Care Home: Lapal House & Lodge

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What the care home does well People who live at the home continue live in a well run home. It is safe, clean and decorated and furnished to a high standard. Appliances and equipment are regular serviced and tested and produces are stored safely to reduce the risks of accidents occurring. There are good procedures for assessing the prospective users care needs. They are provided with information about the service the home is able to provide and are welcome to visit prior to making a choice about where they wish to live. A dedicated, competent and stable staff team provide residents with care and support that meets their individual needs. Residents are able to follow their individual routines and are encouraged to maintain their independence.Personal and health care needs are met by the home in accordance with their care plans. Suitable systems are in place for residents to access local and specialised health care services The home continues to provide good opportunities for residents to express their views. There are procedures for staff to follow when dealing with any concerns raised about the service and to ensure residents are protected from abuse. What has improved since the last inspection? Extensive building work has been carried out to improve facilities in "The Lodge". The work includes the installation of a shaft life, an additional bedroom, a hairdressing salon, an office and a more spacious lounge. The home has re-organised residents files to enable staff be able to access information about the individual more quickly. The resident, their relative or representative are signing care plans and agreements. Contracts/Statement of Terms and Conditions are being reviewed regularly and a record kept of any changes agreed. The shortfalls in medication practices have been addressed. This includes the process carried out for recording details of medication prescribed outside the usual delivery cycle to reduce the risk of errors occurring. Residents continue to be provided with a choice of nutritious meals that meet their dietary needs and person preferences. New dining arrangements have been introduced to ensure residents who require assistance from staff receive this in a more relaxed atmosphere. CARE HOMES FOR OLDER PEOPLE Lapal House & Lodge Lapal Lane South Halesowen West Midlands B62 0ES Lead Inspector Linda Elsaleh Unannounced Inspection 20th May 2008 11:00 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 Lapal House & Lodge DS0000024965.V364902.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. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lapal House & Lodge Address Lapal Lane South Halesowen West Midlands B62 0ES 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) 0121 503 0326 0121 550 1562 michelle@lapalhouse.co.uk Mr Anthony Billingham Mrs Pamela Billingham Mrs Michelle Upperdine Care Home 41 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (35), of places Physical disability over 65 years of age (5) Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 2007 Brief Description of the Service: Lapal House & Lodge is located in an attractive area of Halesowen. It is not far from the A456 from Birmingham to Kidderminster and accessed via a minor road. A link to the M5 motorway is nearby. The home is set in acres of land, giving picturesque views from most windows. There is a farm to the rear. Service users who have bedrooms at the back of the home have the benefit of views of the farm and surrounding countryside. All the grounds are maintained to a high standard. The home is operated in two sections, the House and The Lodge. There is a registered Manager who has overall responsibility for the two areas. There are lift facilities in The House and a stair lift in The Lodge. There are separate dining and lounge facilities in both areas. The home operates a no-smoking policy for service users. The manager should be contracted for information about the fees charged for this service. Lapal House & Lodge DS0000024965.V364902.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 star. This means that the people who use this service experience excellent quality outcomes. This unannounced inspection was carried out on 20th May 2008. The purpose was to assess the home’s performance against the key standards identified in the National Minimum Standards for Care Homes. Our findings are based on the information received by the Commission for Social Care Inspection, (the commission), examination of relevant records and documents kept at the home and discussions with the manager, staff and people who live in the home. The atmosphere within the home was relaxed and friendly. Positive comments were received from residents and relatives about the staff and the service they provide. Below is a selection of the comments we received: “I am very happy at Lapal House” “All staff are kind and caring and are genuinely concerned about the welfare of the residents” “Provides best possible care for my relative” The inspector wishes to thank the residents and staff for their hospitality and co-operation during this visit. What the service does well: People who live at the home continue live in a well run home. It is safe, clean and decorated and furnished to a high standard. Appliances and equipment are regular serviced and tested and produces are stored safely to reduce the risks of accidents occurring. There are good procedures for assessing the prospective users care needs. They are provided with information about the service the home is able to provide and are welcome to visit prior to making a choice about where they wish to live. A dedicated, competent and stable staff team provide residents with care and support that meets their individual needs. Residents are able to follow their individual routines and are encouraged to maintain their independence. