Care Home: Ladyville Lodge Nursing Home

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What the care home does well Residents are actively involved in the running of the home through quality assurance systems and resident meetings. The service has a good day time activities programme, to ensure they can meet all the needs of residents and offers a good selection of meals. There is a clear complaints procedure, which includes timescales within which a complaint is to be investigated. The service promptly contacts health professionals where required to ensure the health care needs of residents are met and medication practices always ensure the safety of people who use the service. What has improved since the last inspection? At the last key inspection 18 requirements were made in the following areas; Care planning; risk management; areas relating to the physical environment; reviewing the staffing levels; staff training; the manager to register with the Commission for Social Care Inspection; identified health and safety issues; to complete detailed pre-admission assessments, to complete regulation 26 visits and the manager to submit their application of registration to the Commission for Social Care Inspection. A meeting took place on the 30th October 2007, between the Commission for Social Care Inspection, and representatives of Southern Cross Healthcare, to discuss the Commissions grave concern at the deterioration of the service, following the inspection of 24th September 2007. The Commission is pleased to note the co-operation of the registered organisation and the improvement in the quality of service provision at this inspection. At this inspection 17 of these requirements have been complied with. 1 requirement has not been met from the last inspection in relation to the environment and documentation in relation to health and safety checks. This requirement has been repeated at this inspection. The service has worked very hard to meet the requirements from the last inspection and improve the services provided to its residents. What the care home could do better: 4 requirements were made at this inspection in the following areas: activities; the provision of specialist equipment, recruitment and health and safety checks. Failure to act on requirements that relate to the care provided for the people living in the home impact on the welfare and safety of people who use the service and may lead to the Commission taking enforcement action against the registered person. The registered provider, the manager and the staff team may wish to refer to the Commission`s Key Lines of Regulatory Assessment (KLORA), to consider how they may additionally further enhance the overall quality of care in the home. CARE HOMES FOR OLDER PEOPLE Ladyville Lodge Nursing Home Fen Lane North Ockendon Upminster Essex RM14 3PR Lead Inspector Harbinder Ghir Unannounced Inspection 23rd January 2008 09:50 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 DS0000015597.V358195.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. DS0000015597.V358195.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladyville Lodge Nursing Home Address Fen Lane North Ockendon Upminster Essex RM14 3PR 01708 855 982 01708 854 899 ladyville.lodge@ashbourne-homes.co.uk 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) Ashbourne Homes Ltd vacant post Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (26) of places DS0000015597.V358195.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 26 BEDS FOR ELDERLY INFIRM 18 BEDS FOR RESIDENTIAL CARE MINIMUM STAFFING NOTICE Date of last inspection 24th September 2007 Brief Description of the Service: Ladyville Lodge is a 44- place care home for older people. Twenty-six of the beds are registered for nursing care and 18 for residential. Southern Cross Healthcare Limited runs the home. The home consists of a large, two storey house, with a large purpose built annex, set in spacious grounds. All bedrooms are spacious, airy and bright. They all have hand basins, TV points and a call system. There is a passenger lift in place. There are two lounges and a dining room overlooking the garden with disabled access. There are car-parking facilities to the front of the property for staff and visitors. The home is situated in a rural part of Upminster and is not convenient to access by public transport. It is close to the M25, A127 and the A12 and easily accessible by car. The range of fees currently charged by the service for residential care can range from £416 to £520 and for nursing care can range from £520 to £650. Further information regarding fees can be obtained directly from the home. DS0000015597.V358195.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This was the 2nd key unannounced inspection for the service since the 24th September 2007 the last inspection. This inspection was undertaken by Regulation Inspector Harbinder Ghir on the 23rd January 2008 between 9.50am and 5.00pm and the 24th January 2008 between 9.30am and 11.30am. The manager was available throughout the days of the inspection. An expert by experience also assisted the inspector during the inspection and inspected the activities and meals provided at the home. Their findings have been included in the report. The London Borough of Havering, who is the host authority for the service was contacted, inviting their comments on the service they are commissioning. Their feedback is included in the report. During the inspection the inspector was able to talk to residents residing at the home, staff on duty and relatives visiting the home. Their comments have been included in the report. