Care Home: Lambspark Residential Home

What has improved since the last inspection? The changes to the daily care notes alert senior staff and the Registered Manager to changes in a person`s health or well-being and ensure prompt action is taken to seek medical attention. Staffing levels have improved and sufficient care and ancillary staff are employed to meet the needs of those currently living in the home. General improvements to the environment continue including redecorating and refurbishment, automatic door closure to doors that are required to close in the event of a fire and window opening restrictors have been changed to a more robust type. What the care home could do better: Care plans should be reviewed with the person they have been written for and/or their representative to ensure they meet the person`s needs in a manner acceptable to them. Staff should record the leisure and social activities people have participated in to demonstrate how they have spent their day and to demonstrate the home`s good practice. Key inspection report CARE HOMES FOR OLDER PEOPLE Lambspark Residential Home 38 Merafield Road Plympton Plymouth Devon PL7 1TL Lead Inspector Jane Gurnell Key Unannounced Inspection 14th May 2009 09:30 DS0000003538.V375262.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lambspark Residential Home Address 38 Merafield Road Plympton Plymouth Devon PL7 1TL 01752 330470 01752 345126 lambspark@supanet.com 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) Mr Richard Wraighte Mrs Tracey Elizabeth Wraighte Care Home 36 Category(ies) of Dementia (36), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (36), Old age, not falling within any other category (36), Physical disability over 65 years of age (36) Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The following person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category, aged 60 years and over on admission- Code OP Mental disorder, excluding learning disability or dementia, aged 60 years and over on admission- Code MD(E) Dementia aged 60 years and over on admission- Code DE 2. Physical disability, aged 60 years and over on admission- Code PD(E) The maximum number of service users who can be accommodated is 36. 8th August 2008 Date of last inspection Brief Description of the Service: Lambspark is registered with the Care Quality Commission to provide residential accommodation and personal care, for up to 36 persons due to age and who may also have a dementia, a mental disorder and/or a physical disability. The home does not provide intermediate care and it is not registered to provide nursing care. Lambspark is a detached, three storey property situated in the residential area of Merafield in Plympton. The home has 2 double and 32 single bedrooms with en-suite facilities situated on three floors. A shaft lift provides access from the ground floor to the 1st and 2nd floors, and a stair lift provides ease of access over the two steps leading from the hallway to the shower room on the 2nd floor. A lounge room with dining area is situated on both the ground and first floors. Also on the ground floor is a small separate lounge with a conservatory attached available for use by people living in the home who wish to smoke. There is a call bell system throughout the home. The home has a garden with seating available and limited car parking is available in the grounds of the home. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 5 Weekly fees range from £305.00 to £450 and are according to assessment of the person’s personal care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, journals etc, all charged at commercial rates, and escort for hospital/GP appointments. Written information including information about additional charges is available for people considering going to live at Lambspark and for those who are resident. A copy of the most recent CSCI inspection report is available from the home. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star, good. This means the people who use this service experience good quality outcomes. This unannounced inspection was undertaken on 14th May between 09:30 and 3:50pm with a follow-up visit on 20th May to meet with the owner who was not available on the first day. The Registered Manager was available on both days of the inspection and she and her staff team assisted us throughout the visit. This inspection included a tour of the building, talking to people who live at the home and care staff working on the day shifts. A two-hour direct observation period was undertaken using the Commission’s Short Observational Framework for Inspection (SOFI) documentation. This enables us to directly observe the well-being of people living in the home and the quality of staff interaction. This observation was undertaken in the ground floor lounge room. We also looked at the care plans for 3 people, one of whom was newly admitted to the home, the recruitment and training files for 3 staff files, medication records and documentation relating to the servicing of equipment such as the fire alarm system. Following the previous inspection, Plymouth City Council’s Adult Safeguarding Team had raised concerns over the care of a person living in the home. These concerns were looked into and it was concluded that the care plans and daily care notes needed amending to alert staff more effectively about changes to people’s care needs and the action taken by staff to adder these needs. The owner and Registered Manager have made changes to the way people’s needs are recorded and the actions taken by senior care staff to seek further medical advice. These changes were reviewed through this inspection to monitor the success these had made. What the service does well: People said they were very happy living at Lambspark. Staff are well trained and were described as “lovely and “very kind and caring”. The home was found to be very clean with no offensive odours: those people spoken with said it was always this clean. Regular social and leisure activities provide people with stimulation and the opportunity to socialise with each other. Meals are nutritious and varied and the home cooked meals are enjoyed by all. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the 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 considering moving to Lambspark receive good information about the home in order to make an informed decision about whether it is right for them. Pre-assessment ensure people’s needs are known and planned for before they move to the home. EVIDENCE: Anyone considering moving in to Lambspark is invited to the home, along with their family or friends to meet the staff and the other people living in the home. A copy of the home’s Service User Guide (also called the home’s brochure) and scale of care fees are given to everyone moving into the care home to enable them to make a decision about whether the home is suitable for them. The pre-admission assessment for one person newly admitted to the home Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 10 was looked at and was found to give detailed information about the person’s needs and allowed the Registered Manager to prepare for their admission as specialist equipment and advise from the District Nurse was necessary with regard to the person’s health care needs. Two people who had recently moved to the home said their relatives had chosen the home on their behalf as they had been unable to visit: they said they were very pleased and had settled in well. They said staff had been very welcoming and caring. Lambspark Residential Home DS0000003538.V375262.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. People using the 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’s health and personal care needs are well met in a manner that respects people’s individuality and dignity. Medication practices are safe. EVIDENCE: Those people spoken with, and who could make an informed comment about the care and support they receive, said they were very happy and felt well cared for. Comments included, “it’s lovely here”, “I’ve settled in really well, I like it here” and “very nice, the staff are lovely”. Those people who were unable to directly comment appeared relaxed and contented; they were well groomed and staff interaction was seen to be gentle and respectful. The care plans for three people who had specific care needs relating to skin care and nutrition were looked at. These care plans set out a good description of people’s needs and the action required by staff to meet those needs. One person had recently returned to the home from hospital after a period of serious illness and his family told us they were concerned he was not going to Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 12 recover. However, they said they have seen a significant improvement in his health since returning home and they were very thankful for the staff’s care and attention: they believe his improvement is directly related to the quality of the care he has received since returning to Lambspark. There was evidence that the care plans had been updated and regularly reviewed each month but there was no evidence that these reviews had included the person themselves or their relatives. The Registered Manager said she and her staff discuss people’s needs with them and their relatives frequently and she was advised to make a record of this on the review form. Additional records included contact and visits from the GP, District Nurse, chiropodist and other health care professionals such as the dentist, and the outcome of these visits. These records allowed ease of monitoring medical intervention and each person’s health conditions. The Registered Manager explained that any changes to medication or health regimes are faxed by the GP to the home to reduce the risk of errors that may occur from taking instructions over the phone: this demonstrated good practice. A recent survey undertaken by the home included asking visiting health care professionals their views of the care and support provided at the home and the results were very favourable. Care notes are completed each day and were detailed and easy to read. As noted in the summary of this report, the owner and Registered Manager had reviewed their communication methods for taking action to meet people’s changing needs. This new system was seen in practice and was a simple system that alerted all staff to a change or event that required staff action, such as the need for a clinical sample, or contact with the District Nurse. This alert remained “active” until a member of staff had taken the necessary action. It also allowed staff to look back over the care notes to review the pattern of changes in someone’s needs that might indicate a significant medical or mental health deterioration. Medication records were looked at and these were accurately completed. Medication is stored safely and all medicines received into the home and returned to the pharmacy were recorded. Only the senior member of staff on duty administers medication, although all staff are provided with training in safe medication administration. On the first day of the inspection we saw the medicines being given out prior to lunch. The member of staff was seen to be safe and unhurried. There were no controlled drugs in the home at the time of the inspection, however they was additional safe storage should there be a need in the future. The Registered Manager said that people who become terminally ill may remain at the home if the staff and the District Nursing Service can continue to meet their needs. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 receive varied and nutritious home-cooked meals. Social activities are well planned and provide interest and stimulation for people. EVIDENCE: People said they look forward to and enjoy the musical activities provided almost every day. There is a variety of entertainers visiting the home each week, including a couple with a keyboard and who sing a selection of well known songs, a guitarist and an exercise session to music. Staff also facilitate daily activities such as card games, scrabble, listening to music and watching films. People were seen to be enjoying spending time in the garden and several people said how much they liked being able to access the garden from their bedrooms. A notice board in the hallway provides information about weekly events and displayed a selection of photographs of recent events including trips out of the home to local places of interest. A Newsletter for people living in the home as well as their relatives provides information about the running of the home and forthcoming social events. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 14 During the 2-hour observation period on the first day of the inspection, we saw people being consulted about what they would like to do. Several people requested to listen to music and chose the music they preferred. People were asked if they wished to go for a walk but those people in the “observation area” who were asked declined: others were seen enjoying being in the garden. It was noted that the daily care notes did not include information about how someone had spent their day and the Registered Manager was advised to record people’s involvement in the activities offered to give a better indication of the quality of the care and support they were receiving. People said how much they enjoyed the meals and this was seen at lunchtime on the first day of the inspection. People were offered a choice of two cooked meals, cottage pie or sausage casserole, with fruit crumble and custard for dessert. People were seen to be offered second helpings and one person who did not want a large meal was offered a selection of alternatives. The cook said that all meals were home made and cakes were baked daily. A record of individual food likes and dislikes was recorded as well as how much each person had eaten at each meal. For those people who were at risk of not eating or drinking enough an additional diet and fluid charts was completed to allow staff to monitor people’s nutritional intake more closely. People said their visitors were made very welcome and could visit at all reasonable times of the day. One visitor said he was encouraged to bring his dog with him as not only his relative enjoyed this but the other people living in the home did. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Lambspark and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. People are protected by the home’s policies and procedures, and by a robust recruitment process. EVIDENCE: Those people spoken with and who were able to comment about how they made any concerns known said all the staff, the Registered Manager and the owner were very approachable and they felt they could bring issues to their attention at any time. The owner and Registered Manager were described as very open and keen to resolve issues promptly. As noted at the start of this report, Plymouth City Council’s Safeguarding Team had been working with the staff to look at concerns over the care of someone living in the home. It was concluded that the daily care notes identifying people’s changing needs had not been used as effectively as they could have been in informing the staff to seek advise as necessary from the District Nursing Service. This had lead to a delay in seeking medical attention. The owner and Registered Manager have introduced an alert system to draw all staff’s attention to changes in care needs and places an obligation on each staff shift to act upon the changes noted. This alert system was seen in use in Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 16 each of the 3 care plans examined and demonstrated its effectiveness in prompt action being taken. The complaints procedure is included in the Service User Guide and includes the contact details for the Commission. A complaints and suggestion box has been placed in the main hallway to allow people to comment anonymously if wished about issues they wish to bring to the owner’s attention. The training records showed that all the staff had received both in-house training about the protection of vulnerable adults as well as that provided by Plymouth City Council. This means that staff will be able to recognise any signs of abusive or neglectful behaviour and know how to take appropriate action should they suspect someone is at risk of abuse. We made a random selection of staff personnel files and found that all the required checks including police checks and references had been completed correctly, ensuring as far as possible only suitable staff are employed. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lambspark is a spacious and comfortable home with sufficient facilities to meet the needs of those currently living there. EVIDENCE: Lambspark is a large building covering three floors. It is a very light building due to lots of large windows. There is a lounge room with a dining area on the ground and first floors: the lounge room on the first floor has extensive views across Plympton towards Dartmoor. There is a further lounge room and conservatory on the ground floor for use of people who wish to smoke. Bedrooms are provided over all three floors and many have pleasant views of the countryside. The bedrooms on the ground floor each have a tilt and turn style door that allows access to the grounds of the home. Those bedrooms looked at were very pleasantly decorated and it was obvious people had Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 18 brought personal items with them to make their rooms as homely as possible. All bedrooms provided en suite toilet facilities. Radiators are covered to reduce the risk of burns should someone come into contact with them when on, hot water temperature is restricted to reduce the risk of scalds and window openings are restricted to reduce the risk of accidents. Bedroom doors are fitted with Yale type locks which have a turn knob on the inside but require a key from the outside thus providing security for people’s belongings when they are not in