Care Home: Lister House, The Royal British Legion

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What the care home does well The people I spoke to said they were happy with the care and support they receive. One person said `the staff are really caring they are smashing`. Others said that staff were `very helpful and kind to everyone`. The pre-admission assessments are thorough and the majority of people commented that they had sufficient information about the home before choosing to live there. One person said `I came to look around and I didn`t want to leave , it was perfect`. People are encouraged to personalise their own rooms and many had. The home was clean and very well maintained. The facilities that people have at the home are excellent. There is a range of different communal areas for people to use. There are several large communal lounges, a bar area, a formal meeting room, a library and small intimate lounges. The decoration and furnishings are very good and there is specialist equipment available for people to use, such as hoists, assisted bathing facilities and specialist nursing beds. There are thorough recruitment and selection procedures in place, to make sure that staff are suitable and safe to work with the people who live at the home. All the staff receive a range of training to equip them with the skills and knowledge they need to do their work properly. People who live at the home have a say in how the home is ran and the manager listens and tries to implement these suggestions to improve the service offered. What has improved since the last inspection? These are some of the things that the manager told us in the AQAA that had improved since the last inspection. `In the last year we started a Saturday film club which is well attended. A raised garden for the disabled has recently been completed and is appreciated by a few residents at the moment but next spring it is hoped that more use will be made of it. The loop system has been successfully installed in the garden lounge. One young disabled resident has visited Turkey twice this year. The catering department have been asked to provide different dishes from time to time.` A new manager has been appointed to the home, she is very experienced, staff said that they felt very supported by her and were confident in her abilities to manage the home. One member of staff said,`It`s really nice to be listened to, and consulted on changes in the way we work.` People who use the service said that she is always around checking to see if everything is okay and `running smoothly`. What the care home could do better: The manager needs to review the way in which people`s care is recorded, to make sure that people are given the right care and support. Detailed care plans need to be put into place that are reviewed and updated regularly, this will ensure that people are getting the right care and that staff have clear instructions on what care and support they need to provide. The home has a complaints policy and procedure. Staff were very vague on how complaints should be dealt with, and thought this was a task for the manager to deal with. To make sure that people can be confident in the complaints procedure all key staff members should be trained in how to handle complaints. Key inspection report Care homes for older people Name: Address: Lister House, The Royal British Legion Southgate Ripon North Yorkshire HG4 1PG     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: Bridgit Stockton     Date: 2 1 0 1 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: Lister House, The Royal British Legion Southgate Ripon North Yorkshire HG4 1PG 01765607878 01765690917 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.britishlegion.org.uk The Royal British Legion Name of registered manager (if applicable) Type of registration: Number of places registered: care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Lister House is a large purpose built building set in its own well-kept grounds within near Ripon town centre. The Royal British Legion owns the home and admission there is normally limited to those people who have served or have served in the Armed Forces or their dependants. There is a hydrotherapy pool on site and a staffed physiotherapy department. There are pleasant landscaped gardens. To the front of the home there is a small remembrance garden and a unique arrangement of a small tank, an aeroplane propeller and an anchor as acknowledgement of the homes relationship with the armed forces. A major redevelopment programme has recently been completed, which included building a separate 16 bedded unit in the grounds for Care Homes for Older People Page 4 of 25 Over 65 16 55 0 0 0 5 Brief description of the care home people with dementia requiring residential care (called Colsterdale). There are separate areas within the main home for nursing, residential and younger physically disabled service users. The main home is laid out over two floors and the first floor is accessible by passenger lift and stairs. Care Homes for Older People Page 5 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: 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: The purpose of this inspection was to assess the quality of the care and support received by the people who live at the home. The methods I used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. The home had also returned to the Commission an annual quality assessment audit. This gives a lot of information about the home including what changes and improvements have been made since the last inspection and what is planned for the home in the forthcoming year. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 25 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 Care Homes for Older People Page 7 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their care and support needs are properly assessed prior to being admitted to the home. This makes sure that the home has the resources available to meet peoples needs fully before admission to the home. Evidence: The care plans I looked at showed that comprehensive pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the persons needs. A senior member of staff, usually the manager visits the person at home, or in hospital to discuss their care needs. Social Services assessments are also used to determine this as well; these were also available to look at. In the AQAA the manager said All prospective service users and their families are encouraged to visit the home prior to admission. A senior staff member discusses with service users and visitors what the home provides and what the prospective service Care Homes for Older People Page 10 of 25 Evidence: user requires. A comprehensive service user guide and statement of purpose are provided to prospective service users, these are also available in audio and CD-ROM formats. The home does not provide intermediate care. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people have a plan of care, they are not always written in sufficient detail or evaluated properly to instruct staff fully on how to meet peoples needs, and therefore some assessed needs may be overlooked. Evidence: I looked at four care plans in detail and randomly sampled several others. Good information had been gathered on people prior to, and following admission to Lister House and a care plan had been formulated from this. However the actual plan of care had not been updated fully when peoples needs had changed and did not reflect the care and support people were receiving currently. For example a person was having dressings applied on a daily basis, however there was no current paperwork associated with this area of care. Risk assessments were in place and although some had been updated they require review to make sure people are being looked after safely. People told me that they could see the doctor when they wanted to and that specialist health care professionals also visit the home such as dietician, district nurses and the optician. The home has its own physiotherapy unit which people who live at the home can access and use the facilities that it offers. Care Homes for Older People Page 12 of 25 Evidence: The manager told me that a new medication administration system is about to be introduced at the home, which will improve the way in which peoples medication is handled. Currently peoples medication is held securely in peoples bedrooms in a locked cupboard. The nurses on duty said that this was not ideal and that they had raised their concerns with the previous manager but there had been no changes made to the system. They had approached the new manager about this situation when she came into post, who had listened to their concerns and has implemented the new system. People are treat with dignity and their privacy is protected and safeguarded. Staff were kind and spoke to people courteously, offering support discreetly. Care Homes for Older People Page 13 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. The recreational and social needs of people are excellently catered for, which enables them to make daily choices and promotes independence. Evidence: Staff were very welcoming to the home, and there was a very inclusive atmosphere. Visitors were coming and going throughout the day and said they were made to feel very welcome. Some people sat in the large spacious communal lounge areas or else were in their own bedrooms. Some were watching television or reading newspapers or chatting with the staff. People told me that there were organised activities for them to partake in. An activities program was on display it was varied and included, craft sessions, visiting entertainers and quizzes, trips out in the minibus and gardening sessions. We were told in the AQAA that Religious services are held in the chapel and in a quiet room on the Colsterdale unit. One to one spiritual care can also be administered in residents rooms if requested. All the Christian feast days are honored and celebrated in the home or chapel and Lister House strives to ensure that close working relationships are formed with the pastoral assistant of Ripon Cathedral, a member of the Roman Catholic Church and a member of the local Methodist Church. People told me they could more or less please themselves with what they did during Care Homes for Older People Page 14 of 25 Evidence: the day. One person said there is always something going on, if I want to join in I can, if not we are not made to, sometimes I just watch. There are lots of rooms where activities take place within the home. There is a library, activities room, community room and a large bar lounge area. In the younger disabled unit, activities are more structured. In the lounge area there is a computer for people to use. Some of the younger people have one to one activity sessions where they can do whatever they please. I was told that one person enjoys going out to the theatre, whilst another likes going out to the pub on an evening. People told me that the food was excellent. The lunchtime meal was observed. The food looked lovely and people said it tasted very nice. There was sufficient staff on duty to assist and support people over the mealtime discreetly.The kitchen has recently been refurbished and the EHO has awarded a 5 star rating. 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. Safeguards are now in place to ensure that people are protected from harm. Although complaints are dealt, staff were vague about the homes complaint procedures and practices. Evidence: There are written policies and procedures in place to deal with any complaints, or concerns that may arise regarding the service. During the inspection the complaints log book and the complaints procedure could not be located. Staffs knowledge on how to deal with concerns or complaints was vague. Staff need to be aware of the correct procedures to follow in order that they are able to address any issues or anxieties of residents, relatives and visitors to the home promptly. Staff told me that training had taken place in the protection of vulnerable adults in abuse,and were clear what action to take if they suspected someone was being mistreated. I looked at four personnel files and found that staff recruitment procedures are good and staff were employed and deployed following appropriate checks. However on reading some documentation in a personnel file, a