Care Home: Lydiate Lodge

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What the care home does well The home had a homely and welcoming atmosphere. It was warm, clean and nicely decorated and furnished. People living at the home looked well cared for and happy. The home ensures that people are only admitted to the home after a full assessment of their needs has been carried out. This is to ensure that the home can meet these needs in full. People living at the home have a care plan which enables staff to deliver care in a consistent manner. The home has good working relationships with local health care professionals. We saw that people are treated with privacy and dignity. People are provided with a well balanced diet that takes into account their likes and dislikes as well as any special dietary requirements. There is a formal complaints procedure and people feel listened to. Staff have a good knowledge of recognising bad care practice which helps safeguard people from the risk of abuse. The home ensures that peoples` medicines arehandled safely and appropriately. Staff are well trained and staffing levels are good so that people are able to receive the care they need. The home ensures that good health and safety practices are in place. What the care home could do better: Information relating to peoples` personal histories, and social/recreational interests needs to be included in care files. This would enable activities to be planned on an individual basis and tailor-made to suit them. People living at the home should be consulted and involved in the day-to-day decision making, with their views regularly sought (both informally and formally). Any new staff recruited must have the necessary pre-employment checks carried out before they commence work at the home. CARE HOMES FOR OLDER PEOPLE Lydiate Lodge Rock Lodge Park Lynton Devon EX35 6DN Lead Inspector Victoria Stewart Unannounced Inspection 15th January 2008 10:15 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 Lydiate Lodge DS0000039201.V351226.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. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lydiate Lodge Address Rock Lodge Park Lynton Devon EX35 6DN 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) 01598 753256 01598 752661 http/www.devon.gov.uk Devon County Council Mrs Carol Ann Mitchell Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15), Terminally ill (1) of places Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 Brief Description of the Service: Lydiate Lodge is a Local Authority home registered to provide care of up to 15 people over 65 years of age. The home was originally built in the 1960s but has undergone modernisation to provide modern and up to date facilities. Some private rooms are situated on the ground floor but the majority are on the first floor. All areas of the home can be accessed by a modern passenger lift. There is a selection of communal rooms on both floors with the main dining room on the ground floor. There are outside seating/patio areas at the back and front of the building. A large car park is provided for visitors. The home is situated in the coastal area of Lynton and sits at the head of the town. All local facilities are within easy walking distance although the area can be fairly steep. The latest CSCI report on the home is displayed in the entrance hall of the home and readily available for people to look at. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since this inspection took place before the end of January 2008, it does not qualify for a quality rating at this time. This visit was unannounced and carried out as part of the normal programme of inspection for the current year. It took place on 15 January 2008 and took 6 hours to complete. There were 13 people living at the home. Prior to the visit, the manager completed an Annual Quality Assurance Assessment (AQAA), which was used for this inspection. This confirmed the dates of maintenance of equipment and what policies and procedures were in place. Information from this document was used to write this report. Information was also gathered from talking with people both living and working at the home, management, looking at a selection of records (including care files, staff files, financial records, staff training records, health and safety records, medication records, quality assurance surveys) and a tour of the building. During the inspection 3 people were case tracked. This involves looking at peoples’ individual plans of care, and where possible speaking with the person and staff who care for them. This enables us (the Commission) to better understand the experience of everyone living at the home. What the service does well: The home had a homely and welcoming atmosphere. It was warm, clean and nicely decorated and furnished. People living at the home looked well cared for and happy. The home ensures that people are only admitted to the home after a full assessment of their needs has been carried out. This is to ensure that the home can meet these needs in full. People living at the home have a care plan which enables staff to deliver care in a consistent manner. The home has good working relationships with local health care professionals. We saw that people are treated with privacy and dignity. People are provided with a well balanced diet that takes into account their likes and dislikes as well as any special dietary requirements. There is a formal complaints procedure and people feel listened to. Staff have a good knowledge of recognising bad care practice which helps safeguard people from the risk of abuse. The home ensures that peoples’ medicines are Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 6 handled safely and appropriately. Staff are well trained and staffing levels are good so that people are able to receive the care they need. The home ensures that good health and safety practices are in place. 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. Lydiate Lodge DS0000039201.V351226.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 Lydiate Lodge DS0000039201.V351226.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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Lydiate Lodge can be assured that they will receive full information about the home. Those that choose to live there will receive an assessment before they move in to make sure that the home can fully meet their individual needs. EVIDENCE: Surveys received from people living at the home showed that they or their relatives had received enough information about this home before deciding to live there. The home ensures that assessments are carried out from health and/or social care professionals prior to admission to the home. These are obtained to ensure the home can meet all the prospective person’s needs in full. Health care professionals also confirmed this happens. