand to support those who needed it. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 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 the following standard(s): 18 The availability of adult protection policies and procedures and training for staff in adult protection issues ensure service users living in the home of protected from abuse. EVIDENCE: All staff completed adult protection training in July 2005 as required from the last inspection dated March 2005. Staff have access to robust policy and procedures to guide them in protecting service users. These were available in the home. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 24, 26 There are some outstanding environmental issues that need addressing to ensure that service users live in a safe environment, conducive to their needs. EVIDENCE: Since the last inspection there have been some improvements to the property. A medication room has been created which provides improved storage and security for medication. The main staff office has been revamped to create an open plan area which is accessible to service users staff and relatives. Relocation of the laundry facility has not taken place. The Commission for Social Care and Inspection was informed that this will be costly and requires major architectural work. This standard is not fully met. The tour of the building indicated that there are ramps, hand rails and raised toilets seats which assist service users with mobility difficulties. Each unit has an assisted bathing and shower facility within easy access to service users.
Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 16 There were no records to indicate that equipment provided, has been assessed by a qualified professional. Each of the three units was clean, comfortable and well maintained. Corridors and communal areas are spacious providing ample room to those with wheelchairs to negotiate around the building. Service users have access to well maintained and very pleasing outdoor areas, which they say they enjoy. Those bedrooms viewed, did not meet the minimum spatial standards. This affects the degree of furniture prospective service users will be able to take into the home with them. It is important therefore that this is specified in the Service User Guide and Statement of Purpose to ensure service users are informed in advance as this may influence their choice of home. Though service users spoken to at the time of the visit were happy with their bedrooms, and the fact that they had their own key. Service users cannot control the heating in their bedrooms. This was raised at the last inspection and remains an outstanding requirement. Lighting throughout the home is domestic in style and emergency lighting is available. Hot water outlets are tested weekly with water temperatures recorded, this alert staff to the risk of school doing for service users. All areas of the home were found to be clean, odour free and comfortable. At the previous inspection, service users personal items were evident in communal bathrooms. There was no evidence of flannels, creams or sponges in these areas at the time of this inspection. This ensures personal items are not shared among service users. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 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 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, 29 The staffing numbers are appropriate to the needs of service users. There is a difference of opinion among staff as to how they are deployed to each unit, and how this affects their ability to meet needs. Recruitment practices have improved and provide safeguards for service users. EVIDENCE: Rotas sampled indicated that minimum staffing levels are maintained at four care staff throughout the waking day. This is in addition to a senior carer or manager. There are three units. One is identified as higher dependency and requires two care staff. The other two have one care staff each, with a floater between them. In discussion with individual staff there were conflicting opinions as to how many staff are actually working on each unit. One staff member said, it is often only one member of staff on the unit, and its difficult to manage all the tasks involved. Another commented, that its most likely to carers, but not always there are clearly some internal differences that need to be resolved internally. Some service users described a flexible routine in relation to getting up, going to bed or having a bath, which indicates that there are sufficient staff members to enable them to exercise choice in their daily arrangements. However, not all service users were present and not all were able to state their opinions. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 18 Domestic, commercial and maintenance staff are employed to ensure that standards relating to food, hygiene and maintenance are met. The home is currently carrying a 10 hour night staff vacancy which is being covered by day staff. Staff records showed that staff are undertaking mandatory training to enable them to undertake their role. A training matrix is available to ensure this is achieved. Since the last inspection, all staff have attended adult protection training. A number of staff files were examined and found to contain two written references, satisfactory police checks, application form and a complete work history. A record of interview is also maintained. The manager since the last inspection has restructured staff files to ensure that the recruitment documentation is evident. This further insures the protection of service users. Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 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 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, 36 A period of temporary management arrangements has impacted upon the consistency of staff supervision. EVIDENCE: The current Acting Manager has many years experience of working within a care home for older adults. She has recently achieved her Registered Managers award. The standard was not assessed further as the Acting Manager was taking a group of service users away for a week’s holiday in Paignton. Five staff files were sampled. These show that staff supervision has not been consistent. Records show that in 2004 supervision was fairly consistent, usually on a monthly basis. There has been a long gap in the recording of supervision, which recommenced in August 2005. The inspector was informed that this was due to the change in management arrangements at that time. It is envisaged that staff supervision will be re-established and maintained.
Lyttleton House DS0000033561.V254252.R01.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 2 3 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 3 3 1 X 1 2 3 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X X Lyttleton House DS0000033561.V254252.R01.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 OP1 Regulation 4 Requirement The Registered Manager shall ensure that the Service User Guide is amended to include the correct name of the Commission, current manager details and a list of those bedrooms which do not meet the standards. This was a previous requirement. Laundry facilities require relocation. This was a previous requirement. An assessment of the premises, facilities and equipment is required to ensure they meet with service users’ assessed needs. The Registered Person shall ensure that where service users rooms do not meet minimum standards this is stated in the Statement of Purpose, Service User Guide and Statement of Terms and Conditions. Timescale for action 24/11/05 2 OP19 23 24/11/05 3 OP22 23(2)(b) 10/10/05 4 OP24 16(2)(c) 10/10/05 Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 22 5 OP25 12 (3) 6 OP27 18(1)(a) 7 OP36 18(2) The Registered Person must ensure that service users are able to control the heating in their bedrooms. This was a previous requirement. The Registered Person shall ensure that at all times suitably qualified, competence and experience persons are working at the care home in such numbers as are appropriate to the health and welfare of service users. The Manager should ensure that staff are appropriately deployed to each unit and appropriate levels maintained. The Registered Person shall ensure that persons working at the care home are appropriately supervised. Staff should receive formal supervision at least six times a year. Action plan to be submitted 10/10/05 10/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lyttleton House DS0000033561.V254252.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Lyttleton House DS0000033561.V254252.R01.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!
