Care Home: Lakeside House

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What the care home does well Up to date information about the home is available for people to help them decide if the home is the right one for them. People have their needs assessed before they are admitted to the home. This helps the care home to decide if they are able to meet those needs and offer the person a place at the home. Care plans are in place that identify how service users` needs should be met. This provides guidance for staff to follow to help ensure a consistent approach. Health care needs are met by staff within the home and staff who are part of the wider community health services. Medication is managed appropriately. The privacy and dignity of individual service users is respected by the staff who work at the home. Activities are available for people to take part in. Visitors are welcome in the home. Nutritionally balanced meals and regular refreshments are provided to service users throughout the day. A system is in place to respond to complaints. The home refers appropriately to the local authority on issues of adult protection. Staff are recruited properly. Staff training is provided to help them understand their roles and to do their jobs. The manager demonstrates leadership within the home. The quality of the service provided is monitored for improvements. Service user finances are managed appropriately. Staff benefit from regular supervision. The home is well maintained. One relative told us "I am very pleased with the care (my relative) has received and also support to myself." What has improved since the last inspection? There are planned reviews of care that include service users and their relatives. This means that people are involved and consulted about how their needs will be met. Care plans include detailed information and instructions for staff in respect of the administration and management of medicines to be taken when required. Staff who are new to the service are provided with an induction programme. Staff training and supervision is provided. Staff who work at the home told us "Had loads of training, just finished infection control, bed rail and moving and handling." and "Good team work, good organisation, good future. It is brilliant." What the care home could do better: Supplies of medication occasionally run out before the month end because 28 days supply are not always prescribed for all regular medication. Medication Administration Records should be checked after each administration to make sure that all records have been fully completed. Review policies to identify if service user choices are limited or restricted unnecessarily in any way. Staffing levels may not always be sufficient to meet some service users` needs for close observation. Staffing levels and staff deployment must be kept under review to ensure that service users needs are met at all times. The manager should register with the Care Quality Commission as soon as possible. One relative told us "The staff do not appear able to build relationships with the person needing care and lack understanding in dementia." We were also told "I feel that some company policies make it difficult to offer client personal choice or client based care." Key inspection report Care homes for older people Name: Address: Lakeside House Lakeside Lakeside House Darlington County Durham DL1 5TH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jean Pegg     Date: 2 9 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Lakeside House Lakeside Lakeside House Darlington County Durham DL1 5TH 01325286000 01325361253 lakeside.darlington@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross OPCO Ltd Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: the maximum number of users who can be accommodates is 67 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, maximum number of places, 67 Dementia - Code DE, maximum number of places, 67 Physical disability - Code PD, maximum number of places 12 Date of last inspection 2 8 0 4 2 0 1 0 67 0 12 Over 65 0 67 0 Care Homes for Older People Page 4 of 25 Brief description of the care home Lakeside House is a purpose built care home which is able to provide both nursing and residential care to people with dementia. The home also has a unit for younger people with physical disabilities. All bedrooms have en-suite facilities and each unit has its own dining room and lounge areas. There is a private car park for visitors to use. Fees range from £490 for private clients and £428 for clients funded by the Local Authority. For private dementia nursing clients the fees are £610 per week. Please contact the manager for further details. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was completed over three visits between 15 and 29 June 2010. The inspection was completed by two compliance inspectors and one pharmacy inspector. Before we visited the service we looked at all the information that we had about the service. This included surveys sent to us by people who work at the home and the relatives of people who live at the home. We received three surveys from people who are relatives of people living at the home and five surveys from people who work at the home. When we visited the home we looked at documents and records held by the home, we talked to people who live and work at the home and we walked around the home to make sure that it was clean, safe and comfortable. After each visit we told the manager about what we had found. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: Supplies of medication occasionally run out before the month end because 28 days supply are not always prescribed for all regular medication. Medication Administration Records should be checked after each administration to make sure that all records Care Homes for Older People Page 8 of 25 have been fully completed. Review policies to identify if service user choices are limited or restricted unnecessarily in any way. Staffing levels may not always be sufficient to meet some service users needs for close observation. Staffing levels and staff deployment must be kept under review to ensure that service users needs are met at all times. The manager should register with the Care Quality Commission as soon as possible. One relative told us The staff do not appear able to build relationships with the person needing care and lack understanding in dementia. We were also told I feel that some company policies make it difficult to offer client personal choice or client based care. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported to make an informed choice before moving into the home by receiving detailed information about the service, following an assessment of need. Evidence: The statement of purpose and service users guide had been updated to reflect staff changes in the home. The information was available in the entrance foyer of the home, for any visitor to access. There have been no new admissions to the home since our last inspection visit. We checked the assessment records for someone who had been readmitted to the home from hospital and found that they were satisfactory. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems are in place to ensure that the planning and delivery of care meets peoples needs in a dignified way. Evidence: We looked at a sample of care plans and found that they were satisfactory. They contained sufficient information to guide staff as to how individual service users needs could be met. The records we looked at showed that staff were in contact with other health care professionals for advice as to how to care for people. For example community psychiatric nurses. The service has made significant improvements in the handling of medication in the home since the previous pharmacist inspection in March 2010 and we noted that a pharmacist from the local primary care trust had been supporting the home to achieve this. Care Homes for Older People Page 12 of 25 Evidence: Medicine Administration Records (MARs) are now checked three times a day to ensure that all medication has been administered and fully recorded. During the inspection we looked at the current MARs and a number of medicines were counted and checked against the medication administration records. We found very few discrepancies although it was not possible to balance the quantities of Digoxin Liquid and Frusemide Liquid remaining with the administration records for one resident on the ground floor. We found two gaps on the MARs where medication administration had not been recorded or a non-administration code added. In both cases the medication was no longer in the monitored dose pack, indicating that administration had probably taken place, but had not been recorded. In addition, the quantities of medication received into the home, or carried forward from the previous month are now recorded on the MAR. This means that there is a complete record of medication in the home and allows administration records to be checked accurately against medication stocks. These findings indicate that people living in the home can expect to receive their medication as prescribed. A number of people living in the home who were prescribed medicines to be taken as required such as painkillers, laxatives and medication for agitation. Care plans were in place, with copies attached to the relevant MAR, which provide detailed guidance to staff on why the medication might be required, how to recognise that treatment may be appropriate,when to offer medication to each person and how much to give. This means that staff have sufficient guidance to give as required medication in the way intended by the doctor. We noted that one person was receiving medication covertly, mixed with drinks. The care plan contained a comprehensive record of the steps taken to involve relevant health care professionals, relatives and the local mental health team and included appropriate service user assessment and detailed practical guidance for staff. Full records of medication ordered and received into the home are maintained and stocks of medication packaged in cartons or bottles are counted daily to assist in stock control. However we were informed that for some medication such as nutritional supplements, the surgery would only issue 14 days treatment and not 28 days, and occasionally led to the home running out of supplies. During the inspection we noted that supplies of Fortijuice and Fortisip were recorded as out of stock for two people in the home and Mirtazapine dispersible tablets were not available for another resident for the last three days because of problems relating to supply by the pharmacy. All medication was securely stored within the appropriate temperature range in the treatment rooms and medicines fridge. Care Homes for Older People Page 13 of 25 Evidence: During our visit we noticed that staff were respectful towards the service users they were caring for. Assisstive technology has also been installed to help staff respect the privacy and dignity of service users who may be on timed observations. The views of relatives about the care provided differed. For example one relative told us I am very pleased with the care (my relative) has received and also support to myself. another said they could Get to know the individual better. Have a key worker who begins to understand the individual. Have patience and learn how to get the best out of their individual needing care. and The staff do not appear able to build relationships with the person needing care and lack understanding in dementia. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain a good lifestyle through the provision of a variety of activities, relaxed routines and accessibility to family and friends who are welcome to visit. People can enjoy a nutritionally balanced diet and regular refreshments during the day. Evidence: The manager told us that she has experienced some difficulty in recruiting someone to manage activities within the home. Although there is no one designated to this role we did observe that the care staff did make time to facilitate activities. We also learned that the handyman had initiated two new activity groups, one for gardening and one for D.I.Y. On the day of our visit, a group of people were going out on the bus to visit a local ice cream parlor. There was also evidence of people watching the world cup football games. The fixture lists were prepared and displayed by staff for people to see. During our visit we noticed a number of visitors present. The dining rooms were nicely presented and we observed refreshments and snacks being served during the day. Menus are planned to provide a nutritionally balanced meal and food supplements are generally available for those who need them. Care Homes for Older People Page 15 of 25 Evidence: These are some of the responses made by the three relatives that returned surveys to us. We asked Do the care service respond to the different needs of individual people? One person said Always and one person said Usually We then asked Does the care service support people to live the life they choose? One person said Usually and one person said Never We were also told I feel that some company policies make it difficult to offer client personal choice or client based care. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to make their concerns known and know that they will be responded to. People can be confident that any issues relating to adult protection will be responded to appropriately in accordance with local authority procedures. Evidence: There have been no formal complaints made to the home since out last inspection visit. In our survey to relatives we asked Do you know how to make a complaint about the care provided by the care service if you need to? All three relatives said Yes We also asked Has the care service responded appropriately if you or the person using the service have raised any concerns? One person said Always and one person said Usually. All five staff who returned surveys to us also confirmed that they knew what to do if someone had concerns about the home. The management of the home have shown that they know how to make referrals to the local authority adult protection team. They have also participated in adult protection meetings chaired by the local authority. The home have experienced a number of service user on service user altercations that have resulted in adult protection strategy meetings. The management of the home also inform the Care Quality Commission when these incidents occur. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a clean and pleasant environment that is well maintained. Evidence: The home is clean, tidy and nicely presented. Internally, furnishings are to a good standard. The dining rooms were decorated with fresh flowers that one of the service users arranges each day. Externally the grounds are kept tidy and gardens and patio areas were very colorful, decorated with plant pots and hanging baskets. There were no unpleasant odors evident in the home. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not always have their needs met due to the number of staff available at certain times during the day. Good systems are in place to ensure that suitable staff are recruited to care for people in the home. Evidence: At the time of our visit, the home had twenty two service users in residence. The nursing unit, which is on the first floor, operates with one qualified nurse and two carers for ten service users. Down stairs in the residential unit there is one senior care assistant and two carers for twelve service users. The majority of incidents reported by the home to the Care Quality Commission relate to people in the nursing unit. This might indicate that staffing levels are not always sufficient to maintain the level of observation required for some people, to prevent incidents occurring. In addition to care and nursing staff, the home employs a manager and deputy, an administrator, catering and housekeeping staff and a handyman. The home ensures that there is a qualified nurse on duty at all times. Both the manager and deputy manager are qualified nurses. The staff qualification report that we were shown identifies that 58 staff have a National Vocational Qualification in Care Homes for Older People Page 19 of 25 Evidence: Care at level 2 (NVQ) and 16 have a qualification at level 3. Three staff are currently registered to work towards achieving their NVQ award. We checked the recruitment records for staff recently employed by the home and found them to be satisfactory. The appropriate checks had been carried out including employment references and criminal record bureau checks. New staff are also guided through an induction programme to help them settle in. Staff have received a lot of training since our last inspection visit. For example training in dementia care, infection control, deprivation of liberties and leadership. The staff we spoke to confirmed that they had received training. In our staff survey we asked people to give us examples of what the home did well. We were told Training and supervision. and Had loads of training, just finished infection control, bed rail and moving and handling. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear leadership is demonstrated within the home and staff are supported through the provision of regular supervision and training. Good systems are in place to monitor the quality of the service provided. Evidence: The home has appointed a manager. The manager is a qualified R.M.N. holds a management qualification and is experienced in managing care homes. The manager has not yet applied to register with the Care Quality Commission. We looked at some of the quality assurance reports that the home completes for example medication audits, catering audits and regulation 26 visit reports. The home have been asked to send us copies of the regulation 26 reports completed until October 2010. The home are complying with this request. The manager has sent out surveys to relatives of service users to gain their opinion of how the service is operating. These completed surveys were looked at during out last random inspection visit that took place 28 April 2010. Care Homes for Older People Page 21 of 25 Evidence: Service user finances managed by the home are looked after within an umbrella bank account held with a high street bank. The home holds receipts for purchases made on behalf of service users. We spoke to staff who confirmed that they were now receiving regular supervision. We also checked the supervision documents held by the home. These are some of the comments made by staff that we spoke to. Ive had a few supervisions, had a fair bit of training, positive experience. I enjoy what I do, I like it, it is getting better. and Ive had a few supervisions this year, very helpful. Done quite a few training courses recently. Good team work, good organization, good future. It is brilliant. We looked at a sample of maintenance checks and service contracts and found that they were all in date. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 9 Support should be obtained from the Primary Care Trust and the community pharmacy to review the quantities of regular medication prescribed to help prevent running out of supplies before the month end. Medication Administration Records should be checked after each administration to make sure that all records have been fully completed. Review policies to identify if service user choices are limited or restricted unnecessarily in any way. Staffing levels and staff deployment must be kept under review to ensure that service users needs are met at all times. The manager should register with the Care Quality Commission as soon as possible. 2 9 3 4 14 27 5 31 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 25 of 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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