Care Home: Lancaster Court

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• Chirnside House
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What the care home does well The emphasis in this service is on providing a positive experience for older people. Mr and Mrs Kershaw have owned and managed this service for approximately 23 years. The service has a history of being well run and the emphasis is on continued improvement so that residents live in a comfortable and well maintained service with staff and resident safety paramount. The service is family managed with some of their staff employed for many years. Residents and relatives have told us that the family are in the service Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 every day and make sure that they are all well looked after. Staff interviewed stated, “It has a homely attitude. The owners are always here and on hand. People feel part of a family unit” and “The owners are approachable”. Relatives canvassed for their views commented, “Lancaster Court is exceptionally well run and has caring, friendly staff” and “The home provides high quality, professional, friendly and consistent care Prospective residents are met by the quality manager who will visit them to carry out a full and detailed assessment prior to being admitted to the service. This ensures that the service is able to meet the individual needs of the resident. Residents receive a high standard of personal and health care from staff that are very familiar with their needs. Residents interviewed told us they were happy with the care and support provided. Residents stated, “They do discuss the care I need, staff come in to help me, they will put cream on my skin and the Dr has visited a couple of times. My key worker is very good, she helps to bath me, it’s lovely” and “Staff know how to look after me, I have a call bell if I need help”. Residents are encouraged to maintain family and friend links. Residents interviewed stated, “I have a friend who comes at lunch time and she has her lunch, friends are always offered a cup of tea, they don’t have special visiting times. I’ve had visitors in the morning and the evening” and “I tell my friends not to visit me after lunch as I have a nap”. A relative interviewed stated, “I come when I want to, staff make me welcome, I am offered a cup of tea”. Residents are protected by the service policies and procedures. Residents live in a very well maintained service, which provides a high degree of comfort. Residents have a highly trained team of staff to care for and support them. Relatives canvassed for their views commented, “The staff are excellent” and “The care staff are very attentive and efficient”. The service ensures robust pre employment procedures select staff that are suitable to care for the residents who live at Lancaster Court. The service is very well managed with the best interests of residents as their priority. Residents and staff benefit from the ethos, leadership and management approach of the service. What has improved since the last inspection? Resident contracts have been reviewed to ensure all the information is included. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 Medication policies and procedures have been updated and included the Commission pharmacy tips. Medication storage is at present changing to another area to ensure more secure storage. No complaints have been received in the past year and questionnaires completed by residents’ evidence a high level of satisfaction. The service has continued to redecorate all areas of the service including resident bedrooms to maintain a high standard of décor. New carpets have been fitted to hallways and stair cases to ensure residents comfort. The provider/registered manager arranged for a fire risk assessment to be carried out earlier this year and recommendations made have been implemented. The lift and shaft have been improved and new fire doors fitted throughout. Hot water mixer valves have been fitted to resident bathrooms. Additional training on nutrition and diets for older people has been included in the inducting for new staff this year. Staff will also have further training with regard to pandemic flu. The service has also put a mechanism in place to ‘track’ the policies and procedures to ensure they are regularly updated and revised to ensure good practice. What the care home could do better: It is recommended that all staff files should evidence proof of the individual staff members’ identity. Schedule 2 lists a photograph, copy of the staff passport, the person’s birth certificate and documentary evidence of any relevant qualifications of the person. This will ensure the person’s identity is authentic. Key inspection report CARE HOMES FOR OLDER PEOPLE Lancaster Court 21 Lancaster Court Southport Merseyside PR8 2LF Lead Inspector 0Mrs Margaret Van Schaick Key Unannounced Inspection 1st December 2009 09:00 DS0000005332.V378420.R01.S.do c Version 5.3 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. Lancaster Court DS0000005332.V378420.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 Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lancaster Court Address 21 Lancaster Court Southport Merseyside PR8 2LF 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) 01704 569105 jandjkershaw@btinternet.com Mr John Kershaw Mrs Joan Kershaw Mr John Kershaw Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 30 OP The service should employ a suitably qualified and experienced manager who is registered with the CSCI 18th December 2006 Date of last inspection Brief Description of the Service: Lancaster Court is a privately owned care service that is registered to provide residential care for 30 older persons. Mr John Kershaw and Mrs Joan Kershaw own the service. Mr Kershaw is the registered manager. It is pleasantly situated in the residential area of Birkdale village, which lies within easy reach of Southport and all the amenities that the seaside town offers. Accommodation consists of 30 bedrooms. One of which has an en suite facility. All bedrooms and public rooms are accessible by staircases and a lift. There is a separate dining room and a large sitting room with various seating areas. The service provides ramp access at the front entrance and additional ramp access is available to the rear garden areas. Garden furniture suitable for residents is available. The service has suitably adapted equipment to assist with the needs of the residents and a call bell system is in place throughout and in each bedroom. Car parking facilities are available at the front of the service. The weekly fees are £475. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means that people who use this service experience excellent outcomes. A site visit took place as part of the unannounced key inspection. It was conducted over one day by one inspector and lasted 8 hours. 28 residents were accommodated at this time. As part of the inspection process many areas of the service were viewed including some of the residents bedrooms. Care records and other documentation were also viewed. Discussion took place with residents, staff and visitors. Have your say about…. Questionnaires were delivered to the residents and their relatives by the Commission prior to the inspection. These were completed. A number of comments included in this report were taken from the questionnaires and interviews. Three residents were case tracked (their care files were examined and their views of the service were obtained). All of the key standards for older people were inspected. The inspection was conducted with the registered manager and provider John Kershaw and the quality manager Karen Malone. AN AQAA (Annual Quality Assurance Assessment) has been completed. The AQAA comprises of the self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including numbers and training. What the service does well: The emphasis in this service is on providing a positive experience for older people. Mr and Mrs Kershaw have owned and managed this service for approximately 23 years. The service has a history of being well run and the emphasis is on continued improvement so that residents live in a comfortable and well maintained service with staff and resident safety paramount. The service is family managed with some of their staff employed for many years. Residents and relatives have told us that the family are in the service Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 Page 6 every day and make sure that they are all well looked after. Staff interviewed stated, “It has a homely attitude. The owners are always here and on hand. People feel part of a family unit” and “The owners are approachable”. Relatives canvassed for their views commented, “Lancaster Court is exceptionally well run and has caring, friendly staff” and “The home provides high quality, professional, friendly and consistent care Prospective residents are met by the quality manager who will visit them to carry out a full and detailed assessment prior to being admitted to the service. This ensures that the service is able to meet the individual needs of the resident. Residents receive a high standard of personal and health care from staff that are very familiar with their needs. Residents interviewed told us they were happy with the care and support provided. Residents stated, “They do discuss the care I need, staff come in to help me, they will put cream on my skin and the Dr has visited a couple of times. My key worker is very good, she helps to bath me, it’s lovely” and “Staff know how to look after me, I have a call bell if I need help”. Residents are encouraged to maintain family and friend links. Residents interviewed stated, “I have a friend who comes at lunch time and she has her lunch, friends are always offered a cup of tea, they don’t have special visiting times. I’ve had visitors in the morning and the evening” and “I tell my friends not to visit me after lunch as I have a nap”. A relative interviewed stated, “I come when I want to, staff make me welcome, I am offered a cup of tea”. Residents are protected by the service policies and procedures. Residents live in a very well maintained service, which provides a high degree of comfort. Residents have a highly trained team of staff to care for and support them. Relatives canvassed for their views commented, “The staff are excellent” and “The care staff are very attentive and efficient”. The service ensures robust pre employment procedures select staff that are suitable to care for the residents who live at Lancaster Court. The service is very well managed with the best interests of residents as their priority. Residents and staff benefit from the ethos, leadership and management approach of the service. What has improved since the last inspection? Resident contracts have been reviewed to ensure all the information is included. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 Page 7 Medication policies and procedures have been updated and included the Commission pharmacy tips. Medication storage is at present changing to another area to ensure more secure storage. No complaints have been received in the past year and questionnaires completed by residents’ evidence a high level of satisfaction. The service has continued to redecorate all areas of the service including resident bedrooms to maintain a high standard of décor. New carpets have been fitted to hallways and stair cases to ensure residents comfort. The provider/registered manager arranged for a fire risk assessment to be carried out earlier this year and recommendations made have been implemented. The lift and shaft have been improved and new fire doors fitted throughout. Hot water mixer valves have been fitted to resident bathrooms. Additional training on nutrition and diets for older people has been included in the inducting for new staff this year. Staff will also have further training with regard to pandemic flu. The service has also put a mechanism in place to ‘track’ the policies and procedures to ensure they are regularly updated and revised to ensure good practice. 