Care Home: Lilycross Care Centre

What the care home does well They ensure that people`s needs and wishes are fully assessed before they move into Lillycross. This helps ensure that the home has the facilities to meet the individuals` needs. Systems were in place that ensured people`s needs and wishes were documented on their care plan and that people received the medical support they require. The home provides a clean and comfortable environment for people to live in. People are supported by staff in a manner that respects their dignity. People were confident that they would be listened to if the had concerns about the service they received. Policies and procedures were in place to protect the health, safety and wellbeing of people. What has improved since the last inspection? This was the first key inspection of this newly registered service. What the care home could do better: To ensure that people receive their medication appropriately they must seek advice regarding the administration of covert medication under the Mental Capacity Act 2005. To help maintain the safety of all the fire detection system must be tested in line with the information contained in the fire risk assessment. To help demonstrate that robust recruitment procedures are in place, all staff files must contain all of the information listed in Schedule 2 of the Care Homes Regulations 2001. Key inspection report Care homes for older people Name: Address: Lilycross Care Centre Wilmere Lane Widnes Cheshire WA8 5UY     The quality rating for this care home is:   two star good 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: Adele Berriman     Date: 1 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Lilycross Care Centre Wilmere Lane Widnes Cheshire WA8 5UY Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Diane Hollingsworth Type of registration: Number of places registered: care home 60 Lilycross Homes Limited ta Lilycross Care Centre Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 60 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, Dementia - Code DE. Date of last inspection Brief description of the care home Lillycross Care Centre is a purpose built home offering people personal care and personal care with nursing over three floors. All bedrooms are en-suite with several rooms also having shower facilities. Care Homes for Older People Page 4 of 28 Over 65 0 60 60 0 Brief description of the care home The home is located close to Widnes and St Helens and is close to the local bus route. A car park is available at the front of the building. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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: We carried out an unannounced visit to the home. The visit began at 10.00am and ended at 6.00pm. The visit formed part of the first key inspection of this new service. All key standards were assessed during the visit. During our visit we spent time talking to five people living at the home, two members of staff, the deputy manager and the manager. We looked at the communal living areas an a selection of bedrooms and bathrooms. We looked at a selection of records, policies and procedures, these included care plans, staff files, medication records and daily records. Prior to our visit the manager of the service completed an Annual Quality Assurance Assessment (AQAA). This document gave them the opportunity to tell us what they thought they did well, what they could improve on and their plans for improvement Care Homes for Older People Page 6 of 28 over the next 12 months. The AQAA also contained some numerical information that we asked for and contained most of the the information we requested. Care Homes for Older People Page 7 of 28 What the care home does well: 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into the home to ensure that their needs can be met. Evidence: We saw that a pre admission assessment was carried out prior to a person moving into the Lillycross Care Centre. The purpose of this assessment was to ensure that staff were aware of peoples individual needs and to ensure that the home had the facilities to meet these needs. We saw that information gained during the pre admission assessment process was recorded on a set format. The document gave the opportunity to record peoples care and health needs within their day to day life. We saw that a further assessment was available for people with dementia. This assessment gave the opportunity to record information about peoples daily routines Care Homes for Older People Page 10 of 28 Evidence: and situations that may enhance or impact on their day to day life. We saw completed pre admission assessments on all of the care plans that we looked at. They told us that people were invited to visit the home, have a meal and spend time with people living at Lillycross prior to making a decision about moving into the home. Lillycross does not provide intermediate care facilities. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from having their care and health needs detailed in their care plans. Evidence: We saw that each person had their own file that contained their personal information, pre admission information and their care plan. We looked at three peoples care plans. We saw that the care plans contained information about peoples day to day needs and wishes. We saw that sections within the care plans relating to peoples preferences and property had not always been completed. These records should be completed to help ensure that staff are aware at all times of peoples preferences. We saw that daily records were maintained and updated throughout the day. The records contained information about personal care and nursing procedures that the person had received. We saw that risk assessments specific to individuals needs formed part of the care plans. We saw risk assessments that considered peoples mobility, living environment, the condition of peoples skin, moving and handling and nutrition. We saw that these Care Homes for Older People Page 12 of 28 Evidence: assessment were being reviewed on a regular basis. They told us that each person was registered with a local GP. We saw records that demonstrated that people had regular access to local health care professionals. People told us that they were able to request to see their GP at any time. They told us that health care professionals from the local Primary Care Trust had visited to advise staff on supporting people with continence issues and falls management. Throughout our visit we observed people being treated in a friendly and dignified manner by the staff team. We saw that they