Care Home: Lezayre Nursing Home

What the care home does well The registered manager left Lezayre in September 2009 and a nurse who was already working at the home took over as acting manager. She told us that she did not plan to do the job permanently, however she has put an enormous amount of work into improving the way that the home is run. The people we spoke with expressed confidence in the acting manager. One resident told us `if you`ve got any problems or need anything you just tell C`, another person said `staff are fantastic, C is wonderful and has made things better for the residents`. A member of staff said `C is a good manager, she is all for the residents` best interests`. A statement of purpose and service user guide have been written to give people information about Lezayre and the services the home provides. A new brochure is available which summarises the information. Each of the people living at the home has a comprehensive care plan that details their personal and health care needs and how these needs will be met, taking into account the person`s lifestyle choices and preferences. We found that the care plans had been written in detail using a person-centred style that `painted a picture` of the person and gave clear guidance to staff. A full daily progress record was written for each person. The care plans were kept up to date and had been audited by the acting manager. Medicines are well managed and the records we looked at suggested that people always receive the medication prescribed by their doctor. Care plans included a social profile of each person including their background, education, employment, family, visitors, hobbies and interests. A record of the activities they enjoy in the home is recorded. The expert by experience spent three hours chatting with people in the lounge/dining rooms and had lunch with some of the residents. Her report included the following observations: `One area of the front lounge had high backed chairs and television whilst the dining table end was occupied by two ladies working with the activities coordinator painting pictures. These two ladies were in their late eighties and were happily painting away before lunch. The male coordinator knew them both well and was lovely, encouraging and directing them and loading a brush with paint for one of the ladies. One lady sitting in the T.V. area looked very frail and was chatting to a young care assistant who was lovely with her. She sat on the chair next to her and faced her and intently listened to what she had to say. She said `that is what is nice here, you can give them time`. There appeared to be enough staff and the home was clean and cared for. From what I saw meals were appropriate and nicely prepared. Some areas would benefit from a paint/decorate but I felt that this was a happy home and staff appeared to be happy. The senior nurse today said that she loved her job and the home and it showed. It was nice to see patients given the opportunity to get out of their wheelchairs to go into bed or into a more comfortable chair in the afternoons. This was a nice visit and I felt privileged to spend time with such a group of nice people and wish them all well for the future.` Although Lezayre is a large building there is a homely feel to it. We found all parts of the building were warm, clean, tidy and safe. The home is well equipped with hoists and other equipment including profiling beds, pressure relieving mattresses and door guards. The home has enough qualified and experienced staff to ensure that people`s can be met in full. Nearly all of the care staff have NVQ level 2 in care and most have level 3. Housekeeping staff have NVQ level 2 in hospitality or catering. This means that there is a very well qualified workforce. What has improved since the last inspection? This was the first inspection since the home was registered in August 2009. What the care home could do better: Screening should be provided in shared bedrooms to ensure privacy when personal care is being given. Parts of the building are in need of redecoration and some of the bedroom furniture is shabby. Some carpets need to be replaced. Although we found the home to be very well managed at the time of our visit, the management arrangements were temporary and an application to register a permanent manager should be made as soon as possible to ensure that the high standards achieved will be maintained. Key inspection report Care homes for older people Name: Address: Lezayre Nursing Home 100-102 Egerton Park Birkenhead Merseyside CH42 4RB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Smith     Date: 1 6 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Lezayre Nursing Home 100-102 Egerton Park Birkenhead Merseyside CH42 4RB 01516449433 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Surecare Health Ltd Name of registered manager (if applicable) Miss Geraldine Mary Parker Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category 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. The maximum number of service users who can be accommodated is: 36. Date of last inspection Brief description of the care home Lezayre nursing home is in the quiet residential area of Egerton Park, Rock Ferry. It is a large three storey property set in its own grounds with a garden at the back and car parking at the front. It is close to local shops and other amenities. The home changed ownership in August 2009. 0 Over 65 36 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means that the people who use this service experience excellent quality outcomes. We (the Care Quality Commission) visited Lezayre unannounced on 16 February 2010 as part of this inspection. Two inspectors carried out the visit with an expert by experience. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. During the visit we spoke with some of the people who live at the home and some members of staff, to find out their views about the home. We walked round the building to see all the communal areas and some of the bedrooms. We checked records kept at the home and spent time talking with the nurse who is currently managing the service. Care Homes for Older People Page 5 of 25 We also looked at any information that we had received about Lezayre. Before the inspection the previous manager completed a questionnaire to give us up to date information about the service. Care Homes for Older People Page 6 of 25 What the care home does well: The registered manager left Lezayre in September 2009 and a nurse who was already working at the home took over as acting manager. She told us that she did not plan to do the job permanently, however she has put an enormous amount of work into improving the way that the home is run. The people we spoke with expressed confidence in the acting manager. One resident told us if youve got any problems or need anything you just tell C, another person said staff are fantastic, C is wonderful and has made things better for the residents. A member of staff said C is a good manager, she is all for the residents best interests. A statement of purpose and service user guide have been written to give people information about Lezayre and the services the home provides. A new brochure is available which summarises the information. Each of the people living at the home has a comprehensive care plan that details their personal and health care needs and how these needs will be met, taking into account the persons lifestyle choices and preferences. We found that the care plans had been written in detail using a person-centred style that painted a picture of the person and gave clear guidance to staff. A full daily progress record was written for each person. The care plans were kept up to date and had been audited by the acting manager. Medicines are well managed and the records we looked at suggested that people always receive the medication prescribed by their doctor. Care plans included a social profile of each person including their background, education, employment, family, visitors, hobbies and interests. A record of the activities they enjoy in the home is recorded. The expert by experience spent three hours chatting with people in the lounge/dining rooms and had lunch with some of the residents. Her report included the following observations: One area of the front lounge had high backed chairs and television whilst the dining table end was occupied by two ladies working with the activities coordinator painting pictures. These two ladies were in their late eighties and were happily painting away before lunch. The male coordinator knew them both well and was lovely, encouraging and directing them and loading a brush with paint for one of the ladies. One lady sitting in the T.V. area looked very frail and was chatting to a young care assistant who was lovely with her. She sat on the chair next to her and faced her and intently listened to what she had to say. She said that is what is nice here, you can give them time. There appeared to be enough staff and the home was clean and cared for. From what I saw meals were appropriate and nicely prepared. Some areas would benefit from a paint/decorate but I felt that this was a happy home and staff appeared to be happy. The senior nurse today said that she loved her job and the home and it showed. It was nice to see patients given the opportunity to get out of their wheelchairs to go into bed or into a more comfortable chair in the afternoons. This was a nice visit and I felt privileged to spend time with such a group of nice people and wish them all well for the future. Although Lezayre is a large building there is a homely feel to it. We found all parts of the building were warm, clean, tidy and safe. The home is well equipped with hoists Care Homes for Older People Page 7 of 25 and other equipment including profiling beds, pressure relieving mattresses and door guards. The home has enough qualified and experienced staff to ensure that peoples can be met in full. Nearly all of the care staff have NVQ level 2 in care and most have level 3. Housekeeping staff have NVQ level 2 in hospitality or catering. This means that there is a very well qualified workforce. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people decide whether Lezayre will be the right home for them. Evidence: A statement of purpose and service user guide have been written to give people information about Lezayre and the services the home provides. A new brochure is available which summarises the information. When we visited there were twenty people living at the home. There have been no new residents since the home was registered in August 2009 following a change of ownership. The acting manager is aware of the need to obtain as much information as possible before anyone new comes to live at the home to make sure that it is the right home for them and that they will fit in with the other people who live there. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are met to a high standard and are recorded fully in their care plans. Medicines are very well managed. Evidence: Each of the people living at the home has a comprehensive care plan that details their personal and health care needs and how these needs will be met, taking into account the persons lifestyle choices and preferences. The care plans have been written following a full assessment of the individual. During our visit we looked at a sample of four care plans. We found that they had been written in detail using a person-centred style that painted a picture of the person and gave clear guidance to staff. A full daily progress record was written for each person. The care plans were kept up to date and had been audited by the acting manager. The care plans gave evidence that peoples health is monitored regularly and the acting manager told us that each person has a weekly head to toe check by the nurse with lead responsibility for their care. The care plans also showed that residents close relatives were consulted and kept informed as appropriate. Risk assessments were Care Homes for Older People Page 11 of 25 Evidence: recorded for any issues identified including smoking, alcohol, use of bed rails. Each person had a moving and handling plan. There were records to show that people have home visits from health professionals as required and are supported to attend medical appointments. One person has long-standing pressure sores and we saw detailed wound care records and records of visits by the wound care specialist nurse. We looked at the arrangements for the storage and recording of medicines. The home has a medicines room of adequate size. It was clean, tidy and well-organised and all medication was locked away. The room temperature and fridge temperature had been recorded daily and were satisfactory. The medicine administration record sheets were fully completed and signed. Medicines are dispensed in blister packs and there were no tablets that should have been given left in the blister packs. There was a minimal amount of stock in the cupboards as a result of careful ordering. One person was prescribed a controlled drug and accurate records were kept. We observed that staff had a positive and respectful attitude towards the residents. The expert by experience wrote: I observed two staff using an aid to help transfer a lady from her wheelchair into an easy chair. The exercise was done without any fuss and with confidence. The lady looked safe and in good hands and the knee support on the aid prevented the patient from bending her knees whilst being transferred. She was settled into the easy chair and looked very comfortable. I saw staff attentive and caring, respectful of the patients abilities and needs. Two people were being looked after in their beds in a shared room. There was no screening to give privacy when personal care is being given to them. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social and recreational needs are recognised and they are supported to make choices and follow their interests. Evidence: Care plans include a social profile of each person including their background, education, employment, family, visitors, hobbies and interests. A record of the activities they enjoy in the home is recorded. A noticeboard in the main ground floor corridor has a variety of information for residents and visitors including a price list for hairdressing, a four week menu, fire information, smoking policy, activities programme for the week and the month. One person goes out to a day centre on week days; a number of others are able to go out regularly either on their own or with a relative or carer. Two people receive Holy Communion in the home, provided by local clergy. An activities organiser works three days a week in the home. He is constantly reviewing activities depending on changing needs and interests of the people living there. People can have visitors at any reasonable time. Some peoples bedrooms were filled with their personal belongings and looked very homely. The expert by experience spent three hours chatting with people in the lounge/dining rooms and had lunch with some of the residents. Her report included the following Care Homes for Older People Page 13 of 25 Evidence: observations: One area of the front lounge had high backed chairs and television whilst the dining table end was occupied by two ladies working with the activities coordinator painting pictures. These two ladies were in their late eighties and were happily painting away before lunch. The male coordinator knew them both well and was lovely, encouraging and directing them and loading a brush with paint for one of the ladies. One lady sitting in the T.V. area looked very frail and was chatting to a young care assistant who was lovely with her. She sat on the chair next to her and faced her and intently listened to what she had to say. She said that is what is nice here, you can give them time. I sat with the three ladies for lunch and the care assistant sat next to the frail lady and assisted her by giving her small spoonfuls of her food. This food was served in a dish and her clothes were protected by a fabric bib-like protector. I noticed that she was offered a soft diet but that the food was in separate small piles ie green peas, carrots, potatoes, minced meat. She was given time to eat her meal but only managed to eat about half of it. She did manage to eat her pudding which was semolina pudding. She was offered a drink of orange juice which she managed herself. This ladys eye sight is very poor evidently. I asked if she got weighed and was told that she was weighed each month. One of the other ladies managed to eat her food unaided and ate a good portion of sausage, mash and carrots, drink of orange and sago pudding. This lady is 89yrs and was very chatty and relaxed saying that she liked being here. The other lady ate a soft diet herself and managed very well. She was very deaf but communication with her was