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 Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.2 Page 8 order line – 0870 240 7535. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 9 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 Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 10 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): OP6 is not applicable. OP 1, 2, 3, 4 and 5 were assessed. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service carries out a detailed and comprehensive pre admission assessment to ensure that they identify prospective residents’ needs prior to admission. This ensures that the service is able to meet the individual needs of the resident. EVIDENCE: Prior to admission prospective residents can visit Lancaster Court. This gives them time to meet residents and staff and view what the service has to offer. The service also provides short term stays for people who wish to take up this facility. Prospective residents are fully assessed prior to admission. The Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 11 quality manager visits the resident and carries out a full assessment of their needs. This ensures sufficient information is collated so that an informed decision can be made as to whether the service is suitable for the resident or not. The admission pack evidences sufficient information is collated prior to admission. All three residents case tracked had full and detailed information about their care, health and social needs in place prior to admission. It was evident from the documentation viewed that individual needs have been identified and discussed. From that information risk assessments are carried out and in place for the individual resident on admission to the service. Their care plans are commenced on the day of admission. Therefore staff have the information they need to provide the specific care for the individual resident. Residents interviewed about the admission process told us it was a positive experience for them. One resident interviewed stated, “My son found this for me, it’s marvellous, it really is, honestly” and “It was recommended. I asked if I could come and have an interview and when I was shown this room, I said yes please, I want this room now”. Relatives interviewed about the admission process stated, “Karen went to the hospital and looked at my mother to see if she was suitable, I had already given her information about my mother. It was a positive experience. They were just great. I was given a wad of information about the home, it was recommended. That was why I came. We have signed a contract. Coming here was like an oasis in the desert” and “My sisters niece sorted it out, we had been round ten homes before finding here, it is so pretty, It’s an ideal home to live in”. Contracts for residents were observed on residents care documentation. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 12 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): OP 7, 8, 9, 10 were assessed. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive a high standard of personal and health care from staff that are very familiar with their needs. EVIDENCE: All three residents had their care plans in place when they were admitted to the service. The care plans were set up following a very detailed assessment of the individual residents needs prior to admission. Discussion had also taken place with the resident and relatives prior to admission about their individual needs as evidenced in care documentation and residents interviews. The care plans viewed identified all of the residents care needs. They were up to date and evidenced regular reviews had taken place during their stay to Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 13 ensure all information held on the care plan was relevant to the individuals needs. Residents, relatives, key workers and manager have all signed to agree the care planned. The care plans viewed showed they were person centred and provided a holistic approach to individual care. The documentation covers many areas such as residents’ normal routine, time they like to get up, cup of tea or not, where they like breakfast and other meals, where do they like to spend their time in their bedroom or lounge, if they like to be checked at night. Direct care needs includes assistance needed with washing and dressing, hearing aids help, oral hygiene assistance, putting on spectacles, mobility aids, prompting for toilet, incontinence aids, bathing, hoist and preparing for bed. The care plan identifies in great detail exactly how a resident needs the support and assistance of care staff. Where they are able to manage independently this is recorded also and maintaining independence is encouraged. The care plans evidenced when any new changes occur. Residents canvassed for their views gave positive responses. One resident commented, “The home provides good personal care, they always listen, nothing is too much trouble”. A risk care plan is also in place and covers many areas such as, going out alone, carrying ID, kettle in room use, visitors, finances, pattern of day (can they plan their own routine), any agreed use of restraint, smoking, fire emergency, able to self respond or not, evacuation, using the lift, meals, hot drinks, choking risk, medication, falls, hot water taps, bathing, pressure areas, weight, moving and handling. These have been signed and dated by the resident, their representative, social worker, key worker and manager. A full social history is sought and recorded. One resident had refused to give this information on admission but the quality manager told us, “a little information is now coming out a bit at a time and this is recorded”. Hobbies and family involvement are also recorded. Residents interviewed confirmed they were happy with the care provided. Residents interviewed stated, “They do discuss the care I need, staff come in to help me, they will put cream on my skin and the Dr has visited a couple of times. My key worker is very good, she helps to bath me, it’s lovely” and “I have a care plan, staff know how to look after me, I have a call bell if I need help. I see the chiropodist regularly every 6 weeks”. Families interviewed told us they were very happy with the care and support provided to their relative. Relatives interviewed stated, “Staff keep me informed, I think they manage my mother very well, she is happy here and content. I have seen the care plan; I get a ‘tick off’ list once a year to tell me they can cope with mother. I like it I’m very happy with mother here” and “You couldn’t wish for a better home”. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 14 Mr Kershaw told us that the medication policies and storage is being improved. We looked at the new policies and procedures file with regard to medication and also noted that the Commission ‘pharmacy tips were also in evidence in the file. Mr Kershaw told us that he has found the website to be invaluable as the Commission website is up to date and easy to access. We looked at the medication trolley and this was well organised. The stock in use was up to date and there was no storage of old stock. The service has a good system of medication returns with records evidencing the returns and pharmacist signature. Controlled medication is secure and records viewed showed correct procedures were being followed. The quality manager organises the medication. She told us she checks the stock and then orders what is needed. When orders arrive she checks them in and then deals with any discrepancies right away with the pharmacist or Gp practice. Aberdeen’s (medication records) were clear, easy to follow and evidenced medication coming in, date of receipt, and staff signature. The Aberdeen’s were signed for at each transaction. All residents interviewed confirmed they received their medication on time. Staff who administer medication have up to date training. A full risk assessment document for residents who self medicate was viewed. None of the three residents’ case tracked self medicates. The service is planning to move the medication storage to a small locked storage room where it will be more secure. They plan to store all medication in this room including the medication trolley. Mr Kershaw asked if he could store the blister packs on shelves in the locked medication room. Clarification was sought from the Commission pharmacist who advised that we would expect them to fit a locked cupboard inside the medication room for this storage. Eye drops were kept in the fridge and temperatures are recorded each shift to ensure medication is stored correctly. Aberdeens evidence individual photographs of residents, which makes for easier identification. A list of staff who administers the medication and their signatures and initials was in place. We looked at the Aberdeens for the month of November. There were no discrepancies. Residents interviewed confirmed they received their medication on time. The service has a homely remedy policy and procedure with information on what medication can be given. The service was in the process of writing to Gp’s to gain their permission to administer the homely medication identified. Night staff have access to homely remedies. Residents who have GTN spray and inhalers self medicate and have theirs by their bedside. It is apparent through care documentation that residents are consulted about how they wish their health and personal care to be delivered. Residents’ privacy is promoted through the caring and supportive approach of the staff. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 15 Staff were observed engaging with residents in a respectful and friendly manner. Residents were observed to receive visitors in their own rooms and health professionals and others are able to see resident in the privacy of their own rooms. All of the residents were well groomed and appropriately dressed during the visit. A relative canvassed for their views was happy with how residents were cared for. They commented, “It’s dignified, relaxed and caring. It is a non institutional atmosphere, family run with very good staff”. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 16 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): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged and supported to live their lives as they wish within their abilities. EVIDENCE: Residents at Lancaster Court can live their lives as they please within their abilities. Residents are consulted at the pre admission assessment process with regard to their wishes and this consultation continues throughout their stay. Care plans were updated to reflect their wishes. Residents interviewed confirmed this. Care plans reflect the individual routines of each resident. The service provides regular activities suitable to residents needs. These include, exercise class, various visiting entertainers, bingo and quizzes. Information with regard to the planned activities for the month of December is on display and events for resident’s guests to be invited to be displayed so that Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 17 visitors to the service can see what is planned. Church representatives visit the service regularly to visit individual residents and Holy Communion is provided weekly for those residents who wish to participate. A church representative was visiting a resident during the inspection visit. Residents are encouraged to keep in touch with family and friends. The care documentation evidences their wishes with regard to family input. Relatives and other visitors were observed visiting residents during our visit. There are no restrictions on visiting although residents themselves have placed some restrictions with their own visitors. Residents interviewed stated, “I have a friend who comes at lunch time and she has her lunch, friends are always offered a cup of tea, they don’t have special times. I’ve had visitors in the morning and the evening” and “I tell my friends not to visit me after lunch as I have a nap”. A relative interviewed stated, “I come when I want to, staff make me welcome, I am offered a cup of