their room as well as privacy when required. The majority of people had chosen not to use the locks, however, the senior staff on duty during the day and both night staff carry a master key to open the doors in the case of an emergency. The owner said that for those people who may not be able to manage this type of lock he would change it to one that was specifically designed for people with confusion. There are two shower rooms: one on the ground floor and one on the second floor. Both shower-rooms are very spacious and allow easy access for people with restricted mobility. On the 2nd floor there are two steps from the hallway to the shower room and chairlift has been fitted for those people who are unable to negotiate stairs easily. At the time of this visit there was no bath to offer people a choice of a bath or a shower and the Registered Manager said that the people living in the home had been consulted over their preferences before the shower rooms had been refurbished and the bath removed: all were in agreement that they preferred the ease of a shower. There is a garden at the rear of the home that is accessible via a ramp. It is enclosed and has a security lock on the gate. There is seating and shaded area for people to use in warmer weather. On the first day of the inspection people were seen to be enjoying the garden with assistance from staff. One person said how much they enjoyed being able to go into the garden from their bedroom and another said she enjoyed seeing the plants and flowers outside her patio doors. The home was well maintained and in a good state of repair. The owner said he was willing to consider enhancing the internal environment further in line with guidance from the Alzheimer’s Society so that corridors on each floor could be differentiated, and bedroom and toilet/bathrooms doors more individualised and easily identifiable. This would enable anyone with a dementia to have a better awareness of where they were, and to find their way around the home. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the 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 cared for by well-trained, caring staff, employed in sufficient numbers to meet the needs of people currently living in the home. EVIDENCE: People said the staff were very kind and caring and always came promptly indicating there are sufficient staff on duty. The Registered Manager said there was usually six care staff on duty in the morning, 4 care staff in the afternoon and evening with an additional member of staff from 4:30pm to 8pm and two waking night staff. The numbers did not include the Registered Manager when on duty. In addition the home employs a cook and housekeeping staff everyday of the week. The recruitment and training files for three members of staff were looked at. All contained the necessary pre-employment checks including two written references and a Criminal Record Bureau check to ensure as far as possible only suitable staff are employed. Each member of staff has a training profile identifying the training they had undertaken and whether updates were due. Staff had received training in dementia and mental health care, moving and handling, infection control, fire safety, first aid as well as National Vocational Qualifications in Care. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 20 Records indicated that staff receive regular 1:1 supervision from the Registered Manager as well as annual appraisals to monitor their work performance and identify their training and development needs. Daily handover meetings between each shift and regular staff meetings allow people to discuss the running of the home and ensure any issues are promptly resolved. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lambspark is a well managed home. The owner and Registered Manager have demonstrated their willingness to continue to review care practices and work with other health care professionals to ensure people receive a high quality service. EVIDENCE: The Registered Manager has many years experience of managing Lambspark Residential Home. She has obtained the Registered Manager’s Award and a National Vocational Qualification in Care at level 4, both of which necessitated her to demonstrate her knowledge and competence in managing services for older people. Both she and the owner are supported in managing the home Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 22 by an administrator allowing the Registered Manager to spend more time working alongside the staff in caring for people. The home has a formal quality assurance system to consult with people living in the home, their family and friends as well as visiting professionals such as the District Nurse. The results of the most recent survey in March 2009 showed a high level of satisfaction from all. The results of the survey have been summarised and the administrator said she was preparing the next Newsletter that will contain these results and the actions taken in response to suggestions made. Many of the people living in the home are unable to manage their own finances and the home offers safekeeping of money should they and their family wish. Records of money held were examined and these were detailed and contained receipts for all expenditure as well as evidence of the monthly check by the administrator: a copy of these records are sent to family members each month. Records relating to health and safety matters such as the servicing and testing of the fire alarm system and the lift and hosts were examined and these indicated equipment was maintained in safe working order. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations The care plans should be reviewed with the person they have been written for and/or their family. Staff should record people’s involvement in leisure and social activities. Lambspark Residential Home DS0000003538.V375262.R01.S.doc Version 5.2 Page 25 Care Quality Commission North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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