Care Home: Lansdowne Care Home

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What the care home does well The home is clean, bright and free from malodours. The are committed and experienced staff to ensure that the people who use the service are safe. The meals are good and the coordination and presentation of the activities are commendable. These have enabled people to engage. The practice of providing drinks and ensuring that a jug of water is available in all rooms is a good practice. The recordkeeping and all the activities seen during the inspection indicate how the manager is dedicated, knowledgeable and effective in her style of management. The consultations made through the home`s quality assurance system and through regular relatives` and residents` meetings are good practice. We feel that the people who use the service have the opportunity to give feedback, which would help improve the quality of the service. What has improved since the last inspection? The home has provided new carpets in the office, reception area and the hallway. Fire drills have taken place at nights, as required at the last inspection. From the tour of the premises and discussions with the deputy manager it was evident that the home had taken action to repair the damaged bathroom door on the ground floor. CARE HOMES FOR OLDER PEOPLE Lansdowne Care Home Claremont Road Cricklewood London NW2 1TU Lead Inspector Mr Teferi Degeneh Unannounced Inspection 25th September 2008 09:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lansdowne Care Home Address Claremont Road Cricklewood London NW2 1TU 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) 020 8830 8444 020 8830 8555 lansdowne.cricklewood@fshc.co.uk Four Seasons (No 10) Limited Natasha Lazovic Care Home 92 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (60) of places Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specified service user who is under 65 years of age may be accommodated in the home. The home must advise the registering authority at such times as the specified service user attains 65 years of age and vacates the home. Date of last inspection Brief Description of the Service: Lansdowne Care Centre is a purpose built care home. It opened in 1998. The home is registered to provide nursing care for a maximum of 92 older people. It is a care home owned by Four Seasons. The aim of the service is to be a centre of excellence offering a warm, homely comfortable and safe environment for all who live in it. The building has three floors with separate units on each floor. The reception, manager’s office, kitchen and laundry are all on the ground floor. Pembroke Unit has 28 beds and is on the ground floor. Merrion Unit has 32 beds and is on the first floor. These provide general nursing care for older people. The third unit, Kennilworth, provides nursing care for 32 older people who have dementia. Until 2006, the Kenilworth dementia unit operated under a separate registration but all three units have now been combined under one registration. There is one registered manager for the home, supported by a Deputy Manager. All bedrooms at Lansdowne are single and have en-suite facilities consisting of a toilet and a wash hand basin. There are two passenger lifts. Each unit has a choice of lounge areas as well as a separate dining room. Assisted bathrooms and shower rooms are provided within each unit. There are two attractive paved garden areas with a range of plants and shrubs. Seating is available for service users. Lansdowne Care Centre is near Cricklewood railway station and is well served by local shops and amenities. Brent Cross shopping centre is approximately a mile and half to the north of the home. The fees for the home range from £580-£850 per week depending on their individual needs. Inspection reports produced by the Commission for Social Care Inspection (CSCI) are available upon request from the manager or owner of the home or from the CSCI website at www.csci.org.uk. Lansdowne Care Home DS0000068281.V372103.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 2 star. This means the people who use this service experience good quality outcomes. The inspection was undertaken over a period of two days, starting at 9:20 am on 25 September and concluding at approximately 3:45 pm on 26 September 2008. The deputy manager was present throughout the inspection on both days. Mrs Jane Shaw, a pharmacist inspector and an expert by experience were invited to take part in the inspection process. Both the pharmacist inspector and the expert by experience were present on the first day of the inspection. An expert by experience is a person who has an experience of using a service, and who can give a better picture of what it feels to receive a service. The expert by experience came on their own and spent over four hours engaging with the people who use the service, the management of the home and the staff. Parts of the report produced by the expert by experience and that of the pharmacist inspector are used as evidence to support the judgements. The inspection activity undertaken by the lead inspector included a tour of the building, the examination of the residents’ files including care records, the examination of health and safety records, the viewing of staff rotas and discussions with and observation of people who use the service, care staff and the home’s management. Four relatives who were visiting the residents were also spoken to. Eleven feedback surveys, which were completed by people who use the service, were