Inspection on 17/07/07 for The Lakes Nursing Home

This inspection was carried out on 17th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

The Lakes Nursing Home 06/03/07

The Lakes Nursing Home 12/09/06

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 John Oliver Unannounced Inspection 17th July 2007 10:00 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.V347420.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.V347420.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.V347420.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. 6th March 2007 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 provides accommodation for service users who require personal care only. All rooms are single and 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 current weekly fees range from £343.66 to £500 dependent on the package of care required. Further details regarding fees are available from the The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 5 manager. Additional charges may also be made for hairdressing, chiropody and other personal requirements. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection over a 6-hour period on 17 July 2007. During the course of the inspection time was spent talking to residents, members of staff, the registered manager and unit managers of the home. Other information was also used to produce this report. This included information provided by the registered manager in the Annual Quality Assurance Assessment (AQAA) that had been returned to the Commission for Social Care Inspection (CSCI) prior to the inspection being carried out. Further information was also provided in Service User questionnaires that had been completed by residents living in the home and had been returned to the CSCI prior to the inspection being carried out. Time was spent examining records and some policies in the home and a tour of parts of the premises was also carried out. At the time of the inspection visit 70 people were living in the home. Residents spoke highly of the service and the staff. The staff and the management team demonstrated a positive approach to their roles and tried to ensure that wherever possible, residents were consulted about important matters including the way they wanted their care to be given. What the service does well: Residents spoke positively about living in the home and comments included: “Everything’s great”, “The staff are very good” and “It’s run very well, it’s quiet and very nice here”. The home places great importance on making sure that people with different cultural and religious backgrounds have their individual lifestyle needs met in the most appropriate ways. Most areas of the home were well kept and benefited from regular redecoration and maintenance programmes and residents and their visitors could also make good use of the extensive landscaped garden areas. Staffing levels in the home were appropriate to meet the high dependency levels of the residents. Staff were trained and received regular training ‘updates’ to make sure they can carry out their jobs in the most appropriate way. More than half the staff team have now obtained National Vocational Qualifications Level II. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 7 The home has good links with other professional agencies within the community such as the GP and District Nursing services. Comments from one visiting district nurse during this inspection included, “The service offered in this home is excellent – I enjoy coming here. All staff are approachable and the residents appear to be well cared for, this is one of the best (homes) for preventing pressure areas developing – this is because the leadership is very good with a good communication system”. Care plans on Kendal suite were particularly good. They are written using a focused and person centred approach and there was evidence that residents had been consulted about how they wanted to be supported. The manager of the home operated an ‘open door’ policy, and it was evident that residents, their relatives and staff felt confident in approaching the manager with any issues of concern. Comments included: * * * “If I had a complaint I would see the manager, but I don’t have any complaints”. “I haven’t made a complaint, but I could talk to the staff if I wanted to”. “I have made appointments to see matron (the manager) on many occasions when I’ve been concerned about certain things. I’ve had no problems with this and matters have been successfully resolved”. The Lakes Nursing Home is also a ‘pilot home’ for the Gold Standard Framework (GSF) initiative that allows the home to provide palliative care to residents in the home who are coming to the end of their life. All staff have been appropriately trained to provide this type of care by the Primary Care Trust (PCT) and this has enabled the home to provide end of life care within the home setting without the need for the resident to be admitted to hospital for their last days. During this inspection visit, written feedback from families confirmed that this type of arrangement had made supporting their relative at the end of their life ‘easier’ and some very positive comments were stated including: * ‘Thank you for all the years of outstanding care, love and devotion you gave to our dearest….we were extremely fortunate to have been able to place her in your care for so long…’, ‘The levels of care that she received from you all were of the very highest quality, and it was most reassuring to know that…..was always safe in your hands’. What has improved since the last