Care Home: Lewin House

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What the care home does well People using the service are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. The needs of people previously accommodated by the provider had been taken into account effectively and they were regularly consulted about the move. There is good regard for the diverse needs of the people living at the home and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Activities are being developed to provide people using the service with stimulation. Contact with family, friends and the community is supported tomaintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. The home is spacious, well designed and equipped to meet needs arising through disabilities and is kept clean and hygienic, promoting a positive environment for the people who live there. The home provides staff cover to meet needs and undertakes thorough recruitment procedures, with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the home promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? This was the first key inspection after the home`s registration therefore this section is not applicable. What the care home could do better: The service users living in the house for people with learning disabilities have been used to participation in household tasks, such as meal preparation and their personal laundry. They are unable to continue with these skills as main meals are prepared centrally and laundry is undertaken by staff in the main part of the building. Some thought is needed to whether these restrictions can be overcome so that independent living skills are retained as long as possible. CARE HOMES FOR OLDER PEOPLE Lewin House Belgrave Road Aylesbury Buckinghamshire HP19 9HP Lead Inspector Chris Schwarz Unannounced Inspection 09:45 8 & 9th April 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lewin House Address Belgrave Road Aylesbury Buckinghamshire HP19 9HP 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) 01296 393055 manager.lewinop@fremantletrust.org www.fremantletrust.org The Fremantle Trust Mrs Clare Hedge Care Home 70 Category(ies) of Dementia (0), Learning disability (0), Old age, registration, with number not falling within any other category (0) of places Lewin House DS0000071187.V361572.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 only (PC) Care Home with nursing (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 (OP) Dementia (DE (E)) Learning Disability (LD) Maximum number 8 The maximum number of service users who can be accommodated is: 78. Not applicable 2. Date of last inspection Brief Description of the Service: Lewin House is a newly built care home with nursing, located just outside the town centre in Aylesbury. It replaces two of Fremantle Trust’s homes for older people and additionally provides accommodation for up to eight people with learning disabilities in a separate wing of the building. The home has been developed in partnership with Buckinghamshire County Council and Housing Solutions as part of a phased re-provisioning of care accommodation for older people and people with learning disabilities in the county. The main part of the building consists of four houses, two on each floor, one of which currently provides nursing care. It is envisaged that more nursing care will be provided as the home develops. Each house has either 15 or 20 single bedrooms with en-suite showers and toilets, lounge and dining areas with kitchenettes, additional seating areas, adapted communal bathroom facilities, communal toilet facilities and various storage cupboards. There are carer stations in each house and a treatment room on each floor. A hairdressing salon and shop have been provided and there is access to the gardens from here and from each of the downstairs lounges. A passenger lift has been fitted for access between floors. The house for people with learning disabilities has its own entrance and has been arranged similarly, with bedrooms and bathrooms larger, provision of ceiling tracking, a separate garden area and two lounges. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 5 Lewin House has parking for staff and visitor cars and is accessed via a security gate. Gardens are well maintained and will provide a pleasant area to wander around and sit in during warmer weather. Fees ranged from £484.40 per week to £850 per week at the time of this visit. Services such as podiatry, hairdressing, personal toiletries and newspapers are at additional charge to the individual. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was conducted over the course of two days and covered all of the key National Minimum Standards for older people and took into account the fact that there is a group of younger adults with learning disabilities accommodated at the service. Prior to the visit comment cards were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the home’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager and operations manager at the end of the inspection. The manager, staff and people who use the service are thanked for their cooperation and hospitality during this unannounced visit. What the service does well: People using the service are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. The needs of people previously accommodated by the provider had been taken into account effectively and they were regularly consulted about the move. There is good regard for the diverse needs of the people living at the home and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Activities are being developed to provide people using the service with stimulation. Contact with family, friends and the community is supported to Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 7 maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. The home is spacious, well designed and equipped to meet needs arising through disabilities and is kept clean and hygienic, promoting a positive environment for the people who live there. The home provides staff cover to meet needs and undertakes thorough recruitment procedures, with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the home promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lewin House DS0000071187.V361572.