also considered as part of this inspection. The evidence collected through the surveys, discussions with the people who use the service, visitors and the staff showed that the people who use the service are well cared for. A relative commented that they are happy with the staff and the home. A resident wrote in the survey form: “I am very happy in the home because all the staff are very caring”. Another person who wrote in the survey form said that they had been suffering from bed sores before they moved to the home, but “due to the excellent care provided”, [they] were fully cured in a short time”. The expert by experience also made a positive observation when he stated: “I found myself looking at an immaculately clean facility [bathroom] without a trace of foul smell.” What the service does well: Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 6 The home is clean, bright and free from malodours. The are committed and experienced staff to ensure that the people who use the service are safe. The meals are good and the coordination and presentation of the activities are commendable. These have enabled people to engage. The practice of providing drinks and ensuring that a jug of water is available in all rooms is a good practice. The recordkeeping and all the activities seen during the inspection indicate how the manager is dedicated, knowledgeable and effective in her style of management. The consultations made through the home’s quality assurance system and through regular relatives’ and residents’ meetings are good practice. We feel that the people who use the service have the opportunity to give feedback, which would help improve the quality of the service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 7 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 Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. New residents are reassured that their admission to the home is based on the outcome of their assessment and the ability of the home to meet their needs. EVIDENCE: Fifteen residents’ files, which were selected randomly and examined, contain evidence of assessments completed by either the manager or the deputy manager. The home has also received information and assessments from social workers and health professionals for those people who are not self funding. The deputy manager explained the processes of admission. She said that once a referral is received the manager or herslf would visit the prospective resident and complete their assessment. It was clear from the discussions with the deputy manager that the home admits residents only if it believes that the needs of the persons referred can be met. The deputy manager stated that there have been occasions when the home did not admit new residents simply Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 9 because there assessed needs could not be met by the facilities and services available. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The risk assessments and care plans are good. These have enabled the people who use the service to identify their needs and to receive appropriate support. However, the medication administration systems in parts of the home are below the expectation of the people who use the service. EVIDENCE: Fifteen residents’ files, which were randomly selected, showed risk assessment and care plans have been completed and reviewed. The care plans are comprehensive with information about the residents’ needs and the procedures the care staff need to follow to meet the needs. For example, the care plan of one person has guidance for staff to “offer a drink at least 1000 – 2000 mls [millilitre] a day”. It was clear from the files that the care plans are reviewed at least monthly or more frequently as needed. Daily records are also updated regularly. A physiotherapist comes to the home to assess new residents and existing residents whose needs have changed. Discussions with the physiotherapist indicated that the she works closely with the residents to assess their needs and recommend appropriate equipment. The expert by Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 11 experience noted: “Physio [the physiotherapist] encouraged [a resident] to walk with the support of the frame. A few tiny steps up and down the room were taken. The exercise was repeated three times. I was informed that the woman would get [appropriate equipment] eventually.” Discussions with the deputy manager and an examination of the files revealed that the health and nutrition needs of each resident are assessed during admission and reviewed thereafter regularly. From the records and discussions with the staff and relatives it was evident that each resident has access to specialist medical, nursing, dental, pharmaceutical, chiropody services and care from hospitals. A resident and their relative, who were visiting, explained their satisfaction with the services of the home by saying that the resident’s conditions have significantly improved since they were admitted to the home from a hospital. They said the ulcers on their body have gone away, and the resident is now able to speak, which they were not able to do when they were admitted. The relative of the resident said, “They [the home] are marvellous; they brought [the resident] back from the dead”. A similar comment was made in the survey form completed by a relative on behalf of a resident. This stated that the person who uses the service had been suffering from bed sores before they moved to the home, but “due to the excellent care