situation had arisen in previous years which should have been referred to the local authority for them to investigate under the safe guarding procedures. This had not occurred; in addition some actions had been identified as a result of a disciplinary meeting with the member of staff, and the homes senior management team had not taken place. Care Homes for Older People Page 16 of 25 Evidence: The new manager is very confident in the protection of vulnerable adults procedures, and has taken positive action in making vulnerable adult protection referrals retrospectively. Care Homes for Older People Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean safe and well maintained home Evidence: The facilities at the home are excellent. There is lots of communal space for people to use, that provide different areas to suit the person. For example there are large communal lounges and a bar area, a formal boardroom where meetings are held, small intimate lounge areas and a physio therapy unit which has a gym and hydro pool. All rooms are fully furnished and have a profiling bed, and a nurse call system. The rooms designated for the young physically disabled have en suite shower facilities and ceiling hoists. Pressure relieving mattresses and cushions are available. I looked around the home and found it to be exceptionally clean, fresh and tidy. One person told me they liked sitting in their bedroom and watching television. They also told me that the bedroom was cleaned and vacuumed nearly every day. The home is well maintained and the furniture is comfortable. Some people had personalised their bedrooms and made them look homely. There is in place a redecoration and refurbishment program on going at Lister House, and it is planned to have a corridor erected between the main home and the dementia care unit which currently is a separate building. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are knowledgeable, skilled and on duty in sufficient numbers to meet the assessed needs of the people who lived at the home. Evidence: I looked at the staff rota. It suggested that there were enough staff on duty at all times to meet the needs of the people who live at the home. People told me that the staff were great and very helpful. The manager has recruited some more nurses and they were due to start work at the home shortly. This will help in the continuity of care people are receiving as it will reduce the amount of agency staff who are currently working at the home. Some training has been provided for staff, and the new manager is keen to support people in attending training. Staff said they really enjoyed the training sessions and were keen to learn. Training sessions for some staff has taken place in the protection of vulnerable adult, infection control, moving and handling and first aid. Staff who were spoken to during the inspection said that they felt that the training they received was very good and relevant to the job. The manager has started to supervise key members of the staff team and this will now continue on a regular basis. There is also a plan in place to supervise all other staff over the forth coming months. Some staff files were inspected, they demonstrated that staff were recruited properly and appropriate checks taken place before they started to work at the home. Care Homes for Older People Page 19 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 safe and well managed and people who live and work at the home can contribute to the decision making processes. Evidence: A new manager has just been recruited into the post. She has very good experience at managing a care home and has already started to influence and change some of the systems at the home. Staff spoke very highly of her and said things like its great we are listened to and our opinion valued. Another person said shes firm but fair, thats what I like. The people who live at the home told me that they were use to seeing her around the home and that they were pleased with her. Another service user said she was always around checking everything is okay. The manager undertakes regular audits on the home and the area manager visits at least monthly to check the progress of the home. Some peoples personal allowances are administrated by the home these were checked and were satisfactory. Receipts are kept for all transactions and money that Care Homes for Older People Page 20 of 25 Evidence: was counted tallied with records. The manager needs to make application to the Commission to become registered with us without delay. A selection of health and safety certificates were looked at and were valid. This makes sure that people live and work in a safe place and that their health, safety and welfare is protected. Care Homes for Older People Page 21 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 22 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 1 7 15 Care plans must be reviewed 30/04/2010 at least monthly, or more frequently when a persons care needs change. This will make sure that the care that is being provided is appropriate and its effectiveness can be measured. 2 7 15 Care plans must be written 30/04/2010 in sufficient detail to instruct staff on how to meet peoples assessed needs fully. This will make sure people are cared for and supported properly and their needs will be met. 3 16 13 The manager must satisfy herself that all staff are aware of the homes policy and procedures surrounding the handling of complaints. This will make sure that staff 28/05/2010 Care Homes for Older People Page 23 of 25 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 know how to deal with complaints properly and that people using the service have confidence that they will be listened to, and that the complaint is taken seriously by the home. 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 18 It is recommended that the new manager audits staff files to ensure that any action that should have come about regarding disciplinary procedures has been followed. The manager needs to submit an application to become the registered manager with the Commission 2 31 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. 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