Care Home: Lothian House Care Home

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What the care home does well The needs of the people who live at the home are assessed before and after they move into the home. This means that their care needs can be planned and properly met. All of the people who live at the home have a care plan so staff know how to meet their needs. Information about the home is available to help people decide if it is the right home for them to move in to. Health care needs are well met by using a multi agency approach. This helps the people who live at the home to stay healthy. The home has medication systems for the staff to follow to make sure that the people who live at the home are not put at risk. The people have opportunities to take part in leisure pursuits and interests which provides them with a stimulating environment and helps them keep their social skills and self esteem. The staff team at the home value the differing needs of the people who live there and make sure that they are aware of each person`s preferences. They treat the people who live at the home as individuals and support them to live the life they choose as much as possible so they know they are valued. There are procedures in place at the home that make sure that the people who live there are protected and kept safe from abuse. The staff are supervised and trained so they know how to provide the people with good care. The manager is qualified and experienced. They are approachable and clearly present in the home to give direction and support to staff and make sure that the service is centred on the people whom live at the home. What has improved since the last inspection? Medication is now dated once it is open so staff know when to replace it. This means residents only receive medication that is not out of date. What the care home could do better: If the floor was sealed in the bathroom and the broken cabinet replaced in one of the residents bedrooms this would make it less likely that of the people who live at the home or a member of staff may injure themselves. If all of the care plans had sufficient detail the manager would know that the staff have sufficient information to meet all of the residents needs and provide them with goodcare. More staff in post at the home would mean that they could spend more time with residents and allow more of them to take part in trips out and activities. This would enhance their daily quality of life and choices. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lothian House Care Home Clyde Terrace Spennymoor Durham DL16 7SG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Hilary Stewart     Date: 2 5 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Lothian House Care Home Clyde Terrace Spennymoor Durham DL16 7SG 01388811488 01388811693 lothianhouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Home Properties Limited care home 48 Number of places (if applicable): Under 65 Over 65 0 33 dementia old age, not falling within any other category Additional conditions: 15 0 The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category of service only: Care Home only - PC 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 - maximum number of places 33 Dementia - Code DE, maximum number of places 15 Date of last inspection Brief description of the care home Lothian House is a registered care home providing personal care and accommodation for up to 48 older persons in the category of (OP). It is owned by Southern Cross Healthcare Properties Ltd and operates within the private sector. The home is located on the outskirts of Spennymoor, County Durham, close to local amenities. It is a two-storey building located in its own well-maintained private grounds that are easily accessible. Personal accommodation and communal areas are Care Homes for Older People Page 4 of 27 Brief description of the care home provided on both floors. All bedrooms are used as single accommodation giving the home an occupancy level of forty seven older persons. Thirty three of the bedrooms have ensuite facilities. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. How the inspection was carried out. Before the visit we looked at the information we have received since the last visit on 15th and 29th June 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people and the views of people who use the service and the staff. An unannounced visit was made on 25th June 2009. Care Homes for Older People Page 6 of 27 During the visit we talked with people who use the service staff and the deputy manager. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept and checked that staff had the knowledge, skills and training to meet the needs of the people they care for.We also looked around the building to make sure it was clean safe and comfortable. We checked what improvements had been made since the last visit. Then we told the manager what we found. 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. The home charges £436.60p to £516.50p per week. What the care home does well: What has improved since the last inspection? What they could do better: If the floor was sealed in the bathroom and the broken cabinet replaced in one of the residents bedrooms this would make it less likely that of the people who live at the home or a member of staff may injure themselves. If all of the care plans had sufficient detail the manager would know that the staff have sufficient information to meet all of the residents needs and provide them with good Care Homes for Older People Page 8 of 27 care. More staff in post at the home would mean that they could spend more time with residents and allow more of them to take part in trips out and activities. This would enhance their daily quality of life and choices. 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 set out 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 9 of 27 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 10 of 27 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 are offered a place at the home. The manager looks at this assessment to see if the home can meet the persons needs. They then carry their own assessment out prior to the person moving in so they can use this information for the care plan. People can visit the home before they make a decision. Evidence: The deputy manager said that the people who live at the home have had their needs assessed before and after they move in. A person can only move into the home if they are certain that their needs can be met there. They also said that the assessment of the peoples needs is on going, they evaluate them regularly and up date the care plans if necessary. If a person decides to move into the home they can visit before they move in permanently. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 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. All of the people who live at the home have individual care plans through which staff monitor and promote their health. This helps the people stay healthy. Furthermore the manager and staff respect the privacy and dignity of the residents so they know that they are valued as individuals. Evidence: The manager said and records showed that each person who lives at the home has an individual care plan. Each plan contains information for staff. It describes how they are to meet the needs of each person at the home. They contain information about their health care, a persons likes and dislikes and their social and personal care. Some of the plans needed more detail. One persons plan said one carer to assist with bathing but does not go on to say what gender the carer should be or how they should assist the person. For instance does the person need to be supported to carry out the task themselves, do they need verbal prompts or does the member of staff need to carry out the task for them. Another said encourage to wash and dress independently but again did not go on to describe how staff would do this. Do they need support with Care Homes for Older People Page 13 of 27 Evidence: choosing clothes do staff have to physically help the person dress themselves or do they just need verbal prompts. Another persons care plan said that one person had mood swings, the care plan did not have any evidence to support that this is what the person was suffering from or how staff were to support the person. Another person care plan stated that in the case of fire and the person needed to be evacuated they require assistance 2x persons a sledge. It did not go on to say where staff would find the equipment or how they should carry the task out. Staff spoken to could describe how they would carry this task out. This was drawn to the attention of the manager who said that they would make sure that all staff were clear about the procedure. There are procedures for staff to follow when they deal with medication. The deputy manager said that all staff have received training in how to safely administer medication. Staff said and records showed that any changes of medication or medication procedures are recorded and followed in the home. Two staff always sign them as a safety measure. Records showed that in some cases this had not occurred two peoples records did not have two signatures when a change to their medication had been hand written in the records. A list of specimen staff signatures of those who have been assessed as being competent to administer medication is kept in the medication records. Staff said that this needed to be updated as some staff had now left home. The operations manager said that the names and signatures continue to be kept once staff have left as they may be needed in the future to support investigations, complaints and the like. These documents should only be updated to add names. The Pharmacy Inspector for the Commission advised that if speciman signatures are kept of staff who dont work at the home anymore the records should clearly state this and the date they left. The deputy manager said that people are supported to manage their own medication if, following a risk assessment it was found to be safe enough. In the EMI unit upstairs all of the people had their own medication cabinet in their en suite. The medication records were up to date and some were checked and were correct. Records showed that the peoples health care needs are met at the home. Details of visits by the district nurse visits to their GP and hospital appointments are recorded in the individual files. The deputy manager said that the health and welfare of the people who live at the home is monitored all of the time. One person who lives at the home said the staff are good and a relative said they are looked after well. The people who live at the home looked comfortable. One person said when asked if they decide what they wanted to get up in the morning they said you can choose another said the staff are nice. One member of staff said some staff are dignity champions, they make sure that people are well groomed and are given choices. Care Homes for Older People Page 14 of 27 Care Homes for Older People Page 15 of 27 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. The people who live at the home are able to follow their own daily routines which satisfy their social cultural and religious needs. They can see their family and friends at any reasonable time. This helps to prevent them from feeling and becoming isolated. Evidence: The deputy manager and staff said that they arrange a variety of outings for the people who live at the home. An activities coordinator has been appointed who has planned an activity programme. Records showed that some people had been involved in activities such as going out shopping or playing bingo. The activities coordinator said in her survey response that they find it difficult to motivate people to take part in activities sometimes. Some staff said that activities would be improved if they could spent more time with individuals but staffing levels restrict this. They have arranged for for some people to have a trip to Beamish and a day event in the garden. Some of the people at the home were playing bingo during the visit. Three people had been out to town on the bus and others were planning to go into the garden in the afternoon. Staff said that they are fund raising for the home by holding a car boot sale and taking part in a sponsored spooky walk in October. One person said I like bingo. Some staff had taken some people on holiday to Blackpool. Care Homes for Older People Page 16 of 27 Evidence: Staff and the people who live at the home said that relatives and visitors are welcome and encouraged to visit at any reasonable time throughout the day and evening. Visitors were observed during the visit. On relative said you are made to feel welcome. Staff said that the people have been asked for their opinions about the food provided and the menus are based on the likes and dislikes of the people who live there. Menus are put out everyday for people to choose what they want to eat. A cook is employed and they said that there are choices at meal times and if people want something different they will make it for them. Special diets can be catered for. One person said the food is fine and a relative said the food is of a high standard.The dining area is comfortable and pleasantly decorated. Hot drinks and snacks are always available throughout the day and evening. The kitchen was well stocked and there were fresh fruit and vegetables. Staff were observed supporting people at meals times. Care Homes for Older People Page 17 of 27 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. Complaints are dealt with so any problems are taken care of quickly which helps good relationships to be maintained. Staff know about and have had training in how to protect people from harm, so the people who live at the home are kept safe. Evidence: Copies of the homes complaints procedure are in the information about the home. It is also displayed on the wall. Staff said that the people who live at the home and their relatives know how to make a complaint. Three complaints has been made to the home since the last inspection visit pn the 19th June 2007 which the deputy manager said had been resolved. There is a complaints record which is kept up to date. One of the people at