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 6 Personal and health care needs are met by the home in accordance with their care plans. Suitable systems are in place for residents to access local and specialised health care services The home continues to provide good opportunities for residents to express their views. There are procedures for staff to follow when dealing with any concerns raised about the service and to ensure residents are protected from abuse. What has improved since the last inspection? What they could do better: The home should introduce a system to ensure preferences expressed by a resident about dignity and privacy issues during the assessment and admission process are regular reviewed to ensure their preferences have not changed. Recruitments processes for staff should include a system of checking all relevant information has been obtained and verified prior to appointments being confirmed and applicants commencing employment to ensure the safety and well-being of the residents are fully protected. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 7 In an effort to avoid confusion, the record kept of the one-day induction to the home provided to newly appointed staff should accurately reflect the level and quality of the information provided and discussed with them. The quality assurance systems in the home should include a formal system reporting on the home’s performance and future plans for the service to residents and other stakeholders. 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. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is good. Prospective service users are provided with the information they need to make an informed choice about where to live. They are provided with opportunities to visit the home and their needs are assessed prior to them moving in. Each person is provided with a copy of their agreed contract/statement of terms and conditions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and additional information about the home is displayed in the reception area and accessible to residents and visitors. People who use the service that responded to our survey stated they received enough information to enable them to decide if the home was the right place for them. This was also confirmed in the responses received from the relatives of people who use the service. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 10 One resident told us s/he came to live at the home on her/his daughter’s recommendation and following a visit from the manager whilst when s/he was in hospital. The manager carried out an assessment of their needs, which is available on the resident’s file. Another resident told us s/he visited the home with members of her/his family “to have a look round” and was impressed with what they saw. A needs assessment was carried out by a member of the senior staff team during the visit and included discussions about their personal preferences. The manager told us careful consideration is taken to ensure prospective residents meet the home’s criteria for admission and also given to whether there are any implications for the people who already live at the home. For example; people need to be mobile (this can include the use of a walking frame) and do not display any behaviour that may challenge the service. The home endeavours to continue to meet the needs of people whose physical and health care needs change once they become resident and seeks advice and support from the person’s GP and relevant health care specialists. We examined the files of two people who live at the home in detail. The information confirmed assessments are undertaken by the home and, where applicable, by relevant social and health care specialists. As well as identifying the care needs of the prospective service user, the home also discusses their personal preferences and how it is able to make to meet these. A recently promoted member of staff told us the manager supports them to develop their skills in assessing the needs by involving them in this process and arranging relevant training courses. Copies of the individuals’ contracts were available on all the files we looked at. There is an additional sheet for recording dates when contracts have been reviewed and any changes, such as fees. The home notifies the individual or their relative by letter of any proposed changes. One resident told us s/he is happy with the arrangement she has with the home “to contact my family about any contractual changes”. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. People who live at the home have access to local and specialised health care services. They are supported to maintain their independence and are provided with assistance where required. The home understands the need to comply with safe medication management processes and have policies and procedures in place to protect people who manage their own medication and those whose medication is managed on their behalf. These are reviewed regularly and action is taken to address any shortfalls identified in the home’s practices. The home respects the residents right to privacy and meets their needs in a caring and sensitive manner. Personal preferences should be periodically reviewed with individuals to ensure these have not changed. This judgement has been made using available evidence including a visit to this service. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans have been produced by the home based on the assessed needs of the people who use the service. The files have been re-organised to enable staff to access information quickly. The resident and/or their relative/representative sign care plans and agreements. Information is provided in the plans about how the individual’s personal care needs are to be met. For example one person’s care plan states how s/he is to be supported with their personal care. It identifies the tasks to be undertaken by staff and the tasks the person undertakes for her/his self. Another person’s plan states s/he is independent in most tasks such as being able to wash and use the toilet. It also states s/he does need assistance getting in and out of the bath and a risk assessment for using the hoist is available on their file. Three staff we spoke to identified the needs of both residents, how these were to be met and described their personal preferences, such as when they like to bathe, in accordance with the information detailed on their care plans. Key workers meet each month with individual residents to discuss how they are feeling and complete a monthly report on her/his progress. Residents are encouraged to include their own comments in these reports. A senior member of staff undertakes monthly monitoring of the individual’s care plan and risk assessments. Reports are also produced for review meetings held with the resident and, with their permission, other