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection 18 requirements were made in the following areas; Care planning; risk management; areas relating to the physical environment; reviewing the staffing levels; staff training; the manager to register with the DS0000015597.V358195.R01.S.doc Version 5.2 Page 6 Commission for Social Care Inspection; identified health and safety issues; to complete detailed pre-admission assessments, to complete regulation 26 visits and the manager to submit their application of registration to the Commission for Social Care Inspection. A meeting took place on the 30th October 2007, between the Commission for Social Care Inspection, and representatives of Southern Cross Healthcare, to discuss the Commissions grave concern at the deterioration of the service, following the inspection of 24th September 2007. The Commission is pleased to note the co-operation of the registered organisation and the improvement in the quality of service provision at this inspection. At this inspection 17 of these requirements have been complied with. 1 requirement has not been met from the last inspection in relation to the environment and documentation in relation to health and safety checks. This requirement has been repeated at this inspection. The service has worked very hard to meet the requirements from the last inspection and improve the services provided to its residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000015597.V358195.R01.S.doc Version 5.2 Page 7 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 DS0000015597.V358195.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5, 6 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments are completed before prospective residents move into the home, ensuring that the service will meet their needs. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. The service does not provide intermediate care. EVIDENCE: DS0000015597.V358195.R01.S.doc Version 5.2 Page 9 Since the last inspection the service has introduced a new pre-admissions assessment form, which is very comprehensive and ensures the needs of prospective residents are fully assessed before they can move into the home. Four pre-admission assessments were closely examined, two of which were for newly admitted residents, which covered the physical, social, religious, and emotional needs of residents. Wounds assessments and body charts were also completed as part of the initial assessment. All pre-admission assessments since the last inspection have been completed by skilled and experienced members of the senior management team within the home, to ensure they can meet the needs of people moving into the home. Care management and healthcare assessments examined on file had been obtained prior to the residents being admitted. All prospective residents and their relatives and family are given the opportunity to visit the home prior to being admitted. One resident who recently moved in to the home spoken to at the inspection informed, “The home is quite good, the food is good, the service is good and staff are pleasant. Before I came here, my daughter came to look around. I like my room, because I can open my door into the garden.” Relatives of another newly admitted resident spoken whilst visiting the home, informed, “The home has been very good. My mother before coming to this home said she would rather die than move into a residential home. But since she has been here she has improved so much. She is content and happy. She always tried to escape at a previous home she was placed at. She now tells us how nice everything is here, we can’t believe it, we can’t fault the home. She has got her own room and she has brought in a few of her things. She has decorated her room the way she likes it, as we were told that it was her room.” The service does not provide intermediate care. DS0000015597.V358195.R01.S.doc Version 5.2 Page 10 DS0000015597.V358195.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, 11 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. Care plans are detailed and ensure the needs of residents can be met effectively. There are clear medication policies and procedures to follow, ensuring the safety of residents. Residents’ wishes at the time of their death are briefly identified and should be considered to be recorded in more detail, to ensure their spiritual needs and rites are fulfilled by the service. EVIDENCE: The service has reviewed most residents’ care plans since the last inspection and is in the process of reviewing the remaining care plans, meeting the DS0000015597.V358195.R01.S.doc Version 5.2 Page 12 requirements made at the last inspection. The care planning system is now very detailed and identifies the needs of residents and how they are to be met. Information clearly sets out residents’ health, personal and social care needs. Evidence was seen of care plans being devised with the assistance of family and relatives and residents themselves, ensuring that they were person centred. Four care plans were closely examined and case tracked. It was positive to observe the service recording the preferred communication styles of the individual and using proven methods to enable the person to lead a full life that promotes independence and choice. For one resident their needs assessment specified that they were hard of hearing. The care plan in turn informed staff that “all attending staff should know that M is hard of hearing and should be at her body level when communicating with her.” Reference was also made to speaking loudly to ensure M heard and understood what staff were saying. Another resident’s health and care management assessments highlighted the resident’s short term memory loss which was also identified in the individuals care plan and clearly recorded how the service was to meet her needs and promote her independence. On speaking to the daughter of a resident she informed that her father likes to be well dressed and has always liked to wear matching clothes. On case tracking this information in the care plan, the