inspection? The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 8 It was clear from this visit that the manager and management team of the home is continually developing aspects of good care practice in the home. Further development work had taken place regarding activities that are available in the home. Discussion with the manager confirmed that a second activities organiser was soon to be employed which would give residents more access to activities they wished to participate in on a daily basis. A number of bathrooms and shower rooms were being refurbished/updated. New carpets have been fitted in the lounge areas on Coniston and Derwent suites. New window blinds have been fitted on Kendal and Coniston suites. The manager confirmed that where bedrails are used to protect residents from falling out of bed, risk assessments are now put in place to minimise the risk to the resident. Staff confirmed that they were now receiving regular ‘supervision’ and/or personal support and development meetings. Staff are not employed to work in the home until all satisfactory preemployment checks have been received such as Criminal Record Bureau (CRB) enhanced check and POVA First. The manager confirmed this. 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. The summary of this inspection report can be made available in other formats on request. The Lakes Nursing Home DS0000025440.V347420.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.V347420.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed before moving into the home. EVIDENCE: Five residents’ care files were seen during this inspection visit, two from Kendal suite, two from Coniston and one from Derwent suite. Where people were funded by the local authority, community care assessments were in place that gave very detailed information about the persons background and their identified needs at the time of admission into the home. To ensure that the home could meet the persons needs, once a placement at the home had been requested a manager from the home will go to visit the prospective resident to carry out a further assessment of need on behalf of the home. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 11 During this assessment visit the opportunity is used to furnish the prospective resident/and or their family with detailed information about the home and the service they could expect. Wherever possible the residents whose care files have been examined were also spoken to during the visit. However, most were unable to remember or comment on the pre-admission assessment process but did remember visiting the home before coming to live there. Comments from residents included, “Everything’s great”, “The staff are very good” and, “It’s run very well, it’s quiet and very nice here”. It was confirmed by the manager that intermediate care was not offered by the home. The Lakes Nursing Home DS0000025440.V347420.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were in place that detailed the needs of the individual resident and supporting policies and procedures were in place to ensure the safe handling and administration of medication in the home. EVIDENCE: Residents spoken with in all parts of the home had positive comments about the quality of care and service they received. Two files were examined on Kendal suite, which is a unit providing personal care only (residential). Files were comprehensive in their contents and care plans were very much based on a person centred approach. The care plan of one particular resident clearly identified that their needs changed daily and emphasised the importance of evaluating the person’s condition every day. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 13 Part of the care plan stated, ‘staff to ask…if she wants/needs assistance, how much she wants to be supported, be guided by her’. Care plans on Kendal suite were well documented and showed evidence of a holistic approach, covering all aspects of social, physical, emotional and cultural care needs. All care plans were seen to have been regularly reviewed with the outcomes from those reviews stated. Care plans were written using a focused and person centred approach and there was evidence that residents were consulted and involved in developing their own care plan. Residents are consulted about how they want to be supported, however, this approach was less evident on Consiton and Derwent suites. Both these suites provide mainly nursing care but there are some residents receiving personal care only on the units. The care plans on these two units were written clearly and provided staff with the information they needed to meet the individuals’ needs. However, the care plan system used was very much ‘nursing led’ and ‘clinical’ and offered very little evidence of the person being involved in the care planning processes. Discussion with the registered manager confirmed that along with the unit managers she was in the process of reviewing the care plan formats. A recommendation has been made for the organisation to develop care plans in all units using a person centred approach as adopted on the Kendal suite. This will help to ensure that all residents using the service are provided with the opportunity to be fully involved in deciding how they wanted to be supported. Individual risk assessments are integrated into the care plan. Input from other professionals demonstrated that the home uses a multidisciplinary approach to ensure that all healthcare needs are met. There was evidence of input from other agencies during this visit, as residents were in the process of receiving dental screening and district nursing