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Inspection report

Date of Inspection: 22 May 2012
Date of Publication: 21 June 2012
Inspection Report published 21 June 2012 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

People experienced care, treatment and support that met their personalised needs and protected their rights in a comprehensive way.

The provider was meeting this standard.

User experience

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare.

We spoke to one person who read us a poem they had written, which included the following lines about what their experience of moving to the home had meant to them:

‘ A whole new life was beginning for me

Friendly, helpful and caring, these are the qualities that all staff showed

Deep down inside I knew I should have moved to Lucerne years ago’.

Everyone we spoke with told us how staff were kind and we were told about the wide range of interests and activities they enjoyed. The home had an ‘engagement’ agenda. This was to ensure that people had something to do that interested them and so that they could feel useful and occupied, especially those people living with dementia. Attention was paid to ensuring that everyone at the home was involved and received regular input from staff to aid their wellbeing. Care plans included monthly activities reviews, which were informative. A musicality programme focused on finding out what music people enjoyed or evoked good memories. Each person had their own playlist on the home’s I-pod. This was also used when people were feeling low in mood or displayed behaviour that could be challenging to staff to help minimise any distress.

We saw that meal time was a social event in a lovely setting. Staff and relatives also sat and had coffee with people living at the home and staff did not appear rushed. We saw people being assisted to eat and drink in a discreet, patient way whilst staff chatted to them about topics that they might understand or were relevant to them. This showed that staff were knowledgeable about people. One person was upset so we saw staff sit with them looking at a book to distract them. People were able to choose where they sat in the dining room or they could choose to eat in their rooms. Each plate was personalised for the person’s needs, such as cut up or for a person with a small appetite. We heard that meal times were flexible so that people could eat when they wanted to. The food was of good quality and well presented. The kitchen received the top food hygiene rating when last assessed in 2011.

The Shillingford unit had a memory lane project where individual areas had been made to add interest and purpose for people, especially those living with dementia, such as a bus stop, pub, garden shed, office, church, outside beach harbour area, hat shop and barbers, shop, bank and airport. We observed that people seemed happy and occupied throughout the day undertaking a range of activities which included gardening, flower arranging, reading and enjoyed singing and music.

The activity programme was wide ranging and well staffed by an activity team as well as input from care workers. It had been well thought out to meet people’s individual needs and capabilities. Activities were not confined to each unit, people are welcome to attend any activity. For example, one person had popped out from Shillingford to attend the ‘Gossips’ coffee club on Alphinbrook. During our visit there was an Olympic torch event, a ‘torch’ had been made and was visiting each person at the home to celebrate the torch relay in the UK. There was a men’s club and ladies’ club, fitness with care, social get togethers, bingo, music nights, drama club and one to one sessions amongst others.

The outside space was purpose built to enable people to be more independent. There was a raised bed gardening area, a shady, sensory woodland walk, water feature, a music therapy area and benches. A new area was being built into a beach harbour with a boat, sand, crazy golf, Punch and Judy and beach huts. All new areas will be safe and secure and accessible with ramps.

Other evidence

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We looked at five care plans in depth. Care records were very detailed, they were written in a person centred way such as when people liked their bed changed, how people liked a care worker to help them and what activities people could manage by themselves. There were good assessments about potential nursing needs and short term problems were clearly documented and assessed separately and signed off when they were no longer an issue.

Care records were kept up to date by all staff in the daily records. All areas of care were clearly recorded such as oral hygiene, foot care, communication, specific risks and information about family and relationships.

We saw that staff monitored areas of risk well, such as weight, nutrition and fluids as well as falls risks. We saw a good example of falls monitoring. All falls were recorded in individual care plans. One person had two falls in a week and this had been noted and an appropriate referral made to enable staff to further protect this person by minimising the risks and taking remedial action. Another person was identified as being reluctant to eat. This had been managed very well by offering finger food that the person could eat ‘on the go’ and to ensure that food and drink offered was high in calories. To promote the use of natural nutritional drinks, the home, with GP input, have made up a recipe for a nutritious smoothie called the ‘Lucerne drink’. People’s weights were regularly monitored to alert for any unusual patterns which might indicate a change in wellbeing and action taken accordingly. This showed action was taken to ensure that people’s wellbeing was maintained.

We noted in care records that people regularly saw a variety of health professionals such as opticians, dentists and chiropodists. Staff said people were escorted to their medical appointments. The home ensured that hospital staff were well informed about people’s needs. The home gives the hospital a copy of the persons’ ‘This is Me’ summary as well as verbal and written transfer information.

We spoke to the GP for the home. Although people are able to keep their own GP if they wish, the home has an allocated GP who offers a surgery at the home twice a week. The GP has been able to build up a rapport with people and said that people benefitted from the fact that they could see people in their own environment throughout the day and got to see more people. The home is unusual in that the GP has a computer link to the local surgery, which means that all the patient information is available and prescriptions can be ordered straight away. The home also has equipment to undertake some blood tests in house. Medication administration was done from the treatment room on a one by one basis to minimise the clinical feel and/or anxiety of a drug ‘round’.

People’s care was planned and delivered in a way that ensured it was in their best interests.

We were told by staff how the service worked with one person, their family, their care management team and other agencies to in making a best interest decision about where they would live in order to ensure that their care and welfare needs were met.

People’s care and treatment reflected relevant research and guidance.

We were told that Ide unit in the home was working towards the Gold Standard Framework for ‘end of life’ care and towards a national recognised award for best practice in dementia care. One example of good practice described in relation to end of life care was how the home had introduced anticipatory prescribing to ensure supplies of medication were available when needed. This ensured people remained comfortable and did not have to wait for medication. There was a good relationship between staff, the local hospice team and the GP to ensure that end of life care was comprehensive and up to date. The staff also encourage