Care Home: Lapstone House

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• Chirnside House
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What the care home does well Lapstone House provides accessible information for people thinking of coming to live there to help them make a decision. People are also well supported, through a planned admission process. The manager and supervisors do individual needs assessments before people are offered accommodation in the home so they can be sure the home will be able to meet their personal care needs and their expectations. The manager and staff try to make sure that there are plenty of opportunities for people to be involved in activities in the home and there is an activities programme within the home ranging from bingo to baking. People are well supported to follow interests that have meaning for them and within their local community. The home is comfortably furnished and the atmosphere is relaxed and homely. The home is being maintained, with a maintenance programme and safety testing to keep people safe. The gardens are tidy and accessible to people living there and some people, who enjoy gardening, are able to help out with this. The bedrooms in the home are single occupancy and people can bring in their own things to make their rooms more personal. The lounges and dining areas are warm and welcoming and furnished with suitable chairs for different needs and seats are arranged in informal groups. We saw these areas are well used for group and individual activities. We also observed the calm atmosphere within the home and that there appeared to be a happy atmosphere and a good rapport between the staff and people living there. The service has good systems in place for recruitment and training and this helps make sure that people are supported by the right staff who understand their needs. The management team have good systems for monitoring the home`s performance with regular quality audits and through consultation with the people living there and the staff working there. This helps to make sure they are meeting people`s expectations and helps show if they need to improve any aspects of the service to make it better or safer for people. There are effective complaints and safeguarding systems for the people living there, and for staff, to help make sure that concerns and complaints are taken seriously, investigated and action taken. People living there expressed confidence in the manager to deal with any concerns they might raise. The home has a competent management team that display a clear focus on maintaining high standards of care in the home and on supporting staff in professional development to improve the care they give. The home also maintains good working relationships with local doctors and specialist and district nursing services. The manager keeps CQC informed of any changes or incidents in the home and responds positively to the inspection process and any advice given. There is a good standard of catering in the home and menus show choice and availability of nutritious food , prepared by the home`s cooks. The home is clean and tidy and systems are in place to minimise any cleaning issues such as odours. What has improved since the last inspection? Since the last key inspection the home has invited prospective users of the service in to take part in arranged activities. This helps them to get a flavour of life in the home and one person joined them for their Christmas party. The manager is currently working to increase and give greater range to the activities programme in the way people living there have said they want. Since the last key inspection the numbers of care staff working there with NVQ qualifications at level 3 in care has increased and there is a high percentage of care staff with the qualification at level 2. The staff have also been developing more links with the district nurses to help provide supportive end of life care for people living there, should it be needed. Staff training has continued to be given great emphasis by the manager and 100% of staff have achieved their personal targets in training for 2009/10. This helps make sure staff have the skills and knowledge they will need to support people safely and as they want and expect. As part of developing staff skills some supervisory staff have received IT training to be able to work with people on their care plans. Other supervisors have gained certificates in `Team Leading` to improve their skills and help the home run effectively for the people who live and work there. Important improvements have been made to the environment and the home has worked with Stirling University and its dementia programmes to find ways to make the units where people with dementia live more `user friendly`. This includes signs to help people find their way around and be more independent in the home and using appropriate decoration so people with dementia have a supportive living environment. What the care home could do better: Lapstone House has its own effective procedures in place for monitoring and improving practices. The manager acts on areas identified as needing improvement or change. The manager has already identified the need for more opportunities for people to have more organised trips out, through their own consultations, and is already taking steps to address this. We did recommend to the manager that they should make sure that staff are fully completing the nutritional assessment tool they are using with the factual information needed so it can always be used effectively. Key inspection report Care homes for older people Name: Address: Lapstone House Lapstone Road Millom Cumbria LA18 4BY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marian Whittam     Date: 1 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Lapstone House Lapstone Road Millom Cumbria LA18 4BY 01229772527 01229775887 lapstone.house@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Christine Pidduck Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of service users who can be accommodated is: 25. Date of last inspection Brief description of the care home Cumbria Care is an internal Business Unit