Care Home: De Lacy House

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What the care home does well The atmosphere of the home was welcoming and friendly and the care staff were very knowledgeable about the people they were looking after. Direct observation of the staff working with people that use the service showed that they treated everyone with dignity and respect. Staff were not employed to work at the home until after the managment had received all the required checks to say that they will not put the people that they work with at risk of harm or abuse. The individual care plans for each person living in the home were generally clear and identified all of their needs. Staff had access to a wide variety of training and received good support and regular supervision. This means that the staff have all of the knowledge and skills to be able to safely provide support to the people that use the service. The home was very clean and tidy and offered comfortable accomodation for people. What has improved since the last inspection? The home now has an experienced registered manager. What the care home could do better: To ensure staff have all the information required to meet peoples needs consistently the homes assessments and care plans could be more detailed. The care plans should be regularly evaluated to ensure that they are kept up to date. Hand transcribed prescription instructions on the administration records should be checked for accuracy and signed by a second person to minimise the risk of errors. Peoples interests should be recorded and they should be given opportunities for stimulation through leisure and recreational activies which suit their needs, preferences and capabilites on a more consistent basis. The action plans arisng from the outcomes of quality surveys should be produced in a more timely manner. Key inspection report Care homes for older people Name: Address: De Lacy House De Lacy House 42 De Lacy Way Winterton North Lincolnshire DN15 9JX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kate Emmerson     Date: 1 8 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: De Lacy House De Lacy House 42 De Lacy Way Winterton North Lincolnshire DN15 9JX 01724733755 01724735083 pauline.oliver@northlincs.gov.uk www.northlincs.gov.uk North Lincolnshire Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Jacqueline Mary Campbell Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE (E) and Physical disability - Code PD. Date of last inspection Brief description of the care home De Lacy House is owned by the local authority of North Lincolnshire and situated in Winterton. Part of the building includes the Poirier Suite, previously designated as a Care Homes for Older People Page 4 of 24 Over 65 30 30 0 0 0 30 0 9 0 6 2 0 0 9 Brief description of the care home rehabilitation unit with six en-suite bedrooms but now incorporated within the whole service. The suite has a kitchen, sitting room and a dining room. The main part of De Lacy House has twenty-four beds. De Lacy House is a purpose built unit with four lounges and a large dining room. One of the lounges has a `Loop System installed to aid those service users who have a hearing impairment and one of them is designated for activities used by day care services. All the bedrooms are single. The home has ramps to all entrances. There are gardens to the front, side and rear of the building and adequate car parking facilities. The fees payable are individually assessed by the Local Authority care managment team. Items not included in the fee are personal toiletries, hairdressing, chiropody services and newspapers. These fees are reviewed annually. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and completed over one day in May 2010. Prior to visiting the home We looked at all the information that we received, or asked for, since the last inspection. The home had been requested to complete an Annual Quality Assurance Assessment and they had returned this to us within the set timescales. During the visit we looked at documentation held in the home, spoke with people that use the service, care staff and management of the service. We also completed a tour of the building and looked at some of the bedrooms and facilities provided. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they are admitted to the home. This helps to make sure that the home can meet their needs safely and that their needs are within the range of the homes registration criteria. Evidence: There had been some reorganisation of the structure of service provision by North Lincolnshire Council over recent months which had changed the focus of the care provision in the home. The home does not now admit people for intermediate and long term care. The care provided in the home is now for respite or re enablement with an average stay for people of between six to eight weeks. The home does however have four people living with them who have been in the home for a considerable amount of time and who will continue to be cared for in the home unless their needs change. We looked at four care files of the people that use the service. This included looking at all of the information recorded in the home in relation to the care that people Care Homes for Older People Page 9 of 24 Evidence: received. The care management team complete assessments of peoples needs prior to admission to the home and these were seen on three of the four care files examined. The senior care staff that were employed to work at the home were responsible for making a further assessments of peoples needs to enable the development of the care plan. The information in all the assessments completed by the home was basic in terms of identifying and recording peoples needs. In the one case where there was no care management assessment the homes assessment had not identified or recorded the persons communication difficulties. Whilst this had not had an impact on this persons care as they were well known to the home, other peoples needs may not be met if these are not identified and clearly recorded at assessment. