Care Home: Lake View Manor

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What the care home does well Lakeview Manor provides a clean and homely environment for people. It is well maintained and there is space outdoors for people to enjoy fresh air in warmer weather. One person said, `it`s always beautifully clean`. The staff team enjoy their work at the home and residents describe them as very caring. They told us the staff looked after them well and listened to what they had to say, `its an excellent home`, `the staff are kind and pleasant` and `its practically like a hotel`. The home had a calm and pleasant atmosphere on the day of the visit. There is a low staff turnover and they know the residents needs well. Relatives told us they were made to feel welcome, were kept informed and could visit at any time. People told us in surveys and discussions that there were enough activities going on and that they enjoyed the meals provided. The home received very few complaints. The one that was received last year was dealt with straight away and resolved quickly. Staff know how to deal with any issues of concern or poor practice and have received training in how to safeguard vulnerable adults from abuse. The staff told us they received support from their manager and sufficient training to help them complete their tasks. 62% of care staff have gained a national vocational qualification (NVQ) in care at level 2 or 3, which is an excellent achievement and exceeds the standard. There is a good quality monitoring system in place that ensures the home is audited and that people are consulted about the way it is managed. Residents` money, held for safekeeping, is managed well. What the care home could do better: People must have a comprehensive care plan that includes all their assessed needs and have clear guidance for staff in how to meet the needs. At the moment all the information is in a care file and not structured in any clear plan of care. The documentation used has not been updated for several years and staff have been adding to the original set of documents required for each resident. This means that staff have to record care in lots of different areas and it can be confusing trying to follow the information. The documentation could be streamlined to make things simpler. The staff manage medication well and ensure that people receive it on time. However, there are some good practice recommendations that should be actioned. The information in medication `when required` protocols should be increased so that staff have clearguidance about when it is needed, and about the amount of time required between the next dose. Also consistency is required when staff hand write information onto the medication administration record and sign it. A witness signature helps to avoid any mistakes being made. Random inspection report Care homes for older people Name: Address: Lake View Manor 29-30 Pearson Park Hull East Yorkshire HU5 2TD three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Beverly Hill Date: 0 7 0 4 2 0 1 0 Information about the care home Name of care home: Address: Lake View Manor 29-30 Pearson Park Hull East Yorkshire HU5 2TD 01482447476 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Elaine Garland Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr G Davies,Mr G Abel care home 26 Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 Lake View Manor is a large Victorian property, which consists of two houses in Pearson Park in the west of the city of Hull. There is a bus route close by, a rear garden for residents to use and a small car park to the front. There are shops, pubs and health services close by. The home is registered to provide care and support to twenty-six people. The home has ten single and eight shared bedrooms arranged over three floors. The upper floors are accessed by a passenger lift. The house is well maintained and decorated and bedrooms are personalised. Care Homes for Older People Page 2 of 13 Brief description of the care home Communal areas consist of a main lounge on the ground floor, a dining area that leads onto a conservatory and a quieter lounge on the first floor. There is a shower room on the ground floor, two bathrooms on the first floor and a further bathroom on the top floor. There are sufficient toilets throughout the home within easy reach of bedrooms and communal areas. Information about the service is included in the homes statement of purpose and service user guide. The current inspection report is available in the home. The weekly charge for receiving the service is currently £359.50p. Care Homes for Older People Page 3 of 13 What we found: We visited the home from 10.30am to 16:30pm. During the visit we concentrated on three core areas of practice; health and personal care, complaints and protection, and management and administration. We checked several records and spoke to the registered manager and care staff. We also had discussions with some of the residents and two relatives. Choice of Home Not assessed at this inspection. Health and Personal care We looked at two care files during the visit and each contained a wealth of information about the individual residents. Assessments and care plans were obtained when completed by the local authority for people funded by care management. The manager also completed a pre-admission assessment to enable an initial decision about whether the home was able to meet needs, a reception assessment with basic details about contacts and people involved in their support and then a tick box skills assessment, that covers activities of daily living and graded how much support was required. Preference lists were completed for times of retiring and rising and dietary needs. There was a strength and needs page and goals that were important to the resident. The staff had also completed a, wish list for each resident. This included personal things the resident would like to do or places they would like to go, for example, one person wanted to go shopping down Newland Avenue - a thing they used to do in their past. Risk assessments were completed for specific areas and those seen covered the potential to fall, mobility and declining to take medication. The care file in its entirety was looked on by the manager and staff as the care plan, however, the information required by staff to care and support people was spread throughout the care file and would benefit from being more streamlined. A detailed plan of each care need and the tasks staff need to complete to meet the identified needs would ensure they had full information written down. This would enable staff to have clear guidance on how the person needs and prefers to be cared for. The home has a low staff turnover and staff members know the residents needs very