of Cumbria County Council and they operate Lapstone House. The accommodation and services can be provided for up to 25 older people, some of whom may have dementia. Lapstone House is situated in the centre of Millom a small town in the South Lake District. There are local facilities and services close to the home. There are three units for people living there and each provides Care Homes for Older People Page 4 of 28 Over 65 0 25 25 0 Brief description of the care home lounge and dining areas, bathing, toilet and shower facilities. There are outside seating facilities and a small enclosed garden and patio to the rear of the building. Car parking facilities are available at the front of the home. Charges range from four hundred and fourteen pounds per week to five hundred and four pounds per week, depending on care needs. The home manager makes information available about the service in their Statement of Purpose and service user guide. Inspection reports are also available in the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that the people who use this service experience Excellent quality outcomes. This site visit to Lapstone House forms part of a key inspection. It took place on 10.03.2010 and we were in the home for seven hours. Information about the service was gathered in different ways: 1. We (CQC) sent out an Annual Quality assurance Assessment (AQAA) to the home for the registered manager to complete and return to us. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from the providers about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. Care Homes for Older People Page 6 of 28 2. We sent out surveys to people living in the home to complete to get their views on the home and the service they received. We also sent out surveys to staff working there so we could get their views on working there and the training and support they received. 3. We looked at all the information we have about the service, any changes they have made and how the management has dealt with any complaints or the safeguarding of vulnerable adults. We looked at what the management has told us about things that happened in the service, these are called notifications, and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. 4. We spent time during our visit talking to people who live at Lapstone House and spent time with them at meal times and throughout the day. This helps us to see what happens during their day and ask what they think about the way the home is run for them. We also spent time talking with visitors to the home and to staff who work there to get their views. 5. We looked at any relevant information we had received from other agencies and organisations and any written comments or concerns people have made to us. During the day we spent time talking with people while they were in the lounges, dining rooms and also in private in their rooms. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in, how it was being maintained for people and what facilities and choices were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. We also assessed the handling of medicines through the inspection of relevant documents, storage systems and meeting with the manager and staff. Feedback was given to the registered manager at the end of the visit. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Since the last key inspection the home has invited prospective users of the service in to take part in arranged activities. This helps them to get a flavour of life in the home Care Homes for Older People Page 8 of 28 and one person joined them for their Christmas party. The manager is currently working to increase and give greater range to the activities programme in the way people living there have said they want. Since the last key inspection the numbers of care staff working there with NVQ qualifications at level 3 in care has increased and there is a high percentage of care staff with the qualification at level 2. The staff have also been developing more links with the district nurses to help provide supportive end of life care for people living there, should it be needed. Staff training has continued to be given great emphasis by the manager and 100 of staff have achieved their personal targets in training for 2009/10. This helps make sure staff have the skills and knowledge they will need to support people safely and as they want and expect. As part of developing staff skills some supervisory staff have received IT training to be able to work with people on their care plans. Other supervisors have gained certificates in Team Leading to improve their skills and help the home run effectively for the people who live and work there. Important improvements have been made to the environment and the home has worked with Stirling University and its dementia programmes to find ways to make the units where people with dementia live more user friendly. This includes signs to help people find their way around and be more independent in the home and using appropriate decoration so people with dementia have a supportive living environment. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into Lapstone House are given information about the home and have their needs assessed so they will know if their needs can be met when they come to live there. Evidence: People living at Lapstone House are provided with information about the home and the services it offers when considering a move into the home. The homes Statement of Purpose and service user guide is available and the most recent inspection reports. The manager updates these documents as things change in the home People may visit the home before deciding to come to live there if they want to and the manager and staff encourage this but it is not always possible for people to do this. However a person who recently came to live there had visited and spent time in the home before deciding to live there and joined in the Christmas party with the other people living there. Care Homes for Older People Page 11 of 28 Evidence: The majority of the referrals taken by the home come from either the local social work teams or the hospital. The manager and supervisory staff work closely