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs were set out in individual care plans, some lacked the detail necessary to ensure consistency of care at all times. Where able people were enabled to be responsible for their own medication. People were very happy with the care provided and felt that their privacy and dignity was protected. Evidence: We looked at care plans for four of the people that were living in the home. Factors which impact on the quality of the care plans in this particular service such as the quick turn over of admissions to the home, the short length of stay and the often rapid improvement of the person admitted were taken into account when making judgements on the care plans. However whilst there was some very detailed care planning seen, some of the care plans did not identify all the care required in sufficient detail to ensure peoples needs were always met in a consistent manner. This was due in part to gaps in recording information at assessment but also to lack of regular evaluation of care plans and management checks. These checks would help to identify inconsistent practice and changes in peoples care needs. Care Homes for Older People Page 11 of 24 Evidence: For example, one person had very detailed care plans regarding general care requirements and mobility incorporating information from health professionals. However care plans to reflect changes with regard to treatment required for an eye condition and changes to dietary intake needs had not been developed. The diary entries and observation indicated that care was being provided in these areas although indicated eye care may not have been as consistent as was required. In another case there was no specific care plan to detail where a person required cream to be applied due to a skin condition, diary sheet entries showed that the cream was applied but in an inconsistent pattern. Whilst there were some gaps in care planning, observation and discussion with care staff showed staff had a good working knowledge of each persons individual needs. Individuals spoken to stated that they were happy with the care that they received at the home. One person said you could not be better looked after if you were the Queen and another said you are well looked after from the day you come in. They also felt that they were treated with respect by the carers and that their privacy was protected when they were being assisted with their care needs. People admitted to the home were encouraged and enabled to maintain control over their own medication and this was supported through risk assessment. Senior staff were responsible for medication in the home and were trained in this task. Staff were observed to assist people who struggled or were reluctant to take their medication in a kind and very patient manner. The medication records including those relating to controlled drugs were well maintained although hand transcribed prescription instructions on the administration records should be checked for accuracy and signed by a second person to minimise the risk of errors. Peoples photos were included with their medication record sheets. This is good practice and helps to make sure that the prescribed medication is given to the right person. This is particularly important in this service where there is a high turnover of people using the service. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a good quality of life at the home, however the range and frequency of activities available to them could be improved. Evidence: We observed people throughout the inspection and looked at the information in relation to activities that were held at the home. The records showed that there is a lack of consistency in the provision of activities. There is no specific member of staff with responsibility for ensuring there are meaningful activities taking place in the home. The senior on duty should delegate this task to the carers. An activities plan was displayed but was not implemented on the day of the inspection. The staff stated that this was because the hairdresser was in the home. The activities records showed very minimal activity in the early part of the year and more frequent activities in March and April including an monthly church service. In the surveys returned to us the activities was the only area to receive negative comments. Two people said need more activities and outings and one commented sometimes I get a bit bored. Staff stated that some of the problem with arranging activities was that the service Care Homes for Older People Page 13 of 24 Evidence: has now moved towards short term care for people that had been discharged from hospital, or were admitted to the home as an alternative to a hospital admission. This meant that the home had a constant turnover of people living in the home which made activities difficult to plan. However there was little information sought at assessment as to the persons interests in order to ensure that they could provide a suitable activity for that person. A choice of meals was available at each meal time. The meals observed were well presented and people were offered choice on the day. People stated that all of the meals at the home were of a good quality. Comments from people living in the home included the food is very good, good meat, always tender and they always do good food. All were offered seconds and were offered a choice of drinks. Where one person required assistance to eat the staff member was attentive to their needs and very patient. Staff were generally very careful to supervise people where this was necessary, prompting people as required to ensure an adequate diet was taken. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People knew how to make a complaint and staff were provided with training to make sure that they can safeguard the best interests of the people that use the service. Evidence: Since the last inspection of the service there had been no formal complaints recorded at the home and none had been received directly by the Commission. In surveys people stated that they knew how to make a complaint. People stated that they were very happy with the care they received and one person said, when asked what the home does well, they listen to you. The home is owned and managed by the local authority. Therefore the staff receive safeguarding adults training provided by the local authoritys safeguarding adults team. Staff interviews and training files confirmed that they had received this training and were aware of what could constitute as alleged abuse and how to report it. Policies and procedures relating to this area were in place and displayed in the home. Since the last inspection the home had been involved in three safeguarding issues. One investigation with relation to a person wandering from the home was founded. New practices were implemented to the home to make sure that similar events did not reoccur in the future. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service are provided with a comfortable, clean and safe environment at the home. Evidence: The Commission made a tour of the premises as part of the site visit to the service. The home was pleasantly decorated and reasonably well maintained. The gardens were well maintained and new garden furniture had been purchased. The toilets and bathrooms in the home had been kept extremely clean and tidy and the whole home was free of any offensive smells and odours. In surveys all stated that the home always very clean and tidy. A local authority environmental health report gave the kitchen a rating of 4 stars. The records for the homes moving and handling equipment showed that they are serviced and maintained on a regular basis to make sure that they are fit for purpose. The home provided a variety of equipment to assist those with physical disabilities including a ceiling hoist in one bedroom, a level floor shower and electric doors. The home had procedures in place to support the control of infection in the home including extensive provision of hand gel dispensers around the home for use by staff and visitors. Care Homes for Older People Page 16 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the knowledge and skills to be able to safely deliver care and support to the people that use the service. Evidence: The Commission looked at the recruitment files for two of the staff that work at the service. This evidenced that equal opportunities policies and procedures had been implemented when they were employed to work in the home and that all the required checks had been obtained such as two written references and a criminal record check. Staff records and rotas indicated that the home is meeting its minimum requirements in relation to the residential forum guidance for care staff. People living at the home and those who replied in surveys felt they were well cared for. Staff stated there were sufficient staff to meet peoples needs. Although there had been some significant changes in the staff group following a recent work force review by the Local Authority the staff felt well supported. The senior staff working at the home had been given some day to day management responsibilities such as quality audits and supervision. Staff training had had been maintained and was mostly accessed internally. Training included included subjects such as moving and handling, health and safety, dementia Care Homes for Older People Page 17 of 24 Evidence: care and diversity. Induction training was provided and this included shadowing other staff for at least two weeks. Information provided in the homes Annual Quality Assurance Assessment stated twenty six of the homes 28 care staff had completed National Vocational Training (NVQ) 2 in care. Senior staff at the home are encouraged to work towards higher levels of NVQ in care. Ancillary staff were also encouraged to work towards NVQ qualification in their role. Care Homes for Older People Page 18 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced registered manager is in place. The home provides a well managed service to people. Evidence: The manager had recently completed the process to be the registered manager for this service. She is also the registered manager for another of the local authorities resources. The four senior care staff support her in her role and have some delegated management tasks. The senior staff that were spoken to by the Commission stated that they were happy with the support that they received in this role. It is recommended the manager should evidence that she is regularly overseeing and monitoring that this work is fully and consistently completed. The home seeks the views of those who use the service through meetings and quarterly surveys. However the action plans arising from the outcomes of the quarterly surveys take some time to be produced and do not have time to be implemented before the next surveys are due out and are therefore not as effective in Care Homes for Older People Page 19 of 24 Evidence: improving the quality of the service as they might be. Regular quality audits of processes such as care plans, health and safety and medications were regularly completed. The home only assists those people who live in the home long term with their finances. Records relating to this assistance were clearly maintained and receipts for transactions were held. A random check of the records against cash held showed these balanced. Health and safety in the home was well managed. There was evidence that equipment had been serviced as due and staff had received mandatory training in areas such as moving and handling and fire safety. Care Homes for Older People Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must identify 30/08/2010 all the care people require in sufficient detail to ensure peoples needs are met in a consistent manner. To ensure peoples needs are met in a consisitent manner. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 To ensure staff have all the information required to support people and meet all their needs the homes assessments should be more detailed and clearly identify all care requirements. Hand transcribed prescription instructions on the administration records should be checked for accuracy and signed by a second person to minimise the risk of errors. Peoples interests should be recorded and they should be given opportunities for stimulation through leisure and recreational activities which suit their needs, preferences and capabilities on a more consistent basis. The action plans arising from the outcomes of quality surveys should be produced in a more timely manner. Page 22 of 24 2 10 3 12 4 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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