Care Home: Lancaster House

What the care home does well The owner and Registered manager were warm and friendly in their approach to residents and visitors. One resident’s visitor said, “All the staff were approachable, friendly and always had the resident’s interests first.” Lancaster House is able to provide accommodation to 13 residents with mental health needs. Residents live in clean, homely surroundings and one resident said, “The home is kept clean, they help me to look after my room and keep it pleasant.” Staff were seen to be caring and supportive towards residents and said they felt well supported by the owners and management. Staff supported some residents to clean their rooms and some residents have a key to their room. We asked residents about their views of the staff. These are some of their responses; “They assist me in keeping physically and mentally well.” And “The staff help me greatly when I am not well”, “They are marvellous and respect my need for privacy”. “They are friendly and always put us residents’ first.” One of the owners completed the AQAA before the inspection visit and in response to the question what do you do well responded, “We provide our residents with a safe, caring and homely environment for people recovering from mental illness who could not live independently that meets their physical and social needs. Staff and residents who come from other homes always comment on the friendly and relaxed atmosphere of the home.” Lancaster House advise the CQC of any event or incident that impacts on the health or well-being of residents, for example, accidents or incidents experienced by residents. In the AQAA the manager does look at areas they could improve upon to improve the quality of life for the people living at Lancaster House. What has improved since the last inspection? Since the last inspection the owner/manager have used the services of an external company to assist them in the following areas; employment law and health and safety policies. To safeguard residents and offer some degree of protection the manager has made improvements to the recruitment and selection procedures. Recruitment files included two written references, a completed job application form, copies of identification, qualification certificates, police check and complete employment history were obtained before staff commence work unsupervised at Lancaster House. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 The management have increased the number of staff working at the home to allow more escorted trips out to take place. Staff have increased the amount of day time activities provided to keep residents occupied and to increase their social skills. One person said, “I like going to the gym now and then but it is hard to make myself go.” Residents have been encouraged to do their own laundry and to prepare their own light meals and snacks to encourage their independence. The manager has updated the Statement of Purpose and the Service User Guide. What the care home could do better: We looked at three care plans. These should provide additional information to detail what staff have to do to support the individual person. Where skills like prompting and encouragement were used, this was not identified in the support plan. Staff need some further guidance to complete care plans in a more person centred way. Key inspection report CARE HOME ADULTS 18-65 Lancaster House 10 Eccles Old Road Salford Gtr Manchester M6 7AF Lead Inspector Elizabeth Holt Unannounced Inspection 26th October 2009 10:45 Lancaster House DS0000008366.V378189.R01.S.doc 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 home adults 18-65 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 House DS0000008366.V378189.R01.S.doc Version 5.3 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 House DS0000008366.V378189.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Lancaster House Address 10 Eccles Old Road Salford Gtr Manchester M6 7AF 0161 737 1536 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) cairn.lancaster@btinternet.com Mrs Audrey Kelly Mr A Kelly Mrs Audrey Kelly Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Physical disability (13) of places Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Physical Disability - Code PD The maximum number of service users who can be accommodated is: 13. Date of last inspection 13th October 2008 Brief Description of the Service: Lancaster House is a registered care home providing support, personal care and accommodation to 12 residents with mental ill-health and one resident who also has a physical disability. The home is privately owned and registered to Mr and Mrs Kelly, and Mrs Kelly is the registered manager of Lancaster House. Lancaster House is a three storey, detached house, which has been converted from two semi-detached properties. The home is situated in a residential area of Salford, within easy access of public services and amenities. We were told the fees charged for accommodation at Lancaster House ranged from £335.26 to £426.71 per week. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This visit was unannounced, which means the owners, manager and staff were not told we would be visiting, and took place on 26th October 2009 commencing at 10.45am. The inspection of Lancaster House included a look the information received by the Care Quality Commission (CQC) about the service since the last inspection in October 2008. We also sent the owners a form before the visit for them to complete and tell us what they thought they did well, and what they need to improve on. One of the owners completed this. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Lancaster House was inspected against standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to staff and to residents to obtain their views of the service, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We found our information at the visit by observing care practices, talking with people staying at Lancaster House; talking with the owners and staff. A sample of care, employment and health and safety records were seen. The main focus of the inspection was to meeting the needs of residents and how sure that they had the skills, training needs of residents and to follow up inspection. understand how Lancaster House was well the staff were supported to make and supervision needed to meet the the requirements made at the last The care service provided to two residents was looked at in detail to help form an opinion of the quality of the care provided. A brief explanation of the inspection process was given to one of the owners and to one of the senior care workers at the start of this visit. Feedback was given to both owners/Registered Manager at Lancaster House. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 6 Since the last inspection at Lancaster House we have not received any complaints, concerns or safeguarding matters. What the service does well: What has improved since the last inspection? Since the last inspection the owner/manager have used the services of an external company to assist them in the following areas; employment law and health and safety policies. To safeguard residents and offer some degree of protection the manager has made improvements to the recruitment and selection procedures. Recruitment files included two written references, a completed job application form, copies of identification, qualification certificates, police check and complete employment history were obtained before staff commence work unsupervised at Lancaster House. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 7 The management have increased the number of staff working at the home to allow more escorted trips out to take place. Staff have increased the amount of day time activities provided to keep residents occupied and to increase their social skills. One person said, “I like going to the gym now and then but it is hard to make myself go.” Residents have been encouraged to do their own laundry and to prepare their own light meals and snacks to encourage their independence. The manager has updated the Statement of Purpose and the Service User Guide. 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. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard 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 2 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. Prospective residents receive information about the home and have their needs assessed; this enables them to make an informed decision about moving into Lancaster House. EVIDENCE: Information provided in the AQAA showed that, “Our new residents have an assessment prepared by their external care team in order that we may ensure that our home will suit their needs and that they will fit in with its current residents.” People who are thinking about going to live at Lancaster House are invited to visit the home, stay for a meal and then overnight for a short time before moving to the next stage, which would be a six-week trial period. The managers invite representatives of the new resident’s care team, friends and family to visit Lancaster House and discuss the placement. Resident’s spoken to said ,”Even though we have our differences, even in the football teams we support, we all get on really, we are like a family.” The manager considers that Lancaster House has; “ a pleasant and harmonious Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 10 atmosphere, which shows that our residents get along with each other remarkably well. Our trial period ensures that residents have the time to fit-in to their new home before making the decision to stay long-term”. One person said that they were “really pleased when the chance for a place at this home came up because they knew it would help them and it is doing. I feel settled and happy here. I came to visit a few times before I eventually moved in here and I couldn’t wait to move in.” Seven people returned surveys and in response to the question did you receive enough information about this home before you moved in so you could decide if it was the right place for you six residents said yes and one person said, “No” but said they were asked if they wanted to move into Lancaster House. We looked at the pre admission information held on file for two people who had moved into Lancaster House since the last visit. The information provided included a detailed assessment prepared by their external care team; this gave the staff the information they needed to know to start writing a plan of care. An assessment had been completed by the local authority and then by the deputy manager so that the care plan could be written. The assessment process is to check that the home has the appropriate facilities to meet the needs of the person and that the staff has the necessary training to meet the person’s needs. This long term assessment was detailed and included the persons’ likes and dislikes. We looked at the updated statement of purpose and service user guide provided at Lancaster House. The information in these documents tells people about the home and what services are provided to them. The manager said these were given out when a person showed it was likely the offer of a place would be made at Lancaster House. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): 6, 7, and 9 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 were supported to make choices about their lifestyle and are supported to maintain their independence. Care plans provided some detail of residents’ care needs and risk assessments were in place to ensure the safety and well being of residents. EVIDENCE: Three care plans were looked at, these generally showed the needs and support needed but some care plans did not always show in detail what staff have to do to support the individual person. Examples of good practice were seen where the use of prompting, encouraging, needs reminding by staff were used. For one person the daily statement showed the person was prompted to have a warm, bubble bath, however this was not recorded as part of the support needed in the care instructions. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 12 We discussed the need to specify the detail in the assessment /problem/need so staff has the clear information for how to support a person and manage their behaviour as necessary. When support was needed the care plan did not always give the detail as to how and when the support needed should be taken. The care plans showed a person centred approach although this could be developed further. We talked about the need for staff to have some further training around the care plan system in place. The manager stated some of the difficulties were around making this model fit around adults, not older people which it appeared more suited to. Some care plans did not include the persons’ signature to show their involvement with care plans although people spoken to were aware of their plan of care and one person said ,”I know what it written about me in the staff’s folder.” There was some evidence of records from members of the multi disciplinary team. Information was recorded following meetings with psychiatrists, and community psychiatric nurses into the care plan. In the AQAA the manager stated that; “Our residents are encouraged to take part in the day to day running of the home such as preparing snacks, shopping for the home, feeding the birds, tending to the garden, putting out the dustbins, cleaning and tidying, washing clothes for example.” Residents spoken said, “It’s good to help in the running of the home.” There was information on file about the specific care needs of individual residents. There was important information in the assessment to help and assist staff to manage some aspects of resident’s behaviour. During the visit observations were made of staff using strategies to motivate people to address personal hygiene needs and activities around the home. One staff member stated they felt the care plans could be improved upon; “I think we would make the care plans better by thinking about a key worker system so that we had responsibility for individual people’s records.” Care plans included risk assessments and some strategies to minimise risks were put in place. Risk assessments and care plans were reviewed on a regular basis. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 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 have choices to take part in appropriate activities and have their rights respected. EVIDENCE: The manager said that some residents attend part-time work or visit day centres, drop-ins and art classes. The in-house basic skills class has shown improvements in the personal development of some of the residents. Some residents went to Llandudno in September for a week’s holiday and two people spoke positively about this trip. Another person said, “I am hoping to go on holiday next year, I think it would be great.” Staff told us, “I have worked for this service for several years. I would not work here if I wasn’t satisfied with the service provided. The owner/manager is Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 14 always looking for ways to improve, when necessary, the everyday life styles of our residents”. A computer was provided to support residents who showed an interest in developing their computing skills. The activities each person takes part in are based on their interests, abilities, needs and goals. These are recorded in part but these could be linked more to the care plan to show the activities are meeting the person’s identified goals. One person wrote, I do my own washing and clean my own room, I would like to do more.” One person goes out to buy food when their mood allows this; one person said how much they liked their work in a garden centre one day a week. Another person has started a creative writing course and was doing a lot of writing work at the moment. Residents spoken to during the visit were positive about the food provided. They said they had a choice of meals and could eat what they wanted. Some of the comments made in relation to food were, “the meals are good here,” “We get a choice of what we want to eat,” “I have never been hungry here; they even made me scampi because I fancied some.” Staff had received training in basic food hygiene to make sure safe practice was carried out when they were preparing or serving food. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): 18, 19 and 20 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 arrangements in place supported residents to have their healthcare needs met. Medication procedures were sufficient to protect the interests of residents. EVIDENCE: Residents were supported by Community Psychiatric Nurses or social workers from the mental health services. Appointments are made and arranged as necessary with mental health consultants. Residents appeared well dressed and during the visit staff were heard encouraging people in a dignified manner to have their personal needs met. Records of visits from healthcare professionals were in place and residents care plans showed their individual health care needs were recorded and monitored. The manager wrote in the AQAA “We support our residents in order that they can attend their appointments with their healthcare providers such as chiropodists, dentists, GP’s etc. Some of our residents feel the need to be escorted to external appointments.” Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 16 Information provided by Lancaster House to the Commission indicated, “residents’ health and wellbeing are monitored on a regular basis. We work in partnership with GP’s, consulants and CPN’s to ensure an holistic approach to healthcare. Residents are weighed every month and action is planned to ensure a healthy lifestyle”. The registered manager confirmed that all residents had received annual healthcare checks. Residents are offered yearly health checks with their GP although some residents see their GP far more often because of the medication they have been prescribed. Residents are encouraged to self administer their medication if their consultant or CPN agrees. We looked at a sample of the medication administration records and the medicines that belonged to that person to check that residents were being given their medicines correctly. These were completed appropriately with no unexplained gaps. We told that the newly recruited manager audits the medication system in place and observes staff practice periodically, this includes medication administration and this would be part of their development supervision. In the past year the managers have noted that GPs are initiating the offer of a health check for all residents rather than wait for staff at Lancaster House to request it. Some residents are frightened of visiting doctors, dentists and opticians. Those who feel unable to attend alone are escorted by members of staff. On the day of this visit a resident had been supported to attend an appointment and he said, “I wouldn’t go to have my blood taken probably unless someone came with me, it’s a great help.” Staff said that, “The service provides care and understanding and promotes independence, choice”. We were also told by staff that they feel, “We provide a good and caring environment”. “Both Lancaster and Cairn House are very caring residential homes which provides a good service to the user”. On the last inspection a recommendation was made in relation to providing photographs on the medication administration charts to promote best practice and to aid in identification. During this visit there was evidence of photographs on each person’s medication chart. A further recommendation that had been addressed was in relation to handwritten medication on the medication records, the person writing out this detail signs the record and this is also signed and verified by a second member of staff. To enable an audit to be undertaken of the medication received and administered the amount of medication received, the date it is received and the signature of staff on receipt needed to be indicated on the medication records. This detail had been maintained on the medication records and also Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 17 on a separate record. Advice was given that this detail can all be indicated on the medication records for ease. Medication which is no longer required or is discontinued and is returned to the pharmacy needed was recorded as received by the pharmacist. An individual risk assessment was in place for people who manage their own medication to make sure they are safe. The risk assessment is reviewed now and again to make sure these residents continue to be able to take the medicines safely and correctly. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): 22 and 23 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 know how to complain and are confident they could raise concerns/complaints. EVIDENCE: Lancaster House has a written complaints procedure in place. The AQAA indicated that the managers have not had any complaints made in the last 36 months. The manager and staff spoken to did recognise the need to ensure that residents understand that it is their right to make a complaint and would support someone to do this. Two residents said they were aware of who to speak to if they were unhappy, many naming particular staff or the owner managers as possible contacts if they were not happy with anything. One staff member said they would quite easily approach the manager if they had any concerns involving residents or other staff members. Since the last inspection in October, 2008 at Lancaster House we have not received any complaints, concerns or safeguarding matters. From the seven surveys returned, all seven people stated they knew how to make a complaint and with whom they would speak to if they were not happy. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 19 Recruitment procedures are in place to safeguard service users and following a requirement made at the last inspection these have been improved to safeguard people living at Lancaster House. Adult protection procedures are in place. Responses from the survey showed that the care staff and manager treat them well. A review of a sample of training records showed that most staff had received safeguarding training. We were told this is in house training from a DVD and then staff have signed to say they have watched this. A copy of the Local Authorities safeguarding procedures was available for the staff to access and we were told staff were aware of what to do if an allegation of abuse was made. A staff member spoken to was clearly aware of what course of action they would take in the event of an allegation of abuse. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): 24 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 live in a home that is well maintained and provides a comfortable, environment. EVIDENCE: The home was clean, homely and pleasantly furnished. In the AQAA the manager stated that ,“ Residents are free to invite their friends and relatives to visit them at the home. Residents are encouraged to personalise their rooms and are involved in choosing the room’s layout, furnishings and decorations.” One visitor said, “I am always made to feel welcome and it’s good for my son that his room and the home is kept clean.” Residents spoken to were pleased with their bedrooms and from comments made they were proud of them. Residents who filled in surveys stated the home was “Always” or “Usually” clean. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 21 The AQAA indicated that “We have redecorated and re carpeted several rooms in the house in the last twelve months.” Comments from residents who responded in the surveys were, “I am very content living here at Lancaster House,” and “We have a bedroom and sitting room of our own, we enjoy being here and I think they do well at everything.” The owner managers said that there have been no major changes to the house since the last inspection. On that inspection the environment was described to be good. The manager stated that, “Visitors often comment on the home’s relaxed and homely atmosphere.” This was confirmed by a visitor and the atmosphere was relaxed during this visit. We reported at the last visit that the lighting in the combined lounge and dining room is not particularly bright which may make it difficult for residents to read or take part in other activities. There appears to have been no changes made to the lighting, the owner confirmed the use of appropriate energy saving bulbs and said he would monitor this. Two residents spoken were satisfied with the lighting and did not consider this affected their ability to read. The standard of kitchen hygiene was good following a recent assessment of the kitchen by environmental health. A recommendation for good practice was made for the staff toilet to provide paper towels rather than a communal hand towel to minimise any risk of cross infection. The garden is well maintained and accessible for residents to use. A gardener attends to the garden on a weekly basis. Patio furniture was available for residents and their visitors to sit out, weather permitting. A summerhouse in the garden is used by residents to smoke outside. One of the residents said, they “liked to feed wild birds in the garden and carries out tasks around the house when needed”. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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): 32, 34 and 35 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. Staffing arrangements, recruitment and training ensured that people are supported safely. EVIDENCE: When we asked in the AQAA what the home does well in relation to staffing the manager responded, “Our staff have a good relationship with our residents and there is a mutual feeling of friendship between the two groups. On the whole our staff do a very good job in meeting the day to day needs of the residents while promoting a homely and friendly atmosphere.” Comments from the residents’ surveys showed that the staff at Lancaster House are caring and friendly towards them. Staff spoken to confirmed that, “They did their best to promote a friendly and relaxed atmosphere within the home and that they worked well as a team.” The information we received before the inspection visit identified that some staff have skills in arts & crafts, hairdressing, music, relaxation techniques, Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 23 etc. these staff are supported and encouraged to use these skills. The manager told us that the results of a recent survey by questionnaire gave very positive feedback about the staffs conduct and abilities, from residents, their advocates and relatives. Comments from residents about the staff included; when asked do staff treat you well one resident said “They respect me as a person and assist me with any needs.” Another person said, “The