with the other professionals involved in a persons care to help make sure the home has the appropriate resources and equipment to safely manage their needs when they come to live there. We looked at peoples admission records to make sure that they have had a full needs assessment undertaken before they were offered a place to live there. We examined some pre admission assessments, including the most recent, which are completed with the person, their relatives and any professionals who are involved. The manager and senior staff had visited people and done the assessments with them and the home had a copy of the care management assessment undertaken by social services. There was also transfer information where a person had come to live there from hospital. In this way the manager can gather a clear picture of a persons needs and preferences before they arrive and can prepare for their admission by providing equipment and appropriate accommodation to help make their admission and transition to living there as smooth as possible. The information gathered was being used to begin their assessments and care planning once a person came to live there. We examined the contracts and terms of conditions held on file by the home. In addition to contracts the home had with those paying for the service, individuals also had their own terms and conditions of residency. These set out a persons rights and responsibilities while they live in the home and had been signed by the individual and/or their representatives. Lapstone House does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Lapstone House receive the care and support they want in a way that protects their privacy and dignity and meets their individual needs and expectations. Evidence: All the people living at Lapstone House had an easy to follow individual plan of care, based on their initial assessments and stated preferences. Each persons care plan we looked at was set out clearly with their health, personal and social care needs and how they would like to be supported. A lot of background information had also been collected with people about themselves, with help from relatives if appropriate. There was useful nformation about their occupations, interests, family, friends, pets and the things that they valued and wanted in their lives. This information, called All about me and Whats important is very useful in giving a full picture of a person so staff can know about the person they are supporting as an individual. Staff have had training on using a person centred approach to care planning and the care plans were written to reflect the individual and outcomes for them. From what we observed of staff approaches and interactions and from what people told us and said in their surveys there was evidence that person centred care was generally being put into practice. We Care Homes for Older People Page 13 of 28 Evidence: observed staff with people doing activities, at meal times and going about their duties. Staff clearly knew the people they supported well and could say what they liked to do and if they had any particular behaviours or individual ways of doing things. We looked at several peoples care plans and three in detail and these had relevant and clear risk assessments in place. These included mental health and cognitive assessments, mobility, falls and associated moving and handling needs, personal care, social and cultural needs and preferences and skin and pressure area care. These assessments and associated care plans had been reviewed and changed as needed to make sure they correctly reflected peoples needs and expectations and were being used as working documents. There was evidence of prompt referral to other professionals when needed and where possible people could chose to visit their doctors or the practice nurse in the town as they had always done. We looked at nutritional assessments and information being collected and found that the tool being used was not always being completed fully. Some information required in order to use the tool to effectively highlight potential nutritional risk was not always being put in. The results may not then give a full picture of any risk and so what actions staff would need to take to respond at different risk levels. People were being weighed regularly and staff were aware of any issues with diet generally. We recommended to the manager that they made sure that the nutritional assessment tool in use was being fully completed by staff doing the assessment so it can be more effective. Visitors we spoke with and people living there all confirmed that the care given was focused on the individual and what they wanted from their care and life in the home. One visitor told us, It is a lovely home, I pop in every other day and they always make me welcome. I would come here myself- but not yet. We did a spot check of the medicines handling and recording. We looked at storage, handling and records and how these were being monitored and managed. A mobile lockable drugs trolley was used on medication rounds and all medicines were stored securely. We counted a sample of medicines and compared these with records to check if they tallied and to show they were administered in the prescribed dosage. The sample we checked was in order. The home has protocols on the appropriate use of as required medicines. These provide guidance for staff when they need to give people medicines for a particular reason, such as pain, nausea and agitation. The protocols gave detailed guidance for staff to follow to make sure people only had these medicines when they needed them. Information in the care plans we checked along side medication records indicated the reasons why and occassions on which they had been given. The records for receipt and disposal of medicines were clear. We looked at the policies and Care Homes for Older People Page 14 of 28 Evidence: procedures in use and the medication records we checked were being completed correctly. Medicines liable to misuse, called Controlled Drugs, were checked and were in order and securely stored. The controlled drugs register was signed and witnessed appropriately. We spoke with people living there, visitors and some staff and spent time in communal areas of the home observing what went on during the day. We saw that communication between staff and people living there was appropriate and any communication problems were outlined in the individual care plans. Staff were able to spend some time chatting with people or supporting them to go out for walks and into the community. Comments made to us on care included, They (staff) keep me clean, healthy and safe. They (staff) are friendly and helpful and always available if I need any help. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Lapstone House have support to make choices about their lifestyles and following their cultural, religious and social preferences. The quality and choice of meals provided meet the expectations and nutritional needs of people living there. Evidence: We judged the outcome of these standards through observations made during the visit, from survey responses, care plan and activities records and by talking to people on the day. We spent time with people on the different units during the day to see what was going on and how people were being supported to take part in activities and follow their own interests. We observed the lunch time meals on the units. We found that the food we saw being served to people at mealtimes was nutritious and from what we could see and what people told us was well presented and hot when served. One person on Parkview unit helped get the tables ready for lunch and it was well prepared with napkins, cutlery and drinks. People could have juice with their meal if they wanted and one liked a cup of tea. The meal times were sociable occassions with staff on hand to assist if needed and plenty of good natured banter around the tables. One person we talked to told us, The food is good and another that it was Always nice. The menus in use showed that there was a choice at mealtimes and Care Homes for Older People Page 16 of 28 Evidence: survey responses were also complimentary about the food. We saw there was a choice of hot meals each day and a choice of puddings. The cook serves a roast meat meal twice a week and a record is kept of the food people have chosen and been served Alternatives can be provided when a person does want a particular meal or changes their mind. The home does cater for therapeutic diets such as for people with diabetes and the home had achieved 5 stars from the environmental health departments inspection. The staff and manager at Lapstone House work to promote peoples right to live a life that is meaningful both inside and outside the home. Peoples interests and hobbies are recorded and these are considered when supporting them to enjoy their interests and in providing opportunities for recreation. There is a 2 weekly programme of organised activities displayed on the homes large notice board. This showed a range of organised sessions including, exercise sessions, bingo, play your cards right baking, arts and craft and visits from the hairdresser. In addition staff are flexible in their approach and support people to do as they choose during the day. We saw staff playing dominoes with a group of people in the morning on one unit and there was singing going on in Thwaites lounge during the afternoon. The large lounge on Rosewood is arranged in an informal way with chairs in small groups around coffee tables so they could chat rather than in an institutional manner. We could see that people were able to move around the 2 units and lounges on Rosewood and Thwaites units and their own rooms as they wished and take part in what was going on as they chose. We spoke with people on all units who were going outwith family, friends or with staff, one to buy cakes and another who had already been for a walk that morning. One person went out each day after lunch and was able to spend time with their pet and another went to their local pub to have a pint and play dominoes with friends. We could see that daily routines were flexible and people were being supported to follow their interests and preferred lifestyles. Peoples comments to us and survey responses also indicated this was usual. There is provision for people to follow and maintain their own religious and cultural beliefs and support for them to remain actively involved. There is a regular multi denominational service taken by local Anglican clergy and people may receive communion from them or see their own priests. This provision helps make sure that the different spiritual and pastoral support needs of the people living there can be met as they prefer. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Lapstone House know how to raise a complaint through an effective and accessible complaints procedure and are confident that their concerns will be listened to and acted upon to make sure they are safe and protected from harm. Evidence: The home has a complaints procedure and a system for logging and responding to any complaints made. The procedure is on display in the foyer and throughout the home and in the homes Statement of Purpose and service user guide. Records indicated that the home has not received any complaints in the last year and we (CQC) have not received any complaints about this service. We looked at the documents used for recording any complaints and compliments and could see that several families had sent the manager and staff letters and cards praising the care and support the home had given to their relative. Those people living at Lapstone House who responded to our surveys indicated that they did know how to make a formal complaint and also all felt they had someone to talk to informally if they were unhappy. People we spoke to told us that they knew who to talk to if they were unhappy about something and that they would speak directly rather than make a written complaint. People told us that they did see the manager most days if they wanted to talk about anything they were unhappy with or raise a complaint directly. There are policies and procedures in place to protect vulnerable people from abuse and whistle blowing procedures for staff to report any bad practice. There are also Care Homes for Older