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 Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 3,6 People using the service are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A detailed service users guide and statement of purpose were in place to provide information to people using the service and those who are considering moving in. Copies of these were available on display in the home and service users guides had been put in all of the bedrooms. The majority of people living at Lewin House at the time of the inspection had previously resided in homes run by Fremantle Trust. For these people, the move had been a gradual process involving consultation, ascertaining their wishes, and producing detailed care needs assessments with involvement from the local authority. For people admitted from other areas of the community, detailed pre-admission assessments had been carried out outlining their care needs, with information dated and signed. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 10 The service does not provide intermediate care therefore this standard is not applicable. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. There is good regard for the diverse needs of the people living at the home and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had a care plan outlining their needs and care requirements and how these are to be met. Each file that was looked at contained a photograph of the person and documented their preferred name, religion and ethnic origin, next of kin and doctor details, general physical health, mental health needs, mobility, communication needs and personal care needs. Likes and dislikes had been ascertained, such as food preferences, and all aspects of the care plan had been signed and dated. Assessments were in place to accompany the care plans, covering areas such as moving and handling, risk of developing pressure damage and nutritional screening. Most of the files that were examined had been written to a good standard and contained sufficient information to ensure continuity of care, for example including the type and size of incontinence pad that was needed, good information on managing independence under the section dealing with mobility and what equipment was required to assist people Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 12 with safe moving and handling manoeuvres; links to medicines prescribed to deal with symptoms of dementia were included in some care plans. On the house providing nursing care, a different style of care plan had been developed with information divided into five easy to follow sections and included additional information such as baseline assessments which had been undertaken on admission. Most of the care plan files across the service showed that people were being weighed regularly and a record was being kept of visits to/from health care professionals. Files showed that people’s needs were being reviewed regularly and care plans and assessments amended as necessary. Some formal reviews of placements were taking place at the home on the second day of the inspection. Medication was being managed well. Each of the houses in the main part of the service had a locked room containing the medication cabinets with the key kept on one of the staff. Controlled drugs were being stored separately on the nursing house. All medication cabinets were secure, sturdy and in good order. Medication fridges were also in place on each house. Samples of medication administration records were looked at and found to be in good order. In the house providing accommodation to people with learning disabilities, individual medication cabinets had been provided in their rooms. There was good regard for people’s privacy and dignity throughout the service. All personal care was carried out in bedrooms, treatment rooms or bathrooms. Bathrooms have been fitted with a curtain close to the door to provide screening if a second member of staff is needed, for example just for moving and handling manoeuvres. Staff were respectful in their approach to people; one member of staff was heard complimenting people on how nice their hair looked after they had been to the salon. Staff have access to an operations manual to refer to policies and procedures for dealing with personal care issues and there is an additional manual of clinical procedures to provide guidance for nursing staff. Three health care professionals returned surveys, indicating that people’s health care needs are largely met. All considered that people’s privacy and dignity were respected by staff and that people using the service were ‘always’ or ‘usually’ supported to manage their own medication or the home managed it correctly where this was not possible. All considered that staff had the right skills to meet people’s needs with one person commenting that supplementary training from the district nursing team would be of benefit. Good regard for people’s needs arising from equality and diversity was reported. Additional comments included ‘a very caring environment’ and ‘generally I am very impressed’ and a note that there was good holistic care. Most staff considered that they are ‘always’ or ‘usually’ given up to date information about people’s care needs, such as in a written care plan. One person commented ‘care plans have got all the information you need to know Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 13 about a particular person’ and another said ‘care plans are well thought through and well laid out in an index form…and easy to understand. Makes a good reference.’ Most of the people using the service who completed surveys considered that their medical needs are being met and that they ‘always’ or ‘usually’ receive the support they require and ‘usually’ enough staff are around when they need them. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Activities are being developed to provide people using the service with stimulation. Contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. Some independence for people with learning disabilities is restricted through the design of the service, which could mean that skills are being lost. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service who completed surveys said there were ‘sometimes’ but few activities arranged by the home. It is acknowledged that this an area being developed in all parts of the service and measures are already in place to improve the range and number of activities available to people. One activity organiser was in place in the older persons part of the service, with a second organiser due to start once all recruitment clearances had been received. In the meantime, an activity organiser from another service was providing assistance to the main part of the home. Newspapers were being delivered each day to anyone who wanted one and several people were seen taking an interest in the news. An aromatherapist visits and there are gentle exercises once a week. The local vicar holds communion once a month and service users are invited to attend the local church. Entertainers have visited the home and a Christmas party was held; the manager was making Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 15 preparations for a forthcoming visit by Princess Alexandra followed by a champagne buffet for service users. There is a good size hairdressing salon on the ground floor with three hairdressers visiting each week. Opposite the salon is a shop/bar – the manager is aiming to recruit volunteers to run this. The school opposite the home has offered use of its library which the home will start to make use of once there are volunteers to help take people over there. Visitors are able to see their relatives and there are numerous areas to sit and talk in private, other than in bedrooms. There is a hotel style telephone service with telephone points in each bedroom to make or receive calls in private. People can opt to have their own telephone number if they wish. In the house providing accommodation for people with learning disabilities, a part time activity organiser post was being advertised. People using the service were attending clubs and groups in the area such as Gateway and the Tuesday club. One person had some involvement with the Jigsaw Theatre in Aylesbury and some people had enrolled for music, drama and nature courses. Crafts and games were seen being used. The manager of the house said there are plans for a member of staff to develop sports with service users, as a further source of interest and stimulation. Staff were managing to take service users out in groups and individually, making use of taxis to transport people. One person who was met during the inspection had just returned from town with a member of staff, having enjoyed lunch out. Service users were occasionally going out for walks and accompanying staff to local shops. There was good regard for people’s rights to make choices at the service and to have control over their lives as far as they were able or wanted to. Staff working on the house for people with dementia, for example, were observed offering choices sympathetically, such as explaining what the food items were on the menu to help people select their breakfast options and showing glasses of different types of drinks to help make a choice. The only points raised for discussion with the manager and operations manager were in relation to service users with learning disabilities. Their house does not have a name or way of referring to it other than the ‘learning disability unit’ which feels out of keeping with how the service operates and its philosophy of care. Also, the people living in that house are used to assisting with meal preparation and laundry and both of these functions are now handled by staff in the main section of the service. This may have taken some of their independence away although it is acknowledged that in the long term people being admitted to this part of the service would have far greater needs. It was suggested that ways of continuing people’s independent living skills in these areas should be promoted if at all possible. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 16 Meals are prepared in a central kitchen and taken to the houses in trolleys. A varied menu was in operation with a copy on each dining table throughout the service. There are choices of meal and food is presented attractively with serving dishes used for vegetables. People had enjoyed their lunch of home made chicken and mushroom pie, new potatoes, carrots and peas and a deep filled lemon meringue pie. There were ample quantities of food available to people and tables had been set attractively with table cloths, place mats and glasses for drinks. People who completed surveys said that they ‘usually’ liked the meals. Lewin House DS0000071187.V361572.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has complaints and safeguarding/adult protection procedures in place to respond to issues. Training in safeguarding is given to staff and all staff who completed surveys were aware of what to do if anyone raised any concerns about care practice. Most people using the service who completed surveys were also aware of how to raise concerns. The complaints log showed a small number of complaints being received relating to various aspects of care provision, all responded to appropriately. A larger number of compliments had been received about the service. Age Concern and other advocates were providing support to some of the service users. The Commission has not received any complaints about this service and has not been made aware of any adult protection/safeguarding issues. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is excellent. The home is spacious, well designed and equipped to meet needs arising through disabilities and is kept clean and hygienic, promoting a positive environment for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lewin House is situated close to the town centre on the Meadowcroft estate. There are public transport links into the town centre and library services, local shops, pubs and a medical centre nearby. The service has security gates to prevent intruders and is well signed for easy identification. There is parking for staff and visitor cars and designated bays for disabled drivers. The grounds have been landscaped attractively with all downstairs lounges having a door leading to communal garden areas. Pathways are level and seating areas have been created to encourage people to use the garden, which provides a large space to wander round safely. Staff have added bird feeders to attract birds into the garden. The house for people with learning disabilities has its own section of garden with patio, seating and a lawned area. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 19 Each of the four houses in the main part of the service has a lounge area, dining room with well equipped kitchenette, adapted bathroom and toilet facilities, sluice, cleaning store, linen store, carers station and secure room for medication and care plan storage, single en-suite bedrooms and additional seating at the end of corridors. Windows are large and most in the main part of the building overlook the gardens or the park beyond the home. Telephone and satellite points have been fitted in each room and smoke detectors and a sprinkler system are in place. Window restrictors have been fitted and radiators are covered to prevent accidental injury. There is a sense of space throughout the home and the additional seating areas at the end of corridors are a good addition to facilities and provide people with a place other than their bedroom to sit quietly or receive visitors. Each floor has a large communal space adjacent to the lift with sofas and chairs. On the ground floor the hairdressing salon and shop/bar lead off from the communal area which also has access to the garden. Pictures from the two former homes for older people have been brought over to provide familiarity for service users. Hearing aid induction loops have been fitted in lounges and all grab rails in corridors have been fitted with sensory nodules for people with visual loss to navigate by. Corridors are wide enough to easily allow wheelchairs and trolleys to pass by. Bathrooms have been fitted with height adjustable baths and hoisting equipment. Beds are height adjustable also. Each floor also has a treatment room. A call system has been fitted throughout the building. In the house for people with learning disabilities, the design is similar with larger bedrooms and en-suites and an additional lounge area plus the house manager’s office. Ceiling tracking has been fitted to three of the bedrooms in the accommodation for people with learning disabilities and other rooms in this house have been carefully designed with a wall panel which can easily be removed for bathroom access if further tracking is required. The central kitchen and laundry have been well thought out with a one way flow system of traffic and a laundry chute from the first to the ground floor. Non-slip flooring has been used in these rooms, as well as in bathrooms and toilets. In all parts of the service there was a high standard of cleanliness and good regard for infection control measures, such as wearing disposable aprons when serving food and using disposal gloves when carrying out personal care and staff have been provided with hand gel. Given the high level of incontinence at the home, it is worth noting that no offensive odours were evident and all bathrooms and toilets that were seen had been maintained in a clean and Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 20 hygienic condition. The home’s house keeper was vigilant in walking around the building to make sure that standards were being maintained. Lewin House DS0000071187.V361572.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. The home provides staff cover to meet needs and undertakes thorough recruitment procedures, with effective training to ensure staff have the right skills and competencies to support the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most of the staff working at the home have come from the two older persons homes that Lewin House replaces with some staff from learning disability services also. This continuity has helped people to settle and has made the move more manageable for them. Recruitment was taking place at the time of the inspection to fill vacant carer hours; the full complement of nursing staff were in place and a bank or nurses had been established. The management structure of the home is in keeping with the size and nature of the service and includes a registered manager for the service overall, a deputy manager who is also the clinical lead nurse, a manager of the house for people with learning disabilities, a dementia care manager and chef manager. There are five group care leaders, nurses, carers, house keeping, administrative and catering staff completing the staff team. All staff who were met during the inspection spoke positively about the home and were clear of their roles and responsibilities. A good sense of team work was described, and was apparent, and people took pride in what they were doing. Staff consistently offered cups of tea and were hospitable, friendly and co-operative throughout. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 22 A duty senior is in place throughout the day with responsibility for running and co-ordinating the shift and dealing with any emergencies. Handovers take place between shifts to ensure information is passed on. Eight completed staff surveys were returned. Comments about induction varied from it covering everything staff needed to know ‘very well’ to ‘partly’, in some cases depending on the length of time that staff had been working for the organisation and job title. Seven said that they receive training that is relevant to their role and that there were opportunities to meet with their manager for support and to discuss how they are working. Staff said that communication systems ‘usually’ worked well and opinion was divided between ‘usually’ and ‘always’ when asked if there are enough staff to meet individual needs of all the people who use the service. Staff were also divided equally between ‘usually’ and ‘always’ regarding having the right support, experience and knowledge to meet the different needs of people such as those arising from disability, sexuality, gender, race, faith and ethnicity. Additional comments included ‘meetings are always being held to discuss new ways of providing services to our service users’, ‘the service did very well in the move from each of the homes to Lewin House’, ‘staff are always kept informed by handovers, message book and general communication’ and ‘trains and develops the staff team. Provides person centred care towards the residents, promotes the residents’ well-being especially with dementia care services’. A sample of recruitment files was looked at and found to be in good order with the necessary clearances undertaken. Training was taking place on a large scale to refresh skills or provide them for the first time. Courses had been arranged up to October this year on mandatory and specialist topics. The home was also developing link nurses for areas such as MRSA, diabetes and infection control. The home had already achieved at least 50 of staff with National Vocational Qualification level 2 or above and further staff were working towards a qualification. The registered manager and manager of the house for people with learning disabilities had already achieved Registered Managers Awards. The service’s manager and dementia care manager are trained in dementia care mapping. Lewin House DS0000071187.V361572.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. The management and administration of the home promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a registered manager who is experienced in care provision and has worked for the organisation for a number of years. All of the other department managers were also experienced and, apart from the deputy manager who is also the clinical nurse lead, had worked for the organisation previously. Lines of accountability were clear within the home and there were procedures in place for dealing with emergency situations. Monitoring visits have been taking place by the provider to evaluate standards of care and reports of these were available in the duty office. A quality assurance exercise had also taken place recently and the report was being Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 24 prepared. The operations manager for the service was also visiting on a regular basis. People using the service can choose to have their money managed in the provider’s residents’ savings scheme. This system was being properly documented with receipts to verify money deposited and expenditure and access to the system and records restricted to the two administrative staff with oversight by finance staff at the provider headquarters. The service users in the house for people with learning disabilities were maintaining the arrangements they had prior to moving in, retaining accounts with banks/building societies and withdrawing money as they needed it. Individual locked tins were held in the safe with transaction records maintained by staff. Records of financial transactions were looked at and found to be properly documented with receipts in place. A check was made of balances in some of the tins and all tallied with recorded balances. There was good regard for health and safety at the service, backed up by training such as moving and handling, fire safety and food hygiene. Generic, fire and individual risk assessments were in place and Legionella testing was taking place at the same time as the inspection. Accidents were being recorded and a falls register was in place. In the kitchen, hazard analysis had been identified, fridge and freezer temperatures were being monitored and core food temperature checks were recorded. Clinical waste was being disposed of appropriately, sluicing and bedpan washing facilities were in place and, as previously mentioned, infection control and cleanliness were being maintained to good standards around the home. Health and safety policies, procedures and guidance were available for staff to refer to. Lewin House DS0000071187.V361572.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 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 4 4 4 4 4 4 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 x X 3 Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/a STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP14 Good Practice Recommendations Ways of continuing people’s independent living skills in relation to meal preparation and personal laundry should be promoted for those service users with learning disabilities. Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lewin House DS0000071187.V361572.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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