service had recorded that “C’s clothes must be matching” and reference was made to his appearance to be smart. The resident during the inspection was seen to be dressed very smartly and wearing matching clothes. Each care plan identified residents’ daily routines and stated what times they preferred to go to bed and get up in the morning. Daily case recording notes evidenced residents going to bed and getting up what time they liked. One resident spoken to stated, “It’s a friendly place, staff are very nice. They don’t force me to go to bed, you have choices here.” Another resident spoken to added “We can have a lie in any time we want.” The documentation/ health records relating to pressure care areas; management of diabetes, falls were examined. The records for these were found to be detailed and were adequately maintained. There was evidence that care plans were being reviewed at least monthly, with family, relatives and representatives invited to attend the review. One relative when asked whether she had been invited to attend reviews at the home stated “We have had one care plan review meeting recently. We found the meeting very useful and Emma (manager) went through everything with us.” Monthly weight checks were undertaken for all residents and appropriate action being taken where necessary. Records indicated other health professionals such as the district nurses, optical, dental and chiropody services saw residents, and that professionals were contacted promptly to ensure the healthcare needs of residents are met. The district nurse for the home was spoken to as part of the inspection. She stated that “We have no concerns regarding the home or with the patients we see.” DS0000015597.V358195.R01.S.doc Version 5.2 Page 13 Risk assessments are routinely undertaken for all residents around nutrition, manual handling, continence, falls and pressure care areas and challenging behaviour if required and are reviewed on a regular basis. One resident who had chosen to smoke at the home had a risk assessment completed to promote his choice and was supported by staff to smoke in the garden. He was seen throughout the day of the inspection going to the garden with the support of staff to have a cigarette. The accident and incident book was reviewed. Since the last inspection the number of accidents and incidents has significantly reduced. In September 2007, 24 falls were recorded and November 2007 this had reduced to 7. All accidents incidents are recorded in full. Residents received follow up checks to ensure there were no further health-associated risks. The Commission for Social Care Inspection, in line with Regulation 37, of the Care Homes Regulations 2001, has been informed of accidents since the last inspection. The home has a medication policy which is accessible to staff. Medication records were up to date for each resident and medicines received, administered and disposed of are recorded. An audit of two residents’ medication was carried out, which was all found to be in order. Each resident has their own medication file, with their photo and a list of their current medication. On viewing care plans, the contact details of family and relatives were recorded who were to be contacted in the event of an individuals death or ill health. However, no other information was provided on whether an individual preferred to be buried or cremated or their preferences of spiritual rites. It is recommended where appropriate that the arrangements residents want are openly and sensitively discussed during the development of the care plan, and clearly recorded and known to the staff delivering care. To ensure a residents’ death is handled with dignity and propriety, and their spiritual needs and rites are fulfilled by the service. This will be stated as Recommendation 1. DS0000015597.V358195.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a programme of activities available and residents are given the opportunity to take part in a variety of activities, however the programme does not meet everyone’s needs. There is a wide choice of meals available at the home, to ensure they meet the needs and choices of all residents. Visiting times are flexible and people are made to feel welcome in the home, so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: An expert by experience contributed to the inspection by inspecting the daily life and activities and the meals provided at the home. Their findings were as follows; DS0000015597.V358195.R01.S.doc Version 5.2 Page 15 Ladyville Lodge is a large two-storey dwelling situated in the quiet countryside of Upminster. Although access to the property is ideal by car and within easy reach of the M25 and A127, it is not easy for visitors travelling by public transport. The property is set in spacious grounds, has a nice frontage, parking for staff and visitors and a very pleasant area for the residents to sit and enjoy the fresh air. During a meeting with the inspector, it was suggested that my main role today would be to look into the food and the activities of the home, which I was happy to do. I did observe some other minor points outside this role, but my time was spent mainly on the two objectives. The Kitchen I spoke at length with the Chef who had been working at the home for some time and had several systems in place. He is extremely well organised and methodical. Although I was not inspecting the kitchen’s cleanliness minutely, nor did I see inside any cupboards, storerooms or refrigeration, my observation was that it was extremely clean and tidy. The chef is solely responsible for the kitchen, the ordering of the food, the menu and the preparation of the meals. The chef keeps a log of all food ordered – meat, fish, dairy products, bread deliveries and other goods. Some of the orders are delivered on a daily basis, others at a two-day