well, however, a reliance on knowledge remaining with the staff team and not written down could result in important care being missed. The care documentation used had not been updated for many years and when new information was gathered about the resident, or needs changed, the documentation was added to. This meant that staff documented care in several different places and it could be confusing. The documentation process could be streamlined and simplified to ensure important information is in one place and is not duplicated. For example, as well as assessment information, staff documented in key worker notes, staff time analysis, general notes, daily notes, night care notes, a kardex system for information for the manager, GP visits page, accountability charts and other monitoring charts, a bath list, Care Homes for Older People Page 4 of 13 weight records, a file had just been started for nutrition and there were other one-off pieces of information and charts completed. A better recording system may free up more staff time to spend with residents. There was evidence that reviews of the care provided had taken place annually with the local authority, and at the six month stage, it was completed in-house with the resident and family present. We discussed with the manager and deputy manager how documentation and care planning could be improved. There was clear evidence that people had access to health professionals for advice and treatment. All residents were registered with a General Practitioner. Six surveys were received from health and social care professionals and comments were very positive about the care provided and the staff team. Some comments were, always helpful - the manager and staff always attend to nursing needs, patients seem happy and well cared for - there is a positive atmosphere, very caring environment - supportive and well informed staff who know their patients, residents are well cared for, respected and happy. Staff appear competent and helpful and they involve the service users in the home. Surveys received from ten residents all stated they received the personal and medical care they required either, always or usually. People spoken with told us they were happy with their care. Comments from discussions and surveys were, they look after residents and find time in their busy day for us, they do everything well, the girls look after me, staff are very good to us, he gets his medication on time and he is always smart, the staff are very, very kind, he had a bed sore when he first came here but it is healing now, I see the district nurse daily, and the optician and chiropodist, they carry on your independence and help you when you need it and I get my painkillers regularly. In discussions, staff members spoken with described ways in which they would promote the core values of choice, independence, privacy and dignity, make sure doors are shut and curtains are closed and always knock on doors, they have choices about clothes they wear and where to sit and we have no set times about getting up - some people do choose to get up early though. The home managed medication well and it was stored and administered appropriately. The medication administration records (MARs) had a front page with a photograph of each resident and information about any allergies, their GP, their medication, general health and any disabling conditions. The majority of MARs were correctly recorded with signatures when medication was received into the home and on administration, however, there were some recording issues that need to be addressed as good practice recommendations. Generally, there were two signatures when changes in medication had occurred via instructions from the prescriber but this was not consistent on all the MARs examined. A witness signature helps to avoid mistakes being made when instructions are hand written. Although the MARs did not evidence that remaining medication, ordered in a previous month had been carried forward onto the current MAR, the staff kept a running total in a separate book. This helped to audit medication and the system had been advised by the local pharmacy. Two residents had medication that was prescribed for use when they became agitated. They were not used very often and protocols were in place. However, the protocols need to have more information especially about the length of time between doses and they Care Homes for Older People Page 5 of 13 could detail the signs staff need to be aware of when the persons agitation is rising. Daily Life and Social Activities This area was not assessed but surveys received and discussions with residents and staff told us that activities and occupational stimulation was provided in the home and meals were enjoyed. Two relatives spoken with told us that they were always made to feel welcome, were offered refreshments and were kept informed. They confirmed there were no set times for visiting. Complaints and Protection The home had a complaints policy and procedure that was on display. The manager confirmed that any complaint was taken very seriously and addressed as soon as possible. Records seen evidenced this. The home had received one complaint in the last year. This was responded to thoroughly the next day. The manager completed a hygiene audit as a result and the incident was discussed in a staff team meeting to prevent a reoccurrence. To improve the process further, the complaints form could have a space for the complainants signature, to evidence they are satisfied with the outcome. The manager advised that the quality assurance and care review systems also check for any complaints so issues can be sorted out quickly. In discussions and surveys staff were clear about what they had to do if people raised concerns with them. Residents also confirmed they knew how to make a complaint and who to speak with if they were unhappy about anything, I would soon tell them if needed. Elaine (manager) is lovely - very fair and Id complain to the boss - Elaine. Fourteen staff have completed the local authority safeguarding of adults training - seven staff are still to complete the course. However, whilst waiting for the training, they have been given a booklet in how to recognise abuse and alert any concerns, policies and procedures have been discussed in induction and some have gained a national vocational qualification in care (NVQ) during which, a safeguarding module was completed. The manager needs to complete the more in-depth safeguarding training with the local authority specifically for managers and their referral role. Contact was made to secure a place on the next training course during the day. However, the manager had demonstrated their awareness of policies and procedures by completing an alert when required to ensure a specific resident