Care Home: Lound Hall Nursing Home

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What the care home does well Relatives told us: "Makes the residents feel safe and secure. Keeps the residents and their surroundings clean. Looks after their medical and personal needs." "The staff have been excellent when any problems have arisen and done everything possible to rectify any concerns." The home provides a good standard of support to people with a range of physical and mental care needs. Residents are treated as individuals and likes and dislikes are respected. Comprehensive care plans are reviewed regularly and cover the physical, mental, emotional and social needs of each person. Medical advice is sought at the appropriate time, together with the support of other NHS professionals. Staff follow a national quality framework for the care of those who are terminally ill. This ensures that the person receives all the care required and that appropriate agencies are called in to support them. Residents` nutritional needs are identified and all special diets are catered for. What has improved since the last inspection? All staff are now receiving training in moving and handling from a qualified external trainer, as well as training in the protection of vulnerable adults. This benefits residents who are supported by competent staff. All medications are now recorded as being administered as prescribed, for the safety of residents. Several areas have been redecorated and refurbished, giving residents a more pleasant environment to live in. The kitchen has been re-equipped for safer and more efficient working. Additional equipment for the comfort and care of residents has been purchased, including special beds, mattresses and seat and hoist scales. The lift has been refurbished. A housekeeping supervisor has been appointed to improve quality and infection control in the laundry, cleaning and maintenance areas. CARE HOMES FOR OLDER PEOPLE Lound Hall Nursing Home Jay Lane Lound Lowestoft Suffolk NR32 5LH Lead Inspector John Goodship Unannounced Inspection 27th August 2008 10:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lound Hall Nursing Home Address Jay Lane Lound Lowestoft Suffolk NR32 5LH 01502 732331 01502 732331 loundhall@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lound Hall Ltd Post vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2007 Brief Description of the Service: Lound Hall is a care home with nursing, accommodating a maximum of 43 service users, aged 65 years and over. The home offers long term, short term and respite care. The accommodation consists of twenty-nine single rooms and seven shared rooms. Thirty of the rooms have en suite facilities. The main part of Lound Hall is a listed building and has accommodation over three floors. Access to the upper floors is provided by a passenger lift. There are a number of assisted baths and shower rooms throughout the home. There is a choice of four separate lounges and two dining rooms that all overlook the attractive gardens. The ground floor rooms all have direct access to the gardens. Lound Hall is situated in the small village of Lound in north Suffolk. There is a long private drive to the house and a stand of mature trees around the front of the building. Ample car parking space is available. Fees for the home range from £381.00 to £725.00 weekly depending on the accommodation and the dependency of the resident. These fees do not include chiropody, hairdressing, newspapers/magazines, dry cleaning, postage, a private telephone or the cost of staff accompanying residents to appointments. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that the people who use this service experience good quality outcomes. We visited this home on a weekday for an unannounced inspection, focussing on the outcomes for the residents. The visit lasted eight hours. The two directors and the manager were present. We toured the home, and spoke to four residents in different parts of the home. We also interviewed two members of staff, one who had been recently appointed, and another who had worked at the home for some years. We observed how staff spoke and supported residents. We examined three care plans, three staff files, maintenance records and training records. This report has been compiled with information available prior to the inspection and evidence found on the day. A questionnaire survey was sent to the home for completion by residents, relatives, and staff. We received back four relatives’ surveys, one staff and one resident survey. Comments and result of these surveys have been quoted in the relevant outcome group. The directors also completed our Annual Quality Assurance Assessment questionnaire. Information from this has also been included in the report. What the service does well: Relatives told us: “Makes the residents feel safe and secure. Keeps the residents and their surroundings clean. Looks after their medical and personal needs.” “The staff have been excellent when any problems have arisen and done everything possible to rectify any concerns.” The home provides a good standard of support to people with a range of physical and mental care needs. Residents are treated as individuals and likes and dislikes are respected. Comprehensive care plans are reviewed regularly and cover the physical, mental, emotional and social needs of each person. Medical advice is sought at the appropriate time, together with the support of other NHS professionals. Staff follow a national quality framework for the care of those who are terminally ill. This ensures that the person receives all the care required and that appropriate agencies are called in to support them. Residents’ nutritional needs are identified and all special diets are catered for. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3. 6 is not relevant to this home. Quality in this outcome area is good. People who use this service can expect to have sufficient information to make an informed choice about the home and have their needs assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the information provided for prospective residents. The home had a well-produced Statement of Purpose that was up to date and available in the entrance hall for any visitors. Prospective residents were given a copy when they visited or an enquiry is made. In the surveys we received a relative told us that a friend’s father had been a resident for two years and the home came highly recommended. A copy of the service users’ guide, called Information for Residents, together with a copy of the last inspection report were also available in the hall. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 9 We examined the pre-admission procedure for a recent admission. This included a redesigned assessment form, gathering information from a variety of sources, the family, social workers and the hospital as relevant. The assessment covered areas of health needs such as diet, continence, mobility, skin integrity, night needs, personal hygiene and communication. The resident’s psychological state and level of anxiety had been assessed and information recorded about family involvement and any known allergies. The home had recently included questions about end of life arrangements, relating to the Mental Capacity Act, such as lasting powers of attorney and advance directives, so that the person’s wishes could be followed at the appropriate time. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. People who use this service can expect to have their health needs met and be protected by the medication administration practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the files for three residents, one of whom was a very recent admission. All contained an individual plan of care to help carers support the resident, as they would wish. The plans all contained information about the resident’s preferences around meeting personal hygiene needs and their level of mobility, their continence and night needs. Needs were identified with an accompanying action plan to guide staff on what support the person needed. Individual entries for some residents covered wound care or prevention of falls, weight loss or gain, pressure area care and fluid intake. One care plan recorded that the person had lost ten kilos since January 2008. They were recorded as being given special food to stabilise their weight. The most recent Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 11 review of this resident produced an action plan to minimise risks from moving and handling. Equipment provided included an airwave mattress. Another plan was for a resident receiving terminal care. The home based its care on the Liverpool Care Pathway system. This was part of a Department of Health drive to improve palliative and terminal care. The home was completing a monthly checklist from this system which covered physical, emotional, personal and social support, as well as action to take at the last days, and bereavement support to the family. The manager told us that the home had good links with the local NHS Palliative Care Team. The Macmillan team, who also had helped to train the staff, usually provided equipment for pain relief such as syringe drivers. The files contained records of the consent of the resident or their representative to the use of bed rails for their safety and comfort. The files contained contact details of any health professional involved with the resident including their GP, chiropodist and optician. There were records of visits to or by the GP and notes of any treatment prescribed or any changes to care. Risk assessments for moving and handling, skin integrity and nutrition were completed and updated. We were told that one resident had their urine checked regularly as they were prone to infection. We saw the daily report on this. During our tour, the manager noticed that one resident looked poorly. They called the senior nurse, moved the person to her room, and called the GP who arrived within the hour. The manager also informed the person’s family. The daily records were well written and gave a comprehensive account of the resident’s daily experience. There was a record of whether the resident had had a bath or shower and a note if they had been offered one but refused. Wound care was recorded with the size of the area and a detail of the condition of the wound together with progress in healing. The records in some cases recorded the resident’s activities during the day and their mood. All these items contributed to a full picture of the way each resident’s needs were being met. The AQAA told us that additional aids had been purchased to assist in the safe delivery of care, including more profiling beds and pressure relieving mattresses, seat and hoist-based weighing scales and a stair climber. We saw these items in use as we toured the home. The home demonstrated to us the action they took to prevent falls, with evidence that residents were referred to the GP and the NHS Falls Prevention Service. The manager had analysed the incidence of falls of one resident which showed a tendency for falls to happen after tea. More fluids were now offered Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 12 to them to maintain hydration, and they were given the choice of going to their room immediately after tea if they wished.. The home used a monitored dosage system (MDS) so tablets were dispensed by a local pharmacy into prepared blister packs for individual residents. The trolleys were purpose made and kept securely in the clinic room when not in use. The medicine administration records (MAR) contained a recent photo of each person. The manager told us these were especially useful for agency nurses to check that they were administering to the correct person. The reason for giving any PRN medication (when required medication) was not recorded on the MAR sheets but in the daily record. We saw the record of the medication to be returned to the pharmacy. We checked the controlled drug (CD) cupboard which was of the correct specification. The stock of one resident’s CD drug was checked against the record and the amount of stock remaining was correct. Proper signs were on the door of the room where a resident was using oxygen. These examples of good practice, with comprehensive records and safe procedures, helped to ensure that residents’ needs were met in a timely and appropriate way. Staff knocked on doors prior to entering rooms and we saw them adjusting a resident’s clothing in one of the lounges to maintain residents’ dignity. A resident whom we spoke to in their room told us: “They look after me very well. These girls are very good.” Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Residents can expect to be offered a choice of activities. They are supported to maintain family and other contacts. They can be confident that they will be offered a choice of nutritional meals with a choice of where they take them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ files which we saw all contained contact details of the next of kin and people important to the resident. Care plans also recorded each person’s likes, dislikes, hobbies and interests. Daily records noted when a resident spent time with a relative or went on a visit out of the home. The surveys received by CSCI from relatives indicated that the staff always or usually kept them updated with information about their relative or they were free to ask when they visited the home. The manager told us that the home had not been successful in recruiting an activities organiser. However a senior carer in consultation with residents had planned the year’s special events, and one person was assigned responsibility Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 14 each day for in-house activities. As well as day-to-day activities arranged by the staff, such as board games, cards, bingo, quizzes, flower arranging and reminiscence, there was an annual programme of special events and outings organised. These were discussed and agreed at residents’ meetings, minutes of which were available to those residents unable to attend. We saw a schedule of events on the noticeboard which included a fete the coming Saturday, two musical acts in July, a trip to a donkey sanctuary and a boat trip on Oulton Broad. The home also put on themed days, such as a Spanish day and a Mediaeval day. A visit to a pub had been cancelled two weeks previously, as the weather had been too bad. The manager told us that they would like to arrange more small scale personal activity as this was the least well developed aspect of daily life in the home. It would give residents more choice and could better meet their own preferences. Two relatives told us that they would like to see the home put on more activities and more opportunities for physical and mental exercise. One resident told us that there were usually activities arranged that they could take part in. The religious beliefs of residents were recorded in the care plans and the AQAA told us that there were regular visits from clergy of both the Church of England and the Roman Catholic Churches. The menus were seen and showed that there was a choice of main meals and desserts each day. On the day of inspection the choice was turkey and ham pie or ham, egg and chips followed by sticky toffee pudding. When the meal was served we noted that some residents had further alternatives such as fish or a salad. Residents spoken with said they had enjoyed their lunch. One told us: “We’re well looked after, with plenty of food”. The cook said they catered for special diets such as a reducing diet, diabetic and gluten free diet, soft food, liquefied food, and small portions. There was a board in the kitchen detailing the specific needs of residents. The menus offered a cooked snack for tea such as sardines on toast or cheese and broccoli bake with a dessert and/or cakes but in addition there was a supper menu for anyone who wished to have a late snack. The supper included cheese and biscuits, sweet biscuits, soup, fruit or yoghurts. The cook said they had taken advice from a dietician when planning the content of the menus to ensure they contained sufficient nutrients to meet the needs of older people. We were told by a member of staff that residents could choose to take breakfast in the dining rooms or in their own room. A resident who we spoke to in their room confirmed that this was so. The kitchen had been refurbished since the last inspection. The AQAA told us that a new pass-through dishwasher, a new range and extractor had improved the efficiency of the catering staff. The cook told us that they were pleased with the equipment. The Environmental Health Officer had inspected the kitchen in February 2008. Their report asked that the seals on a freezer should Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 15 be cleaned, and the floor of the external vegetable store should be cleaned. The manager told us that these were attended to after the inspection. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. People who use this service can expect to have their concerns taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints policy that was displayed in the entrance hall and available in the statement of purpose and service users’ guide. All the relatives and residents who responded to our survey said they knew how to make a complaint if they needed to. We examined the home’s complaints log. It contained records of four complaints made to the home in the last year, with accompanying correspondence, the outcome and any action taken. Topics covered were care practices, lift not working, query about an invoice, and a privacy matter. In three cases the owner agreed that they should be partly upheld. Complainants were recorded as being satisfied with the result. An anonymous complaint had also been received by the Commission in July 2008 through the local MP. The Commission had replied to the MP on the basis of evidence already known to us from the last inspection report. The concerns were around fire prevention, unsafe repairs and lack of shower facilities. The concerns were addressed Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 17 through the inspection of all the key standards at this inspection. We found no evidence to give cause for concern. In addition the home had properly instigated two referrals under the local vulnerable adult procedures concerning allegations of abuse against residents by a carer and a nurse from two agencies. The two persons had been excluded by the home from working there any more and any action was being taken by adult social care services with the care agencies concerned. The staff we interviewed confirmed that they had received training in the protection of vulnerable adults (POVA). The AQAA and records showed that the in-house induction programme included training through the ‘No Secrets’ video. The home had purchased a new training DVD on POVA and the training records showed that nearly all staff, including non-care staff, had been through this earlier this year. The AQAA told us that the home kept the electoral register up-to-date and residents were able to choose to participate in the election process through postal voting or attendance at a polling station. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. Quality in this outcome area is good. People who use this service can expect to live in a clean and well-maintained environment with specialist equipment available if required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The central building of Lound Hall was a three storey listed Georgian house that had been adapted and added to over a period of years. The building sat in two and a half acres of grounds with a long drive to the entrance and a stand of mature trees in the front. The accommodation consisted of seven shared rooms and twenty-nine single rooms most of which had en-suite facilities. The gardens were maintained by an outside contractor, apart from the lawns, which were cut by the in-house maintenance man. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 19 There were two shower rooms on the ground floor, together with a Parker bath and an assisted bath. On the first floor was one bathroom which the owner told us they would like to convert to a wet room. One of the bedrooms on this floor had an en-suite shower. On the second floor, four bedrooms had en-suite baths and there was also one shower room. This ratio was adequate and suitable to meet the needs of residents. There were two large lounges and two dining rooms on the ground floor. The two lounges had been redecorated recently, with new carpets and curtains. All the ground floor rooms had level access to the well-maintained gardens. One relative was concerned that the only exit for wheelchair users to reach the garden was by a side door near the kitchen. A director showed us that access could be gained to the patio by the garden doors, as there was a portable ramp. He agreed that this should be made known to visitors. The owner advised the Commission on February 4th 2008 that the lift had broken down. The lift was completely refurbished, with new control; panels and internal doors. The work took eleven days. During this time the lift was out of action, so the home organised a dining area and meeting area upstairs, with a Stairlifter, to ensure residents were not confined to their rooms. The owner told us that the manager spoke to all residents, who seemed to cope well. The AQAA told us that a full audit of the plumbing was undertaken during the year with a number of toilets, hand basins, taps and mixer valves being replaced. We were shown some of them. This work had ensured that these facilities were safe for residents. The home was clean and tidy with no unpleasant odours noted. A relative told us the home was ‘very clean and tidy’, and another said the home ‘keeps the residents and the surroundings clean’. The laundry was visited and found tidy. The washing machines had sluice programmes and there was a good supply of alginate bags for transporting soiled linen. Protective clothing was available and staff spoken with were able to talk about precautions to prevent cross-infection. The manager told us that one of the nursing staff had taken responsibility for ensuring that the control of infection policy was followed. The manager acted promptly and in conjunction with health services when it was identified by the home that a resident had been admitted from hospital with and infectious condition. This ensured that any risk of cross infection would be minimised. The home employed Hospitality Assistants part of whose role was to collect and wash the laundry, and then iron and sort it. Carers then took the clean items to residents’ rooms. This helped to ensure that residents’ laundry was done as quickly as possible, and the clean clothes returned to the residents’ rooms by carers who knew residents’ wishes about where they wanted them stored. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 20 The AQAA told us that a new post of Housekeeping supervisor had been filled this year with responsibility for laundry cleaning and maintenance. The manager told us that this had led to an improvement in quality and improved control of infection. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. People who use this service can expect to be supported by sufficient numbers of correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the duty rotas, which showed that during the early shift there was one registered nurse and six carers, the late shift had one registered nurse and five carers and one nurse and two carers cover the night shift. The manager explained that these numbers were down by one because the home was not full at the moment. In addition there are three members of staff called hospitality staff who do domestic and other tasks that do not involve personal care. There were three vacancies for qualified nurses at the time of our inspection. These were being covered by agency staff. The manager told us that they try to use the same agency staff for the benefit of the residents and to ensure the home staff were not training new staff each time. There was an agency nurse on duty during our visit who told us they came to the home regularly. The manager described the efforts made by the home to recruit to their vacancies. The AQAA, which was completed in May 2008, told us that in the previous three months, two nurse shifts and seventy-seven care shifts had been Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 22 covered by agency staff. One relative wrote in their survey form: ‘The home is often short staffed and therefore the residents can feel rushed and that not enough time is given to tasks. Agency staff are sometimes used who are not familiar with the residents.’ Two relatives thought that staff did not have time to check all the rooms to see, for example, if residents had been able to drink their tea. ‘Cups of tea left and not given if person unable to get it. More visits to sitting rooms to check.’ The home had recruited nine staff in the previous six months. The files for three of them were examined. They were a nurse, a care supervisor and a care assistant. All had been cleared through the POVA First procedure before starting work, with the full Criminal Records Bureau certificate arriving shortly after their start date while still under supervised training. All files had full application forms with two references, and the appropriate identification documents. One person had had their three month and six month review. Records of attendance at training sessions were in the files. There was evidence of an induction programme that covered fire awareness, care planning, the home’s policies, food handling, moving and handling, recognition of abuse, infection control and health and safety. One person had an NVQ Level 3 in Clinical Procedures from their previous employer. Half of the permanent care staff had achieved NVQ Level 2 or above. The owner told us that they were encouraging more staff to do NVQ, including office and hospitality staff. Training records showed that nearly all staff had done a moving and handling course this year, and health and safety, using an external qualified trainer. Eight staff were booked to start a course on dementia awareness using a distance learning programme from a local college. Three staff had also done a course in venepuncture just prior to our visit. We spoke to two staff in detail about their work and training. Both were able to confirm the training they had received. One was a recent appointment and described how they were inducted and supervised when they started. Staff meetings were held and one said that ‘We all work together.’ Both were confident that they would recognise abuse of a resident and they knew the correct reporting procedure. The principle of confidentiality was understood, and one was able to give an example which showed that they understood when the health of the resident took precedence over confidential information. Both said that they received formal supervision. It was unfortunate that only one staff survey form was returned to us and that one was wholly negative about the home. The writer did not wish to speak to an inspector and remained anonymous. Their comments were not reflected in what we found and in our discussions with staff and residents. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. Residents and relatives can expect the home to be well run, by competent staff. Their safety is assured by the home’s health and safety practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present manager had been in post since June 2008. They had not yet made an application to be registered with the Commission. The owners told us that they took an active interest in the running of the home and were accessible to residents, their representatives and staff. Both of them were present on the day of this inspection and had an office in an adjoining Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 24 building. One of the owners had told us that in early 2008 that they were taking a more active involvement in the service during the previous manager’s absence. The owners had always informed the Commission of issues required by the Regulations, affecting residents’ health and safety. Staff we spoke to confirmed that the owners were in the home every week, and were actively supporting the manager in, for example, trying to recruit staff. One of the owners told us that they had recently appointed a consultant to review their staff employment policies to ensure compliance with current legislation. The home purchased the National Care Association quality monitoring tools and these were starting to be used. Feedback forms were given to all respite care residents. We saw some of these. All expressed themselves happy with the care. Questions covered the promptness of answering call bells, meals and meeting personal care needs. We were told that there had been no recent surveys of residents and relatives. We recommend that this should be done, to capture for example comments that were made to us about staffing levels and activities. In addition the owners complete a monthly management visit report, which met the requirements of Regulation 26. We saw some of the recent ones which were comprehensive, including comments from residents and staff. The home reported promptly to us any incidents and occurrences under regulation 37. For example, three notifications were sent us about the situation with the lift described earlier. This showed that the management were working with us in an open manner. We saw evidence of regular formal supervision sessions with staff, using an agreement form and a record taken from Skills For Care. This ensured that staffs competence and care practice were monitored to provide appropriate care for residents. The administrator managed personal cash for some residents. At the previous inspection, the system used was explained and records checked. The wallets inspected at random tallied with the records and with receipts kept there was a clear audit trail. The administrator printed a statement for each resident every three months that was either kept by the resident or filed in their personal records. There were written and computerised records and the manager also had access to the finances. Otherwise residents or their representatives control their finances. One concern raised with us by an anonymous person was that the fire safety systems were not adequate. We had asked the local fire service to visit the home to do their own assessment. We were told that the Fire Service were due to inspect the home the day after our visit. The owner told us later that this had happened but at the time of writing this report, we had not received the Fire Officer’s written report. A verbal report by the owners told us that no enforcement action had been required. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 25 We saw the current Fire Risk Assessment which had been compiled in June 2007 by an external consultant. The assessment did not identify any issues which required immediate attention, but listed several recommendations. The home had actioned some of them. After we had discussed the remaining recommendations with the owners, they agreed to action the fitting of smoke seals to doors on the top floor immediately. Other recommendations had not been implemented, the owners told us, because they had been waiting for planning permission for an extension which would have incorporated aspects of the recommendations. This planning application was later withdrawn by the owners. They would wait for the Fire Officer’s report before proceeding further. We noted that the fire equipment had been serviced in May 2008. The fire log recorded the weekly fire alarm tests, and the monthly emergency lighting tests. Following the annual check of emergency lighting by the contractors, eight units had been replaced. We saw the five-year electrical installation certificate, which had been renewed in July 2008. We saw the record of the hot water temperature checks by the maintenance person, who was also qualified to do portable appliance testing. We saw the Waste Transfer Note for the clinical waste contract with an approved contractor. These systems helped to promote the health and safety of residents, by meeting its legal obligations. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP20 OP33 Good Practice Recommendations All wheelchair users and their relatives should be informed how to access the patio safely. The views and comments of residents and relatives should be sought and recorded on a regular basis. Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lound Hall Nursing Home DS0000024439.V370595.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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