Care Home: Llysfield Nursing Home Ltd

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What the care home does well The home is benefiting from good management and a committed staff team who are now well trained and supported to deliver good quality care. People`s needs are assessed prior to them being admitted to the home and written plans are produced to guide staff as to how people`s needs should be met. Detailed records are then maintained as to the care provided, and people`s condition monitored regularly so that changes are identified and acted upon. The home has good links with local health professionals and seeks specialist advice when needed. Llysfield provides a homely and comfortable environment and there is a refurbishment plan ongoing to upgrade decor, carpets and equipment. What has improved since the last inspection? Training has continued to provide staff with skills and knowledge to equip them to do their jobs well. Work has started on refurbishment and new beds and bedroom furniture has been provided. This has increased residents` safety and made their rooms more pleasant. New curtains have been provided and some rooms redecorated. New equipment for assisting people to move has been purchased. What the care home could do better: There are good assessments and plans of care; it still remains the case that care plan evaluations could be more descriptive to so that staff have involved residents and ensured that the current care plan and delivery is meeting their needs. Staff need to ensure that residents` privacy and dignity is upheld at all times and review current practice of undertaking minor dressings and foot care in the communal area. Although training provision is much improved, the service needs to ensure that new staff are provided with a thorough and structured induction, which is signed off by both the new employee and the member of staff who judges them to be competent. Key inspection report Care homes for older people Name: Address: Llysfield Nursing Home Ltd Middleton Road Oswestry Shropshire SY11 2LJ     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: Deb Holland     Date: 0 4 0 5 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 24 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 24 Information about the care home Name of care home: Address: Llysfield Nursing Home Ltd Middleton Road Oswestry Shropshire SY11 2LJ 01691657511 01691670812 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Llysfield Nursing Home Ltd Name of registered manager (if applicable) Ms Sharon Francis Dellow Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 30 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: Older People (OP) (30) Date of last inspection Brief description of the care home Llysfield is owned by Llysfield Nursing Home Limited and managed by Ms Sharon Dellow. The home is registered to provide nursing care for up to 30 older people, although it is unlikely to reach this level of occupancy as some double rooms are used as singles. Llysfield is located in a pleasant residential area of Oswestry, within reach of local shops, amenities and transport links. Bedrooms are provided on both ground Care Homes for Older People Page 4 of 24 Over 65 30 0 0 0 Brief description of the care home and first floors with lift access for those who cannot manage the stairs. Both bathing and showering facilties will be available in the near future. The home has a pleasant and accessible garden area for residents use and car parking for visitors. Care Homes for Older People Page 5 of 24 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: This was a routine, unannounced key inspection conducted because of a change of ownership of the home. We inspect all services which are new and this includes where ownership has changed. The home did not know when we would visit. Prior to our visit to the home we requested their Annual Quality Assurance Assessment (AQAA), which is a self assessment process that requires care services to record how well care outcomes for people living in their service are being met as well as providing a range of statistical information about the service. We also reviewed other information which we hold such as information about complaints (none in this case) and notifications about significant incidents. During our visit to the home we looked in detail at the care for two people and also looked at the documentation relating to two people who were due to be admitted for respite care. This gave us a good picture of how the manager and staff approach assessment of peoples needs and how they go about meeting those needs once people Care Homes for Older People Page 6 of 24 are in the home. We spoke to residents and people who were visiting as well as to staff and the homes manager. We had a general look around to establish how much progress is being made with the homes refurbishment. We looked at some records, for example, to make sure that safety is being monitored, to make sure that staff are only employed when they have been checked thoroughly and to check that people are receiving their medication as they should. Care Homes for Older People Page 7 of 24 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 24 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 24 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 are able to make an informed choice about whether the home is suitable for them. Good pre-admission assessments lead to focused and individual care plans and mean that people can be assured that their needs can be met Evidence: The manager told us that she and two other nurses are trained to conduct preadmission assessments. We looked at the documentation for people who have been admitted to the home recently and for people who were