services. One district nurse visiting a resident on Kendal suite said, “The service offered in this home is excellent – I enjoy coming here. All staff are approachable and the residents appear to be well cared for” and, “this is one of the best (homes) for preventing pressure areas developing – this is because the leadership is very good with a good communication system”. Discussion with the registered manager confirmed that wound care monitoring had improved and systems were now in place to make sure that close mapping of wounds was being maintained with appropriate records being kept to ensure staff can see any deterioration or improvements in any wounds and take appropriate action where needed. The home is also a ‘pilot home’ for the Gold Standard Framework (GSF) that allows the home to provide palliative care to residents in the home who are coming to the end of their life. All staff have been appropriately trained to The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 14 provide this type of care by the Primary Care Trust (PCT) and this has enabled the home to provide end of life care within the home setting without the need for the resident to be admitted to hospital in their last days. It provides the resident with continuity of care, in familiar surroundings with their family around them if they wish with care delivered by staff they already know and have formed bonds with. The Community Palliative care team who are available 24 hours per day, seven days a week, supports the home. During this inspection visit written feedback from families confirmed that this type of arrangement had made supporting their relative at the end of their life ‘easier’ and some very positive comments were stated (see Summary). Medication is administered on Kendal suite by the unit manager and on the other two suites by nursing staff. Since the last inspection visit the manager confirmed that she has updated the policy and procedure relating to medication practice. Medication is administered using a Monitored Dosage System (MDS) and a random selection of medication of Derwent suite was checked. Medication Administration Records (MAR) were found to be appropriately signed and a random selection of medications were checked. Those checked were found to have been appropriately administered. However, a number of medications such as Paracetamol to be administered ‘as and when required’ were difficult to check as no running balance was being maintained. Also, there were some high stock levels of this type of medication being stored that should really have been returned to the pharmacy. The Commission received a letter from the registered manager confirming that appropriate action had been taken to address these issues the day following this inspection visit. A number of MAR’s had been handwritten. It is strongly recommended when this needs to be done that one person completes the details on the MAR and another checks the details and both then sign it. This will help prevent errors occurring and safeguard residents. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Daily routines in the home demonstrated that residents were encouraged to maintain control over their lives were encouraged to maintain contact with the community and, are provided with a wholesome and well balanced diet. EVIDENCE: The home employs the services of a full time activities organiser and discussion with the manager confirmed that extra hours were going to be allocated to further develop the activities that are available in the home. The activities organiser carries out an individual profile with those residents who state they wish to participate in activities on offer. This profile is then used to plan the types of individual activities that people have a personal interest in. During a tour of the home residents were seen participating in various things such as watching television in their rooms, reading books and The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 16 newspapers, drawing and painting and others sat in small groups chatting about daily life. Nine residents returned completed survey questionnaires to the Commission in which the question was asked: “Are there activities arranged by the home that you can take part in?” Two stated ‘always’, four stated ‘sometimes’ and, two stated ‘usually’ and written comments included, ‘Don’t always like the activities so don’t take part’, ‘Doesn’t interest me’ and ‘Activities are available but by choice I prefer not to participate’. Visitors are made welcome at the home and during the day of this visit relatives, family and friends were seen to come and go. Residents said, “My brother visits me, brings me drinks”, “I get visitors twice a week and the staff make her feel very welcome”. On arrival at the home breakfast was being served on an ongoing basis, indicating that a flexible routine was in place. Lunch was served at 1: 00pm and the evening meal at 5: 00 pm. All the meals for the three separate units were prepared in the main kitchen and the menu for the day was advertised on a menu board outside each dining area. The weekly menu was also displayed in three formats, ‘diabetic’, ‘summer menu’ and, ‘evening meal menu’. Families provided some meals on occasions and appropriate risk assessments were in place to ensure the well being of the individual resident (from food prepared ‘off site’). The manager stated that cultural needs were met as required and that the cook works closely with families and uses their experience in providing a meal that meets individual needs. Specialist supplements were available for people with specialist dietary needs. The menu on the day of the visit was: Spring vegetable soup, Mackerel fillets with potato salad and bread and butter followed by butterscotch mousse. Individual alternative choices were also available. Comments from residents included, “It was fish for dinner, the meals are very good here” and, “The food’s really good”. The Lakes Nursing Home DS0000025440.V347420.