the home said I would tell the staff if I wasnt happy. A relative said I work as a carer and I would say if something was wrong. The manager said that all staff have had training in how to safeguard the people they care for. There is a copy of the Local Authority procedures and the home has copies of their own adult protection procedures for staff. Staff said that they have had the training and they could describe what they needed to do if someone disclosed abuse to them. All staff have had training on the homes whistle blowing policy and procedure. Care Homes for Older People Page 18 of 27 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. People live in a safe and clean home, although some repairs are necessary. Evidence: The home is comfortable, warm and clean. There are enough bathrooms and showers for the people who live at the home. The deputy manager said that the garden had been improved this year. The flooring in one bathroom needed to be repaired as there was a gap between it and the bath which could make it difficult to clean properly and lead to a risk of cross infection. All of the communal bathrooms had hand soap and paper towels. Each person has their own bedroom and they looked comfortable and clean. They were all personalised and made very individual. There was a broken cabinet in one persons room, staff said that they were waiting for replacement furniture. One member of staff said that the home had improved a lot since the new manager had come. A relative said the manager is hot on smells, she makes sure they are dealt with as soon as possible. The laundry is organised and clean. Quite a few staff said that at times the home was very hot upstairs, the manager was informed of this and they said that they would look into this immediately. Care Homes for Older People Page 19 of 27 Care Homes for Older People Page 20 of 27 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. Sufficient numbers of staff are in post to keep the people who live at the home safe but the staffing levels limit how much time staff can spent talking to people or taking them out. Staff have opportunities for training so they know how to give them good care and meet their needs. Furthermore the home has a recruitment procedures in place, which help to prevent risk of harm to the people who live there. Evidence: Staff said that they receive training, which helps them with their work. The manager said that all staff receive the training and support they need. One member of staff said we get loads of training. Staff said and records showed that they all have mandatory training such as first aid, food hygiene and safeguarding adults training. The deputy manager said that 80 of staff have vocational qualifications. Sufficient staff were on duty at the time of the visit. Staff said and records showed that sufficient staff had been on duty in the home the previous week. One relative said that after 8pm sometimes people are left without support in the lounge downstairs as staff have to take people upstairs to bed. She was concerned that on one occasion a resident had needed support and she had had to go and find staff. The manager was informed of this following the visit and they said that they would look into this straight Care Homes for Older People Page 21 of 27 Evidence: away. Some of the staff and relatives said that there were sufficient staff on duty to keep the people safe but the staffing level s did not allow for the staff to spend much time with the people talking to them or supporting them with activities. The deputy manager said that all staff have been CRB Criminal Records Bureau checked at an enhanced level to make sure they are suitable people to work at the home. All staff go through a recruitment process and they cannot not start to work at the home until this is completed. They are interviewed and are only successful when they have two satisfactory references. Copies of staff records showed that checks had been carried out. Care Homes for Older People Page 22 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered person is qualified and experienced and runs the home in the best interests of the people who live there and there are procedures in place that make sure they are protected as much as possible. Evidence: There is a quality assurance system in place and people who live at the home and their families are asked their views about the running of the home. One relative said that they are sent questionnaires by the home. A news letter is sent to residents and their relatives every month. Safety checks have been carried out on the equipment in the home such as testing electrical equipment and the servicing the central heating boiler. Fire safety risk assessments had been completed and the fire logbook showed that fire drills take place. Fire instruction was not included in the Southern Cross fire log. The operations manager confirmed that the fire instruction records for staff are kept in indiviual Care Homes for Older People Page 23 of 27 Evidence: records. Staff said that regular fire drills take place and a resident at the home said yes we have fire drills. Records showed that there were fire evacuations plans for residents. Records showed that regular training is provided for staff in fire safety and first aid. Accidents are recorded in a central record which the manager checks and signs of the reports did not have a date. The manager confirmed that she is qualified and experienced to run the home effectively. It was observed that there was a friendly atmosphere at the home and a pleasant rapport between the people who live there and staff. The staff said that they could approach the manager with any concerns one member of staff things have improved a lot since this manager came to the home and another said the manager is secound to none. Staff said that they liked working at the home. The deputy manager said that staff receive individual supervision six times a years and they have regular staff meetings. Records showed that individual formal supervision takes place and staff meetings. The home has procedures for staff when they deal with the peoples money so it is kept safe. Records showed that staff sign records when any of the residents money is used and the manager checks them regularly Care Homes for Older People Page 24 of 27 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 25 of 27 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 The Registered Manager must make sure that care plans have sufficient detail and are accurate. This is so staff have enough information to meet each persons needs and provide them with good care. 28/08/2009 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 2 19 33 The manager should make sure that the bathroom floor is repaired and the broken cabinet is replaced. The manager should make sure that there are consistently enough staff available to meet the needs of the people using the service with more available at peak times of activity. The staffing structure should be based on delivering outcomes for people. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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