Care Home: Lennox House Care Home

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What the care home does well The Registered Providers and staff in the home continue to work well with us. They responded in a positive and open manner to enforcement action and supplied us comprehensive improvement plans and demonstrated a commitment to improving the quality of life for the residents. There has been open and honest debate in the meetings to monitor the improvement plans (these have been joint meetings between the Care UK and the London Borough of Islington). There is a continuing support system in place for friends and relatives who visit the care home. The service has shown good practice by keeping relatives updated through meetings chaired by an independent facilitator. They have actively sought feedback from the people who are stakeholders. The home continues to let us know about things that have happened since our last key inspection and has demonstrated that they have managed difficult situations well. The staff in the care home continue to provide a good standard of personal care for the people they look after. During the inspection people living in the care were seen to look well presented in appearance and clean. People continue to feel confident to raise any concerns they may have. What has improved since the last inspection? Two requirements from the last inspection have been met. The communication needs of a resident whose first language is not English have been addressed. The home promptly investigated and reported on the non-administration of insulin to a resident. Recommendations on care planning and recording have been met. What the care home could do better: Two requirements were made at this inspection.Medication records should be complete and accurate to facilitate auditable control of medication and to provide accountability of administration in accordance with the prescriber’s direction.Staff providing supervision to nursing staff should have the clinical expertise to check their competency.Lennox House Care HomeDS0000069788.V375542.R01.S.docVersion 5.2The following recommendations are made: That full information on why a resident has been referred is obtained before the person is admitted. That the home continue to build and test nursing staff competency to ensure that residents’ needs are met. That the medicine fridge maximum/minimum temperatures readings relate to the current recording period by resetting the thermometer. This will provide accurate data to ensure the correct storage of medication to maintain its therapeutic efficacy. That there are systems in place to ensure that medicines requiring handling precautions are handled safely. That allergy status is noted on the reference cover sheet for all users of the service. That the home review its staffing of the reception area. That the daily fire warden responsibilities be included in the handovers, so that staff are clear about fire safety. That a system be put in place to ensure wheelchair cleanliness. That the home have an ongoing programme to build the competency of staff in dementia care. That staff be trained in English as a second language in ways that could assist their practice. Key inspection report CARE HOMES FOR OLDER PEOPLE Lennox House Care Home 75 Durham Road London N7 7DS Lead Inspector Margaret Flaws and Fay Bennett Unannounced Inspection 9 and 10th June 2009 10:15 th DS0000069788.V375542.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lennox House Care Home Address 75 Durham Road London N7 7DS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7272 6562 0207 561 3638 manager.lennoxhouse@careuk.com Care UK Community Partnerships Ltd Manager post vacant Care Home 87 Category(ies) of Dementia (56), Old age, not falling within any registration, with number other category (87) of places Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N 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 2. Dementia - Code DE (maximum number of places: 56) The maximum number of service users who can be accommodated is: 87 3rd December 2008 Date of last inspection Brief Description of the Service: Lennox Lodge is situated in Finsbury Park, in residential area. Good transport links are within walking distance from the home. There is pay and display parking on the street that Lennox Lodge is situated in. The home was purpose built as a care home and provides accommodation over three floors. At the time of this inspection the third floor had just begun to take admissions. There are communal lounges on each floor and all bedrooms have ensuite facilities. The providers are Care UK who are working in partnership with the London Borough of Islington to provide forty (40) beds. Under the partnership arrangements fees for personal care only are £540 and for nursing £700. For the remainder of the beds Care UK will charge for personal care £550 and for nursing care £750. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was completed over one two days. On the first day, Fay Bennett, an inspector from the CQC Regional Enforcement Team accompanied Lead Inspector, Margaret Flaws. A total of twenty five hours were spent in the home by the inspectors. The CQC Pharmacy Inspector also visited the home to inspect the medication arrangements on 21 April 2009 and his report is included here. At the time of the last key inspection in December 2008, the care home was subject to enforcement action which prevented the Registered Providers from admitting new residents until the Commission for Social Care Inspection (known as the Care Quality Commission, or CQC, from 1 April 2009) was satisfied that significant improvements had been made in key areas. In line with our enforcement approach, the Registered Providers submitted an improvement plan. This showed what actions the service will take in order to meet statutory requirements, including who will be responsible and the timescale for compliance. Two CQC Regulatory Inspectors, Pippa Cantor and Caroline Marshman, visited the home on 25 March 2009 to review progress. They were satisfied that the home had made sufficient improvements to recommend that the Notice of Condition preventing admissions be lifted. The home recommenced admissions on 28 May 2009, at a self imposed limit of no more than two admissions per week. At this key inspection, we reviewed all the key National Minimum Standards. Prior to this inspection, we reviewed the information that the Care Quality Commission had about the home. This included improvement plan update reports sent by the providers showing the progress. We also looked at the previous inspectors’ reports. During this visit, we saw the care records for six people and visited them in their rooms. We spoke to people living in the home, to staff and visiting relatives. We observed staff working in the home and interacting with residents. We followed the care of six current residents to see how the care plans linked to the care being given. We also inspected staff files, general home records and made several tours of the building. The home also supplied us with an Annual Quality Assurance Assessment, which gave us good information for this inspection. