CARE HOMES FOR OLDER PEOPLE
The Lilacs Resource Centre The Lilacs Resource Centre Warwick Road Scunthorpe North Lincolnshire DN16 1HH Lead Inspector
Beverley Hill Unannounced Inspection 9th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Lilacs Resource Centre Address The Lilacs Resource Centre Warwick Road Scunthorpe North Lincolnshire DN16 1HH 01724 869635 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) North Lincolnshire Council Jacqueline Mary Campbell Care Home 30 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (6) The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Twenty four (24) in category DE(E) to be accommodated in units 3, 4 and 5 Unit 1 (Dove Suite) to only be used for Six (6) OP and/or PD(E) for the provision of intermediate care Only unit 2 lounge area may be used to accommodate up to 8 day care service users. Bedrooms in unit 2 May only be used to accommodate service users when the Commission has confirmed this area fit for purpose. The bungalow in the grounds may only be used to accommodate service users when the Commission has confirmed this area fit for purpose 9th February 2005 Date of last inspection Brief Description of the Service: The Lilacs is a purpose built home owned and managed by the local authority. It is situated near to the centre of Scunthorpe and close to local amenities, rail and motorway links. The home provides ground floor accommodation for a total of thirty service users. Twenty-four people, over the age of 65years who may have needs associated with dementia, can be accommodated in the main unit and six people who have intermediate care needs in the Dove Suite. Day care is also provided for up to eight service users and there are people whose needs are met with regular respite breaks. The home is divided into five units. Unit one is the Dove Suite, a separate unit, which contains six en-suite bedrooms, a lounge, a bathroom and shower room, an assisted toilet and a rehabilitation kitchen. Unit two is mainly used for storage and offices and units three, four and five are for service users. All bedrooms are single and the main unit has two assisted bathrooms, an assisted shower room and eight single toilets throughout. In addition there are two lounges, a combined lounge/dining room and a separate dining room. There is also a designated smokers lounge and various smaller communal rooms for visitors, the hairdresser and therapies. The central garden space is accessible to service users and has been improved to make a more attractive area. The enclosed, paved area consists of a water feature, mature shrubs and seating. All areas of the home are accessible to
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 5 service users via wide corridors and ramps. The focus of the home has gradually changed and the home accommodates more short-term care such as respite and intermediate care. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager, a senior care officer, two ancillary staff and three care staff that was on duty at the time of the inspection. Throughout the day the Inspector spoke to nine people who lived at The Lilacs. The inspector looked at a range of paperwork in relation to rotas, care plans, accidents, risk assessments, staff supervision and training, medication, policies and procedures and complaints. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a tour of the building. What the service does well:
The manager and staff team work very hard in planning and organising all the admissions and discharges that happen at The Lilacs whilst making the service users who live there permanently feel that it is their home. The home is used for people who may have a crisis at home or who may need to go somewhere quickly for an assessment and only eight people live there permanently. The staff team had developed a good working relationship with health professionals who visited the home and held a regular meeting to support carers. Most of the staff team had worked at the home for several years and knew the service users well. People who stay at the home said that the staff members were caring, patient, kind and they looked after people well, respected their privacy and made their relatives feel welcomed. There were enough staff members on duty at any one time and people said that they answered call bells quickly. The home provided a pleasant environment. It was clean and tidy and had a welcoming, homely feel. It was decorated to a good standard. There were areas throughout the home where people could sit quietly and plenty of areas in which to congregate for activities. People spoken to stated that the meals were very good. They had two choices at lunchtime and had plenty to eat and drink. If they didn’t like the choice on offer they could have an alternative. Staff members deal with any complaints quickly and keep a record of them. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection? What they could do better:
The home needed to improve the assessment form they used to include a full range of needs. This had been completed at the last inspection but the form had been changed again and one section had been missed off. Also the home did not always receive assessments about the people funded by care management. These were really important because all staff needed to have information about the people living at the home and when changes occurred in their needs so they could support them fully. When staff writes care plans or checks them to see if they are still meeting needs they must sign and date them. On the whole the home managed people’s medication very well, however some people were able to manage their own medication and staff needed to make sure that these were checked at intervals.