People Page 18 of 28 Evidence: policies and procedures on gifts to staff and handling peoples monies to safeguard their interests. Staff survey responses indicated that they knew about safeguarding procedures and what to do if they suspected abuse or bad practice. The service uses the local authority multi agency guidance on safeguarding and records showed most staff had received mandatory training on safeguarding in the home and also cover this topic in their NVQ courses. The manager has made 2 safeguarding adults referrals to social services under safeguarding procedures to protect the interests of people who use the service. These were reported by the manager and investigated by the appropriate agencies to promote peoples safety and best interests. The home does not manage any residents finances but holds small amounts of spending money on their behalf. People are supported to maintain control over their own finances where possible or with the help and support of family and representatives. All the homes financial processes are audited annually by the Local Authority. We discussed with the manager the arrangements in place to make sure people living there would be supported to vote, if they wished to, in any forthcoming elections. These systems were already in place with some people registered for a postal vote and others who would be supported to go to the polling station to cast their vote. Some people had indicated they did not want to vote and this was respected. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Lapstone house enjoy a suitably adapted, clean, homely and comfortable environment that encourages safety and independence. Evidence: Lapstone House is a well furnished, warm and comfortable home for the people living there. The provider organisation has an accommodation manager who liaises with the homes manager to complete an annual buildings survey and agree a programme of repairs and renewal to maintain the building. We looked at the recent survey and this indicated that no urgent items had been identified for maintenance. Under the planned programme carpets are due to be replaced in 5 bedrooms and 1 corridor and a new kitchinette fitted on Parkview unit. New carpet is due to be laid in the communal areas that people with dementia use, this is a plain pattern, in keeping with good practice in dementia care. The furnishings and decor are currently being maintained to a good standard and provide a safe and homely atmosphere. There is ample communal space for people to use on the units and these are all accessible by passenger lift. There are well lit and comfortable lounge/dining areas on all the three units. All areas of the home are accessible to people using wheelchairs and there are appropriate aids and equipment, either owned by the home or on loan. The equipment is provided to suit individual moving and handling needs and help maintain peoples independence. Staff records Care Homes for Older People Page 20 of 28 Evidence: showed staff had received training on safe moving and handling techniques and using the equipment and records also indicated regular servicing to help make sure equipment was safe and in good working order. The bedrooms we saw were suitably furnished and people had brought personal items in to make their bedrooms more homely and individual. People are encouraged to personalise their bedrooms with their own possessions, furniture, ornaments, paintings and photographs from their own homes to help them feel at home. All the bedrooms are for single occupancy and some are smaller than others, but the manager takes that into account when assessing peoples needs before offering them a room. There are also bathrooms, a shower and toilets, with appropriate aids and signage, on each unit. Toilets were available close to communal and bedroom areas so people could get easy access. A new rise and fall bath is due to be installed this month to provide people with better assisted bathing facilities. The home was clean and tidy and smelt fresh and pleasant. There are sufficient cleaning staff to make sure it is kept clean and as free from odour as they can. Surveys we received back from people living there indicated that they found the home to be always fresh and clean. One person living there told us, The home is kept nice and clean and the food is very good as well. The home has infection control procedures in place and we saw staff on the units using protective aprons and gloves when attending to personal care and using appropriate clinical waste disposal. Records show that staff are given training on the prevention and control of infection and food hygiene training on induction. We observed that staff followed good hygiene practices at meal times. The laundry for the home is on site and, although small, was clean and suitably equipped. The day and night staff attend to the laundry as part of their duties. There are separate sluice rooms away from communal areas and these were kept locked for safety. The grounds and gardens are well kept and provide good space for people to sit outside and enjoy when the weather allows. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are being supported by a well trained and experienced staff group and the robust recruitment procedures in operation mean that the safety and well being of people is promoted. Evidence: We examined the staff rota, observed staffing levels during the visit and talked to the manager, staff and people living in the home to help us form a judgement about outcomes for people living there. From this it was evident that there were suitable numbers of staff in place to meet the needs of the people currently living in the home. Some staff work split shifts so they are available during the busier periods of the day. The home currently enjoys the benefits of having a very stable staff team who have developed good relationships with people living in the home and are committed to providing a personalised service. Staff surveys we received indicated that staff felt there were always enough staff to meet peoples individual needs. Morale amongst the staff we talked with appeared to be good. People living there indicated in