to arrive imminently. The files we saw contained detailed pre-admission assessments which enable the manager to decide whether the home can meet peoples needs and forms the basis for the development of care plans to ensure that individual needs are met. People are provided with information about the home in writing through the updated Statement of Purpose and Service User Guide. People also have access to CQC reports. Care Homes for Older People Page 10 of 24 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. Residents health and personal care needs are set out in plans of care which ensures that staff deliver care on an individual basis. Residents well being is promoted and they are provided with access to specialist services as and when required Evidence: The quality of assessments and care plans has much improved. The assessment leads into an indexed set of care plans, which contain the detail of how peoples needs should be met. Each care plan is followed by an evaluation sheet where reviews are noted, mostly quite briefly. Care plans show evidence of the involvement of the resident. Residents health is promoted and involvement sought from relevant professionals as and when required e.g. the tissue viability nurse had advised on the care of a wound, and this was added to the plan of care; professional guidance has been sought when people have had difficulty swallowing or are at risk of poor nutrition due to their disabilities. Plans show attention to the individuals capabilities and how to maintain these e.g. a mobility plan was very clear as to what staff should and shouldnt do to assist while promoting independence. The manager reported that nobody has developed pressure sores while she has been in charge and given the Care Homes for Older People Page 11 of 24 Evidence: dependency levels of residents this reflects a high standard of care by the staff team. Where people are at risk, turning regimes are in place alongside the provision of appropriate equipment and records are maintained in residents bedrooms showing that staff adhere to these plans. The manager audits care files and her suggestions as to how they can be further improved were seen. One file we looked at related to someone who needed a small wound dressing daily. The records did not demonstrate that this had received attention daily and staff need to be reminded to record diligently. We looked at how the home managed medication and this seemed well organised. We found for one person on a particularly drug regime which is subject to regular review and change that an error might have been made and the nurse on duty undertook to audit this; we also found that insulin in use was being stored in the fridge which shouldnt have been (although the guidance on the container was confusing) and the homes manager agreed to ensure that staff are reminded of what does and doesnt need refrigeration. People we spoke to, including residents and relatives, were generally positive about the care provided at the home. During the inspection we were aware that staff attended to a residents dressing in the communal lounge and a beauty therapist gave another resident a pedicure treatment in the same area. Consideration needs to be given as to whether this is appropriate and whether peoples privacy and dignity would be better served by receiving this type of attention in their own rooms. Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to take part in group activities where possible and staff promote social interaction where people are more frail and potentially isolated. People are provided with wholesome food which meets their dietary needs and individual preferences. Evidence: Routines within the home are flexible and people can spend time where and how they prefer. Some residents prefer to stay in their own rooms and some prefer to spend time in the communal areas. In good weather people can be supported to spend time in the homes gardens. An activities co-ordinator is employed part time and encourages people to take part in activities such as quizzes, bingo, religious services, entertainment and outings when the weather permits. The activities co-ordinator promotes group activities but also spends time one to one with people who prefer to stay in their own rooms or who are unable to leave their beds, or will assist people to simply go out for a walk if that is their preference. The home provides a wholesome and nutritious diet and consults with residents about their preferences and ideas for menus. Generally people prefer plain food but the catering staff are clearly willing and able to respond to requests. The meal served on Care Homes for Older People Page 13 of 24 Evidence: the day of inspection was well received and people commented that they enjoyed their food. The home uses local sources for fresh produce such as vegetables and meat. Care Homes for Older People Page 14 of 24 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. The home has procedures in place to safeguard people from potential abuse and staff receive training in adult protection and local procedures. Residents have access to a complaints procedure should they wish to raise any concerns but the staff and management approach means that any problems are generally sorted out quickly Evidence: People have access to a complaints procedure which is displayed within the home. No complaints have been received in the last eighteen months. The manager states that she operates an open door policy which means that minor issues are dealt with quickly and do not become major issues. Staff are provided with access to training in adult protection and awareness has been promoted through group discussion. The home has had three allegations made about care provision and two