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 6 The new rating for this service is two star, good. What the service does well: The Registered Providers and staff in the home continue to work well with us. They responded in a positive and open manner to enforcement action and supplied us comprehensive improvement plans and demonstrated a commitment to improving the quality of life for the residents. There has been open and honest debate in the meetings to monitor the improvement plans (these have been joint meetings between the Care UK and the London Borough of Islington). There is a continuing support system in place for friends and relatives who visit the care home. The service has shown good practice by keeping relatives updated through meetings chaired by an independent facilitator. They have actively sought feedback from the people who are stakeholders. The home continues to let us know about things that have happened since our last key inspection and has demonstrated that they have managed difficult situations well. The staff in the care home continue to provide a good standard of personal care for the people they look after. During the inspection people living in the care were seen to look well presented in appearance and clean. People continue to feel confident to raise any concerns they may have. What has improved since the last inspection? What they could do better: Two requirements were made at this inspection. Medication records should be complete and accurate to facilitate auditable control of medication and to provide accountability of administration in accordance with the prescriber’s direction. Staff providing supervision to nursing staff should have the clinical expertise to check their competency. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 7 The following recommendations are made: That full information on why a resident has been referred is obtained before the person is admitted. That the home continue to build and test nursing staff competency to ensure that residents’ needs are met. That the medicine fridge maximum/minimum temperatures readings relate to the current recording period by resetting the thermometer. This will provide accurate data to ensure the correct storage of medication to maintain its therapeutic efficacy. That there are systems in place to ensure that medicines requiring handling precautions are handled safely. That allergy status is noted on the reference cover sheet for all users of the service. That the home review its staffing of the reception area. That the daily fire warden responsibilities be included in the handovers, so that staff are clear about fire safety. That a system be put in place to ensure wheelchair cleanliness. That the home have an ongoing programme to build the competency of staff in dementia care. That staff be trained in English as a second language in ways that could assist their practice. 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. Lennox House Care Home DS0000069788.V375542.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 Lennox House Care Home DS0000069788.V375542.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that their needs will be assessed before they come to live in the home. EVIDENCE: Between 30 October 2008, when a Notice of Decision to Impose Conditions was issued, and May 2009, there were no new admissions to the home. CQC decided not to lift the conditions following the key inspection on 3 December 2008 until further progress had been made on the service’s improvement plan. In January 2009, Care UK applied for the Notice to be lifted. On 21 March 2009, two CQC inspectors, including a Registration Inspector, visited the home to review progress. They were satisfied that good progress had been made and recommended that the Notice of Condition be lifted. They found improvements in record keeping, care planning, risk assessments, staff training and doctor Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 10 and health professional liaison. They found that these improvements, while not perfect, contributed to better nursing care outcomes for residents. The inspectors also noted improvements in staff morale and relatives’ confidence. The home recommenced admissions on May 2009, at a self imposed rate of no more than two admissions per week. The Responsible Individual for the home (the Care UK Operations Manager) told us that the gradual admission process was to ensure that each admission was managed appropriately and to ensure that the resources of the home matched the needs of the residents. The home was still only partially occupied at the time of the inspection. We saw the care records of six people living in the home, including three people very recently admitted. We also spoke to these residents, if they were able to talk to us, and to some of their visiting relatives. We saw assessment information kept electronically on the Saturn Datebase and paper files, including assessments completed prior to admission. This enabled us to gain an impression of the assessment process. Generally, these assessments showed evidence of good practice. It was clear from the documentation that both residents and a relative had been involved in the initial assessment process. Two new residents had been admitted to the home the day before the inspection and one had been admitted ten days prior. Assessments