interval, weekly and monthly. I was given a copy of the meal plan for a week and this appeared to be quite varied. From this weekly plan, there was only one item of breaded fish and one of fish fingers, no fish pies or other fish dishes but this may well be the preference of the residents. There was no mention of fresh fruit on the menu, but again, this does not indicate that it is not available. If, having selected a particular dish from the menu, the residents changed their mind, there is always an alternative available and any particular request could be catered for. For the benefit of relief catering staff, instructions are displayed concerning special dietary needs for some residents, which included “soft” meals. These are generally liquidised for any resident who has difficulty in swallowing. The liquidised meal is presented showing the meat and vegetables separately to make it as appealing as possible. I was informed that the majority of the food is prepared and cooked freshly each day and that very little frozen foods are used. By 11.45 on the day of my visit there was nothing cooking in the kitchen, the food was already in the hot cupboard, ready to serve. Talking to one of the residents, I was informed that for breakfast residents could have more or less what they wanted to eat, whether it be a full “English” DS0000015597.V358195.R01.S.doc Version 5.2 Page 16 breakfast or cereal. Drinks were constantly being served most of the time I was there. I sat with three residents whilst their lunch was served to them. Two of the three did not attempt to eat any of the vegetables which were cauliflower and Brussels sprouts, saying that they did not like them. An offer of salad was made, but refused. The third resident did not eat anything at all. Several attempts were made by staff members to encourage the eating, but to no avail. I observed another resident struggling with the effort to manipulate food onto a fork and knife and several times they were quietly offered assistance. The Manageress and the Chef are looking into the use of the Nutmeg system which is a menu planning and nutritional analysis software. This will give an indication of the nutritional guidelines regarding their menus. For example, this software package will analyse the salt, sugar, fat, etc. content of the weekly menu, highlight any possible “culprit” ingredient and suggest alternatives to correct any imbalance Activities At present one member of staff’s main role is to deal with Activities. The hours are between 11 a.m. and 4.00 p.m. Monday to Friday. On the day of my visit, the morning post was being delivered by this member of staff. Part of the routine was to visit each resident who spent a lot of time in their own room. The residents who were scattered between the dining room and the two parts of the lounge were encouraged to group together for the morning’s chair aerobic session. During the session the Activities Co-ordinator moved around and faced each individual, ensuring that they were joining in and that they were doing the exercise correctly. The Co-ordinator encouraged the residents the whole time. Following on from the aerobics session was a mental stimulation game, again encouraging all to contribute. A list of the week’s activities is displayed in the reception area and these include reading stories or newspapers; hand massage/manicure; quiz; bingo; arts and crafts; cooking; card games; painting and drawing. The Co-ordinator ensured that residents who are confined to their room are visited and given the opportunity to participate in any of the activities. Outings are arranged quite frequently to either garden centres, nearby Lakeside, Southend and to an activity park. Garden parties are also organised in the grounds and a dog show was a great success. Visitors to the home include hairdresser, entertainers, library, displays of slippers and shoes, dresses and clothing and a church service is held once a month. DS0000015597.V358195.R01.S.doc Version 5.2 Page 17 The Residents: I also spoke to a few of the residents and the impression I received was that they were happy both with the food most of the time and with the service provided. Conclusion: The Activities Co-ordinator has a very friendly, happy disposition, appears to be very caring and is welcomed by the residents. The Co-ordinator also assists at meal times with transferring and feeding residents. The dining room was bright and roomy, tables set so that there was ample room to manoeuvre wheelchairs, walking frames, etc. Meals were served in a relaxing, unhurried manner and help was at hand where necessary. I spoke with several members of staff and all were very pleasant and eager to assist me and answer any questions. By observation I felt the staff had a caring and calming attitude towards the residents who appeared to be responsive to the staff. The inspector on speaking to residents and relatives also received further positive feedback regarding the activities and meals at the home. One resident spoken to informed, “Since Emma (manager) has been at the home, we have seen changes. She gets things going. We have had more activities and she goes out and buys things for residents who have won things whilst doing the activities.” From the activity timetable, it is noted that the activities co-ordinator only works during the day and limited activities are organised during the evenings and weekends. Some residents spoken to also informed that they get bored in the evenings. One resident stated “ We get bored in the evening, we just watch TV. It can be a bit of a drag, from the time we have our tea and go to bed. I would like to do more at these times.” The service has also received surveys from family, relatives and representatives and their comments continuously highlighted the need for more activities for individuals who are bed bound. The manager of the home is examining the whole activities programme within the home and has already made some changes, which have been reflected above. However, the programme does not cater for evening or weekend activities or for those individuals who are less able. The home also has residents who suffer from short term memory and may also be unable to participate in the activities arranged. It is Requirement 1 that the activities within the home matches residents’ expectations and preferences, meeting their recreational needs, at different times of the day. DS0000015597.V358195.R01.S.doc Version 5.2 Page 18 Visiting times were flexible and visitors could visit at any time convenient to residents. Relatives, family and friends were seen to visit residents throughout the time of the inspection and were made to feel welcomed by the staff at the home. DS0000015597.V358195.