provided”, [they] were fully cured in a short time”. The residents’ files and discussions with the deputy manager confirmed that each resident has their own general practitioner, who visits them regularly. A relative wrote in a resident’s survey stating that the home deals with their concerns without delay. For example, they said, the staff called a general practitioner immediately when their relative was not well. Another visiting relative said, “I recommend this home to anyone”. The residents spoken to praised the staff. From observations and interviews it was noticed that the care staff interacted appropriately with the residents by ensuring their privacy, dignity and choice. The relatives made positive comments about the staff by saying that “The nurses are quite nice. The staff are caring. The staff treat residents like their families.” An observation by the expert by experience showed that the staff respect the resident’s privacy. Thus, the expert by experience noted: “The staff knocked at the door and asked for permission to enter.” The receipt, storage, recording, administration and disposal of medications on all the three units in the home were inspected. The home has comprehensive policies and procedures and these had been updated in 2008. Medicines are appropriately stored on all the floors. One of the medication fridges needed defrosting as the temperature was too low. It was noticed that on the first floor there were five or six boxes of an injection kept at room temperature when they should have been in the fridge. Controlled drugs were all stored in cupboards meeting the requirements of the Misuse of Drugs Act. These must be designated cupboards and not used to Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 12 store other items such as watches which we observed was the practice. Balances were all correct but we noticed that recording was untidy-names of residents were not on the top of the pages and there were frequently empty lines left and crossings out. There were some omissions in recording. For instance on the second floor we noticed that co-beneldopa -a medicine for Parkinson’s disease was not recorded as given for two nights on 8th and 9th September. When we counted the tablets left it seemed that one tablet had been given and not recorded and another had not been given at all. We noticed for two residents they did not have a supply of aspirin, perindopril and bendroflumethiazide-all for heart conditions on the first day of the cycle. The person in charge said that the pharmacist did not supply them in time. Another resident had gaps for citalopram and lactulose and another co-beneldopa one night. We noticed that paracetamol was prescribed regularly for several residents but that it was being given as required and only recorded when given. There was evidence of review of medication on the second floor by the GP and we were able to track to the doctor’s notes medicines which had been discontinued or dosages which were reduced. We noticed that warfarin was recorded correctly throughout the home and the latest results of blood tests kept with the MAR for evidence. There was sometimes some delay in these being received though from the hospital. Other tablets such as nitrazepam were also not recorded when carried forward from a previous month so we could not reconcile balances. We noticed on the first floor that an Oxygen cylinder was not secured in the clinical room. This could be a safety risk if it fell over. Lancets for checking blood glucose were those designed for self-testing and not professional lancets–to prevent the risk of transmission of blood borne diseases. On the first floor we noted that two residents were receiving both calcium tablets and calfovit sachets. On checking further it was noted that the GP had discontinued the tablets over a week ago but the residents were now receiving both. The tablets had not been stopped by the home. A resident was prescribed a weekly analgesic patch but there was no evidence of administration. Another resident was prescribed a morphine patch every 72 hours when needed but staff were administering it every 96 hours regularly. It was difficult to find evidence of regular monitoring for pain for these residents and we felt that there should be more clarity in instructions for pain relief and more evidence of monitoring. We audited omeprazole for several residents. For one there were 17 capsules left but from the signatures we would have expected 10. For another there were no records of receipts so we could not reconcile the balance. Weekly Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 13 alendronic acid was also not clearly marked out on the MAR so that nurses knew which day to give. On the ground floor there were clear records of discontinued medicines and dates when injections were due. We were able to audit warfarin and omeprazole and tamoxifen and both were accurate. Gaps were noted on the MAR sheet for ferrous sulphate on 10/9 and nystatin 16/9.The ferrous sulphate was not in the blister. There was evidence of monitoring blood glucose and not giving metformin when the blood level was too low and recording why. An audit of co-beneldopa for one resident showed that 35 tablets were left when we would have expected 31. This infers that tablets were not given but signed for. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The social and leisure activities provided at the home have enabled the people who use service to be engaged. The quality and presentation of the meals are good. The people who use the service have benefited from the availability of drinks in their rooms. EVIDENCE: Entertainments and activities are organised by a full time and part-time activities co-coordinators. From discussions and observations with the deputy manager and the staff, it was evident that care staff and a volunteer person also assist the residents during the entertainment and activity sessions. Each day there are three sessions of activities, that is, in the morning, afternoon, and evening, which the residents can participate in. From conversations with some residents and the activities’ coordinator it was clear that the residents are consulted about the type of activities they would like to be offered. The Activity programmes for each week are displayed in the dining rooms and reception areas. The staff also inform the residents the activities available for each day. An examination of the programme for the week starting on 22nd September 2008 showed that various activities such as paperwork, hairdressing, arts and crafts, games sessions, music and movement, outing to Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 15 St Agnes Young at Heart Club, musical evenings, reading sessions, poetry group, bingo, and films evenings are planned. On the day of the inspection some thirteen residents were observed taking part in the bingo games organised by the activities coordinators. Some of the residents were able to participate in the game independently while a few of the residents were supported by care staff and the activities organisers. From discussions with the deputy manager and the residents, and from observations it was evident that the residents can bring personal belongings to the home. The home has a four weekly rotating menu. The chef and the deputy manager explained how people choose the meals. They said that the staff ask the residents if they want the options on the menu or if they would prefer an alternative meal. The chef said that the home can provide meals that meet the cultural or dietary needs of the people who use the service. The expert by experience stated: “The food was simple, light and tasty.” A comment was made in a survey stating that a resident would like the home to provide ethnic food. A number of the residents said they were happy with the meals. The deputy manager and the chef also confirmed that they can provide ethnic food for a resident who wants it. The home also consults with the residents and relatives through their regular meetings. The food provided on the day of the inspection appeared to be nutritious and sufficient in amount. Observations showed that the people enjoyed their meals, which were served with drinks (water and juice). From the menus it was evident that the home provides breakfast, lunch and supper, and snacks and drinks at mid morning, mid afternoon and evening. We also noticed during the tour of the premises and conversations with the residents that a jug of water is always available in the residents’ bedrooms. The expert by experience and the inspectors noticed that staff were available to support during meal times. But we were concerned that the number of the staff available was not sufficient to allow each person to stay with a resident and give them the maximum care and time they would need to enjoy their meals. On one occasion the expert by experience had to call a member of staff to attend to the needs of a person who uses the service. From various records, for example, relatives’ meeting minutes and the visitors’ book it was clear that the residents are visited by their relatives and friends. Observations and conversations with the people who use the service and visiting relatives indicated that the residents are visited by their family, friends, and professionals. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that they are protected by the availability in the home of trained staff and satisfactory complaints and adult safeguarding policies. EVIDENCE: The visitors spoken to confirmed that they can speak to the staff and the manager if they have concerns. The home has informed the Commission for Social Care Inspection whenever there have been safeguarding issues. There is a complaints procedure. The complaints made to the home during the year in writing, and sometimes by email, were seen. These have been dealt with following the home’s procedure. From discussion with a number of people who use the service, relatives, and from the survey forms it is evident that the people know how and who to complaint to if they have a concern. The home has responded to some anonymous concerns made by people through CSCI. We are satisfied with the manner in which these have been handled. From the records it is evident that the staff have attended training on adult safeguarding. The home’s policy says it takes all incidents or allegations of abuse “seriously”. The staff spoken to gave good descriptions of and action they take in case of allegation. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The maintenance arrangements, the facilities and the cleanliness of the home make it a safe and comfortable place to live in for the residents. EVIDENCE: The home was clean, bright and free from malodours. The visitors and the residents spoken to said good things about the home. For example, a visitor said that they always found the room clean and tidy. They said they would recommend the home to anyone. A relative who assisted a resident to complete a survey wrote: “The Landsdowne Care Home is always very clean and tidy…” Another person who uses the service commented in the survey form: “This place is better than I expected”. There are appropriate facilities and equipment for the residents’ wellbeing. Records and certificates showed that there are systems in place for the regular Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 18 maintenance of these facilities and equipment. Commenting on the condition of a bathroom, the expert by experience wrote: “I found myself looking at an immaculately clean facility without a trace of foul smell.” From tour of the premises and discussions with the deputy manager it was evident that the home had taken an action to repair the damaged bathroom door on the ground floor, as required at the last inspection. New carpets have also been provided in the office, reception area and in the hallway. The home is located off a busy road with easy access to the London buses, trains and shops. There is a car park in front of the home for visitors. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who use service have benefited from the availability of staff who are trained, experienced and caring. The residents can be more reassured if and when staff are available in sufficient number to provide support that meets their needs. EVIDENCE: As quoted earlier, the residents are happy with the staff but are concerned with their number. For example, a respondent said: “….the staff are extremely good considering they have a lot of old people to care for”. Another resident also commented: “Occasionally when the staff are very busy one has to wait a while for attention”. Concern about the staffing level had been previously made to us on the phone by an anonymous caller. The manager had been informed and asked to address this. One person said: “Most of the time the staff listen to one’s needs”. A relative of a resident, who assisted the resident to complete the survey wrote: “I am quite happy with the care that my mother receives, but I do feel that the ratio of staff to residents could be improved, especially with residents who have dementia and who are unable to do anything for themselves”. The expert by experience observed a similar situation when he wrote: “I saw [a resident] desperately struggling with [their] dress. Respecting [their] dignity I turned away and located a member of the staff. She rushed to the room with an air of urgency, closing the door behind her.” Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 20 The rota showed that there are eight staff in the morning and seven in the afternoon on the first and second floors. On the ground floor there are seven and six staff in the morning and afternoon shifts. At night there are three staff on each floor; that is, one staff nurse and two carers. There are times when these staffing numbers change due to a sick leave or absence of staff. From discussions with the staff and an examination of a number of staff files it is obvious that the staff have attended training on moving and handling, fire safety, infection control, safeguarding adults, food hygiene, death and dying, first aid, communications, dementia, medication, health and safety, and equality and diversity. The staff files also showed that many have achieved a national vocational qualification at level 2 or above (in care) or a nursing qualification. The home has a training plan, which identifies the training programmes and dates available for staff training. The staff spoken to said that they are satisfied with the training opportunity and support they have at the home. Three members of staff who were interviewed, and many others, who were observed, seemed committed, experienced and professional in their interaction with the people who use the service and visitors. Thee staff were able to describe what “abuse” means and the appropriate actions they would take to deal with a suspected or real abuse. The expert by experience described how the staff ensure privacy and dignity of the residents when he wrote: “The staff knocked at the door and asked for permission to enter.” It has been mentioned earlier in this report that the relative have confidence in the staff. Some relatives made positive comments such as “the staff are caring; the staff treat residents like their families”. All the staff files which were seen contain copies of job applications, two written references, job descriptions, terms and conditions of employment and evidence of satisfactory criminal record bureau (CRB) checks. All the staff have CRB and two written references. The home has policies and procedures on recruitment of staff and equal opportunity. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who use the service are satisfied with the management arrangement of the home. There are good quality assurance systems which have enabled the residents and their relatives to influence the quality of the service by giving feedback. The people who use the service are confident with the health and safety arrangements put in the place at the home. EVIDENCE: The manager was away and the home was being managed by a deputy manager. The regional manager was also present during part of the inspection on the first day. The deputy manager has worked at the home for eight years and has been the deputy for the last four years. The manager has also a long experience of managing the home. The relatives spoken to and the people who Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 22 use the service said good things about the manager. Some relatives said she deals with things promptly while