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 9 Health care professionals confirmed that staff at Lydiate Lodge only have people living there who can have their needs met fully. During our visit to Lydiate Lodge, we observed the process of a new person coming to stay at the home. This was being carried out with the close involvement of health care professionals. The home ensured it had all the paperwork necessary before the person came to Lydiate. This was to make sure that the home and staff could look after this person properly and meet their needs fully. We looked at three people’s care files and these showed that some information is gathered before people move into the home. Lydiate Lodge DS0000039201.V351226.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ health and personal care needs are met by staff who treat them with respect and dignity. EVIDENCE: Surveys received from people living at the home showed that they were ‘always’ happy with the care and support provided. One health care professional commented in their survey that the home ‘usually’ meets the individual needs of people living at the home. One other health care professional spoken with during the inspection felt that the home was “wonderful” and that “people love it”. This professional commented that excellent working relationships with the staff at the home had been developed and we saw this during the visit to the home. We spoke to all the people living at Lydiate Lodge during our visit and everyone commented how happy they were there. Seven relatives responded to surveys and we spoke with a further six. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 11 We looked at the care files of three people who had varying health and social care needs. These all contained all the documents necessary to look after each individual and included suitable risk assessments and plans of care. However, not all care plans included peoples’ hobbies or interests and there was little detail about their previous life histories. This would help the home to plan suitable recreational and social activities for people. We were told that the home is in the process of starting ‘life histories’ which would help staff understand people’s lives before they moved into the home. Care plans showed that they were regularly reviewed, although this had lapsed recently with reviews not being carried out since November 2007. After speaking with one person, it was obvious that he/she’s care needs had changed recently and this had not been recorded in her care file, for example the care plan stated that this person needed a wheelchair to go into the dining room and needed a member of staff to accompany in the lift. However, he/she stated that this was now no longer required and he/she did these tasks independently now. We looked at the management of peoples’ medication. Medicines are ordered, dispensed, recorded and disposed of appropriately. Controlled drugs were checked and these were satisfactory. The home has a designated drugs fridge in the cold kitchen store area which is used to store medication in, such as insulin. This type of medication is given with the assistance of the district nursing team who draw up the medication ready for the staff to administer it – adequate records are kept of this dispensing. The AQAA states that the home maintains peoples’ privacy and dignity and this was observed during our visit. The home has unrestricted visiting and people confirmed that their friends/relatives dropped in at any time and they could use either their private rooms or a choice of communal rooms if desired. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. The open, friendly atmosphere makes people feel welcome at the home. Food served in nutritious, varied and suits individuals’ needs. Activities on offer in the home are poor. EVIDENCE: People living at the home commented that there were limited activities to do in the home and the activities programme confirmed this. On our visit, no activities were seen going on and people were observed sitting with the television on. Typical comments were “What is there to do here?” and “We haven’t got anything to do”. Care staff undertake activities as part of their normal duties. The AQAA states that the home knows it could do better with activities and arranging trips to the surrounding area. It also states that they hope to provide more outings in the next twelve months. The assistant manager said that there is a budget for entertainment which pays for entertainers to come in – the last one being a couple of weeks ago. Other people’s interests in the home include one person who likes to go into town shopping on her own, one person who likes to go out with family and one person who likes to help in the home eg laying tables, cleaning silver etc. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 13 People did confirm that their friends and relatives are welcome at any time and the friendly and open approach staff have to visitors was seen during out visit. People were happy with the food served and we shared lunch with them. The menu had choices about which food to choose and we saw that some people enjoyed a meal different to the others, which was not even on the menu. These people confirmed that this often happens and the cook had a good understanding of what peoples’ preferences were. Choices for next day’s lunch are made and people confirmed that they often changed their minds and this did not matter. The menu confirmed that a variety of different types and choices of meal are offered. The cook keeps good accurate food safety records and these are regularly audited. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that their concerns and complaints will be listened to and acted upon. They are protected by staff who have a good knowledge of safeguarding adults issues. EVIDENCE: People confirmed both in their surveys and during our visit that they knew how to make a complaint if they were unhappy. They also confirmed that staff listen to them and act on what they say. Health care professionals also commented that they had never been asked to respond to any concerns individuals may have raised about their care. The Commission has received no complaints since the last inspection. The home’s complaints file was looked at and we saw that no complaints had been raised – all that was on file were ‘thank you’ letters and cards from people who valued the service they had received at Lydiate Lodge. Staff confirmed in their surveys that they had received training about recognition and reporting of abuse and commented that they would report this to the assistant manager on duty. Training records confirmed that staff had attended suitable training. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 15 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People feel comfortable in a home that is clean, well furnished and maintained to a good standard. EVIDENCE: The home is well decorated and furnished. People are able to bring in their own possessions and rooms are individually decorated. The home has a choice of communal rooms for people to sit in which are homely and cosy. Bathrooms in the home are modern, clean and provide the aids necessary for people to bathe in. People can access all areas of the home with the aid of a modern shaft lift. The home takes infection control seriously and each room has disposable hand wipes and soap dispensers. Gloves and aprons are freely available. The home Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 16 has a suitable laundry which has the equipment necessary to wash and dry peoples’ clothes properly. The AQAA states that the home has some planned improvements for the home including replacing carpets, placing down non-slip flooring, some painting and providing a digital television for people. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. People benefit from staff who receive have the necessary skills to look at them properly. The staff recruitment procedures are generally good, but may not always be robust enough to protect people living at the home. EVIDENCE: The home always ensures it has the right amount of staff on duty to meet peoples’ needs. On our visit the home had for the morning shift one assistant manager, two care assistants, a cook and a kitchen assistant. The afternoon shift comprised of an assistant manager and two care staff. The night shift consists of one night care officer and a care assistant. This was satisfactory of the thirteen people living at the home. The home has recently been having problems in the lack of available domestic staff. One member of staff was on long term sick and the other member of staff had had his employment delayed due to the slowness of the necessary pre employment checks. Despite the lack of domestic staff, the care staff must be commended on ‘pulling together’ and keeping the home very clean. People living at the home said that the home was always clean and fresh. The home is also experiencing problems with numbers of care staff and is currently using staff from a care agency regularly. During our visit, one Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 18 member of agency staff was working the morning shift and we saw how welcome she was made to the home and shown around. People confirmed in their surveys that they were happy with the staff and comments included “I would like to say that all the staff work very hard” and “staff are wonderful”. Three staff files were looked at. These staff files used to be held centrally but are now being kept in individual homes. The assistant manager on duty said that the manager and herself are currently looking at the files and ensuring that all the information held is correct and in order. The staff files looked at contained the necessary pre-employment checks but there was some discrepancy in these dates. This meant that, according to the information and dates on the files, some staff had started work before their Protection of Vulnerable Adults (PoVA) or Criminal Records Bureau (CRB) had been received. These dates were discussed with the assistant manager during our visit. Staff files now had all the necessary information on file but it was not clear whether these people had been working at the home before these arrived. This could put people living at the home at unnecessary risk of harm. Staff confirmed that they receive the training necessary for them to do their jobs and records demonstrated the amount and level of training staff attend. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 19 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practices relating to the health, safety and financial procedures of the home are good, but people could be more involved in the running of the home. EVIDENCE: The registered manager has worked at the home for many years and has the Registered Manager’s Award. A team of assistant managers support her during the day and night care officers at night. Questionnaires relating to the service are sent out regularly with the last ones being sent out about 3 months ago. However, the results of these were not available, as they had been sent away for auditing. Outside agencies are asked for their opinions of the service and each person who attends the home for a Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 20 short stay (respite). Meetings for people living at the home are held but not very often – the last one being in September 2007. No minutes of these were available. The records relating to peoples’ monies were looked at. These were in order and receipts kept. A random sample were checked and found to be satisfactory. Staff mandatory training is undertaken including manual handling and fire. Staff have attended other training courses of interest. Servicing and maintenance of equipment is regularly undertaken. Fire records were checked and found to be satisfactory. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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. 1. Standard OP12 Regulation 16 (2) m Requirement You must ensure that people living at the home are consulted about their social interests and hobbies and that these meet their individual needs. Previous timescale of 04/10/06 not met. You must ensure that staff recruited to work at the home have the necessary preemployment checks carried out before they begin working at the home. Previous timescale of 04/10/06 not met. Timescale for action 01/08/08 2. OP29 17 (2) Schedule 4, 6 a,b,c,f 15/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000039201.V351226.R01.S.doc Version 5.2 Page 23 Lydiate Lodge 1. Standard OP7 It is recommended that the care plans include a personal history of each individual person living at the home. Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Lydiate Lodge DS0000039201.V351226.R01.S.doc Version 5.2 Page 25 - 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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