significant people. The care plan is updated to reflect any changes identified. We spoke to three staff individually about the needs of these two residents. All of them identified each resident’s needs and described the support and assistance they provided demonstrating that they were familiar with the content of each individual’s care plan. Residents are supported to access local health care services, such as dentist, optician and chiropodist. The GP holds a weekly surgery in the home which residents are able to access as well as being able to arrange additional appointments. A basic healthcare checklist and assessments are kept on residents’ files to assist staff in monitoring their health needs. Where any concerns are identified, advice is sought from the relevant health care specialist, such as community nurse or dietician. Where there is concern about the safety of a resident the home carries out a risk assessment to identify how this may be managed or reduced. For example risk assessments were seen for residents who use mobility aids, such as walking frames, and those who require the use of the hoist when bathing. The records show these are reviewed monthly. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 13 The Annual Quality Assurance Assessment forwarded to us by the manager states the medication policy and procedures were last reviewed in January 2008. These include the procedures to be followed for residents who administer their own medication. At a previous inspection the issue of covert administering of medication was raised. The manager and a senior member of staff stated this was discussed with staff following the last visit and the procedure and protocol was reviewed. They confirmed there have been no further inappropriate occurrences of this practice. We spoke to the manager and senior staff about other aspects of how medication is managed. We were told the manager and deputy has recently attended a medication seminar. Following the seminar the home arranged to review its practice for medication taken out of the home, for example, if a resident arranges to spend the day with relatives or friends. We were told as written procedure is in the process of being produced. Also, where applicable, details of such arrangements would be included in the individual’s care plan. All medication managed by the home is stored in lockable medication trolleys, one for the “house” and one for “The Lodge”. The pharmacist provides the majority of medication in monitored dosage cassettes. Staff record the date medication not dispensed in the cassettes are opened, such as creams, to ensure use by dates are observed. Information about residents’ medication is kept in a folder in the relevant trolley. At the front is a list of staff authorised to manage medication and a copy of their signature and initials. This allows easy identification when monitoring the medication administration record (MAR) sheets. The training records show these staff have all received appropriate training and attend regular refresher courses. Of the two residents’ files we looked at only one takes regularly prescribed medication. We looked at the medication administration record (MAR) sheets for another three residents. These contained clear administering instructions. Handwritten entries on the MAR sheets for medication prescribed outside the normal delivery cycle is witnessed by a second person to ensure the information is accurately recorded. Where applicable, the appropriate codes in relation to medication have been recorded on the MAR sheets. The senior member of staff who was on shift and responsible for medication explained in detail how different aspects of medication is managed demonstrating s/he had a good knowledge and understanding of the home’s procedures. The home discusses with the resident and/or their relative/representative how their medication is to be managed. A signed agreement states if the resident will be managing their own medication or if the home will manage it on her/his behalf. We looked at the records of a person who manages their own Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 14 medication. A care plan and risk assessment had been carried out with the resident and reviewed regularly. The resident said if s/he had any concerns s/he would discuss them with staff. The medication is appropriately labelled to meet the resident’s needs and a lockable facility is provided in her/his bedroom. The home’s records show the lock on this facility sticks and arrangements are being made for it to be repaired. We observed staff interacting with the residents in a respectful manner and addressing them by preferred name. They did not enter bedrooms without knocking and waiting for a response. They showed sensitivity when responding to requests for assistance. We saw evidence that residents had been asked about personal preferences such as whether they wish to have a lock fitted on their bedroom door or were happy to share a bedroom with another resident. A resident who shares a bedroom told us s/he is happy sharing a bedroom, but would like to move to a single room when one becomes available. Another resident told us s/he would like a lock fitted to her/his bedroom door, but had been told a lock would not be fitted “because staff need to have access in case I have an accident or are unwell and so they can put my laundry away”. The written statements of the residents’ wishes are dated on or around the time they came to live at the home. This was brought to the manager’s attention and it is advised this information is checked periodically with residents to ensure they continue to be happy with the arrangements. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 15 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 & 15 Quality in this outcome area is excellent. People who live at the home are encouraged and supported to maintain their individual routines and lifestyles. They are helped to exercise choice and control over their lives and are free to express their views about the day-today running of the home. The home provides a choice of healthy, well-balanced meals in a relaxed atmosphere that meets the dietary needs and personal preferences of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People at the home were observed following their individual routines. The majority of residents prefer to spend their time in the communal areas whilst a few prefer to spend time in their own rooms. One resident told us they had occupied the same ground floor bedroom since they came to live at the home about 14 years ago. S/he told us the bedroom had recently been re-decorated and “I chose the décor and am very pleased with the result”. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 16 The home employs an activity co-ordinator who spends time with residents talking about their individual interests and hobbies. Activities programmes are produced based on their interests and they are encouraged to try new activities. Residents meet regularly with staff. The minutes of these meetings include discussions about the visiting library, the activities programme and ideas for future activities and events. The response to the surveys we sent to people living at the home expressed overall satisfaction with the activities programme. One resident stated they are unable to participate in some of the activities, but enjoys watching others. Another resident told us they preferred to watch others and did not wish to participate. A third resident, who is blind, told us s/he enjoys the books and tapes s/he receives via postal/courier service. Throughout the visit we observed visitors arriving at different times. Staff provided a warm welcome to all the visitors. A resident told us “the staff are very welcoming to all my visitors”. The home provides residents with a room where they can entertain their visitors and share a meal in private or, if they choose, they can receive visitors in their bedroom. One relative informed us they are “always made to feel welcome and are kept up to date & feel included in [their] mom’s care. Another told us “Staff are very helpful” and they were “pleased with all aspects of care provided for [their] dad”. People who live in the home are encouraged to personalise their bedrooms. The rooms we were invited to view had small items of furniture the resident had brought with them. Some residents manage their own finances or have made arrangements for a representative outside of the home to manage it on their behalf. One resident told us s/he is happy with the way the home manages her/his personal allowance and makes arrangements for them to receive their favourite newspapers and magazines. The home also notifies the local council, on the residents’ behalf, to ensure they are registered as eligible to vote. Catering staff employed by the home provides meals that meet the dietary and personal preferences of the residents. Care staff supports them by serving evening meals and suppers. Training is provided in basic food hygiene. Since our last visit the home has reviewed mealtimes and now provides two sittings. This is to ensure residents who require assistance receive support from staff in a more relaxed atmosphere. The responses received from residents about the meals were positive. The following are some of the comments we received – “There is always a wide variety”, “There are a lot of foods that I do not like but there are usually suitable alternatives” and “The food is always good”. The menus are discussed at with residents in their group meetings and requests for Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 17 alternative meals are provided, wherever possible. The home has been awarded the Dudley Food for Health Gold Award. A report of the recent visit made to the premises by the local environmental health officer has recommended the floor covering in the kitchen be replaced. The manager told us this has been included in the maintenance and improvement plan for the building. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. People who live at the home know how to raise any concerns and are confident these will be listened to and acted upon. The home has suitable systems in place to protect residents from abuse and neglect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided by the home states the complaints procedure was last reviewed in 2007. A copy of the procedure is displayed in the reception area. Surveys have been sent by the home to residents, relatives and health care professionals. Two residents and one relative who responded stated they did not know who to speak to if they were concerned or unhappy about something. The home discussed the complaints procedure on a one-to-one basis with these people and at one of the residents meetings. The response to the surveys sent by the commission to residents and relatives confirmed that they knew how to make a complaint if they needed to. One complaint has been received about the service. This was made shortly after our last visit and was investigated by the manager. She found no evidence to substantiate the complaint. Details of her investigation and Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 19 conclusions were forwarded us. The information she provided demonstrated that the matter had been fully investigated. The home is not responsibility for managing the financial affairs of any of the residents. However, they do look after a small amount of personal allowance for some residents. Each transaction is appropriately recorded and receipts are obtained for every transaction. The manager regularly monitors these records to ensure the procedures are being followed correctly. Training is provided to staff about matters concerning the protection of vulnerable adults. This includes what constitutes abuse and how to report any concerns. Staff we spoke to stated they had no concerns about the residents safety or well-being and were aware that any such issues should be reported to the local authority’s safeguarding team. They confirmed an easy read flowchart was available detailing who contact. The home reports significant events that affect residents, such as accidents and serious illness, to the commission. No protection issues have been reported and no concerns have been identified during this visit. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. People who live at the home are provided with a safe, well-maintained and pleasant environment that meets their individual needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large, traditional type building that has adapted and extended over the years to meet the needs of the people who live at the home. It is set in its own substantial, attractive and well-maintained gardens. Since our last visit work has been carried out to improve the facilities in “The Lodge” and includes a more spacious reception area, additional bedroom, a hairdressing salon and an office. These rooms are in the process of being decorated. A shaft lift has also been installed which provides alternative Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 21 access to most of the bedrooms on the first floor of this part of the home. Residents told us this work has been completed with the minimum of disruption to their daily lives and they are pleased with the results. Several residents we spoke to said they enjoy being in the garden during fine weather. One resident, who has a bedroom on the ground floor, told us there are plans for the area outside their room to be re-landscaped. S/he will be able to access this via the external door that has been fitted in her/his bedroom included in the recent building work. We looked at three bedrooms, 2 singles and 1 twin, with the residents’ permission. These are decorated and furnished to a good standard and residents have personalised these with small pieces of furniture, ornaments and photographs they brought with them. Each room has a different view of the grounds and some overlook surrounding farmland. Daytime and waking night staff are responsible for ensuring laundry tasks are completed. The laundry area can be accessed via either of the two entrances. There are suitable arrangements for the safe storage of cleaning products. Staff we spoke to demonstrated good awareness of infection control practices and the control of substances hazardous to health (COSHH). Certificates of training attended by staff were seen on the records that we looked at. Hand washbasins are located close to all relevant work areas. Liquid soap and paper towels are also available. Signs showing good hand washing techniques are displayed in these areas and in toilets and bathrooms. The manager told us replacement floor covering for the laundry and the kitchen, as mentioned previously, has been included in the home’s improvement plan for the premises. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is good. People who live at the home are provided with competent and trained staff in sufficient number to meet their individual needs. The home has policies and procedures for recruiting staff. However, it should develop a system to confirm each aspect of the process has been satisfactory completed to ensure the safety and wellbeing of the residents is fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents who responded to the surveys we sent to them commented they considered sufficient staff was provided to ensure they received the care and support they needed. Relatives also reported they felt the home was appropriately staff – two of the comments included “all [my relative’s] needs are fully met” and “Staff always try to take account of individual needs and preferences”. We spoke to staff about the support they provide to the catering staff and their laundry duties. All commented these duties are planned for at the being of the shift and does not impact on the quality of care provided to residents. We Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 23 observed staff providing assistance to residents in a timely manner and participating in general conversations. Three members of staff are on duty at night. The care plans we looked at show different levels of support are identified. For example some residents only required periodic safety checks, whilst others required support with their personal care. Information provided to us by the manager shows people who live at the home are provided with care from a stable team of staff. The National Vocational Qualification (NVQ) certificate Level 2 or above is held by over 62 of the care team. All newly appointed staff are provided with a basic induction to the home prior to commencing employment. We looked the induction record for the most recently employed staff member. The programme appeared too extensive to be undertaken in any detail on one day. This was discussed with the manager, who stated the one-day induction was to assist the person to become familiar with the layout of the home, some of the routines and to inform them of the different policies and procedures that are available and where they are kept. The manager is advised to ensure the record for the one-day induction accurately reflects the level of information given to the new recruit. Once, the person has commenced employment a more comprehensive induction programme is provided that meets the Skills for Care specifications. The recruitment file we looked at showed satisfactory safety checks such as PoVA First & CRB, (Protection of Vulnerable Adults & Criminal Record Bureau), were obtained prior to the person commencing employment. Two written references were also available on the file. However, one of the references was dated several months after the date the person commenced employment. The manager stated a verbal reference was obtained and the referee agreed to put this in writing, but she had omitted to pursue this. A routine audit carried out later on staff files highlighted this omission. She immediately contacted the referee and a written reference was provided confirming the verbal information they had previously provided. The manager stated a contract and job description is provided to all staff. The file we looked had a copy of the worker’s job description, but not a copy of their contract. At the last inspection we discussed the application of a recently employed member of staff with the manager. This employee has since left. However, the manager stated a risk assessment was carried out following our last visit and strategies were identified to support the worker to carry out their duties, where applicable. The manager is advised to produce a recruitment checklist where each part of the home’s recruitment process is recorded on completion to ensure this process fully protects the safety and wellbeing of the residents. The manager supports staff to develop their knowledge and skills. This is evident in the success rate of staff who apply for more senior positions within the home. The home has reviewed its staff complement and now includes a deputy post to support the manager in the overall day-to-day running of the Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 24 home. An experienced internal