of these were found to be unsubstantiated. One allegation about staff conduct was substantiated and this was dealt with appropriately. The member of staff has now left. The manager is now aware of what can be dealt with internally and when a referral has to be made. Care Homes for Older People Page 15 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is still a need for re-decoration and re-furbishment, the home provides a safe and homely environment which is being improved by investment by the new provider. Evidence: The home is in new ownership, having suffered from a lack of investment previously which has meant that some areas such as furniture, decoration, carpeting and bathroom facilities have become neglected. The homes new owner is addressing these and has already provided new beds for all the bedrooms plus new bedroom furniture. This has meant that people are more comfortable, safer and have more pleasant individual rooms. The bathrooms are being refurbished so that people will have a choice of shower or bath in the future and flooring which is currently shabby and potentially unhygienic is being replaced. Individual bedrooms are being decorated as and when possible and residents are involved in decisions about colour choice. New curtains have been provided and new bedding purchased. Bed linen is now sent to a laundry agency which has reduced the pressure on the homes small laundry facility. The new owner has also had to invest in a new boiler and heating system. New carpeting is planned. The overall environment, although still needing work in communal areas, is clean, odour free and homely. Work is also being done to the gardens so that people will be Care Homes for Older People Page 16 of 24 Evidence: able to enjoy sitting out when weather permits. Care Homes for Older People Page 17 of 24 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 competent staff group who are provided with good training opportuniites to equip them with relevant skills and knowledge. Evidence: Staffing levels have recently been adjusted due to a fall in resident numbers. We were assured by the manager and by staff that residents needs are being met but that staff would like to have more time to spend with individual people rather than having to move from task to task. There is a good mix of qualified nurses, senior carers and care staff on each shift and there is now a more stable staff team which provides more continuity for residents. There has been a significant emphasis on ensuring that staff have undertaken appropriate training and most have, or are working towards, vocational qualifications. Access is promoted to induction training provided locally but the home also needs to ensure that a robust induction package is available, delivered and signed off in house. Ms Dellow stated that all new members of staff spend time working alongside a senior but there is no record of this. It is anticipated that a member of staff will become a manual handling trainer in the near future. Some formal supervision is being provided by the homes manager, the RGNs and Senior Carers. Senior Care staff have been supported to complete a vocational qualification in team leadership. Distance learning courses provided by the local college in infection control, dementia and health and safety have been completed and there are good levels of training overall. Care Homes for Older People Page 18 of 24 Evidence: Two staff files were examined which contained most of the documents required to ensure that people are suitable to work with vulnerable adults. It was reported that one persons reference had been difficult to obtain, so only a character reference was on file. Care Homes for Older People Page 19 of 24 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 management systems in place ensure that people living at Llysfield benefit from a safe and well run service Evidence: Ms Sharon Dellow has been managing the home since August 2008 through its period in adminstration and now with the new owner. Ms Dellow is well qualified and experienced and has provided an informative Annual Quality Assurance Assessment reflecting both the services increasing strenths and areas for improvement. Efforts have been made to ensure that residents and relatives are involved in the running of the home through discussions and questionnaires. Ms Dellow audits areas of performance such as how well care plans are produced and the homes owner conducts monitoring visits. We looked at a variety of health and safety records which are maintained by the homes maintenance man. Checks such as fire tests, emergency lighting, hot water, Care Homes for Older People Page 20 of 24 Evidence: the safety of bed rails are done regularly and external servicing and certification for equipment and services are up to date. As reported earlier, levels of staff access to training which promotes residents well being, such as moving and handling, health and safety, infection control, fire safety and food hygiene are much improved. Care Homes for Older People Page 21 of 24 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 24 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 The home should review its approach to providing care and/or treatment in communal areas to ensure that residents privacy and dignity is upheld The service should ensure that all documentation as described in Schedule 2 to The Care Homes Regulations 2001 is available prior to staff starting work Staff should be provided with a structured induction programme which is signed off by both the mentor and the new employee on completion 2 29 3 30 Care Homes for Older People Page 23 of 24 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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