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 8 The home needs to continue with the training and supervision plans. In one case, of a person who was admitted for a short stay, the staff were given instructions to monitor their abilities but this had not been done and recorded. The sluice areas had been cordoned off into rooms but the doors were unlocked so people could still enter them. 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 Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 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 Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 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): 3, 4 and 6 The service users had their needs assessed prior to entering the home by the Intermediate Care Team and the Care Management Team, when funded by them. The home did not always obtain the Care Management assessment, which could mean that vital information is missed and the required care not provided. The home provided an effective intermediate care service. EVIDENCE: The senior care officers completed in-house assessments and there was evidence that some assessments completed by Care Management were obtained by the home prior to admission but this was not consistently the case in all care files examined. The assessments were important as they provided vital information for the care planning stage. This was particularly important as the home admitted people for short stays in times of crisis at home and to give the main carer
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 11 respite. The assessment was also crucial in deciding whether the home was able to meet the needs of the person requiring admission. The manager explained that obtaining the full assessment was sometimes difficult due to the emergency of some of the admissions but staff always obtained as much information as possible and had a form to complete at the enquiry stage. Assessments for admission to the Intermediate Care Service were obtained. People spoken to were very pleased with the service they received and felt that the home could meet their needs. The implementation of further training, improvements in care plans and consistent supervision supported the home in meeting service users needs. The general focus of the service has changed and staff commented on the amount of paperwork the frequent admission and discharges generated. This element is currently under review by senior managers. The home provided an intermediate care service for up to six people in a designated area. Assessments and care plans were produced and care staff within the home worked closely with health professionals such as doctors, nurses, physiotherapists and occupational therapists. Care staff had received training in specific areas from members of the health care team. Progress was monitored from admission through to discharge home and the care plans focussed on improving and maintaining people’s independence. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 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 and 9 Progress had been made with the updating of care plans to the new system, although staff needed to ensure that requests to monitor service users abilities were completed. Service users who self-medicated needed to be supervised to ensure their health and safety were promoted, whilst their independence was maintained. EVIDENCE: There had been an improvement in the care plans produced for people occupying intermediate care beds. These focussed more on rehabilitation and supporting people to regain their independence. They had clear tasks for staff and monitored progress from admission through to discharge home. Staff had started the process of updating care plans in the main unit to bring them into line with those for intermediate care. Those receiving permanent care had been completed and when examined covered assessed needs and had clearer tasks for staff. In one case, of a person who was admitted for a short stay, care management had requested staff to monitor their abilities but this had not been completed
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 13 and recorded in then care plan or daily records. On the whole daily recording had improved and there was evidence of follow through of issues from one shift to the next. There was evidence that service users signed agreement to the care plan when possible. Staff who formulate care plans or evaluate them must sign and date them. Generally the management of medication was completed well. Medication was signed into the home and on administration and all medication was stored appropriately. There were a number of service users who had been assessed as able to manage their own medication. This was important in ensuring that people maintained their independence, however supervision systems need to be in place. Staff members needed to ensure care was taken when transcribing medication to make sure the full details were completed. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 The home provided an environment that encouraged contact with family and friends. Staff were polite and pleasant and made visitors welcome. The meals provided in the home were of good quality, offering choice and variety. EVIDENCE: Service users spoken to confirmed that their visitors were made to feel welcome and could visit at any time. The Inspector saw open visiting and people were offered refreshments. The home had links with local schools, churches, voluntary groups and supported employment schemes. The library delivered a range of books on a regular basis and a hairdresser visited weekly. People admitted for short stays continued to access local community centres and the home was host to carer support groups who used a bungalow in the grounds. People spoken to were happy with the meals provided and felt they had sufficient to eat and drink. One person stated that there were always something else if you didn’t like what was on offer.
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 15 Choices were available at each meal and new menus produced had a ‘healthy heart’ option. The cook received information about special diets, likes and dislikes, allergies and medication awareness from senior staff via documentation and in discussion described the range of special diets they prepared. The inspector observed positive staff interaction and support during a meal. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 16 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): The home provides an atmosphere whereby people feel able to make complaints. The home has made progress in adult protection training for staff, however not all staff had received training. EVIDENCE: The homes complaint procedure was clear and displayed in the entrance. It had appropriate timescales for resolution and included contact details of other agencies. Service users spoken to stated they would make a complaint if they needed to but so far they have not. They would tell the person in charge or their families. One person stated, ‘You don’t need to make complaints here there’s no need for it’. Staff were aware of the documentation required for complaints and the manager monitored complaints or niggles for patterns and improvements in practice. Complaints were investigated appropriately. There were no unresolved complaints. The home followed the multi-agency adult protection policy and procedure and some staff had received training in the protection of vulnerable adults from abuse. Training was required for the remainder. Those staff members spoken to were able to demonstrate an understanding of the types of abuse and what to do if they witnessed or suspected abuse had occurred.