tea”. Lancaster Court promotes mealtimes as being a social occasion where residents and their guests can meet up and engage in conversation whilst enjoying their meals. One or two residents prefer to have some of their meals in the privacy of their bedrooms and this is accommodated where wished. One of the mealtimes was observed by us and we saw that residents enjoyed their meals whilst socialising in a relaxed and friendly manner. No one was rushed. Staff provided support where needed. They were discreet and unobtrusive. Residents care documentation evidence their choices as to how they wish to live their lives. Residents and relatives interviewed confirmed that residents were able to make choices. One resident interviewed stated, “I choose when I want to get up and go to bed”. Residents and their relatives were very happy with how the service is run and all gave positive views. Residents interviewed were very happy with the meals served. Residents interviewed stated, “It’s like a top class restaurant, a three course lunch every day. Porridge, prunes and a pot of tea for breakfast, they give you choices, it’s lovely. I get better meals here than I did at home” and “The food is excellent, they know I like fish. The gentleman comes round each day to ask what we would like. I eat a big breakfast, cereal, pot of tea, bacon sandwiches and prunes or grapefruit. I like what I get at dinner. I can get something different if I want. They are very good with cups of tea”. One visitor stated, “The food is very, very good. I have stayed for dinner, where do you get sherry served with your meal? They ask visitors to stay for a meal. They never refuse anybody”. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 18 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): 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. Residents are protected by the service policies and procedures. EVIDENCE: The AQAA told us that the service had a full complaints procedure and during the visit we observed copies of the complaints procedure were attached to the rear of resident bedroom doors. The complaints log was viewed and it evidenced three complaints had been raised. All complaints had a record of investigation and outcomes were recorded for each. The Commission have been kept informed. All of the residents except one canvassed for their views confirmed they knew of the complaints procedure. One resident interviewed confirmed they know of the complaints procedure and stated, “I have never had to complain, it’s like living in a top class hotel”. A relative interviewed stated, “If I had any concerns, I’m sure Karen would take it up right away”. The service does not hold any residents money. A valuables book is now in place and this evidenced when valuables have been held on the residents behalf. Receipts are evidenced to show the valuables have been returned to the resident or their families. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 19 The service has a copy of the local adult protection procedure. The service also has their adult protection procedure. This was viewed. Management is fully aware of how to deal with any concerns that are raised. The service has shown that when needed to, they will make a referral to the appropriate agencies and keep the Commission informed at all times. Staff have attended training to ensure they are familiar with the procedures. Staff interviewed confirmed they attended training and staff files evidence this. Senior staff interviewed were knowledgeable and aware of the adult protection procedure. Through discussion with management it is apparent that they are familiar with the procedures also. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 20 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): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a very well maintained service, which provides a high degree of comfort. EVIDENCE: A tour of the service took place including all floors and some of the resident bedrooms. The AQAA told us that the service has a full maintenance programme and it was evident that the service is well maintained to a very high standard. Every room is beautifully decorated. Landings on stairs are homely and in some areas chairs are in place for residents to use when they go up and down the stairs. Bedrooms and public rooms and stairways were fully carpeted. Resident bedrooms contained many of their own personal Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 21 items, which made them very homely. The service is warm and fresh throughout with no odorous smells. The service is also very clean. Residents interviewed told us they were comfortable living at Lancaster Court. Residents interviewed stated, “What a beautiful place” and “I love my bedroom, I can go out into the garden and go all around the garden. The room is cleaned every day, there is always someone popping in to see your okay and my laundry is cared for, it’s a lovely life”. Two visitors to the service told us they were very impressed with how the service is cared for. Visitors stated, “It is very comfortable and spacious. The gardens always look lovely” and “They keep it so lovely it is always fresh and clean”. The front of the house was well lit and welcoming. The porch and hallway were beautifully decorated, and Christmas decorations were on display throughout the service including resident bedrooms. The large lounge is open plan, warm and homely with several seating areas for residents to choose from. The dining room is carpeted and dining tables with upholstered chairs were set up to provide residents lunch. Contrasting table cloths, matching napkins, place mats, matching crockery, cutlery and flower arrangements were in place. The dining room is traditionally decorated including wall lights and was warm and homely. Residents look comfortable and relaxed in their surroundings. There was plenty of comfortable armchairs placed around the service for residents and their visitors to use. The atmosphere in the service was very friendly and relaxed for residents and their visitors. Gardens