Inspection on 12/09/06 for The Lakes Nursing Home

This inspection was carried out on 12th September 2006.

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

The Lakes Nursing Home 17/07/07

The Lakes Nursing Home 06/03/07

The Lakes Nursing Home 17/01/06

The Lakes Nursing Home 07/09/05

The Lakes Nursing Home 17/03/05

The Lakes Nursing Home 27/09/04

The Lakes Nursing Home 21/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Lakes Nursing Home Off Boyds Walk Dukinfield Tameside SK16 4TY Lead Inspector Tracey Rasmussen Unannounced Inspection 14th September 2006 09:10 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 The Lakes Nursing Home DS0000025440.V307820.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. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lakes Nursing Home Address Off Boyds Walk Dukinfield Tameside SK16 4TY 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) 0161 330 2444 0161 339 0087 elaine@lakescare.co.uk Blackcliffe Limited Mrs Annette Forrest Care Home 75 Category(ies) of Dementia (36), Dementia - over 65 years of age registration, with number (36), Old age, not falling within any other of places category (72), Physical disability (39), Physical disability over 65 years of age (39) The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. No service user under 55 years of age can be admitted to the establishment. No more than 38 places can be used for nursing care. Two Registered Nurses to be on duty between 8 am and 9 pm. One Registered Nurse to be on duty between 9 pm and 8 am. The Manager to be supernumerary to (3 & 4) above for 13 hours per week. Rooms, 4, 5, 6, 7, 8, 9, 10, 11, 15, 16 on Kendal Suite, cannot be used to accommodate service users in the category PD- Physical Disability. 17th January 2006 Date of last inspection Brief Description of the Service: The Lakes Nursing Home is a large home situated in Dukinfield, with easy access to Hyde, Ashton and Stalybridge. The home provides nursing care for up to 38 service users. Personal care and care for people with dementia can also be provided and the total number of service users is 75. The home is owned by a private company called Blackcliffe Limited. Accommodation is provided across two buildings, divided into three suites named after areas in the Lake District. Derwent and Coniston Suites accommodate service users who require both nursing and personal care, whilst Kendal Suite only provides accommodation for service users who require personal care. The most rooms are single, although a small number of shared rooms are available. Approximately half of the rooms have en-suite facilities, whilst the others have toilet and bathing facilities nearby. A large number of communal rooms provide a variety of areas in which service users can socialise, dine and participate in activities that may take place within the home. The home does not have a communal area within the main building that is specifically for the use of service users who do not wish to smoke. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 5 The current weekly fees range from £343.66 to £503. Further details regarding fees are available from the manager. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit was undertaken by two inspectors on the 12th September 2006 and was completed in the course of one day. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with residents; interviewing relatives; interviewing the manager and other members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. Questionnaires for both residents and staff were left at the home and comments from these are included in this report where applicable. Very few of the requirements made at the last inspection had been addressed and a significant number of areas of service development are still necessary to improve the quality of service provided at the home. A brief explanation of the inspection process was provided to the manager at the beginning of the visit and time was spent with the manager at the end of the visit to provide verbal feedback of the findings from the inspection site visit. In the week before the inspection site visit a caller to the CSCI expressed concern about the early rising times of residents and in the week following the inspection two complaints were received about different aspects of the service provided at the home. These were forwarded to the home to investigate. What the service does well: Residents and relatives were complimentary about the staff working in the home and comments included ‘Staff are wonderful –nothing is too much trouble’; “They’ve been very kind to me. I don’t think I’d like to go anywhere else” and one relative said that the manager was ‘very approachable and will deal with an issue straight away’ and there are ‘some excellent staff here’ Areas of the home environment were benefiting from being redecorated and spacious well maintained garden areas were available to residents with pleasant areas to sit out. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 7 Staffing levels in the home were appropriate to meet the high dependency levels of the residents. Staff were trained and more than half the care staff team had a NVQ 2 qualification. Feedback from returned staff questionnaires indicated that there is good team working within the home. Resident’s personal monies are maintained safely by the home. Some general maintenance records for the home were available and these were up to date. What has improved since the last inspection? What they could do better: This inspection process did not identify any evidence that lasting improvements had been made to the service provided at The Lakes Nursing Home. Care planning records for residents provided a general over view of the care to be provided without giving information about each resident’s diverse needs or preference. Assessment and recognition of specialist needs such as sight impairment were poorly recognised. Care plans were not always recorded for each need, some care interventions were vague and whilst these were reviewed, information to say if care was good enough or not, wasn’t available. Care records to ensure health needs were met were poor. Information was inadequately recorded for monitoring of the nutritional status including weighing of some residents and pressure sore wound care plans had not been recorded for some weeks. Risk assessments for the safe use of bedrails had not been recorded. Medication recording and practices had not improved and there had been two recent incidents where residents had been given the wrong medication. Nursing practice to review and improve the safe management of medication following the first incident had not been undertaken. The manager for the home must undertake an urgent review of the medication procedures and practices used in the home. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 8 The focus of the service in the home was task orientated, with fixed routines from getting up, toileting, and meals times. Staff interactions with residents were pleasant and helpful when tasks were undertaken. One staff member transported a resident unsafely in a wheel chair and then called out across a corridor, in front of the resident and visitors that it was the resident’s fault she was using the wheelchair unsafely. This care practice did not promote the safety, privacy or dignity of the resident. Employment recruiting and vetting practices were also unsafe in that criminal disclosures or Povafirsts had not been consistently obtained before the new employee started work in the home. Other records such as references, incomplete work histories and independent checks on the nursing qualifications were not undertaken. This means that people living in the home are potentially not protected from someone with a criminal or abusive background. Management practice in the home as not been one of openness and a further requirement has been made to the home to ensure the CSCI is kept informed of all significant events, accidents and incidents that occur in the home such as the wrongful administration of medication to a resident. Records of social activities and stimulation relevant to each person’s need were not available. The manager did state the home’s activity person had left and she was trying to recruit a new person to the job. Both relatives and residents said that there was very little to do. One resident said ‘There is nothing to do’ and a relative said ‘activities could be much better’. Residents from Kendal suite did say they had been out on some trips and these had been enjoyed. Quality assurance systems need to be developed or implemented more fully and systems to check the quality of care plans and medication practices must be implanted as a priority. Cleaning systems should be reviewed to ensure all rooms are kept smelling clean and fresh. Other areas of improvement include updating the information guides for the home (Statement of Purpose and Service User Guide); updating the home’s complaints procedure; ensuring pre-admission assessments are recorded in more detail; reviewing the routines in the home to promote resident’s personal choices and preferences and to ensure their privacy and dignity. Policies and procedures need updating and practices that do not promote the health and safety of residents should be stopped. 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 Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 9 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 The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 10 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 and 3 Quality in this outcome area is adequate. The home can confirm they can meet the needs of the resident on admission. Residents are not supplied with up to date information about the services the home offers and so cannot make a fully informed decision about the suitability of the home. This judgment has been made using available evidence including a visit to the service EVIDENCE: A Statement of Purpose and Service User Guide which are information guides about the home and the services the home provides were not readily available in the home on the day of the inspection site visit. The manager of the home said that the information brochure about the home was usually available at the entrance of the home. An information brochure pack was provided to the inspector and this consisted of professionally printed information which detailed the various services provided on the different suites in the home. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 11 It was noted that the requirement made at the last inspection to review and update the information guides had not been undertaken. A copy of the home terms and condition was not included; the complaints procedure had not been amended and a copy of the home’s last inspection report was not available. Up to date information guides should be readily available to all residents and visitors to the home so that an informed choice about the home can be made. The manager did say she was going to put a copy of the last inspection out in the entrance to the home for all users and visitors in the home to see. One newer resident at the home said she had not seen a copy of the home’s information but did say her family visited the home before she arrived there. A number of care files were seen on all three suites in the home. Some of the care files did have basic care assessments that were undertaken before the new resident moved into the home but a number of residents were reported to have been emergency admissions and care files had admission assessments that contained basic information. Care management assessments were available on the care file. The home’s pre–admission assessments should be developed further to include more detailed information about the care needs of proposed new admissions. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. Some care practices observed did not promote resident’s privacy and dignity. The care planning documentation was not sufficiently detailed enough to meet the personal and health care needs of residents. Medication practices were not safe. This judgment has been made using available evidence including a visit to the service EVIDENCE: Residents observed in the home were generally neatly presented. There appeared to be a high number of very dependent residents who required assistance from staff with almost all aspects of their daily life. On Conistan and Derwent nursing units staff appeared efficient in providing care to residents although interactions with the residents were focused on the task in hand. One resident said she was ‘enjoying it’ at the home and that she had had ‘No falls’. She also said that ‘Staff are wonderful –nothing is too much trouble’ and that she had a ‘nice bedroom- nice and clean’ The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 13 Another resident said “ They’ve done very well for me, my health is better” “They’ve been very kind to me. I don’t think I’d like to go anywhere else” A regular visitor to the home said the home was, ‘not perfect’ but the ‘care is generally good’. Care plans detailing the resident’s care needs and information about how care needs should be met were examined on all three suites. Generally care documentation was completed to variable standard. Some care plans had very good care plan interventions which explained how care was to be given according to the resident’s need and wishes (person centred care) other care plans were generalised and could apply to any resident in the home. Some records were also untidy and information had not been recorded clearly. Evaluations to see if the care being provided was good enough, were poor and plans were not available for all assessed needs. Some information was out of date. Records indicated that health professional such as GPs or podiatry did visit the home. Some health care needs were not monitored enough within the home. One record indicated a significant and serious weight loss in July but further weights for this resident had not been recorded nor were there any care plans to indicate that nursing staff were aware of this area of concern. Nutritional assessments had been recorded without weighing residents first therefore invalidating the assessment. Similar issues have been identified at previous inspections. One wound care plan had not been completed since July even though a large pressure ulcer was recorded at that time. Good wound care practice of photographing or mapping of pressure sores were not undertaken and information on the type of specialist mattress used and settings of the mattress were not recorded. Similar issues have been identified at previous inspections. Bedrails were used in the home but risk assessments were not recorded. Not all care practices observed were safe. One care staff member wheeled a resident backwards in a wheelchair without the use of footplates. The resident’s feet were trailing lightly on the floor. The staff member shouted out (to the inspector) that she wasn’t using footplates because the resident wouldn’t bend her legs. The resident, other residents, staff and visitors could clearly hear the staff member’s comments. The staff member then proceeded to tip the wheelchair back onto two wheels. The care practices observed were unsafe and did not promote the privacy or dignity of the resident. Moving and handling assessments for the resident did not reflect the care staff member’s reason for providing care unsafely. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 14 Residents did say that on the whole their privacy was maintained, one resident said “they keep private when you’re having a bath” but said only some staff knocked on her door before entering. Another resident said “they always knock on my door before entering” Concerns had been expressed to the CSCI before this inspection visit by a health professional who had been informed that residents were made to get up early in a morning. This was discussed with the manager who stated that residents are got up when they wished to get up but nobody is made to get up. One resident spoken with said she got up at 8.15am for breakfast, another resident said he always got up at 6am because this was his preference but two other residents said that the night staff put the lights on at 6am and told residents they had to get up for breakfast which was served at 8.15am. Discussions with staff did identify that the morning routine was quite rigid in that breakfast was served at 8.15am and ‘resident’s had to be up if they wanted breakfast’. Through out the visit their seemed to be a rigid routine that could be described as institutional practice. Social care needs and preferences were poorly recorded and did not promote equality in meeting the resident’s diverse needs. More information in relation to this is recorded in the next section of this report –Daily Life and Social Care. Requirements made at previous inspections in relation to the safe use and storage of medication had not been addressed. Both treatments rooms where medications are stored on Conistan and Derwent suites were very hot and monitoring of the room temperatures were not undertaken. High room temperatures can reduce the effectiveness of some medications. Both treatment rooms were cluttered and untidy. A sample of medication records were examined and it was noted that photographs were not available for the newer residents, handwritten medications on the drug sheets were not signed or dated consistently and records for the receipt of medication into the home were not always recorded. Some medications were poorly recorded and could potentially put resident’s at risk from over or under administration. The manager was advised during feed back following this visit to review one residents medication administration sheet immediately. On Derwent suite controlled drug, storage and stocks of medication were satisfactory and a record of medication returned to pharmacy was maintained. Examination of the home’s accident log identified that there had been a recent incident where the wrong medications were given to a resident. The CSCI had not been notified of this incident. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 15 The nurse on duty at the time of this incident was asked what practices had she reviewed and amended since the incidence. She responded by saying ‘nothing really, it was not necessary, the staff member was from another unit and didn’t know the residents’. This response gave cause for concern because it indicated that no learning, development or improvement had resulted from this incident. This was discussed with the home’s manager during feedback who said that the drug trolley was placed in the central area of the lounge so all residents could be seen when medication were administered. Within a week of the inspection site visit two separate complaints were forwarded to the CSCI. One complaint referred to the home not following the agreed community care plan and so did not meet the assessed needs of the resident and in doing compromised the resident’s rights to personal choice, privacy and dignity. The second complaint was in relation to the wrongful administration of medication to a resident, requiring short-term hospital admission for observation. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 Quality in this outcome area is adequate. Social activities and stimulation needs to improve to ensure the diverse needs of all the residents are met. . Rigid routines and task-focused service did not always promote resident’s choice. Mealtimes offered a varied menu with some choices. Visitors were welcome. This judgment has been made using available evidence including a visit to the service EVIDENCE: The manager stated that the home had employed an activity co-ordinator but she had moved onto care and that she was trying to recruit another activity person. The manager should recruit an activity person as soon as possible. Throughout the day of the visit from 09:10 to 1900 no activities were observed being undertaken with residents on Conistan or Derwent suites. Care staff interactions with residents was limited to undertaking physical care tasks. All communal areas had large flat screen TVs which were all switched on. Although residents had been placed in front of the televisions many residents were observed to be dozing or did not appear to be taking any interest in these. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 17 The manager provided a record of activities and a folder with social profiles. The social profiles recorded information about hobbies and interests but many of these were only partially completed and the residents whose care files were examined did not have a social profile recorded. The diary of activities was poorly recorded in that it did not detail any information about the activity – who joined in and how much time was spent or if residents enjoyed it or not. One care file contained detailed information in the social worker’s assessment about the resident’s strong religious beliefs and frequency of worship. References to meeting the religious needs of this resident in the home were not recorded. The resident did say that a member of the clergy from her parish had visited her. Care plans for social activities recorded on Kendal suite needed more detail particularly about how specialist needs such as blindness were met. Discussion with the unit manager identified that in practice things had been done to ensure specialist social needs were met. One relative said ‘activities could be much better’. A resident replied, ‘There is nothing to do’ when asked what he was going to do with his evening. And another resident said “there’s not much for me because I can’t see. They tried me with coloured Bingo cards but I still couldn’t see”. Residents on Kendal did say they had been on outings recently and they enjoyed these. Visitors were seen coming and going. Staff said meal times were served at 8.15 am, midday and 4.30pm. The home offers a full breakfast, lighter lunch and the main meal is served at teatime and supper is offered at 7pm. Menus were available outside Conistan’s dining room and this included a diabetic menu and a nutritionally enhanced menu and a menu of alternatives. The dining room on Derwent suite was being decorated and so was not in use. Resident’s comments about food ranged from “We get good food” “ There’s a choice, and you could have something else if you wanted” to ‘Tea was Ok’ ‘nothing special’. Residents were assisted in the dining room after toileting in the morning from about 11.15 am which meant that some residents were waiting for ¾ of an hour before the meal was served. Staff told residents that the lunch was steak and onion baps (as per menu) but a tray of mixed sandwiches arrived. Staff said they did not know the menu had been changed. Two residents had pureed meals these were served in a presentable manner. Staff offered assistance as required and this was pleasant and supportive. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 18 Manager stated that the home had just been awarded the Food safety Award 2006 by Tameside. Manager also said the home is currently undertaking a small pilot study by fortifying meals of six residents. Throughout the visit there was a focus on the tasks that needed to be done and this included meal times, which were served very early and rigidly followed. On Conistan staff took residents in for the evening meal from about 3.30pm following toileting and on Derwent suite all but one resident had finished their main meal of the day by 4.45 pm. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. The complaint procedure was incomplete so residents did not know how long they would have to wait before they received a response from any concern they had raised. Staff awareness of local abuse policies and procedures needs improving so residents are confident the right people are informed if an incident of abuse did occur. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The proprietor of the home provided copies of complaint the home had dealt with. It was reported that there had been no complaints in 2006. The manager printed out a copy of the home’s complaints procedure to go with the home’s information guides. The procedure had not been changed in accordance with the Care Home’s Regulation 2001 and did not have a timescale in which the complaint would be responded to. The procedure also referred to the National Care Standards Commission, which became defunct in March 2004. The provider was asked to update this following the last inspection. Resident’s spoken to said they would tell a staff member if they had any concerns. Training records were available which identified that some staff had had training in abuse and many staff had a NVQ qualification which also includes abuse awareness and the protection of vulnerable adults. The manager had a The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 20 lot of information available from Tameside local authority about safe guarding adults but it was not clear if a copy of Tameside’s safeguarding adults was available in the home. One nurse on duty said she wasn’t aware of Tameside’s safeguarding adults policy and therefore she wasn’t aware of her role or responsibility in relation to alleged abuse within the home. All staff should be made aware of the local policy for safeguarding adults. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. Residents live in a comfortable environment but some areas are cluttered and untidy. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The manager gave a tour of the home. A number of areas in the home had been redecorated and the dining room in Derwent Suite was being repainted. It was reported a number of new carpets had been purchased for different areas in the home. A number of areas in the home such as corridors were cluttered with wheelchairs and hoists which was unsightly. Nursing offices and medication treatment rooms also were cluttered and untidy. Areas in the home should be kept tidy. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 22 In Kendal Suite the entrance and stairway had been redecorated and this provided a light and presentable reception area. Not all bedrooms offer level access on the Kendal suite so there are some rooms designated for people who have no physical disability. One area of carpet covering a low step had been temporarily repaired with tape to reduce any trip hazard, however the tape was fraying causing a further trip hazard. This should be made safe. Resident bedrooms were generally presentable. Some were personalised with the resident’s own possessions. One resident said about her room…“mine was newly decorated when I came, I’ve got some of my own furniture”. Two bedrooms one on Derwent Suite and one on Kendal were odorous and some of the seating in the conservatory also smelt unpleasant. Overall most areas were clean but procedures should be reviewed to ensure odours are removed. Radiators in the corridors on Derwent and Conistan were not covered and had sharp edges so could potentially injure any one who fell near them. These should be covered. One large window was open fully and did not benefit from a security restrictor so potentially allowing intruders into the home. This has been identified in previous reports and Kendal’s suite unit manager said that a restrictor had been fitted but this has broke. This should be repaired. The kitchen and laundry facilities were not inspected at this visit. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. Staffing levels, training and skill mix were appropriate to meet residents’ needs and promote their health and safety. Recruitment vetting procedures were unsafe putting residents at risk of potential harm. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Staffing levels at the time of the visit appeared appropriate to meet the needs of the residents living in the home. A visitor said that there was ‘some excellent staff here’ and a resident said staff were ‘..very good’. Training certificates were available for a variety of care practices including induction, moving and handling, abuse, fire prevention and first aid. Training for NVQ was well established and it was reported that 68 had got a NVQ level 2 or above and a further three staff members were due to complete in October 2006. Staff spoken with said they were supported to develop their skills. Feedback questionnaires returned by staff all indicated that the home was a good place to work and that there was good team work among the staff. Employment recruitment practices had not improved since the last inspection. A sample of personnel files were examined for a number of newer staff to the The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 24 home. It was noted that PovaFirsts had not been consistently obtained before the commencement of employment and one care file had a copy of CRB disclosure obtained for another service. This means that the home is unaware if some of the staff in the home have a criminal history or if there is a potential threat to vulnerable residents. One care file had only one reference available, gaps in employment histories had not been explored, references received were not date stamped and independent checks of nurse’s Nursing and Midwifery Council (NMC) personal identification numbers (P.I.N) had not been undertaken. Requirements have been made previously for the home to address these issues. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. Management responsibilities are not fully discharged which means that resident’s health, safety and welfare has at times been compromised. Residents have had limited opportunities to comment on how the home is run and systems to monitor and improve service quality could be better. Arrangements are in place to ensure resident’s money is safe. This judgment has been made using available evidence including a visit to the service EVIDENCE: The manager is registered with the CSCI and has successfully completed the Registered Managers Award. There are clear lines of accountability within the home and the registered provider is supportive and available on a daily basis. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 26 There has been only limited areas of development since the last inspection and it has been noted that areas identified as requiring improvement at this key inspection have also been identified at previous inspections and where improvements have been made these have not been sustained. Accident records identified that notifications to the CSCI as required by the Care Home’s regulation 2001 had not been made. The manager stated she was not aware that she was required to notify the CSCI of accidents or incidents that occurred in the home, however the last inspection report identified the same concern. The registered provider did have a quality assurance system in place. A business plan was available for 2006-07 and this included a mission statement, goals and objectives and a building and maintenance programme There was a comprehensive action plan with designated responsible team members. A similar action plan of work was available for 2005 but no evidence was available to indicate that audits and the actions listed had been completed. The quality assurance records supplied had no evidence of audits or actual assessment being undertaken since 26/04/04 Resident questionnaires sent out in previous years were not available, the manager reported that the registered provider had these. The manager confirmed that staff meetings were held quarterly and she also stated that resident’s meeting did occur quarterly. Minutes of the resident’s meetings could not be located at this visit. None of residents spoken with could confirm residents meetings took place and one staff member spoken with said she wasn’t aware of these meetings. The manager stated that she did undertake care plan and medication audits, however evidence of this was not available and the ongoing requirements made at each inspection to develop and improve both care planning and medication practices did not support this. This should be undertaken. The registered person employs a team member to walk around the home on a daily basis to ensure care service delivery is provided to a high standard. The staff member confirmed that her role and responsibilities included monitoring care practice, the home environment and being available to residents and relatives. Records of this are not maintained and this should be recorded to ensure regular written reports in accordance with regulation 26 are available. Policies and procedures were available in the home and these were viewed briefly. The majority of these documents were dated 2001 and did not evidence any form of review or updating for example the complaints procedure in the policy file referred the registration and inspection team based at The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 27 Tameside’s social services department. This service was closed in March 2002. all policies and procedures should be updated at least yearly. The majority of residents are assisted with their finances by their families. The home has a bank account set up specifically for the purpose of administering residents’ monies. Separate ledger sheets are maintained for each resident detailing how much money they have in this bank account. The bank account does not attract interest. A selection of maintenance records were viewed and these were all up to date, however health and safety records of the weekly monitoring of fire alarm tests, fire drill and hand wash basin water temperatures were not seen at this visit. Moving and handling care practice (see section 2; Health and Personal Care) continues to be an area of concern. The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 28 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 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure that residents’ care plans are recorded to meet all assessed needs including physical, psychological and social needs and these are evaluated at least once a month and updated to reflect changing needs in health and personal care. The registered person must ensure that risks to the health and safety of residents are identified, recorded and care practices implemented to reduce identified risks to the minimum. This includes the safe use of bedrails and moving and handling of residents. (Timescale of the 31/03/06 not met)/ The registered person must ensure that health care needs are monitored regularly including wound care and nutritional care The registered person must ensure that medication DS0000025440.V307820.R01.S.doc Timescale for action 30/10/06 2. OP7 13 30/10/06 3. OP8 13 30/10/06 4 OP9 13 08/10/06 The Lakes Nursing Home Version 5.2 Page 30 5 OP29 19 administration procedures and practices are reviewed and improved in light of the maladministration of medication in the home. The registered person must 31/10/06 ensure that all information and documents stated in Schedule 2 of the Care Homes Regulations 2001 are obtained in respect of employees at the home and must ensure that checks against the POVA list are made prior to employment. (Previous timescale of 31/10/05 not met). The registered person must ensure that notice is given to the CSCI of any serious injury, illness or incident affecting residents. (Previous timescale of 28/02/06 not met). The registered person must ensure that staff move residents safely and in accordance with risk assessments. 30/09/06 6. OP38 37 7. OP38 13 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that handwritten medication details on the medication administration records are signed and dated by the person writing the record and the details are validated by the staff member and an additional member of staff. The registered person should ensure that photographs of residents used for identification purposes are kept up to date. DS0000025440.V307820.R01.S.doc Version 5.2 Page 31 2 OP9 The Lakes Nursing Home 3 4. OP9 OP12 The registered person should ensure that medicines in the custody of the home are stored at a temperature that does not exceed 25°C. The registered person should ensure that further consideration is given as to how the social care needs of the more highly dependent residents can be met. The registered person should ensure that residents are made aware of their rights to decide how and where they spend their day and should encourage staff to empower residents to exercise their choice in these matters. The registered person should ensure that the menus are displayed on the walls at such a height that residents can easily read them. The registered person should ensure that all staff are aware of Tameside local adult protection procedures and the procedures are readily available to staff in the home. 6. OP14 7. OP15 8. OP18 The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 The Lakes Nursing Home DS0000025440.V307820.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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