had been reasonably completed. There were some discrepancies between the electronic assessments and the information found on the paper files, but these were in the process of being completed at the time of the inspection. The home’s Annual Quality Assurance Assessment states that “care plans are written with 24-48hours of admission.” The home still has some way to go to meet this target. Work is being done through the improvement plan process to ensure, for example, that all hospital discharge information is clear and available at the time of assessment and that the care planning process is well resourced when initiated. Some information had not been provided to the home prior to admission, and in one case, it was not clear from the documentation why one resident had come to the home. It is recommended that the home ensure that full information on why a resident has been referred is obtained before the person is admitted. All new residents were admitted to the ground floor intermediate care unit. Not all new residents had had the opportunity to visit the home before admission (these were people coming for intermediate care). Lennox House Care Home DS0000069788.V375542.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 7,8,9,10 Residents’ care plans continue to improve and risks to residents are assessed. EVIDENCE: Six people were case tracked as part of this inspection. This included checking the assessment process for people newly admitted to the home. Two of these residents had been admitted on the previous day. There was sufficient information available to plan their care and care plans were at least partly written the day after admission. All the longer term residents who were case tracked had a care plan in place and those plans had been regularly reviewed. Care plan improvements have continued and generally contained good detail around individual needs and how staff can meet those needs. There are still some lapses between what Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 12 was recorded on the written care plans (now kept in all residents’ rooms) and what was recorded on the Saturn database but, generally, the care plans are becoming more consistent and the work the home is doing on training staff appears to be paying off. One care plan for a person who speaks little English has been improved to consider their cultural needs and staff showed us language charts they are using to communicate with this resident. A requirement from the last inspection is met. We noted that some care plans contained English language and medical terminology errors that could lead to confusion. A recommendation is made staff be trained in English as a second language in ways that could assist their practice. Staff that we spoke to were able to give a reasonable picture of the needs of the residents in the home and were able to discuss the detailed needs of residents whom they key work. The joint improvement plan and minutes of monitoring meetings identified that there have been issues with nurse competency, in particular where nurses had knowledge that they were not putting into practice. It is recommended that the home continue to build and test nursing staff’ competency to ensure that the residents’ needs are met. Better systems have been put in place to refer, monitor and record communication with the GP and other healthcare professionals, and actions to be taken are highlighted for action. The home now has a contract with a new GP service. There was a strong smell in one part of one unit. We discussed this with the management team. They told us how they are working to improve continence management for a resident. All residents case tracked had risk assessments in place either available on the Saturn Database and/or in paper form. We saw examples of good practice. There were comprehensive risk assessments relating to falls, the development of pressure sores, risk of choking and risks of suicide. Some risk assessments needed review. Accident and incident records mainly noted falls. There was good evidence on the Saturn system of how increased risks were monitored by staff and actions taken to reduce these risks to residents. After the December 2008 inspection, the home responded promptly to an immediate requirement notice that managers investigate an anomaly in the administration of insulin to a resident and take appropriate action. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 13 The values of privacy and dignity are covered in the staff induction process. Staff were seen addressing residents in a respectful way and sitting alongside them to communicate with them. Throughout the inspection, staff were observed ensuring that privacy was maintained when personal care was being given. Residents and relatives told us that the staff were respectful of people’s privacy and dignity and that there had been improvements since newspaper coverage of the late removal of a deceased person from the home last year. Care plans on the Saturn system and the paper file now record the residents’ wishes at time of death and whether they have signed the Do Not Resuscitate Policy. The CQC Pharmacist visited the home on 21 April 2009 and inspected the home’s medication systems. He reported that: The home’s residents’ have their medicines dispensed using the Boots monitored dosage system that includes the provision of medicine administration record (MAR) charts. In most cases medication audit was met and able to confirm that medication was being administered in accordance with the prescriber’s direction. However, for service user E.D. warfarin tablets were prescribed with the three strengths, 1mg, 3mg and 5mg kept and labelled for that service user. The dose to be administered was determined according to the results of regular blood tests carried out at an anticoagulant clinic and the results of the tests were available with the medication records to inform the home’s staff of the dose to be administered. As it is possible for the dosage to change during the 4-week prescribing cycle, the tablets are prescribed without precise direction and dispensed by the pharmacy in the manufacturer’s original packs as opposed to the precise dosage being dispensed into blister packed monitored dosage cards, as for most of the