are mature and very well maintained providing a pleasant outdoor environment for residents to use. Flower pots, trees and shrubs are in abundance and all healthy. There are many seating areas for residents and their visitors to use. Residents are able to easily access the gardens. Following a fire risk assessment this year the service has been upgraded to include their recommendations. The lift and shaft have been improved and all of the fire doors have been replaced throughout. The lift services all floors and residents are able to access their bedrooms easily. New carpets have been fitted to the top floor and stairs. Radiators are covered. Stairs and landings have new carpets and grips. Ramps provide easy access to outdoors. The laundry is in the same building as the service. The floor is waterproof and walls are painted. The washing machine has a sluice facility and red disposable foul laundry bags are in place. One tumble drier was in place with a large capacity. Clean laundry is stored separately in another room in individual baskets for each resident. The service has individual trolley skips for Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 22 dirty linen dependent on type and is colour coded, which helps promote good infection control. Hot water mixer valves have been upgraded in the bathrooms, which helps to ensure safe water temperatures for residents use. The kitchen was bright, clean and well organised. One large freezer and two large fridges were noted in the food store room. The fridges and freezers showed plenty of food including fresh vegetables and fruit, tinned and packet goods etc. Fresh vegetables and food were delivered during the visit. Salmon and various quality meats and foods were in abundance. The floors were screed and walls painted. Fresh fruit was on display in the dining room for residents to eat. We spoke with the chef and he told us that he was up to date with mandatory training. This was confirmed though the training matrix we viewed. Daily, weekly and the weekend schedule of cleaning was viewed. Equipment on view was clean and looked well maintained. All surfaces were clean including cookers. Fridges showed fresh food stored was dated and covered. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 23 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): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a highly trained team of staff to care for and support them. The service ensures robust pre employment procedures select staff that are suitable to care for the residents who live at Lancaster Court. EVIDENCE: The staffing rota evidenced which staff worked each day. The rota showed that sufficient staff were on duty on the day of the visit. The registered manager and quality manager are on duty most days. A shift manager is on duty each day shift to ensure supervision at a senior level is provided. Senior managers are also on call and they check the service by telephone each evening to speak with the senior person on duty to ensure the service is running well. One staff interviewed stated, “Karen telephones each evening to check everything is okay” Sufficient housekeeping staff are on duty to provide a high standard of cleanliness and the chef and cook provide a very well balanced diet to all residents. Staff were noted to be very calm, organised and patient with residents during the visit including at mealtimes. Staff interviewed told us that Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 24 although they were busy they felt that at no time was residents care ever compromised. We always have enough staff on duty. One staff interviewed stated, “Agency staff are used if needed. We always try to get someone who is familiar with the residents and the home”. Residents interviewed told us that they were very happy with the support and care provided by staff and stated, “It’s unbelievable, staff are always smiling. When you are ill and feeling down they always smile, they don’t come in with a grumpy face when they are answering your bell, they smile” and “I like the atmosphere in the place, I have never heard a cross word between the staff and the people who live here, I’m very happy”. One resident canvassed for their views commented, “Staff are all very efficient and I think they are a wonderful team”. The AQAA informed us that nine of the care staff has attained the NVQ Level 2 in care. Some are qualified to a more senior level. Therefore this exceeds the standard expected. Staff interviewed confirmed they had the NVQ qualification. Staff files evidence that pre employment checks have been carried out prior to staff commencing work including written references and police checks. Staff files also evidence application forms with previous work experience documented. The induction programme is evidenced in staff files and staff interviewed confirmed they had received their induction. Staff also confirmed they had attended all mandatory training plus other courses since being employed. Staff files evidenced training certificates. Each staff file also evidences a training and development plan and supervision notes evidence regular supervision takes place. One or two of the newer staff files did not hold a photograph of the staff member or a copy of their passport. The service told us that they had been advised this was no longer necessary. As it was clear that identification was brought in to enable police checks to be carried out prior to employment we have advised the service to hold on to a copy of these documents and have a photo taken of the new staff employed. One staff interviewed confirmed their identification was checked and stated, “I had my staff interview with Karen. I completed an application form and police checks were carried out before I started”. The training matrix for this year was viewed and evidenced the training already carried out and the remaining training planned for the month of December. Courses carried out this year include health and safety, manual handling, fire safety, 1st aid, infection control, abuse, medication, dying and death, nutrition, equality and diversity, mental capacity and risk assessment. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 25 Staff interviewed confirmed that they had attended training during their employment and told us that they had sufficient training. One staff interviewed stated, “I have NVQ 3 and I’m up to date with all my mandatory training, they always make sure that we have our training up to date. We get to choose other training also”. Staff interviewed told us that they enjoyed their work, felt residents were well cared for and had regular supervision and support from senior staff and management. Staff interviewed stated, “We have supervision meetings monthly or more. I love it. I just think it is well set up. We have staff meetings but they are smaller ones rather than have all staff attend. We are definitely well supported” and “The residents are well looked after here. Every morning we have a handover. On a Wednesday we have a sit down for an hour in the afternoon and we chat about various things like strokes etc”. Families interviewed told us they were happy with how staff manage their relatives care and stated, “Staff are very approachable, they are very good and manage my mother well” and “Staff are very attentive”. Families canvassed for their views commented, “The staff are excellent” and “The care staff are very attentive and efficient”. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is very well managed with the best interests of residents as their priority. Residents and staff benefit from the ethos, leadership and management approach of the service. EVIDENCE: Mr and Mrs Kershaw have owned and managed this service for approximately 23 years. The service has a history of being well run and the emphasis is on continued improvement so that residents live in a comfortable and well maintained service with staff and resident safety paramount. Mr Kershaw Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 27 keeps up to date with mandatory and other training. The training matrix evidences this. The service is family managed with some of their staff employed for many years. Residents and relatives have told us that the family are in the service every day and make sure that they are all well looked after. Staff interviewed stated, “It has a homely attitude. The owners are always here and on hand. People feel part of a family unit” and “The owners are approachable”. Relatives canvassed for their views commented, “Lancaster Court is exceptionally well run and has caring, friendly staff” and “The home provides high quality, professional, friendly and consistent care”. Residents told us that they were able to communicate with the manager, quality manager or shift manager on a daily basis. They had no concerns at all about raising anything. Staff told us that they found senior management approachable and had they any concerns they felt they would be dealt with. Everyone we spoke to found the ambience of the service homely and relaxing. The service has attained the Investors in People Award again this year. This award is re assessed every three years to ensure quality is maintained. The service also arranges for an independent quality assurance company to visit each year and carry out a quality audit. We looked at the published results and summary of the report, which gave the residents overall views of the service. Views were all very positive. Residents are also regularly canvassed for their views in other ways including residents meetings. The last of which was in November this year. The minutes of this one and previous meetings viewed showed which residents attended and subjects discussed. Subjects discussed included, the social act, meals, security, Christmas décor and laundry. The manager and staff interviewed told us they do not hold large staff meetings as it suits the service and staff better to have regular meetings in small groups. Staff interviewed confirmed regular small meetings were held. The quality manager carries out regular supervision with records kept. Some of these were seen in staff files. The service also continues to ensure that managers carry out ‘shift checks’. The duty manager always carries out audits of each shift each day to ensure the service is being managed well and to identify where her input is needed. The evening checklist was viewed for the month of November 2009. This covers all aspects of care. We viewed the records made and all are different each day. We observed handover notes re care are also made. These were also signed by staff. None of the residents has money held by the service. Residents have lockable storage in their bedrooms. A valuables book was evidenced. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 28 The AQAA told us that all health and safety checks and servicing had been carried out since the last inspection visit. Some of these certificate checks were viewed including, the lift, bath lifts, hoist, gas, fire alarms, exits, emergency lights, call systems, maintenance record, electricity, Legionella testing and hot water checks. All were up to date. Accident records were viewed for one or two residents and these had been completed correctly. The service is knowledgeable regarding reporting diseases and injuries. All mandatory training is up to date for staff and a full induction programme is provided for each new staff member. This provides an induction to skills for care standard. This was evidenced in staff files, staff interviews and the training matrix. Risk assessments have been carried out for all safe working practices. Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 4 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X X X X 4 4 4 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 X 4 Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 30 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. Refer to Standard OP29 Good Practice Recommendations Lancaster Court DS0000005332.V378420.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. 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