Care Home: Ladyfield House

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What the care home does well The atmosphere in the home is friendly and comfortable. Routines were relaxed and daily life and some activities within the home were flexible. Comments from people and on surveys were positive about the home and care provided. Relatives commented on staff saying, "all level of staff were kind, patient and good humoured"." staff on the EMI unit treat people with respect even in some difficult circumstances". All surveys confirmed that people received medical care when needed, and care plans provided staff with the information they needed to meet peoples care needs. The complaints procedure was accessible and displayed within the home. People using the service and relatives said they were aware of the complaints procedure and made comments for example "I visit daily any concerns that are raised are usually dealt with". Bedrooms seen were homely and personalised; those bedrooms that had been refurbished had matching bedding and curtains. People said they enjoyed choosing how they wanted their bedroom to be decorated. What has improved since the last inspection? What the care home could do better: Staff should evaluate all care plans on a monthly basis this would show that all identified needs monitored and reviewed. Lighting in communal areas should be sufficiently bright enough to facilitate reading and other activities. Further improvements are needed regarding routines in the dementia lounge for example choice of drinks at lunchtime. Tables should be set with the use ofplate guards to encourage independence and the offer of seasoning to people`s meals. Cushions missing from the chairs should be replaced with appropriate cushions that ensure comfort for people to sit on. All these improvements would ensure they provide the same quality of care for all people who use the service throughout the home. CARE HOMES FOR OLDER PEOPLE Ladyfield House Peck Mill View, Ladyfield Road Kiveton Park Sheffield South Yorkshire S26 6UY Lead Inspector Janet McBride Key Unannounced Inspection 25th October 2007 08:30 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 Ladyfield House DS0000065777.V349767.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. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladyfield House Address Peck Mill View, Ladyfield Road Kiveton Park Sheffield South Yorkshire S26 6UY 01909 771571 01909 773989 Ladyfieldhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Post Vacant Care Home 50 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (26), of places Physical disability over 65 years of age (26) Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate 26 service users on the Salvin Wing in the category of (OP) or PD(E) The home may accommodate 24 service users on the Hewitt Wing in the category DE(E) 31st October 2006 Date of last inspection Brief Description of the Service: Ladyfield Nursing home is registered to provide nursing and residential care and accommodation for up to fifty older people. The home was purpose built in 1993, and is situated in the Kiveton area of Rotherham, the home is not on a direct bus service route and is a distance from the main road. The home has two units; Salvin wing provides nursing and residential care, and Hewitt wing provides residential care for people with dementia. Accommodation is provided in forty-six single rooms and two double rooms, with each unit having its own lounge and dining areas. There is a garden with a patio area at the rear of the home, which is enclosed for the safety of residents. Car parking spaces are available at the front of the home. Fees range from £385:00 to £430:00 per week, as at 25th October 2007. Additional charges are made for hairdressing, chiropody, specialised toiletries, and magazines all at various costs. For further information contact the home. Information about the service was available for people and their families in the home’s Statement of Purpose and the Service User Guide. This information was also available in each bedroom. The home last published inspection report was on display in the reception area. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this Key Unannounced Inspection, which took place on the 25th October 2007 for eight hours. As part of the visit another inspector was present and spent two hours in the lounge observing what was happening. This showed what life was like for people using the service. This evidence is included in the report. This procedure is called SOFI observation (Short Observation framework for Inspection). The home is registered for fifty places, at the time of inspection forty-six people were receiving services at the home. Prior to the inspection the manager submitted an Annual Quality Assurance Assessment this gives information about the home and services provided. Pre-inspection work was carried out on the information received and other relevant documentation, for example analysis of statutory notifications and complaint records. During the inspection documentation and records were examined, for example medication, complaints, accident records, staff rotas and staff training files. Two care plans were cross-referenced with other relevant documentation relating to those people who use the service, to evaluate how well their care needs were met. A tour of the premises and direct observation of staff interaction with people who use the service was carried out throughout the visit. Information was gathered from as many different individuals as possible that had contact with people within the home, including individual interviews with the manager and five members of staff .Two relatives were spoken to and four people within the home who receive services. We sent out surveys prior to the inspection, ten were sent to people who use the service within the home, seven were received back. Ten were sent to relatives, five were received back, and five were sent to professionals who had contact with the home and two was received back. They were asked to comment on the standard of care, staff skills, attitude, and how the needs of people using the service needs were met. The inspector would like to thank all the staff, relatives and people receiving services within the home for their co-operation in the inspection process. Any issues or concerns that were raised were discussed with the manager at the end of the inspection. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Staff should evaluate all care plans on a monthly basis this would show that all identified needs monitored and reviewed. Lighting in communal areas should be sufficiently bright enough to facilitate reading and other activities. Further improvements are needed regarding routines in the dementia lounge for example choice of drinks at lunchtime. Tables should be set with the use of Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 7 plate guards to encourage independence and the offer of seasoning to people’s meals. Cushions missing from the chairs should be replaced with appropriate cushions that ensure comfort for people to sit on. All these improvements would ensure they provide the same quality of care for all people who use the service throughout the home. 