their survey responses thet there were Always staff available when they needed them. We could see that there were staff on all the units throughout the day and available to go out with people and support them in activities. We saw that there were handovers given to staff when they came on duty at shift changes so they were all up to date with any changes. Care Homes for Older People Page 22 of 28 Evidence: Eighty eight per cent of the care staff have completed their National Vocational Qualification level 2 (NVQ), with more staff working toward the qualification. In addition almost a quarter of staff have achieved the NVQ level 3 qualification in care. Induction training is provided for all new staff covering the core areas of care over a 5 day induction period. The manager and supervisors monitor the training needs of staff with individual continuing professional development files in place for all staff to record all training and development activity. Training needs were also being looked at during supervision and records are kept of all training the staff have done and their supervision. From the comments and responses on their completed surveys and from looking at training records it was evident that staff training and development is being given a high priority within the home. Staff have had updates on mandatory training and in other important areas such as dementia care. We looked at recruitment records for the newest staff and these were in good order with completed application forms, all necessary references taken up and interview records kept. All staff had appropriate security checks in place, a Criminal Records Bureau (CRB) check and a check on the Protection of Vulnerable Adults (POVA) register to help make sure that they were appropriate to support vulnerable people. These robust recruitment procedures help make sure all new staff are suitable and safe to work with vulnerable adults and that they are aware of their roles and responsibilities in the home. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lapstone House is well managed with systems, policies and procedures in place to help ensure that the health and safety of people living there, and staff, are promoted and protected. Evidence: Lapstone House has an appropriately qualified and experienced registered manager, Christine Pidduck, in post who holds qualifications in both care and management. She has undertaken regular training to maintain and update her knowledge and skills. The manager was able to demonstrate to us that she makes the best use of the resources she has available to her ,and also community resources, to promote choice for people living there. Such as in negotiating to try to get transport form local organisations for more trips out as the people living there have said they would like this. The manager has an open and inclusive management approach and a clear vision of maintaining and continuing to develop high standards in the home. In discussion with us she demonstrated a clear understanding of the different conditions and individual Care Homes for Older People Page 24 of 28 Evidence: needs of the people living there. Staff morale was seen to be good and one staff member told us, Its a very friendly home. Records indicated that there are regular staff meetings and that staff received regular formal supervision to support them in their work and to get feedback on their performance. Staff we spoke to and survey responses also indicated this was the case. We looked at a sample of records required by regulation and found these up to date and in good order. The home does not manage any residents finances but holds small amounts of spending money on their behalf. All the homes financial processes are audited annually by the Local Authority. We checked a sample of individual records where the home held personal monies for people and found these in order. These were securely stored and clear records maintained of all transactions. These were recorded and signed for by two people with receipts retained. This system safeguards both the person and the staff supporting them. The home has effective quality monitoring systems in place to get the views of people living there and their families and to measure the homes success in meeting their aims and objectives. The manager uses a range of assessment methods including satisfaction surveys, staff and residents meetings and internal and external audits to monitor important areas. Less formally people living there told us they could talk to her anytime. The quality monitoring covers important areas including the environment, maintenance and health and safety and also the reviewing and updating of procedures as good practice and legislation changes. We looked at the results of the last survey and there were many positive responses. Items that people had raised such as wanting more trips out, were being addressed by the manager and staff. The manager does checks of medication also doing medicine rounds and supervisors do stock checks. The manager is a visible presence on the different units and in that way acts as a model for her staff. The manager monitors supervisors own quality checks at their supervision to make sure important areas are being properly monitored. This included making sure staff fire training had been done and was up to date, water temperatures tested, care plan reviews done and that record keeping was being done well. This systematic approach helps provide consistency in monitoring performance. There are safe working practices in place to identify and minimise risks to staff and people living there and the home has a comprehensive range of policies and procedures to support current best practice. Records showed equipment is maintained under service agreements. Records also indicate mandatory staff training and fire safety training was up to date. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 The manager should make sure that the nutritional assessment tool in use is fully completed by staff doing the nutritional assessment so it can be used effectively. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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