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be assured their views are listened to and acted on. Staff have received up to date training in safeguarding adults, which ensures the protection of residents. EVIDENCE: The complaints procedure is clear and easy to follow. Timescales within which a complaint would be investigated were stated on the complaints procedure and included that the Commission for Social Care can be contacted at any time or stage of a complaint being made. A complaints and concerns logbook is kept by the home, which was viewed. There were three recent written formal complaints logged, which had been investigated satisfactorily. Residents’ concerns were also recorded by the service, which the service had resolved and responded to promptly. Since the last inspection the Commission for Social Care Inspection has received two complaints about the service, which the service has investigated and resolved satisfactorily. The home also holds regular residents’ meetings and records seen demonstrated that all concerns raised by residents were listened to. DS0000015597.V358195.R01.S.doc Version 5.2 Page 20 Most staff have attended POVA training whilst others have been booked to attend forthcoming training sessions. The service has comprehensive safeguarding adult procedures and protocols in place. The service has obtained safeguarding adult protection procedures devised by The London Borough of Havering. The Commission for Social Care Inspection was alerted before the last inspection by the service of a Safeguarding Adult Protection investigation, which is consequently waiting for a court hearing. The London Borough of Havering, who is the host authority for the service was contacted as part of the inspection. One of the commissioning managers informed “We did raise an issue with the home in October 2006, regarding the Safeguarding of Adults which the home dealt with appropriately. We are quite happy with the way Southern Cross manages the service.” DS0000015597.V358195.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The implementation of a decoration programme has ensured that residents live in a more comfortable home, which provides a homely and pleasant living environment enhancing their comfort. The service must purchase all specialist aids and equipment to meet the needs of people who use the service. EVIDENCE: Since the last inspection the service has made vast improvements to the environment of the home. The reception area of the home has been re-decorated which now provides a more welcoming and homely feel to the home. Residents now use this area to sit down and read the daily newspapers. New carpets have been laid down in all corridors, lounges and fifteen bedrooms. The dining area has also been re-decorated with laminate flooring being put down. All lounge chairs have been replaced with new chairs. The DS0000015597.V358195.R01.S.doc Version 5.2 Page 22 home is undergoing a major re-decoration programme and all residents’ bedrooms have also been included in the programme. On the ground floor a new bath has been fitted which now allows residents to be safely hoisted into the bath. However, on viewing the bathroom, the bathroom did not look totally finished, as the bath had been fitted with a wooden panel, which will be prone to rotting. The general décor of the bathroom required attention, as there were holes in the walls, pipes had not been covered where work had taken place and generally required decorating. During a tour of the building one resident’s room was malodorous and lighting around the home was very dull. An expert by experience who assisted the inspector during the inspection stated in her findings “The lounge area is fairly large with two sections, one of which has a television set. I felt the room would benefit with better lighting as at present it is rather dull.” The manager took all these comments on board and informed that she is aware of these issues. During the next day of the inspection further re-decoration of the building was seen to be taking place with the painting of corridors and the changing of light bulbs to a higher wattage. On touring the kitchen, fridge and freezer temperatures were taken daily with the exception of the weekend when agency staff are employed to prepare and cooks meals. The manager and chef informed that they are now in the process of employing a permanent chef to cover the weekends and to ensure all temperatures are also logged on the weekends. On speaking to relatives and residents they all commented on how the environment of the home has improved. One relative spoken to stated, “This place used to smell to high heaven, it doesn’t now. My relative is also kept very clean and he never smells. If on the odd occasion we want my relative changed, they do it straight away.” A resident spoken to, who was also spoken to at the last inspection informed, “The toilet floor is no longer sticky, they clean it properly now.” The expert by experience