senior care worker has been recruited to this position. Both newly appointed staff stated appropriate training is provided to enable them to carry out their new responsibilities, for example the safe handling of medication and managing a staff team. At the time of this visit some staff were attending Health & Safety training. The home has not used the services of any bank or agency staff during the last 3 months. Where applicable, the volunteers cover shifts of staff who are on training courses providing continuity of care to the residents. All staff we spoke with stated the training provided by the home is very good. The records show, that as well as the training already mentioned in this report, client-centred issues are also addressed such as dementia care and other health & safety areas such as fire safety. One member of staff told us s/he that to complete her/his NVQ course s/he needed to re-new their basic first aid certificate. Another member of staff stated, through the home’s staff survey, they had not completed a moving and handling course. Both staff received a positive response from the manager by training being arranged for them as a matter of priority. A relative of one of the residents told us “I don’t have a detailed knowledge of individual qualifications but I am confident that the management select suitably trained staff”. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 25 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, 36 & 38 Quality in this outcome area is excellent. People live in a home that is well managed. A dedicated, competent and trained staff team are provided to meet their individual needs and personal preferences. The health, safety and welfare of residents and staff are promoted and protected by the home’s policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been employed by the home since she left school and is suitably experienced and qualified to carry out her role and responsibilities. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 26 She has achieved the “Registered Manager’s Award” and remains well motivated to ensure the needs of residents are met and exploring how different aspects of the service can be improved. Regular meetings are held with the residents to discuss the running of the home. This provides an opportunity to share ideas and raise any concerns or queries. We looked at some of the minutes kept of these meetings. They show a wide range of issues are discussed such as, household repairs, the laundry service as well has meals, activities and events. An update on any action taken is reported back to the residents at the next meeting. The home carries out its own quality assurance process to assess its performance. Different aspects of the service are monitored monthly by senior staff and appropriate action taken to address any areas identified as needing attention. The manager told us minor repairs are funded through the home’s budget. The proprietors respond positively in dealing with more costly matters. Future work, where more applicable, is included in the annual business plan for the home. Surveys are periodically sent to residents, relatives, health care professionals and staff. The manager reported the number of responses to received to surveys were low. Nevertheless, the records show action is taken to address any areas they identified. For example; ensuring people who stated they did not know how to make a complaint where provided with the information they needed and staff received the training they needed. The home has yet to develop a formal system for reporting on its performance and future plans for the service to residents and other stakeholders. As previously reported, the home does not take responsibility for managing the financial affairs for any of the residents. However, it does manage a small amount of personal allowance on behalf of a few residents. Senior members of staff have the responsibility for ensuring the procedures for this are appropriately followed and accurate records are kept. The manager carries out regular audit checks. Staff we spoke with told us the manager operates an “open door” policy and is always available to discuss any concerns they may have and to provide support and guidance. Individual supervision sessions are provided every 3 months and include discussions about practice and performance issues and training and development needs. Periodic staff meetings are also arranged to enable the team to discuss changes in regulations, procedural and operational matters. The home has systems in place for ensuring regular testing and servicing of appliances and equipment takes place. Information provided to us by the manager confirms these are carried out at the appropriate times. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 27 The recent building work was subject to regular risk assessments to ensure the safety of residents, staff and visitors was protected at all times. Policies and procedures are regularly reviewed and are easily accessible to staff. The “well thumbed” medication and health & safety procedures coincide with the recent training undertaken by a number of staff. The following comment reflects the overall satisfaction with the service expressed in different ways by residents and relatives “we are happy with how the care home is run”. Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 4 4 X 3 Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP10 OP29 Good Practice Recommendations Dignity and privacy issues should be periodically checked with people who live at the home to ensure they continue to be happy with the current arrangements. A recruitment checklist should be produced and kept on each file to record when each part of the recruitment process has been completed to ensure residents safety is not compromised by omissions in obtaining information, such as written references and exploring declared health statements. The one-day induction records should accurately reflect the level of information given to newly recruited staff. A formal system should be produced for reporting on the home’s performance and future plans for the service to residents and other stakeholders. 3. 4. OP30 OP33 Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI Lapal House & Lodge DS0000024965.V364902.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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