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 good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training measures were in place for staff to support residents to raise any issues of concern and to protect residents from neglect and abuse. EVIDENCE: Since the last inspection visit in March 2007 the information relating to complaints had been updated. Appropriate information is given to residents on how to make a complaint and includes the timescales for action. The manager also confirmed that the policy and procedure regarding complaints had also been reviewed and updated. Complaints received by the home were kept in individual files with all relevant letters of communication between the manager and the complainant. There was also evidence that the Registered Provider (owner) of the home was fully aware of all complaints made to the home and was actively involved in making sure that complaints were fully investigated. One resident spoken to said, “If I had a complaint I would see the manager, but I don’t have any complaints”. Another said, “…I haven’t made a complaint, but I could talk to the staff if I wanted to”. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 18 Of the nine residents survey questionnaires returned to the Commission six answered that they did know how to make a complaint and three said they did not know. Comments included, “ (I would) see Mr Meredith (owner)”, “But I don’t have any complaints”. One relative survey questionnaire stated, “I have made appointments to see matron on many occasions when I’ve been concerned about certain things. I’ve had no problems with this and matters have been successfully resolved”. There was evidence that staff had received training in the protection of vulnerable adults and staff spoken to during the inspection visit demonstrated a good understanding of adult protection procedures and had a good knowledge of how abuse may present and their role in its prevention. The Lakes Nursing Home DS0000025440.V347420.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment was clean, tidy and comfortable. However, some areas of the home could place individual residents at risk. EVIDENCE: The home employs housekeepers and these were observed to be busy throughout the home. All areas of the home were clean and tidy and no unpleasant odours were detected. A continuous programme of redecoration and re-carpeting of bedrooms and communal areas was in place. A new ergonomic bath had been fitted in one bathroom since the last inspection visit and, at the time of this visit a new shower room was being installed in Kendal suite. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 20 New carpets had been laid in Coniston and Derwent lounges and new window blinds fitted on Kendal and Coniston suites. Of the nine resident survey questionnaires returned to the Commission all stated that the home was always fresh and clean and one added comment stated, ‘It’s spotless, I even get new carpets’. A number of residents bedrooms were viewed during a partial tour of the premises and were found to be furnished appropriately and had been personalised with individual possessions and shared rooms had privacy screening. Lounge areas were comfortably furnished and benefited from large wide screen TVs which allowed most residents to watch TV should they wish to do so. A full time maintenance man is employed in the home and his duties include attending to the day to day repairs, general maintenance of the home and monitoring health and safety. However, on Kendal suite the following was noted. The broken wall tiles near the lounge door need replacing as they have jagged edges and could be a health and safety risk to anyone running their hand along the wall. In room 12 and 14 it was noted that sash windows had no restrictors fitted to them. Although both windows appeared fairly difficult to open it is a potential risk to the health and safety of residents whose rooms they are and restrictors must be fitted. It also appeared that the sash cord mechanism needed repair on one of the windows and it is recommended that a full audit of all windows be undertaken to ensure that window restrictors are fitted where required. One resident spoken to who is partially sighted said that the lighting in her room was very poor. On visiting this room it was noted that it had a very high ceiling with a flush type of light fitting offering a very low light. This was discussed with the manager of the unit who said that she would deal with this. A variety of equipment and aids and adaptations were available throughout the home to ensure the physical care needs of residents could be met. The Lakes Nursing Home DS0000025440.V347420.