who assisted the inspector at the inspection in her findings wrote “Watching the residents being transferred from the lounge area to the dining room, I felt that the use of a riser chair would assist both the resident and the staff in the transfer from their armchair to a wheelchair.” Also on speaking to the manager she informed the inspector about a resident who had a high level of complex nursing needs but wanted to be seated out of bed. But the chair required to enable the staff to do this is very expensive and they were going to consult with the family to pay half of the cost towards the chair and the home would pay the remaining amount. The National Minimum Standards state that, “Service users have the specialist equipment they require to maximise their independence” and that “The home provides grab rails and other aids in corridors, bathrooms, toilets, communal rooms and where necessary in service users’ own bedrooms.” Where there is need for specialist DS0000015597.V358195.R01.S.doc Version 5.2 Page 23 equipment to maximise individuals’ independence this must be purchased by the service. This will be stated as Requirement 2. DS0000015597.V358195.R01.S.doc Version 5.2 Page 24 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 using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices must be more robust to ensure residents are in safe hands at all times. Staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. There is a good skill mix of staff to meet the needs of residents. EVIDENCE: Three staff files were closely examined. References, identity checks, POVA first checks and fully completed applications forms were viewed, which were all in good order. However, on requesting to see the criminal bureau checks for staff, only two could be located. It was identified that members of staff who had been employed by the previous providers did not have their criminal bureau checks on file. It is therefore necessary for the current providers to complete criminal bureau checks for these members of staff immediately and review criminal bureau checks for all staff every three years after the date of their first check. This will be stated as Requirement 3. DS0000015597.V358195.R01.S.doc Version 5.2 Page 25 At the last inspection concerns were expressed regarding the low staffing levels at the home. The management of the home since then has reviewed staffing ratios and is also in the process of recruiting five further permanent members of staff to join the staff team. On the day of the inspection there were two members of staff on the residential unit and six members of staff in the morning on the nursing unit, which is increased to eight members of staff in the afternoon. Whilst staff shortages still exist during the mornings where one extra person is required the home has significantly improved its delivery of care to its residents. This was evident on entering the premises, as the emergency call bell was not consistently heard to be sounding, which was observed at the last inspection and relatives also gave positive feedback regarding the staff changes that have taken place. One relative spoken to stated “We feel there is much more co-operation from the staff now. There are more staff on duty, which is why my father is now being toileted better. They virtually take him straight away to the toilet, that has definitely improved. The buzzer isn’t going on all the time and a lot of the staff have been going on courses; we have picked up on that and that was definitely needed.” Another relative spoken to stated “We are happy with the care provided, they care closely for mum. We really appreciate it, and we would not want her to be anywhere else. We love coming to the home. I have recently seen more staff on shift. We are delighted with the care.” Since the last inspection a comprehensive training programme has been devised for each member of staff employed. Some staff had already attended training in pressure care, customer care, care planning, challenging behaviour, dementia awareness, bed rail safety and first aid whilst others have been booked to attend the training. All staff undergo mandatory training in fire safety, fire drills, food hygiene, and moving and handling, C.O.S.H.H, health and safety and infection control. The majority of staff since the last inspection have completed training in safeguarding adults while a few have been booked to attend further sessions in the coming weeks. Currently the service has a ratio under 50 of NVQ qualified staff. Since the last inspection the service has enrolled a number of its care staff to commence the NVQ training course. DS0000015597.V358195.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from an experienced manager who recognises their needs and adequately manages the home. Systems for service user consultation have been implemented, to ensure residents’ views underpin all self-monitoring, reviews and developments by the home. Residents can be confident that the staff team who care for them benefit from regular supervision. There are good systems to manage service users’ financial interests to ensure recorded balances are correct with the monies kept in safekeeping. The welfare of staff and residents is not always promoted by the home’s completion of health and safety documentation. DS0000015597.V358195.R01.S.doc Version 5.2 Page 27 EVIDENCE: A new manager started employment with the service in September 2007, who has had a positive and dramatic effect on the running of the home. The manager is a registered nurse with experience of managing services for this client group. Through discussion and observation it was evident that the manager has the qualities and experience necessary to manage the home. Residents and relatives spoken to at the inspection spoke very highly of the manager. One relative spoken to stated “When Emma (manager) came to the home it was like a breath of fresh air. If you say something it gets done, nothing is left. The staff are happier, they co-operate now. All the barriers with staff have been broken down.” A resident spoken to stated “Since Emma has been at the home we have seen changes, she gets things going.” The informed that she is in the process of sending her application for registration to the Commission for Social Care Inspection. Since the last inspection and a requirement was made in relation to staff not being supervised at least six times a year. All staff have now received an appraisal to identify any practice issues and training needs. A supervision programme has been implemented for all staff to be supervised regularly by the senior management team. Residents’ records of finances were viewed and the inspector tracked the amount of money the service held for three individuals. All amounts were accounted correctly and were in order. The service is in the process of completing its annual quality assurance programme for 2008. Residents and relatives had completed surveys, which the inspector viewed. It is recommended that stakeholders in contact with the home are also included in the quality assurance system, to ensure their views are also sought on the running of the home. This will be stated as Recommendation 2. The service also holds regular resident and relatives meetings which gives further opportunity for people who use the service to be involved in the running of the home. One relative spoken to informed that she finds these meetings vital and very useful. She stated, “I always attend the resident and relative meetings. They are always well organised. At the last meeting Emma went through the last inspection report with us. She was very good, and we really appreciated it.” Health and Safety records were inspected. The gas and safety certificate, gas safety inspection, fire system and emergency lights check and a controlled waste certificate were all in good order and appropriately completed. DS0000015597.V358195.R01.S.doc Version 5.2 Page 28 However, on viewing the maintenance books the information had not been appropriately recorded. Dates of checks were missing for some days and the information recorded was difficult to understand, as the documentation had not been completed in full. Water temperature checks throughout the home were only completed monthly. The Health and Safety Executive in their Health and Safety in Care Homes guidance informs that water temperature checks must be completed on a weekly basis. All documentation in relation to any health and safety checks must be completed in full, which can be case tracked to ensure the health, safety and welfare of service users and staff are promoted and protected; and water temperatures checks must be completed weekly to ensure the safety of people who use the service. The first part of this is requirement is unmet and therefore will be repeated as Requirement 4. The registered persons has completed monthly regulation 26 visits and reports, which the Commission for Social Care Inspection has received copies of. However, the reports are very brief and do not provide enough detail of the findings of the visit or the views of service users during the visit. It is Recommendation 3, that the report format is reviewed to ensure the reports reflect the above information. Failure to act on requirements that relate to the care provided for the people living in the home may lead to the Commission for Social Care Inspection taking enforcement action against the registered person. DS0000015597.V358195.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 DS0000015597.V358195.R01.S.doc Version 5.2 Page 30 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 OP12 Regulation 16, (m) Requirement Timescale for action 30/04/08 2 OP22 23 (2) (n) 3 OP29 19 4. OP38 13 (5) (4) (c) 17 The Registered Persons must ensure that the activities within the home matches residents’ expectations and preferences, meeting their recreational needs at different times of the day. The Registered Persons must 30/04/08 ensure that where there is need for specialist equipment to maximise individuals’ independence this must be purchased by the service. The Registered Persons must 30/04/08 complete criminal bureau checks for members of staff who have no criminal bureau checks on file and review criminal bureau checks for all staff every three years after the date of their first check. The registered persons must 30/04/08 ensure all documentation in relation to any health and safety checks must be completed in full, which can be case tracked to ensure the health, safety and welfare of service users and staff are promoted and protected; and water temperatures checks must DS0000015597.V358195.R01.S.doc Version 5.2 Page 31 be completed weekly to ensure the safety of people who use the service. Repeated Requirement. Timescale of 31/12/07 not met. 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 OP11 Good Practice Recommendations It is recommended where appropriate that the arrangements residents want are openly and sensitively discussed during the development of the care plan, and clearly recorded and known to the staff delivering care. To ensure a resident’s death is handled with dignity and propriety, and their spiritual needs and rites are fulfilled by the service. It is recommended that stakeholders in contact with the home are also included in the quality assurance system, to ensure their views are also sought on the running of the home. It is recommended that regulation 26 visit reports provide enough detail on the findings of the visit and the views of service users during the visit. 2 OP33 3 OP38 DS0000015597.V358195.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. 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