difficult. She again seemed to be at ease and relaxed. The activities coordinator works three days a week in this home. He encourages activities to prevent boredom and encourage people to use their brain. He plays games including floor based games, does craft work, exercises, bingo and quizzes. I was impressed with his ideas and inclusion. He explained that he does name that tune and old time music is played. He uses pictures of well known couples and asks people to match them up. Yesterday he held a Valentines Get Together he said that quite a few visitors came along and joined in. He said that he organizes special events appropriate for the time of year. The residents I saw all seemed to get on well with this man which was nice to see. The other lounge appeared to be bigger and busier. Again there was a T.V. area and an area with tables. One lady was coloring a drawing book with pencils sat at the table. She looked friendly and her clothes looked bright and well cared for. She was Care Homes for Older People Page 14 of 25 Evidence: wearing some nice pieces of jewelry. She was in a wheelchair and was to go to bed in the afternoon for a rest. I did notice that the back of her chair was quite low and there was no neck support on the chair if she nodded off. I spoke with a married couple in their late 90s who live in this home. They looked content, clean and comfortable as did the others in the room. The lady had a rug around her legs and a pillow in her back. Her husband said that they were alright here and that they had a son who visited them who lives locally with his family. The man was wearing a sports jacket no doubt as he has done for years. He was explaining how he had kept himself fit and was a champion table tennis player in his time and that he had inherited a business from his father making picture frames, carving and gilding and renovating old pictures, some of which had been very special from important places. They have separate sleeping arrangements for safety for them both and to enable them both to have a good nights sleep. I noticed that the residents were positioned along one side of the room and were not really able to see the television which appeared to be on all the time. One gentleman was sitting in a Kirton Chair. This chair had the facility of tilting the patient back to prevent him falling out of the chair. This man had his legs elevated and his feet supported by a foot stool. I was unable to communicate with him really but he looked very comfortable and clean and cared for and had a happy lovely face. People were offered plenty of things to do if they wanted to join in. The activities coordinator said that he was self taught but would love to go on some courses. He appeared to have a good range of aids to help him with his job and was able to purchase things which might be of help with the patients. There appeared to be enough staff and the home was clean and cared for. From what I saw meals were appropriate and nicely prepared. Some areas would benefit from a paint/decorate but I felt that this was a happy home and staff appeared to be happy. The senior nurse today said that she loved her job and the home and it showed. It was nice to see patients given the opportunity to get out of their wheelchairs to go into bed or into a more comfortable chair in the afternoons. Just as I was about to leave, one lady who I had shared lunch with arrived into the lounge. She looked lovely having just had her hair done by the hairdresser who comes each week. This was a nice visit and I felt privileged to spend time with such a group of nice people and wish them all well for the future. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Lezayre are protected from abuse. Evidence: A copy of the homes complaints policy is displayed in the entrance of the home and is in the service user guide. We looked at the complaints procedure and the acting manager agreed that it needed updating and making more user friendly. The acting manager told us that no complaints have been made to the home since registration. There is a form to use to record any complaints and the nurse we spoke with was aware of this. People who live at the home are protected by the implementation of safeguarding policies and procedures including the Wirral Councils No Secrets document. All of the staff working at the home have received training about this subject. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lezayre provides a comfortable, clean, safe and homely environment for people to live in. Evidence: Although Lezayre is a large building there is a homely feel to it. We found all parts of the building were warm, clean, tidy and safe. On the ground floor there are two comfortably furnished lounge/dining rooms, giving people a choice of places to sit. There is a garden with patio area at the back and car parking at the front. Bedrooms are on three floors and there are two bathrooms with toilets on each floor and a further two wcs. The majority of bedrooms are en-suite. All baths have hoists and there is a wheel-in shower on the first floor. Each floor has a sluice. The home is well equipped with hoists and other equipment including profiling beds, pressure relieving mattresses and door guards. Certificates are up to date for regular maintenance of all equipment. Rooms are clearly identified with large print signs. There are safety locks on some doors and low level gates at the bottom of the staircases. Parts of the building are in need of redecoration and some of the bedroom furniture is a bit shabby. Some carpets need to be replaced. The acting manager has started a full audit of the building and