received their personal allowance. In discussions, care staff were very clear about their role in alerting any incidents of abuse or poor practice. They told how they would check the resident and make them safe, record details, tell the person in charge and the manager, alert the local authority for them to investigate and notify the Care Quality Commission. Environment Not assessed at this inspection but parts of the environment seen were clean and tidy, and there were no malodours. All ten surveys received from residents stated the home was clean and fresh either, always or usually. Staffing Care Homes for Older People Page 6 of 13 Not assessed at this inspection but surveys and discussions with residents and relatives indicated people were happy with the care provided by the staff team. Most of the staff team commented that they would like to spend even more quality time with residents to sit and chat, take people out more and have more one to one time. There are four care staff on duty during the day and two at night. The manager is supernumerary. Staff members spoken with and surveys from them confirmed there was a training plan in place that covered mandatory and service specific training. The training was a mixture of in-house, distance learning and courses provided by the local authority. All nine surveys from staff stated they received the training required for their role and their induction gave them the information they needed. When asked what the home does well, staff comments were, staff training, new staff have immediate training, develop skills, offers support to new staff, staff training and support, and new and refresher training. Management and Administration The manager has worked at the home for twenty-three years, twelve of them as the manager. She has completed the Registered Managers Award and recently completed a management development programme. She has also completed training in deprivation of liberty safeguards, a mental capacity briefing and a medication training course. Staff members describe the manager as having an open door and always being there to support them, she is brilliant, she works us hard but is lovely and the manager is one in a million. Staff confirmed they received formal supervision, although the manager stated the amount people received had slipped, so in December a new supervision chart had been started and posted on her office wall so she can keep more of an eye on it. The manager and deputy manager both play a role in staff supervision. There is a good quality assurance system that consists of annual questionnaires to residents, relatives, staff and professional visitors and a range of regular audits. These include, medication, care files, activities, bedrooms, maintenance records and a weekly environment check. Some audits take place as a result of specific issues, for example something mentioned in a residents meeting or a care review, and there was evidence of an audit after the one complaint received. A plan is made of action that needs to be taken and the manager stated another audit would check that the action has resolved the issue. The system appears to be working as there are very few complaints and questionnaires have positive comments. Results of questionnaires are placed on the notice board for people to see them. We did not check finances thoroughly but discussed with the manager the system for safekeeping peoples monies. Generally family members manage finances but a small amount of personal allowance is held for safekeeping for those residents that request it. Individual records are maintained and receipts obtained for purchases. The administrator manages the system but always obtains two signatures for any transactions. There is restricted access to the finances and a system is in place for staff to obtain money from petty cash if the manager, deputy manager or administrator are not available for any reason. The home has a residents fund held in the bank and used to provide equipment and social activities for residents. The home continues to be a safe place to live in and work in. Staff participate in Care Homes for Older People Page 7 of 13 mandatory training, fire drills and fire alarm checks are completed, risk assessments are in place, equipment is serviced and the home remains well maintained. What the care home does well: What they could do better: People must have a comprehensive care plan that includes all their assessed needs and have clear guidance for staff in how to meet the needs. At the moment all the information is in a care file and not structured in any clear plan of care. The documentation used has not been updated for several years and staff have been adding to the original set of documents required for each resident. This means that staff have to record care in lots of different areas and it can be confusing trying to follow the information. The documentation could be streamlined to make things simpler. The staff manage medication well and ensure that people receive it on time. However, there are some good practice recommendations that should be actioned. The information in medication when required protocols should be increased so that staff have clear Care Homes for Older People Page 8 of 13 guidance about when it is needed, and about the amount of time required between the next dose. Also consistency is required when staff hand write information onto the medication administration record and sign it. A witness signature helps to avoid any mistakes being made. 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 set out on page 2. Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 13 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, 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 People must have a comprehensive care plan, which is evaluated monthly, that includes all their assessed needs and gives clear guidance for staff in how to meet the needs. This will provide staff with up to date information and prevent care from being missed. 31/07/2010 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 2 7 9 The care file documentation should be streamlined to make it easier for staff and to avoid duplication. Protocols for, when required medication should have more information about the need for it and the length of time required between doses. Hand written entries on the medication administration record should have full instructions and a witness signature. This will help to avoid mistakes. The manager should complete the more in-depth Page 11 of 13 3 9 4 18 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 safeguarding of adults training, specifically for the managers role in referral and investigation. Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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