Inspection on 18/05/07 for Lyttleton House

This inspection was carried out on 18th May 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lyttleton House 10/06/09

Lyttleton House 03/07/08

Lyttleton House 27/11/07

Lyttleton House 04/09/06

Lyttleton House 01/03/06

Lyttleton House 12/09/05

Lyttleton House 24/03/05

Lyttleton House 25/08/04

Lyttleton House 04/03/04

Lyttleton House 09/09/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Lyttleton House 1 Ormond Road Frankley Birmingham B45 0JD Lead Inspector Kulwant Ghuman Key Unannounced Inspection 18th May 2007 08:15 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 Lyttleton House DS0000033561.V334797.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. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 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 7302 Not known Birmingham City Council (S) Linda Wohler Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. That the home is registered to accommodate 30 people over 65 years who are in need of care for reasons of old age which may include mild dementia. Registration category will be 30 (OP) That minimum staffing levels are maintained at 4 care staff throughout the waking day of 14.5 hours. 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. 4th September 2006 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 30 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 30 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 an 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. The fees in the home for respite service users were from £63.25 to £133.00 per week. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this key unannounced inspection over two days during May 2007. Prior to the inspection the CSCI had received a completed Pre-inspection questionnaire from the home that provided the inspector with some information. In addition, five completed relative surveys and three service user surveys were received by the inspector. Prior to the inspection the inspector spoke with three representatives of the people living in the home. During the inspection the inspector spoke with the manager, team manager for the home, five staff and seven of the 29 people who lived at the home. Also as part of the inspection process the inspector sampled two files for people who lived at the home and two of people who worked at the home. A tour of the building was carried out and a meal was taken at the home. No complaints had been received regarding the home since the last key inspection. One issue of adult protection had been highlighted by the home and this had been appropriately dealt with. What the service does well: The home provides a comfortable, warm and homely environment for the people who use the service to live in. Many of the people living in the home and their representatives were happy with the service being provided. Mrs X’s daughter was happy with the care given “ I can’t praise the carers and staff enough.” Another said “Lyttleton House staff seem to be very pro-active in dealing with issues. My mother is encouraged to lead a very active life inside and outside the home.” Another person’s relative said “Care service usually responds appropriately to concerns raised. Not only do they look after my mother well, in respect of making sure she’s safe, well fed and clean but they go beyond that to make her life happier by taking her out on day trips, Lyttleton house is like a home because of the superb staff, not an institution.” The home is generally well maintained and safe. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 6 The meals provided in the home are nutritious and well presented. Choices were available at all meal times. The people living in the home were generally happy with the meals being provided. The management of medicines was generally good in the home. What has improved since the last inspection? What they could do better: The registered person needed to ensure that the care plans for the people living in the home detailed their care needs, how the staff were to assist them and what tasks they could do for themselves in order to remain as independent as possible. All risks needed to be assessed for the people living in the home and plans for managing them needed to be cross-referenced to the care plans. The registered person needed to ensure that all concerns raised in the home were documented and investigated and a record of the actions taken in response to the concerns needed to be available for inspection. There were some concerns about the attitude of some staff towards other colleagues and to some people who lived in the home. The registered person needed to ensure that everyone who lived in the home felt safe and was safeguarded from any type of abuse. The staff needed to be made aware of their roles and responsibilities in relation to any allegations or suspicions of abuse and how to identify any possible abuse. Lyttleton House DS0000033561.V334797.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. The summary of this inspection report can be made available in other formats on request. Lyttleton House DS0000033561.V334797.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 Lyttleton House DS0000033561.V334797.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into the home were assessed, given written information about the home, invited to visit the home and offered a trial visit before deciding whether to move into the home to ensure that their needs could be met at the home. EVIDENCE: The service user guide and statement of purpose were not examined during this inspection but folders containing these documents were available in the bedrooms. Two people living in the home indicated that they had been invited to the home for a pre-admission visit when they had lunch at the home and met the staff before deciding whether to move into the home. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 10 There was evidence on the files sampled that people living in the home had received a residential care agreement when they moved into the home. The three files sampled evidenced that assessments had been carried out by the placing social workers prior to admission. There was also evidence that a review was carried out after a trial period to determine whether the home was able to meet the individual’s long term needs and whether the home was acceptable to the individual. The reviews involved the social worker, the person living in the home, their relative and staff from the home. Lyttleton House DS0000033561.V334797.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans for the people living in the home did not fully identify their needs and how they were to be met. The risk assessments did not cross reference with the care plans and not all risks were fully assessed. The care plans and risk assessments did not show that the needs of the people living in the home were being met in a way that was acceptable to them. The medical needs of the people living in the home were being met and medicines were being given as prescribed. EVIDENCE: The three files sampled all had an individual service statement (ISS) on the files that had been recently written up. The ISS for one person living in the home had some detail on how to meet their personal care needs but needed to have further information regarding what the individual could do for herself and how staff could promote her independence. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 12 The ISS for another person living in the home included some good information about the procedures to be undertaken when getting up. There was no information about the persons level of dementia or how it affected their behaviour or needs. It was identified that the individual used incontinence aids but not what size. The inspector noted that a mattress was put beside the bed in case the individual fell out of bed however this was not referred to in the ISS. There were no guidelines for staff to follow when one of the people living in the home was shouting out and becoming aggressive or for when another person was wandering during the night. There were manual handling assessments in place however they were not always fully completed and did not cross reference with the ISS’s. For example, for one person’s ISS said that a stand aid was to be used. The sling size to be used was not identified and the manual handling assessment only indicated that the Arjo ambulift was to be used for the bath. For another individual there was no mention in their moving and handling assessment that the individual used a zimmer frame in the home and a wheelchair outside. Nutritional and tissue viability assessments were not always completed and there were no plans to manage any risks identified. The daily records were reviewed and summarised on a monthly basis. For one person living in the home this recorded activities and medical visitors and that the individual had been weighed. The forms would be better used if they stated what the weight was, whether there was a gain or loss and what if any action was to be taken. A relative of one of the people who used to live in the home said that on occasions their relative had been left for long times when she needed assistance as there were no staff available. A survey completed by one of the people living in the home also said there were times when the staff were busy and he had to wait for assistance. There was evidence that the health care needs of the people living in the home were being met by appropriate referral to health care professionals including district nurses, doctors and chiropodists. On occasions it was difficult to track the reason and outcome of the visits as the daily recordings and monthly summaries had been removed from the files and had not yet been filed. One of the surveys completed by someone living in the home said that the district nurses and GP were available if needed. The home used a monthly monitored dosage system for the administration of medicines. The management of medicines was generally good however, on Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 13 the first day of the inspection two unlabelled bottles of tablets were left on a desk in the office that was accessible to residents who may have been walking around. During an audit of some of the boxed medicines it was noted that only one antibiotic capsule had been given that morning instead of two. This was rectified when it was highlighted. Where one or two painkillers were being administered the amounts given were not being recorded so that these could not be audited. Two gaps were identified on one of the medicines administration records (MAR) and they had not been raised by staff who had administered medicines after the days on which the gaps had arisen. The amounts of medicines being carried over from one month to the next was not always recorded on the MAR charts. Where an instruction has been given by the doctor to change the doses of medicines to be given this instruction should be checked by a second member of staff and countersigned. The storage and administration of controlled medicines was good. There was no evidence that the privacy and dignity of the people living in the home was being compromised in any way. Keys were available for bedroom doors and a lockable piece of furniture was also available in the bedrooms. Bathroom and toilet doors had the appropriate locks in place. There were no shared rooms in the home. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social needs of some of the people living in the home were being met but others were not fully satisfied. People were encouraged to make choices about their daily routines and generally people were happy with the meals being provided by the home. The meals did not always meet the cultural needs of all the people living in the home. EVIDENCE: People who were living in the home were encouraged to make choices about where they sat and the activities that they were involved in. One of the people who was sitting on Lavender unit told the inspector and registered manager that she liked to sit in the other lounge but was afraid to go down there since there had been an incident with one of the other people who sat there. The manager assured her that she could go and sit there and she would ensure that the other people knew that she lived there and was entitled to sit anywhere. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 15 There were some activities available in the home however there was no programme of events that the residents could take part in. One staff member commented that they undertook activities if the staff were available. Another member of staff indicated that more activities would be beneficial for the people living in the home. There were some activities recorded for individual people such as going for a walk round the corner, going out with relatives, attending church services, sing-a-longs and sitting in the garden. One of the relatives’ surveys said ‘ Activities could be improved but X does go out on day trips.’ Another said ‘Lyttleton House staff seem to be very pro-active in dealing with issues. My mother is encouraged to lead a very active life inside and outside the home. Lyttleton house is like a home because of the superb staff, not an institution.’ Another said ‘Not only do they look after my mother well, in respect of making sure she’s safe, well fed and clean but they go beyond that to make her life happier by taking her out on day trips.’ One of the people living in the home who had only been there for a short while told the inspector that there was nothing to do. They had not done anything since coming into the home. A survey completed by one of the people living in the home said ‘Have been on holiday to Paignton for 1 week during 9/06. In-house activities -religious festivities and dates. Cultural days.’ Another person living in the home commented to the inspector that a member of staff had sat with her throughout the night when she had been ill and frightened. She very much appreciated and remembered this fact. Relatives and advocates were welcomed into the home. It was noted that the registered manager had provided a survey to a relative of someone living in the home who was about to move knowing that the family had some issues with the home so that they could put their point of view forward. This was to be commended. The inspector was aware that one of the people living at the home attended a day centre and there were religious services held in the home. The inspector was able to have a cup of tea and observe some of the people living there having breakfast and join some for lunch. Choices were observed to be offered at both meal times and there was flexibility in what the people living in the home could eat. For example, one Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 16 person had had breakfast but was having poached egg on toast slightly later in the morning. Toast, cereals and porridge were also available. At lunchtime the choices were pork chops or Cornish pasty with creamed potatoes and vegetables. The puddings were banana and custard or rice pudding. The inspector noted that the tureens were being washed before the people living in the home had finished their meals indicating that there was no food left. The inspector asked for more potato and was informed that there was none left. Therefore other people in the home could not have had any more helpings if they had wanted. Meals were plated up from the unit kitchen but no one was asked whether they wanted gravy or not except for one person who was not in the dining area. The cook informed the inspector that there had been a problem with some staff throwing food away and saying there was not enough. This issue was raised with the registered manager by the inspector but she was not aware there had been a problem. The meal was well presented and nutritious. All the people living in the home said they enjoyed the meals but one said that their cultural needs were not being met. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home were not safeguarded from harm and there was no evidence that issues raised with the home were dealt with to the satisfaction of the individuals who had raised them. EVIDENCE: The complaints and adult protection procedures were not examined during this inspection although they were readily available. No complaints had been lodged with the CSCI regarding the service and there were no records of any complaints having been received directly by the home. The complaints folder showed many compliments had been given to the home about the care provided. During discussions it was determined that at least two families had been unhappy about different aspects of the service provided by the home. No documentation about the complaints or the actions taken in response was available. One of the families had spoken with the inspector and stated that issues had been raised but that they had not been addressed and swept under the carpet. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 18 A concern had been raised with the inspector that one of the people living in the home was being sat in a corner of the dining room so that they did not disturb other residents with their talking. No evidence was seen during the inspection to support this. The inspector had some concerns about the handling of issues of adult protection in the home. One of the relatives told the inspector that his relative was afraid to ask for help because the staff shouted at her and he had heard staff shout at other people who lived in the home. Staff also indicated that they were aware that some people living in the home had told them that they were afraid of some staff. Staff were not always fulfilling their duty of care as the information they had was not being passed onto the appropriate authorities. Staff needed to re-visit their responsibilities and discuss the actions they needed to take in the event of actual or suspicion of abuse. Staff needed also to discuss what they would do in the event the allegation was against the manager and issues of confidentiality. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people in the home live in a homely, comfortable environment. There were appropriate aids and adaptations in the home for service users to use if required to ensure their comfort. EVIDENCE: The home was split into three units each with its own lounge/dining room and kitchenette to provide a homely environment. It was generally well maintained, comfortable and homely. Since the last key inspection all bedrooms had been re-carpeted, decorated and new beds purchased. New chairs, dining tables and televisions had been bought for the lounge/ dining rooms. One of the kitchens had been refurbished, the staff room reallocated and new doors fitted to Rosemary lounge and corridor. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 20 The home was all on one level and accessible to the people who lived in the home everywhere except one section but that was used for training of home care staff. There were adaptations in place including emergency call system, grab rails, walk in showers and assisted bathing facilities. All the bedrooms examined appeared to be comfortably furnished, personalised to the occupants liking and included their own furniture if they wanted to bring it in with them. There were sufficient toilets and bathrooms throughout the home. The bathrooms were being kept locked when not in use but there was no clear rationale as to why this was the case. One of the bathrooms had a bolt on the outside. It was highlighted that this could potentially put the people living in the home at risk of being locked inside. The bolt was to be removed that day. Some of the toilets only had support rails on one side. There needed to be rails on both sides to be able to support people with a weakness on either side of their body. Some of the light shades in the toilets were broken and they needed to be redecorated. The lounges were comfortable and met the needs of the people living in the home except the lounge on Lavender unit which could seat only four residents. The registered manager stated that a request had been made to remove the dividing wall between the lounge and adjoining room to make a larger lounge/dining room. The fan by the fryers in the main kitchen needed to be repaired. The fryers could not be used due to the carbon dioxide safety monitor alarming when they were put on. The extractor fan above the cooker needed to be cleaned. Hot trolleys were used to take meals from the main kitchen to the unit kitchens and maintain safe food temperatures. Access to the laundry was via the area where the food trolleys were stored. This was not an ideal situation and had been raised with the home on previous inspections. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people living in the home were not always safeguarded by the numbers of staff on duty and the divisions within the staff group could be detrimental to them. New staff were not adequately inducted and assessed through their probationary period to ensure that they were competent to do their jobs. EVIDENCE: The rota provided by the home indicated that on occasions there were only three staff on duty. When four staff were on duty one acted as a float to provide assistance when it was needed and to cover staff taking a break. The inspector was informed that on occasions the units were left unattended when staff were taking their breaks. Other staff stated they could not take a break as there was no cover for them. The manager needed to ensure that the staffing levels did not fall below a minimum of 4 care staff on the units during the day. The manager needed to ensure that staff were monitored to ensure that people living in the home were safe and comfortable at all times and any issues of concern were appropriately dealt with. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 22 The manager needed to ensure that the staff worked as a team to benefit the people living in the home. Steps needed to be taken to break up the ‘us’ and ‘them’ groups in the home. The inspector was told that 98 of the care staff had achieved NVQ Level 2 or equivalent and all the staff had been completing the ASET training covering all the mandatory training for care staff. All senior staff had undertaken the safe handling of medicines training. The personnel files of two staff were sampled during this inspection. Both files had two references in them, an application form and health declaration. The references on one file were received after the individual had started work at the home. The two files did not evidence that inductions had taken place before starting employment and their probationary assessments had not been completed. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s management team needed to ensure that the home was run so as to safeguard the people living in the home by a staff team that worked together in an effective way. EVIDENCE: During the inspection it became evident that staff were not passing on all relevant information to the registered manager. Sometimes this was due to a misunderstanding regarding confidentiality but at other times the reason was unclear. Therefore the manager was quite surprised when some of the issues were discussed during the inspection. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 24 People spoken with during the inspection said that the manager was visible in the home and there were observed to be some very good interactions between the staff and people living in the home. Some of the completed surveys returned to the inspector stated: ‘ Generally happy with the home’, ‘I can’t praise the carers and staff enough. Lyttleton House staff seem to be very pro-active in dealing with issues’, ‘Lyttleton house is like a home because of the superb staff, not an institution’, and, ‘Outstanding service. Would recommend to others.’ However there were one that stated; ‘Concerns – attitude of staff- more interested in having cigarette breaks. Two or three very good staff’. The homes run by the local authority were carrying quality assurance audits on each other. Lyttleton House had been the subject of a quality audit but had not yet received a report based on the audit. The records for the handling of monies on behalf of the people living in the home were well organised. The registered manager needed to ensure that two signatures were recorded for each expenditure. Health and safety were well managed in the home. This only issues highlighted in this inspection were broken light covers and fire training for staff that was due. The care plans and risk assessments needed to be more detailed and cross-referenced to each other. ‘ Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 25 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 3 2 3 X 3 2 3 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X 2 2 Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no 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 15 Requirement The registered person must ensure that staff are made aware of all the needs of the people living in the home and can meet them in a way that meets the needs and wishes of the people receiving the service. Timescale for action 01/08/07 2 OP8 13(4)(c) This will ensure that the people living in the home receive person centred care. 01/07/07 The registered person must ensure that all risks are identified for the people living in the home and that there is a suitable plan for their management in place. This will ensure that the people living in the home receive a service that maintains their health and safety. Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 27 3 OP9 13(2) All medicines in the home must be stored safely at all times. 01/07/07 4 OP12 16(2)(n) The registered person must ensure that people living in the home receive their medicines as prescribed and that adequate records are kept. This will ensure that the people living in the home will receive their medicines has prescribed. The registered person must 01/08/07 ensure that social and recreational activities are provided for each person living in the home that meets their needs and expectations. This will ensure that each person living in the home will have a fulfilled life. The registered person must adequate records are kept of all expressions of dissatisfaction. This will ensure that people using the service will be assured that their views will be listened to. The registered person must ensure that the people living in the home are safe and that the staff are aware of their roles in the protection of vulnerable people. This will ensure that the people living in the home are safeguarded form harm or abuse. The registered person must ensure that use of the fryers does not leave staff at risk. That will ensure that people in the home are not placed at risk of harm. 5 OP16 22(3)(4)& (8) 01/07/07 6 OP18 13(6) 01/07/07 7 OP26 13(4)(c) 01/07/07 Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 28 8 OP27 18(1)(a) The registered person must ensure that there adequate numbers of staff on duty to meet the needs of the people living in the home. This will ensure that the people living in the home are safe and their needs met at all times. The registered person must ensure that staff have been assessed as being competent to carry out their role before they are allowed to work unsupervised. This will ensure that people living in the home are cared for by staff who are competent and knowledgeable. The registered person must ensure that staff maintain good relationships between themselves and with the people who live in the home. This will ensure that the people in the home will receive care in way that makes them feel comfortable and safe. 01/07/07 9 OP30 18(1)(a) 01/08/07 10 OP32 12(5)(b) 01/07/07 Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 29 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 The registered person should ensure that the monthly summaries are used so as to give meaningful information that can be used to identify if the care plans are sufficient for the people living in the home or if they need to be amended. The registered person should ensure that nutritional and tissue viability assessments are fully completed. The registered person should ensure that records removed from the files for filing elsewhere are accessible if required. The registered person should ensure that changes to prescribing instructions are double checked by a second member of staff and verified on the MAR chart. The registered person should ensure that each person living in the home is facilitated to sit in their area of choice. The registered person should ensure that choices are further promoted at meal times. The registered person should ensure that there is sufficient food available to offer extra helpings if required by the people living in the home. The registered person should ensure all the people living in the home are consulted about how their cultural dietary needs are to be met. The registered person should ensure that there is a risk assessment in place if bathrooms were to be made inaccessible to the people living in the home. Some of the toilets were not decorated to the standard of the rest of the home. There should be support rails to both sides of the toilets to assist independence for the people living in the home. Lights in toilets should be of the enclosed type. The registered person should look at the possibility of access into the laundry by an alternative route. DS0000033561.V334797.R01.S.doc Version 5.2 Page 30 2 3 4 5 6 OP8 OP8 OP9 OP14 OP15 7 8 9 10 11 OP21 OP21 OP22 OP25 OP26 Lyttleton House 12 13 14 OP29 OP33 OP35 The registered person must ensure that all recruitment checks are completed before an individual starts employment at the home. The registered person should ensure that the home is managed to benefit the people living in the home. The registered person should ensure that there are two signatures for all expenditures made on behalf of people living in the home. People attending day centres should be re-imbursed for meals not taken in the home. The registered person should ensure that all documentation is stored in way that enables information to be easily retrieved. 15 OP37 Lyttleton House DS0000033561.V334797.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V334797.R01.S.doc Version 5.2 Page 32 - 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!