identified improvements needed. Jobs that can be done easily are being addressed by the maintenance person who is employed part-time at the home. A refurbishment plan will need to be agreed with the home owners to address Care Homes for Older People Page 17 of 25 Evidence: bigger tasks. The acting manager told us that new bedding has been ordered for all rooms. A vacant bedroom, which is quite small and lacks any outlook, is being used as a hairdressing salon and this looked like a very good use for it. An infection control policy is in place and all staff receive infection control training as part of their induction and then regular updates. All rooms have a soap dispenser and hand towel dispensers. The laundry is in the basement. It is spacious and well equipped. When we visited, the laundry was very clean, tidy and well organised. A staff room is also being developed in the basement, and there is a shelter outside for staff who smoke. The kitchen appeared to be very clean and tidy and the last environmental health officer report (July 09) made no requirements. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has enough qualified and experienced staff to ensure that peoples can be met in full. Evidence: During the day there is a nurse and four care staff on duty, with two people working in the kitchen, and three or four housekeeping staff. In addition there is an acting manager who works full-time, a maintenance person and an activities organiser who work part-time. At night there is a nurse and two care staff. These numbers should be enough to meet the needs of current residents, but will be increased as occupancy improves. A total of ten nurses are employed and this means that they are able to cover for holidays and sickness so agency staff are not needed. Nearly all of the care staff have NVQ level 2 in care and most have level 3. Housekeeping staff have NVQ level 2 in hospitality or catering. This means that there is a very well qualified workforce. Lezayre has a thorough and robust recruitment procedure based on equal opportunities and the protection of the people who live at the home. There have been no new staff since the homes new registration in August 2009. There is a twelve week induction programme for new staff. After this staff have a regular supervision meeting with the acting manager and further training needs are Care Homes for Older People Page 19 of 25 Evidence: identified. During 2009, all staff completed an equality and diversity course and the nurses and care staff did a 12 week course about the care of people with dementia. We looked at the homes training records and spoke with most of the staff on duty. Most staff have worked at the home for several years and have attended a wide range of training courses. There are link nurses for wound care, continence and infection control and they attend meetings with the Primary Care Trust and cascade information to the rest of the team. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed to ensure that people are kept safe and receive a high standard of care and support. Evidence: The registered manager left Lezayre in September 2009 and a nurse who was already working at the home took over as acting manager. She told us that she did not plan to do the job permanently, however she has put an enormous amount of work into the home including: rewriting all of the care plans in new folders; introducing new cleaning schedules and COSHH training; starting new staff training files; carrying out staff supervision and appraisal; in depth meetings for all staff groups; new menus; new staff rotas; updated communication forms; audit of the building; revising the statement of purpose, service user guide and brochure. The staff and residents we spoke with expressed confidence in the acting manager, one resident told us if youve got any problems or need anything you just tell C, another person said staff are fantastic, C is wonderful and has made things better for the residents. A member of staff said C is a good manager, she is all for the residents best interests. Care Homes for Older People Page 21 of 25 Evidence: The home changed ownership in August 2009 and the new owners have held meetings for staff, residents and their relatives. The acting manager said that the new owners are very approachable and give her good support. She held lengthy meetings in January for all groups of staff and the minutes of these meetings showed that a number of important issues were discussed. Some of the previous working practices have been changed and it has taken a while for some of the staff to comply with new ways of working. People can keep personal spending money in safekeeping and good records are kept. We advised the acting manager to discuss the finances of some residents with social services to ensure that appropriate arrangements are put in place to protect their interests. The homes self assessment gave us information about testing and servicing of all plant and equipment. Records kept at the home showed that the fire alarm is tested weekly and the emergency lighting monthly. Door guards and fire escapes are checked regularly and fire drills are carried out and recorded. One person smokes in his bedroom following a full risk assessment. All safeguards have been put in place. He is mentally alert and aware of dangers and is able to ensure that cigarettes are extinguished safely. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 Provide privacy screening in shared bedrooms to ensure that peoples dignity is protected. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 25 of 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!