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. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 &3 People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People that use the service had information about the home and services provided. People were individually assessed prior to admission to ensure their needs would be met. EVIDENCE: The home offers nursing, residential and respite care but not intermediate care. The Annual Quality Assurance Assessment said that information was available in the statement of purpose and service user guide. All surveys received confirmed that people who use the service were provided with sufficient information before moving into the home. Records showed and discussions with people and families confirmed that they welcomed visits before admission to assess the facilities and suitability of the home. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 10 The company had issued all people with up to date contracts/statement of terms and conditions of residency. All people who completed surveys confirmed this. The scale of charges was discussed with the manager and any extras that people pay for, are documented on page five of this report. Records showed that people who use the service were fully assessed prior to moving into the home, with other professionals involved if required. Discussions with people within the home and comments on surveys said people received the care and support they needed. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Care plans provided staff with the information they needed to meet the care needs of people that use the service, this ensured that the majority of peoples needs were identified and met. EVIDENCE: Two care plans were checked these set out in detail healthcare, personal and social care needs in an individual plan of care. This ensured that staff deliver the care required and peoples needs were identified and met. Risk assessments were completed dependent on individual needs. People were nutritional assessed and weighed on a regular basis, and when weight loss had been highlighted they had referred to dietician. Records showed that staff document what care was given on a daily basis, but one care plan had not been evaluated monthly, this means changing needs may not be identified. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 12 All people within the home were registered with a GP and had access to health care facilities. People were referred to other health professionals when required, including a consultant psychiatrist and community mental health services. All surveys confirmed that people received medical care when needed. Administration of medicines was observed; examination of records, storage and recording of medication was all found to be satisfactory. All people were encouraged to make decisions and everyday choices for example what to eat and what to wear, this promoted the choices and dignity of people living at the home. If more complex decisions were required, relatives or advocates would be used Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 13 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 &15. People who use the service experience Adequate outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The majority of people were provided with some stimulation and interesting activities, however further improvements are needed regarding issues raised in these standards. This may affect the quality of care provided for people who use the service on the dementia unit. EVIDENCE: Routines of daily living appeared flexible, activities were being carried out on the dementia unit in the morning. The activities co-ordinator usually spends half a day on each unit and has a range of activities, which vary for each unit. There is a activities plan on the notice board, which sets out what is planned on day by day basis. One person within the home said “they think they should be more activities available for the more capable people within the home”. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 14 Relatives confirmed they can visit at any time, and that meetings for relatives had been held on a more regular basis. Mealtimes on the nursing unit were unhurried and relaxed, dining tables were set with tablecloths, cutlery and condiments. People on this unit made very positive comments about the food, and all surveys received back from people said they liked the food. The inspector that spent two hours in the lounge watching what was happening observed a very different outcome for people on the dementia unit. Dining tables were bare they were not laid until people were seated and only basic cutlery and plastic glasses were put on the table. Only one person asked for salt and pepper, although no other people were offered seasoning. Their appeared little choice of meal at lunch time, although staff said people were asked the day before what they wanted for lunch the next day. There was no choice of drinks at lunchtime. Plate guards were not seen used to assist people to eat their meal independently, however staff did spend time describing the meal provided to one person who was visually impaired. The three people observed were seated for their meal between 45 and 55 minutes before receiving their meal. This is not acceptable as people with dementia often loose interest and would get up and walk away from the table, or get agitated with the delay in getting their lunch. Feedback was given to the manager about our observation in the dementia lounge, who thought it, was a useful observation tool that the home may be able to use to look at the quality of care within the home. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 15 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 &18. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The complaints procedure was accessible and displayed within the home. Policies and procedures were in place on adult protection, this promoted and protected people who use the service. EVIDENCE: There was a comprehensive complaints procedure, which was on display in the home. People using the service and relatives said they were aware of the complaints procedure and some comments were made for example “I visit daily any concerns that are raised are usually dealt with”. The written and verbal concerns I have expressed have been listen to and acknowledged and to some extent addressed”. The manager said they have an open door policy and weekly surgeries with the manager were available, these dates were on display in reception. Complaint records showed that any complaint had been recorded, responded and investigated in an efficient and thorough manner. Policies and procedures were in place regarding the protection of vulnerable adults. Staff confirmed they were aware of abuse polices and procedures, and staff were able to describe the action they would take on receiving any allegations. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24 &26. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People who use the service live in a comfortable and wellmaintained environment. The home was clean and tidy and provided any specialist equipment people required to maximise their independence. EVIDENCE: Communal space is available on each of the units, which included various lounge and dining areas. A tour of the premises found the general appearance had improved with a number of areas being decorated and new dining tables and chairs purchased for both units. In the dementia unit along the corridors staff had created areas of interest and stimulating activity, which encouraged people to touch. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 17 The carpet in the dementia unit were worn and stained, however evidence was seen to show these were to be replaced also the manager said they had ordered new chairs for the lounge. Lighting in the lounges was poor, although there were evidence of standard lamps, which made a slight improvement. People did seem to struggle when reading books, magazines or doing activities if they were not sat near a lamp. It was noticed in the dementia lounge that a number of cushions were missing from the chairs, some cushions had been replaced with wheelchair cushions, which would be uncomfortable for people to sit in for long periods. Bedrooms were seen on both units, some of these were homely and personalised. Those bedrooms that had been refurbished had matching bedding and curtains, some were waiting for new carpets to be fitted. One person said their bedroom was going to be decorated and they were going shopping with a member of staff to choose the wallpaper and colour of paint. The laundry facilities the laundry looked well organised with lots of clean bedding and towels available. No comments were received from people within the home or relatives regarding the laundry. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 18 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 &30. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Staff had the skills and knowledge to fulfil their roles within the home. The development of staff skills ensures that competent staff supported people at the home. Recruitment policies are followed ensuring the safety and protection of people who live at the home. EVIDENCE: Staffing structure within the home was discussed with the manager, checking of duty rotas confirmed there were sufficient staff to meet the needs of people who use the service. The duty rota clearly identified staff within the home and their role. Comments on the surveys said “staff were usually available when you need them”. “Staff are very kind and patient when I ask for things”. Relatives said they felt that staff had the right skills and experience and seem well motivated. There were robust recruitment and selection procedures that ensured people who use the service were safe and protected. A number of staff recruitment files were examined. Recruitment and selection procedure promoted equal opportunities and completed all the required employment checks that are Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 19 required prior to staff being employed. Including Criminal Record Bureau (CRB) Protection Of Vulnerable Adults (POVA) checks. Each member of staff had an individual training file, these were examined and training opportunities were discussed with the manager and staff. Records indicated that a number of the staff team had accessed various courses, for example, dementia awareness, challenging behaviour, abuse, customer care and first aid courses. A number of staff had also achieved National Vocational Qualification level 2 in care (NVQ) with other members of staff continuing to work towards attaining this qualification. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 20 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 &38. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People who use the service were protected by good management practises. The financial interests of people were safeguarded, good health and safety procedures ensured they were protected. EVIDENCE: The acting manager has been in post for almost a year, is going through the process to be the registered manager. Since the last inspection he has completed the registered managers award. He said he was aware of his responsibilities and aims to run the home in the best interest of people who live at the home. Since being in post he’s made himself available to listen to any issues or concerns people may have. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 21 Quality assurance systems were in place and the manager could evidence they monitor the quality of care and services within the home. Discussion with the manager and checking of records confirmed that people’s finances were recorded, receipts kept and audited on a weekly basis. Some people control their own finances, with the help of their families. Maintenance and service records were examined, these were up to date with current certificates. Health and safety meeting are held on a monthly basis with minutes taken. Appropriate policies and procedures were in place with the relevant notices on display throughout the home. Fire safety procedures were in place, records examined showed they were current and up to date with certificates for hoists within the home. This keeps people living and working in the home safe. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 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 2 X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 23 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 23(2)(c) (n) Requirement Cushions missing from the chairs must be replaced with appropriate cushions to assure a comfortable environment that meets the needs of people within the home. Timescale for action 30/11/07 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 2 3 4 Refer to Standard OP7 OP15 OP20 OP28 Good Practice Recommendations All care plans should evaluated on a monthly basis to ensure all identified needs are reviewed. Aids and the right equipment should be available to support people to retain their independence. Lighting in communal areas should be sufficiently bright to facilitate reading and other activities. A minimum ratio of 50 of staff must be trained to NVQ Level 2 or equivalent as soon as possible. Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Ladyfield House DS0000065777.V349767.R01.S.doc Version 5.2 Page 25 - 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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