other medication. Although medication records indicated the dose given, it was not possible to confirm this by audit of the warfarin tablets as only the 1mg strength was recorded. On indicating this issue to the home’s manager, immediate steps were taken to provide a documented record for all the 3 strengths of warfarin. Medicines administration was 17 days into the current 28-day prescribing cycle and there were 4 other audit discrepancies found where the inaccuracy was plus or minus 1 tablet/capsule. This included plus one tablet of levothyroxine 50microgram prescribed for service user E.D. at a dosage of 2 tablets daily, minus one capsule of omeprazole 20mg prescribed for service user E.D. at a dosage of 1 capsule daily, plus one tablet of omeprazole 20mg prescribed for service user I.R. at a dosage of 1 tablet daily, and minus one tablet of quetiapine 25mg prescribed for service user S.B. at a dosage of 2 tablets twice a day. Audit was not possible on 5 occasions where the receipt of medication was not entered on the medicines administration record chart. This included isosorbide mononitrate MR 60mg tablets prescribed for service user M.P., aspirin dispersible 75mg tablets prescribed for service user J.W., senna 7.5mg tablets prescribed for service user J.C., tamoxifen 20mg tablets prescribed for Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 14 service user A.P., and paracetamol 500mg. tablets prescribed for service user S.B. It was therefore not possible to confirm that these medicines have been administered in accordance with the prescriber’s direction. Authorised members of staff are required to write additional information on the charts to indicate any changes, how treatment is provided or to aid medicines administration. Occasionally these entries lacked endorsement with the date and signature of the member of staff making the entry resulting in lack of accountability in confirming records or knowing when changes were made. An example of this included lactulose solution prescribed for service user E.D. where directions were changed from once a day to twice a day. Where the prescribers directions are open to interpretation, for example “as directed” or “when required”, there were occasions when medicines for external application, such as creams and ointments, required further documented directions to be available with the medication records to guide staff carrying out administration. Medicines requiring cold storage were kept in lockable medicines fridges provided on each of the home’s units. Each fridge had a thermometer indicating the maximum, minimum and current temperatures of the fridges, and these temperatures were recorded daily to ensure the correct temperature range was maintained. However, as the thermometers were unable to be reset this resulted in the maximum and minimum temperatures being carried over. This resulted in readings being recorded that did not relate to the current period. On occasions this resulted in temperatures being recorded outside the required range without remedial response being taken by staff. On indicating this issue to the home’s manager, immediate action was taken to arrange an appointment for a representative from the home’s supplying pharmacy to visit the home to address this issue. A medicine requiring handling precautions, finasteride 5mg tablets, was prescribed for service user GD. This medicine was dispensed by the pharmacy into blister packed monitored dosage cards and no patient information leaflet was supplied by the pharmacy. In the interest of health and safety it is recommended that the pharmacy be requested to dispense this medicine in the manufacturer’s original container and include the patient information leaflet indicating the caution. During the inspection entry was made on the medicine administration record (MAR) chart indicating caution when handling and staff were informed of precautions to be taken. The allergy status of the home’s service users was usually entered on the medicine administration record (MAR) chart. One unit included this status on the service user’s reference cover sheet that preceded their MAR charts while other units included this for some of their service users. It is recommended that the allergy status be entered on the cover sheet for all service users as this ensures continuity of the record and avoids the risk of transcription errors. Lennox House Care Home DS0000069788.V375542.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from improved activities that reflect their wishes and interests. Relatives have welcomed improved communication opportunities. Residents continue to benefit from a varied and balanced diet with alternatives to the main menu. They are able to have their meals in a relaxed and social way. EVIDENCE: Each person had a care plan covering their interests and preferred activities. The care plans we saw had good detail on weekly activity programmes. Activity programmes were displayed on each floor and in the reception area. They included one-to-one sessions, gentle exercise, arts and crafts, choice of games and trips outside of the home. The home now has a programme of things to do both inside and outside the home. Just prior to and during the inspection, residents visited the London Eye, Trafalgar Square, an aquarium and went out for a picnic. Some residents also baked cakes and did flower arranging. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 16 We observed residents taking part in group activities such as dancing, playing games and some individuals singing with staff. Residents tended to gravitate to smaller lounges for quiet time on their own or with one or two other residents. Some residents told us that they preferred not to participate in group activities and enjoyed reading, watching television or spending time in their rooms. Life history information is being recorded through interviews with the residents and relatives. We spoke to a new activities coordinator who described this process as very helpful for gaining insight into the residents and their background and interests. The home employs two activities coordinators. They told us that the home was planning a fashion show for the following week and had obtained donated clothes for this event. All residents have an eating and drinking care plan. This reflects the level of assistance they require when having meals and snacks, the type of diet they need or prefer and their likes and dislikes. We observed lunch in one dining room. There was a calm and relaxed atmosphere and improvements to mealtimes have been sustained. The food in the home is good quality, choices are available and the menu addresses peoples’ dietary and cultural needs. Visual menus are on display on the tables. We toured the kitchen and spoke to the chef and assistant. There was plenty of fresh fruit and vegetables in the kitchen, along with fresh baking ingredients and salmon. We saw the residents’ menu choices. Food available included beef stew with dumplings, fresh spinach soup, corned beef salad, chicken curry, vegetarian dishes and options that reflected the cultural origins of some residents. The home has stopped offering sandwiches at night and now provides a full cooked meal in the evenings. The kitchen was clean, hygienic and well maintained. Food and refrigerator temperatures were properly recorded. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their significant others can feel confident to express their views in a safe and understanding environment. They are safeguarded by the home’s policies and procedures and staff training. EVIDENCE: Residents and visiting relatives we spoke to told us that they knew how to make a complaint and whom to speak to if they are unhappy. Since concerns about the home were raised publicly in 2008, the Care UK management team has worked to rebuild the confidence of the residents and relatives. Relatives told us that their concerns have been responded to and care has improved. We inspected the complaints records. No significant complaints had been received since the last inspection. Complaints received had been properly investigated and responded to. There has been one safeguarding investigation regarding staff failing to ensure that a resident received prescribed medication. This was the subject of an extensive investigation by Care UK and the London Borough of Islington. As part of the home’s improvement plan, improvements in staff training, competency checking and changes to medication management systems were put into place. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 18 Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, safe and comfortable environment, designed and maintained to meet their needs. EVIDENCE: We toured the building several times over the two inspection days. This relatively new, purpose built home is well furnished and maintained, with a good standard of facilities throughout. Each floor is well resourced with large and small lounges, dining and bathing facilities. There are also designated smoking areas, and a multi faith room for religious expression or reflection. There are numerous areas that can be used for large or small scale activities. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 20 The ground floor can accommodate nine people for short term, intermediate care. There is also a space for training staff on the top floor. There were fresh flowers around the building. The home has improved signage since the last inspection. One lift was out of order. The staff told us that it had not been working for some time. We confirmed this with the maintenance supervisor, who told us that he was still waiting for parts. The home has a second lift, which was working well. We spoke to several residents in their rooms. Their rooms were personalised and comfortable and they told us they liked the space. Specialist beds are provided for the residents. The reception area, while pleasantly designed and well resourced with a good noticeboard and information about the home, was not welcoming on either morning of the inspection, nor kept secure on the first inspection morning. On the first morning of the inspection, there was no one on reception for three quarters of an hour. There was a large delivery being made and people were able to come and go into the home without being welcomed or monitored. On the second morning of the inspection, there was no one in the reception area for over an hour. The lack of staff on reception over the weekend was also noted by relatives at a minuted meeting in May 2009. A recommendation is made that the home review its staffing of this area. The home was clean and hygienic. Clinical waste is properly disposed of. Cleaning staff we spoke to had a good understanding of infection control and had received appropriate training. Some wheelchairs needed cleaning and it is recommended that a system be put in place to ensure that wheelchair cleanliness. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by safe recruitment processes for new staff and the home’s ongoing staff training programme. They are also enabled by the way the home is staffed and resourced. EVIDENCE: Improvements have been made in the recruitment process to ensure that the home checks prospective staff are competent in areas where weaknesses have been identified in the home. Competency checking includes checking understanding of and writing care plans. Management told us that this was to build the clinical consistency and care provided to residents. We saw the files of six staff on the Saturn Database and the paper files. They had had proper pre-employment checks completed before commencing work. With the home Manager, we discussed the current staffing levels and how they would be increased as more residents moved into the home. At the last inspection, inspectors found that there were sufficient staff on duty, although the home needed to monitor how these staff were deployed. The Manager told us that he home has significantly reduced its use of agency staff and is offering permanent staff overtime or using its own bank staff. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 22 Fifteen new staff have been recruited, including two new nursing staff who were undergoing induction. The home is also in the process of recruiting a clinical nurse manager for the home. Staff training continues to improve. There is a clear record of staff training completed and planned. Staff had had regular training, including updates of mandatory training, such as first aid, medication, food hygiene, safeguarding adults, fire safety, Mental Capacity Act, safe swallowing, moving and handling, infection control, dementia, end of life and falls awareness. Nursing staff had also received training in Coronary Obstructive Pulmonary Disease (COPD), suction, venepuncture, heart failure and diabetes. Training in record keeping has been ongoing and most staff have been recently trained on the responsibilities of being a key worker. The home is registered for a maximum of fifty six people with dementia. It is likely that a significant number of new referrals will be for people with dementia. While some staff have had some dementia training, the home needs to continue to build expertise in this area. It is recommended hat the home have an ongoing programme to progressively build the competency of staff in dementia care. Thirty out of forty three permanent staff have at least an NVQ2 qualification. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from an active improvement strategy for the home and a clear and responsive management structure. The views of residents and their significant others are contribute towards service improvement and their interests are protected. The health, safety and wellbeing of residents is protected. EVIDENCE: There is a clear management structure in place. The new Manager started work on 15th December 2008. The care home also has an experienced deputy manager. There is a clear system in place for management on call. The home Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 24 continues to benefit from the on site management support of the Regional Manager and the Care UK Operations Manager. The new home Manager has had a thorough induction. He has applied for registration with CQC. The Regional Manager said she will continue to be based at the home to support the new Manager until she is confident that all improvements are working well. The management team is still holding monthly meetings with the London Borough of Islington to work monitor progress on the joint improvement plan. The last copy of this document we saw was dated March 2009 and noted significant progress in the actions identified. We spoke to the Operations Manager, Regional Manager, Home Manager and Deputy Manager. They gave consistent and interlinked accounts of the improvements in the home. We saw the minutes of residents’ and relatives’ meetings, which indicated that they were pleased with how the home is improving the quality of care and communication with them. Relatives we spoke to confirmed this. There is an accountable system in place for protecting the residents’ money. Staff responsible for the supervision of staff are appropriately trained. Staff supervisions take place reasonably regularly, although there could be some improvement. Frequency and quality of supervision will become more important as the home becomes busier. Staff supervision is also a good place for checking nursing staff competency and the staff providing supervision should have the clinical expertise to do so. A requirement is made. The home continues to let us know about things that have happened since our last key inspection and they have shown that they have managed issues well, including recent issues around managing staff performance and improving the quality of care. We checked the health and safety records in the home and spoke to the maintenance supervisor. The home had all the required health and safety certificates. The only outstanding matter was the out of action lift waiting on parts. Hoist and other equipment had been regularly checked and serviced. Accident and incident records mainly recorded resident falls. These are addressed under the section of this report, Health and Personal Care. Fire safety records showed that the alarms and equipment are regularly tested and checked. The most recent fire drill was held in February 2009 and was well documented. Staff are trained in fire safety. The home had a fire safety inspection in September 2008 and has a Fire Safety Risk Assessment. Staff have received fire warden training. However, on one occasion, staff were not clear who the fire warden was for that day. A recommendation is given that fire responsibilities be included in the handovers. Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The Registered Persons should ensure that medication records are complete and accurate to facilitate auditable control of medication and to provide accountability of administration in accordance with the prescriber’s direction. The Registered Persons should ensure that staff providing supervision to nursing staff have the clinical expertise to check their competency. The Registered Persons must ensure that full information on why a resident has been referred is obtained before the person is admitted. Timescale for action 30/06/09 2. OP36 18 (1) 30/08/09 3. OP3 14(1) 30/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 27 1. 2. OP30 OP9 3. 4. OP9 OP9 It is recommended that the home continue to build and test nursing staff competency to ensure that residents’ needs are met. It is recommended that the medicine fridge maximum/minimum temperatures readings relate to the current recording period by resetting the thermometer. This will provide accurate data to ensure the correct storage of medication to maintain its therapeutic efficacy. It is recommended that systems are in place to ensure that medicines requiring handling precautions are handled safely. It is recommended that allergy status is noted on the reference cover sheet for all users of the service. It is recommended that the home review its staffing of the reception area. It is recommended that daily fire warden be included in the handovers, so that staff are clear of their responsibilities. It is recommended that a system be put in place to ensure wheelchair cleanliness. It is recommended that the home have an ongoing programme to progressively build the competency of staff in dementia care. That staff be trained in English as a second language in ways that could assist their practice. 5. 6. 7. 8 OP9 OP38 OP 24 OP30 9. OP30 Lennox House Care Home DS0000069788.V375542.R01.S.doc Version 5.2 Page 28 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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