staff are very good staff, they are thoughtful, kind and caring”. In response to the question in the survey, “Do the care staff and managers listen and act on what you say, six out of seven people said “Always” and one person said, “usually.” A visitor said, “The staff are all smashing, they help you in any way they can.” Information provided in the AQAA showed that out of eleven permanent care workers, nine staff hold a National Vocational Qualification in Care or Health and Social Care. Staff told us that “The home is run very well it has good atmosphere”. Staff received induction training. Copies of induction training carried out were held on some of the newly recruited staff files. The manager stated that induction provided to all new staff was recommended by TOPPS England which includes the common induction standards. We looked at the recruitment files for three most recently recruited members of staff following two requirements made at the last inspection with regards to recruitment. The files were organised and included the necessary paperwork. Since the last inspection the recruitment practices had improved and POVA first and Criminal Records Bureau (CRB) checks had been made for these staff. The owner advised that due to delays in the receipt of CRB’s some staff had started work following receipt of the POVA first but they had amended the duty rotas and these people only shadowed a permanent member of the staff team. We looked at the record which told us the training staff had received. We were told in the AQAA and by the manager that some staff were due to receive more updates in basic skills. We discussed that more staff should undertake first aid training particularly as they can regularly be working alone. Staff were seen supporting people in an appropriate way and showed a knowledge and understanding of their needs. One staff member spoken to said they felt that “staff training was quite good because we are encouraged to keep up to date with any changes, we have had some input in relation to the Deprivation of Liberty. When I started here I worked closely alongside the manager for two weeks.” Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): 37, 39 and 42 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 home is being run in the best interests of the people who live there and their health and safety and that of the staff are promoted and protected. EVIDENCE: It was clear from conversations and observations made that the owners/ Registered Manager create an open and friendly atmosphere in the home and that resident’s visitors and staff find them approachable. One resident’s relative commented that, “I am so relieved that my son is here and is settled and happy, everyone is helpful, approachable and supportive and I have the knowledge he is safe and doing well.” Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 25 A quality assurance system is in place to provide residents, relatives and professionals with an opportunity to make their views known about the service provided at Lancaster House. In August 09 a quality assurance survey was analysed. Comments included, “I like it here in the home, put it this way I would not have stayed here for 15 years if I did not like it here, it is great here.” Another comment was, “My brother has lived at Lancaster House for well over 10 years and during that time he has had a lot of help and support in his times of need. My brother could not live in a better place with his illness.” The manager stated that when they had obtained the views of people who use the service they then addressed any areas identified to improve the service provided. In the AQAA the service considered under what they do well is that, “The Registered manager has been in charge of the home for more than 20 years and has achieved great success in line with the aims and objectives of the “care in the community.” Lancaster House has employed a new manager since the last inspection who is working with the current manager (who is planning to retire) and owners to understand the business processes and, where possible, improve them. Some areas have already been improved for example in relation to recruitment, medicines management, risk assessments and staff training. Staff are able to obtain the skills, guidance and direction needed to support them in their role as carers. We were told that all staff have received one to one supervision and a sample of these notes were looked at. Regular Monday meetings are arranged and staff and residents’ views and opinions have been taken on board to assist in the development of the service provided at Lancaster House. Regular residents meetings are scheduled for future months. A sample of maintenance records were looked at including fire and gas safety. The records detailing the fire safety checks are up to date and fire drill training records demonstrated that staff had received fire drill training. Records showed that three most recently recruited staff had received fire safety awareness training. Water temperature checks were being carried out however there is only one bath tap with a thermostatic control valve, a discussion with the manager highlighted that they did not consider residents’ to be generally at risk and therefore these were not put in place for all water outlets. A good practice recommendation was made for thermostatic control valves to be fitted to all outlets to minimise any risk of scalding. The manager said that some staff have had updates in their training in safe moving and handling procedures, food hygiene and health and safety and there are plans for others to receive this training. This supports staff to do their jobs correctly and safely. A look at a sample of personal allowance records showed these were being appropriately managed. Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 26 Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.3 Page 28 Lancaster House DS0000008366.V378189.R01.S.doc NO Are there any outstanding requirements from the last inspection? 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 YA30 Good Practice Recommendations A recommendation for good practice was made for the staff toilet to provide paper towels rather than a communal hand towel to minimise any risk of cross infection. Staff need some further guidance to complete care plans in a more person centred way. The management should consider installing thermostatic mixer valves to all hot water outlets to minimise the risk of anyone scalding themselves. 2. 3. YA6 YA42 Lancaster House DS0000008366.V378189.R01.S.doc Version 5.3 Page 29 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. 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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