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 good This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff are employed in the home, with staff training and development helping to ensure staff are competent to carry out their jobs. A robust recruitment and selection process helps to protect residents from unsuitable people working in the home. EVIDENCE: Staffing levels were appropriate to meet the needs and numbers of residents at the time of this visit. Some of the comments received from residents about staff in the home included, “Staff here are very good”, “Staff are really decent, they’re very nice and they don’t tell you what to do, they ask you, and I think that’s nice”. There was evidence that staff training takes place on a regular basis and since January 2007 various training courses had been completed including protection of vulnerable adults, moving and handling and first aid. All staff had also received training in the Gold Standard Award for administering care to those residents who are nearing the end of their life. The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 22 The manager confirmed that 62 of staff had now completed National Vocational Training Level II. Discussion with the manager confirmed that there was a thorough and robust recruitment procedure in place. The manager had made extensive checks on staff employed from overseas. A number of staff personnel files were examined and all were found to contain relevant documentation including Criminal Record Bureau checks and POVA First details. The Lakes Nursing Home DS0000025440.V347420.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, 33, 35, 36 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents living in the home benefit from having the support of a manager with skills to provide a good quality service and procedures in place to promote their interests and well being. EVIDENCE: The registered manager is a qualified nurse who continues her professional development through attending short courses in line with residents needs. An example of this is the Gold Standard Award in palliative care. Three unit managers are also in post to support the registered manager. Their roles are The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 24 to work alongside the rest of the care teams on each unit, planning and implementing care packages and supervising the delivery of those packages. All unit managers are given administration time over one day per week in order to monitor and maintain documentation on the units. The manager confirmed that she and the other managers worked closely with relatives to ensure that the home meets the ethnicity and cultural needs of those people living in the home in the most appropriate ways. This was a particularly important with end of life care. On Kendal suite there were many ‘thank you’ cards from families and relatives of residents and comments included: ‘Thank you for all the years of outstanding care, love and devotion you all gave…’, ‘The levels of care she received from you all were of the very highest quality…’. The home had made improvements in its quality monitoring systems, including the use of relative’s questionnaires. Information collated from these returned questionnaires is used to devise a list of ‘action’ that could be taken to improve services in the home. There was evidence that resident meetings were taking place. Staff confirmed that they received regular one to one supervision. There was evidence that regular meetings take place between the registered manager the unit managers. It was also confirmed that the registered provider (owner) and the registered manager meet daily to discuss all issues relating to the management of the home. Residents’ monies are held in a non-interest bearing account. Records were maintained of all transactions and receipts of purchases were available for inspection. Equipment in the home is checked and maintained by professionals e.g. lift, emergency call equipment, fire detection and fighting equipment and gas appliances. Staff spoken to said that they could approach the manager at any time with issues of concern and that the manager was always visible in the home. Residents said, “It’s run (the home) very well, it’s quiet and very nice here”. One resident had very limited communication because of a stroke but expressed very positive body language/smiles when asked about the home/staff/life. The Lakes Nursing Home DS0000025440.V347420.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Lakes Nursing Home DS0000025440.V347420.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 OP19 Regulation 13 (4) (a)(b)(c) (a) Requirement The broken wall tiles near to Kendal lounge doorway must be replaced/removed to avoid any risk of injury to residents or staff. The sash windows in rooms 12 & 14 must be fitted with restrictors and sash cords repaired to avoid any risk of injury to residents or staff. Timescale for action 31/08/07 (b) 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 It is strongly recommended that the care plan formats used on Coniston and Derwent suites be reviewed to bring them in line with those used on Kendal suite and reflect a DS0000025440.V347420.R01.S.doc Version 5.2 Page 27 The Lakes Nursing Home person centred approach that includes information about each resident’s needs and preferences and explains how these needs are met. 2. OP9 It is strongly recommended that where Medication Administration Records (MAR) are required to be handwritten that one person completes the details on the MAR and another checks the details and both sign it. This will minimise the risk of wrong information being recorded and reduce the risk to residents. It is strongly recommended that a full audit of all windows be undertaken to ensure that window restrictors are fitted where required. This will minimise the risk of injury to residents and staff. 3. OP19 The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 The Lakes Nursing Home DS0000025440.V347420.R01.S.doc Version 5.2 Page 29 - 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. 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