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 17 The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 18 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): 24, 25 and 26 The home generally provided a homely, clean, safe and comfortable environment for service users. The manager was proactive in meeting requirements. Sluice rooms need to be inaccessible when not in use. EVIDENCE: The home was clean and tidy and free from any offensive odours in the areas accessed by the inspector. Service users spoken to were impressed with the cleanliness and one person said she had noticed improvements in the home. Each bedroom had a lockable facility and had been audited to ensure the required furniture was in place. Bedrooms were furnished according to taste and choice and service users were able to personalise them. Since the last inspection the home had cordoned off sluice areas and made them into separate rooms with coded locks. This ensured that they could be inaccessible to service users when not in use and prevented any scalds from the very hot water used at the water outlets. However during the inspection it
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 19 was noted that the rooms were not locked. This was mentioned to the manager to address. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 20 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 and 30 The home has sufficient staff to support service users but this will require monitoring due to the changing nature of the service. Improvements were noted in training and completion of planned training will add to this. EVIDENCE: Staff rotas were examined and detailed that there were sufficient staff on duty for the current service users. There were twenty-three service users admitted but because of the nature of the service this fluctuated daily. The home also supported between five to eight people for day care during the week. There were four care staff, one of which was allocated to day care, and a senior on duty in the main unit during the day, and three plus a senior in the afternoon. In addition there were two care staff for the intermediate care service. There were two care staff and a senior at night to cover the whole unit. Although in terms of numbers of staff this appeared sufficient on the day of inspection the changing focus of the home to more emergency and short stay placements will have to be monitored closely to ensure the current staff ratios remain adequate. Senior staff work hard to ensure continual exchange of information about new admissions filters through to all staff in the team. The home has some staff members on long term sick and some care staff vacancies to fill. Thirteen staff had completed NVQ Level 2 with a further five progressing through the course and two in the process of registration. One staff member had completed NVQ Level 3, one was progressing and another two undergoing
The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 21 registration. A senior staff member was undertaking NVQ Level 4 in care. When staff members progressing through the course have completed it, the home will have exceeded this standard. This level of participation in NVQ training is a reflection of the commitment of the manager and staff team to ensuring that they have the appropriate skills and knowledge for their role and task. Induction for new staff members was competency based and signed of by the senior care officer on completion. The home had access to a corporate training plan, which covered mandatory and some service specific training. Annual employee development reviews indicated training needs and fed into the corporate plan. There had been improvements noted in the training since the last inspection, although not all staff had up-to-date certificates in mandatory training. All staff had completed a dementia awareness course and those staff that primarily worked in intermediate care had completed training with health professional regarding rehabilitation techniques. This had started to be rolled out to staff in the main unit. All staff had completed fire training and infection control, which was covered in induction. The home had eleven staff members that were appointed first aiders. Training has been planned regarding adult protection and managing challenging behaviour including restraint and also an accredited medication course for senior care officers and others who may administer medication. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 22 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): 36 and 38 The manager ensured that staff received supervision and was proactive regarding the health and safety of service users and staff. To ensure that staff and service users are not put at risk the home needs to continue with planned training and updates. EVIDENCE: Supervision records were examined and they showed that care staff were on target to receive six supervision sessions per year. Individual supervision records and logs were maintained by senior care officers and evidenced that key worker issues, health and safety, quality assurance and training requirements were discussed. Service user files were examined and advice given and recorded. Staff also received annual employee development reviews. The manager supervised the senior care officers and was supervised in turn by the Service Manager. Staff felt supported in their roles. The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 23 There was evidence that equipment used within the home was maintained and repairs completed. Policies and procedures were kept up-to-date, accidents were recorded and reports sent to relevant agencies. The homes annual return stated that fire safety checks and systems had been completed and regular file drills were held. Environmental and individual risk assessments had been completed The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 24 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 2 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 x x x x x 3 2 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 3 x 3 The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 25 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 OP9 Regulation 18(1)(c) Requirement The registered person must provide accredited training in the safe handling of medication to all staff handling medication (previous timescale of 31/07/05 not met) The registered person must provide training in the management of challenging behaviour and restraint (previous timescale of 31/07/05 not met) The registered person must ensure that all staff receive training in adult protection (previous timescale of 31/05/05 not met) The registered person must ensure that the home obtains copies of assessments completed by care management and updates the homes assessment documentation to include psychological /emotional needs. The registered person must ensure that care plans are signed and dated when formulated and evaluated. The registered person must
DS0000033138.V269396.R01.S.doc Timescale for action 28/02/06 2 OP18 13(4)(6) &(7) 28/02/06 3 OP18 13(6) 28/02/06 4 OP3 14 31/01/06 5 OP7 15 09/11/05 6 OP7 15 09/11/05
Page 26 The Lilacs Resource Centre Version 5.0 7 OP9 13(2) 8 OP25 13(4) 9 OP30 18 ensure that care plans and daily records reflect any monitoring requests from professionals to aid in the assessment process. The registered person must 31/12/05 ensure that a supervisory system is maintained for service user who self-medicate and when transcribing medication staff indicate the full instructions. The registered person must 09/11/05 ensure that the new locks on the sluice doors are activated to prevent access and scalding from the hot water outlets. The registered person must 28/02/06 ensure that the training plan is implemented and covers updates in mandatory training. 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 OP27 Good Practice Recommendations The registered manager should monitor closely the deployment of staff in relation to the changing nature of the service to more emergency/short stay admissions and therefore more intensive needs of service users. The home should continue the progress made with regards to 50 of staff trained to NVQ Level 2 and above. 2 OP28 The Lilacs Resource Centre DS0000033138.V269396.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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