others commented that she is always available and listens to them. The staff were also satisfied with the support and guidance they get from the manager and the deputy. They said the manager and the deputy are approachable and helpful. A resident spoken to by the expert by experience confirmed the reason why they like the home by saying that the “manager and the staff are very caring”. The home has various auditing systems. The manager has developed a tool for checking medication. From conversations and records it was clear that the regional director of the company does a monthly visit to check the facilities and the services. A system of quality assurance (customer survey) has been implemented. This is a system whereby stakeholders are asked to give feedback about their views on different accepts of the facilities and services. The last quality review of the home, which was completed in April 2008, showed that there are a number of good aspects of the service while there still remain rooms for improvement to make the home “very good”. The regular relatives’ and residents’ meetings organised by the manager have enabled the home to gather feedback and to make improvements. The minutes of these meetings showed that the level of attendance are high and that the topics are varied. The finances of the residents are managed by either their families or an appointee, usually a local authority. This means that the home does not manage the residents’ money but only looks after personal allowance, which is paid for by the families or appointees. The receipts and recordkeeping of relating to personal allowance transactions were checked and found to be appropriate. As mentioned above, the home was bright, clean and free from bad smells. In describing his impression about the cleanliness of the home, the expert by experience wrote: “All the rooms, bathrooms, toilets and passages had natural fresh smell.” He then went on to say, “Everywhere I went I could feel the natural freshness in the air. For a 92 bed residential unit this is no mean achievement. On this count this care home ranks high.” The deputy manager confirmed that the manager regularly checks the implementation by the staff of the home’s infection infection control policy. It was clear from discussions with the deputy manager manager and from observations that substances hazardous to the health and safety of the people have been kept in locked cabinets. The staff have had training and awareness aabout infection control and substances hazardous to health and safety. A physiotherapist visits the home to complete assess the residents and to recommend appropriate equipment to use. Discussions with the deputy manager revealed that the number of incidents have fallen. There are call alarms in bedrooms, toilets and bathrooms for the residents to use when Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 23 needed. Records showed that these alarms are regularly tested. At the last inspection the manager was asked to carry out fire drills at nights. The deputy manager confirmed that this had taken place. Records and certificates showed that the gas boilers have been serviced on 9/7/08 and the fire alarms were inspected on 15/07/08. A legionellosis audit certificate, dated 18/06/08, confirmed that the risk of legionella [bacteria] was minimum. The deputy manager confirmed that a full time maintenance carries out health and safety checks and records them. Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 24 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 X 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X 3 Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 25 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. 1 Standard OP9 Regulation 13(2 Requirement To ensure that medicines are given as prescribed and not continued when the GP has changed the prescription. This was an immediate requirement. That audits are expanded particularly on the first floor to ensure that medication is handled safely. To clarify the instructions of patches for pain relief and ensure that there is appropriate monitoring of pain so that medication can be administered and reviewed accordingly. This was an immediate requirement. To ensure that medication is stored according to the manufacturers’ instructions so that its potency can be maintained. This was an immediate Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 26 Timescale for action 27/09/08 2 OP9 13(2) 01/10/08 3 OP9 13(2) 27/09/08 4 OP9 13(2) 01/10/08 5 OP9 13(3) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP27 18(1) requirement. To prevent the transmission of blood borne infections by using lancing devices for professional use. Oxygen cylinders must be stored securely in a stand or behind a chain for safety reasons. Oxygen is a prescribed medicine and should be listed on the medication administration record sheets (MARS). Medicines must be recorded accurately when received into the home and when administered. If not administered the appropriate endorsement must be used. Controlled drugs must be stored in a designated cupboard. Record keeping must be tightened up. The staffing level must be increased. This will ensure that the people who use the service are appropriately cared for, for example, without being hurried up at mealtimes. 01/11/08 01/11/08 01/10/08 14/10/08 15/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lansdowne Care Home DS0000068281.V372103.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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