Care Home: Lunesdale House

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What the care home does well People living in the home we talked with spoke very highly of the staff and manager and the help and support they get from them. The home provides a very comfortable, homely and informal atmosphere for residents and we saw that staff have a good rapport with them and know them well. All residents and visitors spoken with commented on the friendly and open atmosphere in the home. People living there commented to us: "This is a `real` home to me". "Staff are always there when I need them". " I really don`t think it could be better". " I feel very lucky to have found such a place". "You couldn`t get better food, I enjoy my meals very much". The home is kept clean and tidy with plenty of storage and is very attractively furnished to a high standard throughout with attention to detail, individual tastes and safety. Many residents have chosen to personalise their bedrooms, to make them more homely and familiar with pictures, ornaments, photographs and some items of their own furniture. Although this is not a large home there is a good level of activities and recreational provision to allow people to follow their own interests or develop new ones. The home provides good opportunities for leisure and recreational activities inside and outside the home, including religious services. Residents told us how much they enjoy the trips out, social events, theatre trips and one to one activities, especially crafts and exercise sessions. People are encouraged to handle their own affairs and supported to be as independent as they can be. The home works with other healthcare agencies and gets specialist help for residents when this is needed. This includes the local GPs and District nursing teams as well as specialist services such as the Macmillan nurse. There is a stable staff team and robust recruitment processes help promote the safety of people living there. What has improved since the last inspection? Since the last inspection the service has addressed the requirements and recommendations made and the recruitment procedure has been improved and all staff have Criminal records bureau checks before they start work and the service takes up two references. This sustained improvement has resulted in a more robust process that better safeguards residents. Notifications of accidents and events that may affect the welfare of residents are being sent to CSCI so we are aware of what is going on and can respond if needed. The owner continues to improve the environment both inside and outside the home for the enjoyment of the people living there. The patio and seating area outside the lounge has been extended to provide more space for people using it. Refurbishment of bedrooms continues and most rooms have now been done unless the resident has said they do not want this doing and there has been the addition of another single bedroom. All bedrooms are now single occupancy and the improvements to them include creating en suite bathrooms with showers as well as redecoration with resident`s involvement in the choice of materials. The laundry facilities have been improved and the storage of dry goods. Both of these changes have resulted in a better use of space and organisation. CARE HOMES FOR OLDER PEOPLE Lunesdale House Lunesdale House Hale Milnethorpe Cumbria LA7 7BN Lead Inspector Marian Whittam Unannounced Inspection 12th August 2008 10:00 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 Lunesdale House DS0000062846.V369959.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. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lunesdale House Address Lunesdale House Hale Milnethorpe Cumbria LA7 7BN 015395 63293 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) Mr Christopher David Green Mr Christopher David Green Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 18 service users to include: Up to 18 service users in the category of OP ( Old age, not falling into any other category) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 9th October 2006 Date of last inspection Brief Description of the Service: Lunesdale House is a residential care home providing personal care and accommodation for older people. The home is a large detached, older property with modern extensions that have been purpose-built to provide additional bedrooms with en-suite facilities, a large reception area and a large communal lounge. The home is on the A6 approximately two miles south of the town of Milnthorpe, a market town in the southern Lake District. The home is set back from the main road and is surrounded by attractive gardens that are easily accessible, with a car park at the front for visitors. There are extensive views over the surrounding hills and countryside from most rooms in the home. There is a stair lift for easy access to the first floor bedrooms. All bedrooms have en-suite facilities and are used for single occupancy only. In addition to the new extensions the home has been extensively refurbished and upgraded throughout. Fees payable at the home range from £400.00 to £440.00 a week as at the date of the site visit. There are additional charges for hairdressing and private chiropody. The home makes information about its services available through its colour brochures, service user guide/ statement of purpose. These are available in the home in the foyer. Lunesdale House DS0000062846.V369959.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 2 stars. This means the people who use this service experience good quality outcomes. This site visit to Lunesdale House forms part of a key inspection. It took place on 12.08.08 and we (The Commission for Social Care Inspection, CSCI) were in the home for six and quarter hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager identifying what the service evidences it does well and what could be improved. This was returned to CSCI before the visit. • The service history. • Interviews with residents, relatives and staff on the day of the visit. • Observations made by us in the home during the visit. • Completed questionnaire survey forms from people living in the home and people who come into contact with the service and staff working there. During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards and improvements Staff personnel and training files were examined and a selection of the service’s records required by regulation. We assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager, other staff and residents. What the service does well: People living in the home we talked with spoke very highly of the staff and manager and the help and support they get from them. The home provides a very comfortable, homely and informal atmosphere for residents and we saw that staff have a good rapport with them and know them well. All residents and visitors spoken with commented on the friendly and open atmosphere in the home. People living there commented to us: “This is a ‘real’ home to me”. “Staff are always there when I need them”. “ I really don’t think it could be better”. “ I feel very lucky to have found such a place”. “You couldn’t get better food, I enjoy my meals very much”. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 6 The home is kept clean and tidy with plenty of storage and is very attractively furnished to a high standard throughout with attention to detail, individual tastes and safety. Many residents have chosen to personalise their bedrooms, to make them more homely and familiar with pictures, ornaments, photographs and some items of their own furniture. Although this is not a large home there is a good level of activities and recreational provision to allow people to follow their own interests or develop new ones. The home provides good opportunities for leisure and recreational activities inside and outside the home, including religious services. Residents told us how much they enjoy the trips out, social events, theatre trips and one to one activities, especially crafts and exercise sessions. People are encouraged to handle their own affairs and supported to be as independent as they can be. The home works with other healthcare agencies and gets specialist help for residents when this is needed. This includes the local GPs and District nursing teams as well as specialist services such as the Macmillan nurse. There is a stable staff team and robust recruitment processes help promote the safety of people living there. What has improved since the last inspection? Since the last inspection the service has addressed the requirements and recommendations made and the recruitment procedure has been improved and all staff have Criminal records bureau checks before they start work and the service takes up two references. This sustained improvement has resulted in a more robust process that better safeguards residents. Notifications of accidents and events that may affect the welfare of residents are being sent to CSCI so we are aware of what is going on and can respond if needed. The owner continues to improve the environment both inside and outside the home for the enjoyment of the people living there. The patio and seating area outside the lounge has been extended to provide more space for people using it. Refurbishment of bedrooms continues and most rooms have now been done unless the resident has said they do not want this doing and there has been the addition of another single bedroom. All bedrooms are now single occupancy and the improvements to them include creating en suite bathrooms with showers as well as redecoration with resident’s involvement in the choice of materials. The laundry facilities have been improved and the storage of dry goods. Both of these changes have resulted in a better use of space and organisation. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 7 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. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 8 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 Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 9 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): NMS 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of people’s needs are done before they come to live in the home to make sure they can be met and relevant information is provided to help people make an informed decision about living there. EVIDENCE: Information is available about the service for prospective residents and their families in the combined statement of purpose/ service users guide and brochures specific to the home and its services to help them make an informed choice about the service. The documents and brochures are kept on display in the foyer and available from the office. Survey responses and conversations with people living in the home indicate that people had visited and spent time there before choosing the home and that they felt they had enough information about the home to help them choose before they came in. This information can be made available in other formats if required by people. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 10 We saw contracts on file, and surveys showed and people we spoke to confirmed they had contracts and terms and conditions of residency so they were aware of their rights and responsibilities. Individual care plans show that before coming to live in the home people have their personal, health and social needs assessed. We looked at the care plans and three peoples’ care plans in detail. We looked at the pre admission assessments that had been done to make sure the home was able to meet an individual’s needs before they came to live there. The pre admission assessments we looked at contained sufficient information from which to develop a basic individual care plan. This information ensures the staff are aware of the level of care required to meet the different needs. Assessments were also done by social workers under care management arrangements, where this applied, as well as by the home manager to meet people’s individual needs. Where the assessment has been done by social services a copy was kept on file. We saw that the manager was visiting one person in hospital to support them and reassess their needs before they returned to the home to be sure that appropriate support was put in place and the home could still meet their needs. The home has a four week settling in/trial period followed by a review to make sure needs are being met and the home suits the resident. The service encourages prospective residents to visit the home and speak with staff and people living there to get an idea about life there. We spoke with one person who had come on a trial visit and stayed. They told us that the manager allowed them as much time as they needed to make their decision and always answered their questions. Another person told us they had visited other homes before choosing this one but “I liked this the best because it seemed so friendly and the other ladies were so pleasant”. The service does not provide intermediate care. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care which people using this service receive is based on their individual needs. Privacy, dignity and personal choice are promoted at all times. EVIDENCE: All residents have an individual care plan, based on initial assessments and risk assessments, setting out assessed health, social and personal care needs and these are being reviewed and updated. The care plans are clearly set out and easy to follow. The information provided covered areas such as a person’s mobility, diet, health needs, personal care and their social and religious preferences. Appropriate equipment to prevent pressure sores is in use, individual’s mental health is monitored and effective nutritional screening is being done and weights recorded, monitored and appropriate action taken if needed. Referrals to doctors and other health care and specialised services are being done and working relationships with other agencies are good. Visits to and from specialised services are recorded and outcomes. People living there told Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 12 us they see doctors, dentists and opticians as they need to and this was supported by the surveys we got back. We talked to care staff who evidently knew the people living there well and their individual needs and preferences and families and spoke in a way that reflected people’s individuality. It was evident in care plans that people’s particular wishes and individual goals were being recognised and respected. Observations during the visit, checking of records of care planning and conversations with residents did clearly indicate that they feel they are treated as individuals with flexible routines and their privacy respected. One person told us “the staff are very understanding”. People we spoke with made it clear that they planned their days and made their own choices and one told us “ I can virtually do as I like as long as I let them know when I go out”. We looked at medication handling, records and practices and found that there are established systems for handling and administering medication and staff kept accurate records of the medicines administered to residents. The manager is currently altering the monitored dosage system in use to improve the effectiveness of the system for people living there. The local pharmacist has visited and advised on this as well as doing a review of medication. There were systems in place for storage ordering and checking medication to make sure that medicines and the quantities received were correct before administration to residents. Only trained senior staff can administer medication and there are reference books available for staff to check the use and action of medications if needed. We found that systems for managing the handling of high-risk medication that required regular blood tests was well managed to keep people safe. People are supported to keep and take their own medicines to promote their independence. This is done within a risk assessment and with their formal consent to self medicate. We spoke with the manager about recording in the care plan if medication is crushed or taken from capsules as for one person or is covertly given and recommended they record this in the care plan. This is to record and show that this action is being done in the best interests of the person and to promote their safety. It should include the discussions with the resident, if appropriate, doctors and people involved in their care who are involved in making this decision in the person’s best interests. Controlled drugs are not kept for people in any quantity and are recorded and kept separately. Lunesdale House DS0000062846.V369959.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): NMS12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices about their lifestyle and are supported to maintain their independence. EVIDENCE: Care plans did have some information on interests and hobbies people enjoy but did not contain personal profiles or pen pictures about people, their backgrounds, significant events and occupations and we recommended this be included in the care plans as this can provide useful information for those supporting residents with activities that are meaningful to them. We looked at records of activities and spoke to people about the things they had been doing. The people we spoke with were well aware what activities were going on and we spoke with several who were meeting in the lounge to take part in the regular Tuesday exercise session. Survey responses also indicated that there were “always” activities arranged that they could take part in and people told us there was “plenty to do” and they did quizzes, bingo and crafts and also flower arranging from time to time. One person told us that they especially liked the theatre outings to the local playhouse and how much they had enjoyed the trip to ‘the Aquarium of the Lakes’. There are regular Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 14 trips out and any appointments and hospital visits are usually combined with a trip or meal out for a person. Activities are listed in the Statement of Purpose and those specifically for the visually impaired such as cards, dominoes and draughts to help them join in. People had televisions in their rooms if they wanted this and some had their own DVD and video players. The home encourages relatives and friends to visit and residents say there are no restrictions on when people can visit them and that they go out as they wished with family and friends as long as they let staff know. One person told us that they “had made some good friends living here, there is no animosity here, all goes very well”. There are arrangements with the local church for services and communion and people may have their own clergy visit if they prefer, residents confirmed this. What people have been doing or activities taken part in are in the daily notes. We visited the kitchen, which was clean and well organised and spoke with the cook and looked at the 4 weekly menus. We discussed the menus and special diets and how people living there influence them and their choice of meals. We spoke with one person who had a pureed diet and they said this was always well presented in individual portions so they had the different flavours and it “seemed more normal” Records are kept of the food served in the home and the alternatives available in addition to the main menu. The food is prepared in the home with fresh produce from local suppliers. The dining room was attractively furnished and the lunchtime meal was relaxed and sociable and people were able to take their time over lunch and chat at the table. A choice of hot and cold drinks was on offer and several people had chosen to have a glass of sherry before their meal. Residents spoke very highly of the standard of food they were offered saying “ the food is very good” and one person said, “Its good food, I eat too much and am putting on weight”. Meals are served either in the dining room or in the resident’s rooms depending on the their preference. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 15 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): NMS 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an accessible complaints procedure and adult protection procedures are in place. People who use this service are able to express their concerns knowing they will be listened to and acted upon. EVIDENCE: There are procedures in place for dealing with complaints and concerns. The process is in the statement of Purpose/service user guide, individual contracts and displayed with CSCI contact details. Since the last inspection the home has not received any complaints but does have a recording system should they receive one. We (The Commission for Social Care Inspection) have not received any concerns or complaints about the service. We discussed the handling of complaints with the manager who felt that regular contact and discussion with people living there meant that matters were dealt with early rather than people feeling they needed to make a complaint. We spoke with residents who told us they knew how to make a complaint but they saw the manager everyday and would have a chat with him if anything bothered them. All the people we spoke to said the manager was approachable and accessible and listened to what they had to say. One person told us, “I have no difficulty saying what I think and what I want, I just tell Chris (manager) and he takes care of it”. Survey responses from people living in the home indicated that all eight who responded were aware of the complaints process and how to make a complaint. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 16 The service has been developing its internal policies and procedures for the Protection of Vulnerable Adults (POVA) with an outside Consultant who is providing the service with new procedures in line with legislation and good practice. The service has recognised that there is a need to improve these procedures and has taken action to do so. A copy of the Local Authority’s guidance and procedures is used to inform practice and there is also information on the Mental Capacity Act. There have not been any referrals made under safeguarding since the last inspection. Training is given to the care staff in house on adult protection and recognising abuse, using videos and care staff cover this topic during their NVQ course that over 80 of staff have completed. We spoke with staff and they were aware of the procedures and staff survey responses supported that. The staff handbook, given to all staff, has the policies and procedures for staff reference. The home does not deal with any resident’s personal finances and encourages and supports people to handle their own money and provides facilities for keeping items securely in bedrooms. Expenses incurred are invoiced to people, their families or representatives quarterly. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 17 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): NMS 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents enjoy a comfortable, safe and homely living environment. The premises are being maintained and improved to provide an environment that suits the needs and lifestyles of the people living there and is being kept to a high standard of cleanliness. EVIDENCE: There is regular, planned maintenance of the home and grounds and the standard of decoration and attention to detail and safety is of a high standard. There is also a planned programme of continued improvement of the environment for people. There are up to date maintenance records for the testing of emergency equipment, call bells, boilers, call systems and water temperatures. The service has risk assessments in place and has consulted with the fire service throughout the refurbishment and building work. We looked around the home and found it to be very clean, tidy and with plenty of Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 18 storage space to avoid clutter. The domestic staff cover 7 days and the hours have recently been increased to maintain the services high standards. The communal rooms are well lit, well decorated and furnished to a high standard in a style that suits the life style and needs of the people living there. Call bells are easily accessible in areas used by residents to summon assistance if they need it. We spoke with several residents sitting in the lounge who were sat in informal groups chatting together, some having pre lunch sherry or soft drinks. We spoke with one person in the conservatory who was having a cup of tea and reading, they said they enjoyed looking out from there and also from the windows in the lounge that overlooks the garden and local countryside. People told us that the home was “very comfortable” and “very clean, our rooms are done every day”. Residents surveys also indicated a high standard of cleanliness and that the home was, “always” fresh and clean. All of the bedrooms are single occupancy and most have now been redecorated and refurbished to a high standard with new soft furnishings and en suite bathrooms fitted with showers provided to improve the environment for residents. We spoke with one person and their relative and they showed us their room. The room had been improved with en suite facilities and was spacious and laid out well like a bed sitting room and had extensive views over the countryside. The person had chosen the colours and materials for their room when it was refurbished and had been able to move into this room from another at their request. They said they were glad they could bring some of their own furniture with them. Remaining bedrooms, in need of improving and redecorating, are due to be done, as occupancy and resident’s wishes permit. One resident did not want their bedroom changed and their wishes were respected. We saw that residents have their own possessions in their bedrooms making them more personal and familiar for them. The home’s laundry is small but the use of space has been improved and it is well organised and clean. The home has infection control procedures and records indicate that some staff have received training in this. Staff were observed to follow good practice in the use of aprons, glove, alcohol hand gel and disposal of waste. There are adaptations and equipment in the home to help residents make the most of their physical independence and to get about the home safely. Outside the gardens are well kept and accessible and there is seating for people. The patio and seating area has been extended to provide more space for people. We spoke with residents and relatives who all made positive comments about the home and environment. People told us “ There is good company here” and “nothing is too much trouble” and “the laundry is very good, they take it away and bring it back the next day”. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 19 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): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and deployment of staff on duty, and on duty rotas, is sufficient to be able to meet current resident’s needs. EVIDENCE: Staff rotas and observation of staff deployment during the visit indicate that the home has a stable staff group with a range of skills and experience to provide a consistently good level of individual care for residents. There is very little staff turnover and the home does not use agency staff but cover in emergencies from within the staff group. There are enough staff on day and night duty to meet people’s care needs at the current levels of dependency. We talked with residents who made comments such as “ The staff are very understanding” and “ They look after us very well”. There are 2 carers in the morning and 2 in the afternoon and the manager. There are extra staff at busy times such as for checking in the monthly medications and to assist people to have baths. Staff spoken with enjoyed their work, felt valued and supported by their manager and the staff surveys supported this. Staff we observed had a good rapport with residents. There is also sufficient domestic cover seven days a week to maintain a clean home and the home has 2 cooks providing full time cover. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 20 The recruitment procedures have been improved and those in place help ensure that appropriate staff support the people using this service. All legal checks are completed prior to the support workers starting work and references taken. There is a staff handbook with policies and procedures including disciplinary and grievance procedures. The home supports staff to undertake training and develop their practice and has a high percentage of staff with NVQ Level 2 in care. Records are kept of training attended by staff including induction however some records were not up to date so it was not possible to assess if all staff had updates or in need of refreshers to maintain their skills. We discussed this with the manager who acknowledged this needed to be monitored more closely to prevent any confusion. We recommended that they had an annual training plan that was easy to follow so no one was overlooked for training and updates. This is to make sure all staff have up to date training to meet the needs of the people living in the home. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 21 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): NMS 31, 31, 33, 35, 36, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being well run in the best interests of the people living there. EVIDENCE: The manager is experienced, qualified and communicates a clear sense of direction to staff, relatives and residents. People we spoke to found the manager approachable and said staff listened to their views and opinions. One person said “We have a very pleasant manager, friendly with everyone” and another person said “ I can speak to Chris anytime but I have never had any complaints in the 3 years I have been here, he’s very good and the staff are very good”. Residents’ families and friends are asked for their views and opinions using periodic surveys, however the home is of a size whereby residents and families can put forward ideas and comments in an informal way. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 22 The service does also hold residents’ meetings and staff discuss any issues during their handover period at the end of each shift. This informal ‘open door’ approach to enabling people to influence the way the service runs was confirmed by residents we talked to and from their surveys and our observation that there was an open, positive and inclusive atmosphere in the home. A relative we spoke with commented they are always made” very welcome” and kept informed about any changes with their relative’s care and visited often. Policies and procedures are in place for staff and in their handbook to follow. The home’s policies and procedures are in the process of being reviewed using an outside consultant to make sure they reflect current legislation and safe practice. The home does not handle any resident’s monies or hold cash for them. People are supported and encouraged to handle their own affairs as long as they want or are able. All expenses incurred by residents are invoiced to the resident or their representative’s quarterly. The home has implemented a more formal programme of staff supervision and senior staff oversee this process that looks at practice and performance. Records of maintenance indicate that the home has up to date fire training for staff and that servicing and testing of equipment and appliances is being done to promote resident health and safety. There is evidence that appropriate testing and servicing of emergency equipment and electrical appliances and boilers is being carried out. The home keeps records of any accidents and incidents occurring in the home that affect residents. Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 3 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 24 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. Refer to Standard OP9 Good Practice Recommendations Care plans should be in place for the crushing or disguising of medication to show that this is done in the best interests of the person, and to include any discussions with them their doctor and people involved in their care. As care plans develop the manager should consider including personal profiles or pen pictures about people, their backgrounds, skills abilities and occupations to help identify what is significant to a person and what their diverse recreational needs might be. The registered manager must make sure that there is a clear and systematic staff training and development programme in place that monitors and records all the training and updates staff need to do and ensure the training/updates are done by everyone. 2. OP12 3. OP30 Lunesdale House DS0000062846.V369959.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection NW Regional Contact Team 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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. 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