had a policy and procedures for the safe management and storage of medication. The policy did not contain information about the administration of medication prescribed on an as and when basis (PRN). Information should be available for the correct administration of PRN medication for people who are not able to request it. This will help ensure that people receive their medication when they need it. We saw that the policy contained information and guidance regarding the use of covert medication. Advice must be sought regarding the use of covert medication under the Mental Capacity Act 2005 and the policy updated appropriately. We saw that the majority of medication was dispensed in monitored dosage systems from the pharmacy which were stored in secure, lockable facilities. We saw that they had a secure facility for the storage of controlled drugs. To ensure that controlled drugs are stored appropriately, advice must be sought as to whether this storage facility meets current legislation requirements. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines are flexible although the lack of social activities means that people may become bored due to the lack of stimulation. Evidence: They told us that their future plans included employing an activities co-ordinator. At the time of our visit they told us that care staff were carrying out activities with people. There was no set activity programme or any information available to tell people what activities were available. One person told us that they could improve the service by providing more activities. They told us that local churches had involvement in the home to help people maintain their faith. They told us that they were trying to forge strong links with the community to bring the community into the home. They told us in their AQAA that their plans for the next 12 months included setting up a residents and relatives committee. People told us that their relatives could visit at any time. One person told us that they thought the home did well as they keep in contact with relatives regarding peoples Care Homes for Older People Page 14 of 28 Evidence: health and wellbeing. They told us that people were encouraged to bring to the home their personal items and belongings to personalise their rooms. People told us that they had a choice of whether they took part in activities, what they wanted to eat and what time they got up in a morning and went to bed. We saw that peoples time preferences for going to bed were recorded in individuals care plans. We saw that a four weekly menu was in use. It demonstrated that set meals were available daily. In addition an alternative menu of sandwiches, ommelettes and salads was available for people not wishing to eat the set meal. We saw that both menus were in written form. The introduction of other means for people to choose their food should be considered to help orientate people at meals times and their choices of food. For example, a pictorial menu. We saw that meals were served in a dining room on the Lillycross unit and in a lounge/dining area on the Bluebell unit. We sat and had lunch with people during our visit. We had sandwiches and lemon sponge pudding with custard. The food was fresh and ample. People told us that they liked the food served at the home. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures available. Evidence: We saw that a detailed complaints procedure was available within the home. The procedure informed people of who to make a complaint to and the timescales in which complaints would be responded to. They told us in the AQAA that people living at the and their families are made aware of the complaints procedure. The told us that they had received one anonymous complaint about the service. We saw that information relating to the complaint had been recorded appropriately. People who we spoke to during out visit knew who to speak to if they were not happy about the service they received. We saw that they had a policy and procedures in place for the protection of vulnerable people. To help ensure that all concerns are managed appropriately the policy should clearly state that all safeguarding concerns and situations should be referred directly to Halton Council under their safeguarding procedures. Care Homes for Older People Page 16 of 28 Evidence: During our visit the manager demonstrated a good awareness of the Local Authoritys safeguarding procedures. However, a copy of Halton Councils procedures was not available during our visit. To help ensure that all concerns are managed appropriately a copy of the Local Authoritys procedures should be available to staff at all times. Training records demonstrated that the majority of staff had received training in adult protection. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean comfortable environment was provided for people to live in. Evidence: Lillycross is a purpose built home that provides accommodation over three floors. At the time of our visit people requiring general nursing care were residing on the ground floor. The second floor was accommodating people with dementia who required personal care. The first floor was not operational when we visited, however, they told us that when it opens it will provide accommodation for people with dementia requiring personal and nursing care. We looked at a number of bedrooms and saw that they were light and airy and when people had wished, they have brought with them their personal effects to make their own room homely. All of the five people we spoke to told us that they liked their bedrooms. We saw that the home was clean and pleasantly decorated throughout. Appropriate procedures were in place for the control of infection. Communal areas were furnished to provide a comfortable environment for people to live. We saw equipment was available around the home to support people with their mobility, for example, adapted bathing facilities and hoists. Care Homes for Older People Page 18 of 28 Evidence: We saw that they had a handy person available several days a week to assist with general maintenance and the testing of equipment. We saw that the temperature of the hot water was being tested on a monthly basis. To help ensure that peoples safety when using hot water weekly temperature checks should take place. We saw that they had a fire risk assessment. The assessment stated that the fire alarm system should be tested on a weekly basis. The last recorded test on the fire detection system had been recorded three months previously. We highlighted this to the deputy manager who immediately tested the system. To help ensure that people live in a safe, well maintained environment regular maintenance checks of the fire detection system should take place in conjunction with the services fire risk assessment. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a staff team who know them well. Staff files must contain more information to demonstrate robust recruitment procedures are in place. Evidence: We saw that the manager, the deputy manager, a senior carer, four carers, the homes administrator and kitchen staff were on duty to meet the needs of the 22 people in residence. We observed staff supporting people in a caring and supportive manner. Staff who we spoke to demonstrated a good awareness of peoples needs and wishes. One person told us staff are very friendly. We looked at the files of six staff members. We saw that the majority of files contained the information required. We saw written references, completed application forms, records of interviews and evidence that Criminal Record Bureau disclosures had been applied for. We saw that two files did not contain a photograph and two files did not contain up to date registration information from the Nursing and Midwifery Council. Although there was evidence that references had been sought, two files did not contain written references. To help ensure that they are able to demonstrate good recruitment procedures all staff files must contain all of the documents listed in Care Homes for Older People Page 20 of 28 Evidence: Schedule 2 of the Care Homes Regulations 2001. They told us in their AQAA that the majority of staff had completed induction training recommended by Skills for Care. Following our visit they sent us a training matrix that recorded the training that staff had undertaken. We saw that the majority of staff had received training in fire safety, moving and handling, adult protection, infection control, food hygiene, first aid and health and safety. In addition, we saw that several staff had undertaken training in dementia, pressure care, falls and nutrition. They told us that further training by healthcare professionals from the local Primary Care Trust was being arranged. They told us in their AQAA that over 50 of care staff had National Vocational Qualifications (NVQ) level 2 or above. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, safety and wellbeing is protected by the homes policies and procedures. Evidence: The manager had many years experience in working in social care environments. A registered general nurse with the registered managers award, she demonstrated a clear understanding of her role and what improvements could be made to the service. At the time of our visit the manager was in the process of registering with the Care Quality Commission as the registered manager. Prior to our visit the manager had completed an Annual Quality Assurance Assessment (AQAA). This is a self assessment document that gives the service the opportunity to tell us what they do well, what they feel they could do better and their plans for improvement over the next 12 months. The document also contained some numerical information we requested. The AQAA contained most of the information we asked for. Care Homes for Older People Page 22 of 28 Evidence: The policy of the home is not to manage peoples personal money. They told us that they planned to monitor and improve quality assurance by sending out questionnaires to people living at Lillycross, their relatives and local healthcare professional involved with the service. They told us that a representative of the proprietors of the home visits on a regular basis. We saw that no reports of these visits were available. To aid the quality assurance process within the home an unannounced visit should be made on a monthly basis and a report of the conduct of the home completed. A copy of this report should be sent to the manager. We saw that accidents were being recorded and copies of the accident reports were being stored on individuals files. We saw that detailed policies and procedures were in place to protect the health, safety and wellbeing of all. Copies of the policies and procedures were readily available to staff on both floors of the home. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Advice must be sought 04/06/2010 regarding the current legislation around the administration of covert medication under the Mental Capacity Act 2005. Advice must be sought to ensure that the current controlled drugs cabinet conforms to current legislation. This will help ensure that peoples rights under the Mental Capacity Act 2005 are adhered. 2 19 23 Fire detection systems must be tested in line with the homes fire risk assessment. This will help ensure that the detection equipment is operational at all times. 07/06/2010 Care Homes for Older People Page 25 of 28 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 3 29 19 Staff files must contain all of 14/06/2010 the information as detailed in Schedule 2 of the Care Homes Regulations 2001. This is to help ensure that the home is able to demonstrate that appropriate recruitment procedures are in place. 4 33 26 An unannounced visit by the 14/06/2010 proprietor or their representative should be made on a monthly basis and a report of the conduct of the home completed. This will assist the home with their quality assurance. 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 7 To help ensure that detailed records of peoples personal effects are maintained the property list section of the care plans should be completed. The medication policy and procedures should be revised to include guidance on medication prescribed on an as and when (PRN) basis. To help ensure that people receive regular stimulation and activity a full review of peoples choices of activity should take place and be provided. The menu should be made available in different formats so that people are able to access the information and to help orientate people through their day. 2 9 3 12 4 15 Care Homes for Older People Page 26 of 28 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 5 18 The policy for the protection of service users should clearly state that all safeguarding concerns and situations should be referred in the first instance to Halton Council under their safeguarding procedures. A copy of Halton Councils safeguarding procedures should be available at the home at all times for staff to access. To help ensure the safety of people, the temperature of the hot water available should be tested on a weekly basis. 6 7 18 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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