Inspection on 30/04/08 for Lawnfield House

This is the latest available inspection report for this service, carried out on 30th April 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Similar services:

Henry Nihill House

Birchwood

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Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Lawnfield House Lawnfield House Coverdale Road London NW2 4DJ Lead Inspector Judith Brindle Key Unannounced Inspection 30th April 2008 08:40 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 Lawnfield House DS0000070920.V361135.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. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawnfield House Address Lawnfield House Coverdale Road London NW2 4DJ 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) 01332 296200 home.law@mha.org.uk www.mha.org.uk Methodist Homes for the Aged Mr Azaad Saumtally Care Home 36 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (36) of places Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 36) 2. Dementia - Code DE (maximum number of places: 36) The maximum number of service users who can be accommodated is: 36 New Service Date of last inspection Brief Description of the Service: Lawnfield House is owned by the Methodist Homes for the Aged. This Organisation was registered as the new owner of the home on the 5th December 2007. Methodist Homes for the Aged is a nationwide charity, providing housing, care, and support services for older people. The care home is part of a large building, which is also the premises for sheltered housing units. For several years the care home has provided accommodation, and personal care for thirty six elderly residents, some of who have dementia care needs. The care home consists of four separate self-contained units, which include the accommodation for people using the service. This accommodation is located on the ground, first, second and third floors of the home, linked by a passenger lift and a staircase. Each unit accommodates 9 residents, and has a ‘quiet’ room/lounge in addition to a separate open plan lounge/dining room. There is also a small kitchen, bathing, and communal toilet facilities within each unit. All the bedrooms are single, and each has its own ensuite toilet, and wash hand basin. The fourth floor consists of the laundry service facility, staff rooms, staff bathroom facilities, and also a quiet room facility that can be used by staff and others. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 5 There is an attractive garden at the rear of the property, and ample off street parking at the front of the premises. Information/documentation about the service is accessible from the care home to people using the service and others. The home has a ‘block contract’ with the Local Authority so residential placements in the care home take place with full participation from the Local Authority Care Management teams. Fees are £801.39p per week. Additional costs are recorded in resident’s statement of contract/terms and conditions documentation. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. The unannounced key inspection took place throughout nine hours during a day in May 2008. There were no vacancies at the time of the inspection. I was pleased to meet and spend a significant part of the inspection with the people living in the home. The registered manager was present during most of the inspection. Prior to this unannounced key inspection the manager supplied the Commission for Social Care Inspection (CSCI) with a very comprehensively completed Annual Quality Assurance Assessment (AQAA) document. The AQAA is a self- assessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. Reference to some aspects of this AQAA record will be documented in this report. A number of feedback surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, relatives/significant others, health and social care professionals and staff. At the time of writing this report, 7 relatives/visitors feedback forms and one survey from a staff member had been returned to us. We did not receive any surveys from people using the service, so talking to residents, and observation during the inspection was of particularly importance. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Also relevant information from other organisations, and what other people might have told us about the service was assessed. I spoke with several people using the service (from each unit), staff (including the Project Manager), two visitors, and had telephone conversation with a relative of a resident during the inspection. Some people using the service have specialist needs including dementia care needs, so several residents had difficulty in expressing/communicating their views of the care home. Due to this I carried out a planned period of two Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 7 hours of observation of five residents (most of which had dementia care needs) who lived on one unit in the care home. This enabled me to observe for signs of ‘well being’, as well as the quality, type and amount of staff interaction, and engagement that staff had with the residents being observed. This inspection tool is called Short Observational Framework for Inspection (SOFI). Aspects of the findings from this will be described in this report. This tool showed that there was significant positive staff interaction between residents and staff, and signs of ‘well being’ from people using the service. Documentation inspected included, some care plans of people using the service, risk assessments, staff training, and staff personnel records, and some policies and procedures. The inspection included a tour of the premises. A person using the service kindly showed me their bedroom, and spoke of being ‘happy’ with their room. As this home has been recently re-registered, it had been inspected by the Commission for Social Care Inspection throughout the period it was under former ownership. The previous unannounced key inspection with regard to Lawnfield House took place in September 2007. Assessment as to whether the requirements and recommendations from that inspection had been met also took place during this inspection. These were found to have been met. 25 National Minimum Standards for Older Persons, including Key Standards, were inspected during this inspection. The inspector thanks the people living in the care home, staff, and the registered manager for their assistance in the inspection process. What the service does well: The care home has a very welcoming, and warm atmosphere. Residents spoke highly of the care home, and of being happy living in the care home, and confirmed that staff were very caring and helpful. Comments included staff “are the best that they can be” and the staff “are nice”, “ they always look after me good”, “there is always someone here to help you”, “you don’t have to worry about anything”. Short Observational Framework for Inspection (SOFI), general observation, and talking to staff indicated that staff were generally aware of resident’s individual needs, and interacted in a respectful, and sensitive manner with people using the service. Staff were seen to be approachable. Stopping to talk with people using the service, and responding positively to their requests and needs. The (SOFI) observation tool showed that there was significant positive staff interaction between residents and staff, and signs of ‘well being’ from people using the service. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 8 Residents’ contact with relatives and others (as agreed by people using the service) is fully supported, and enabled by the care home. Feedback from relatives/visitors informed us that they continued to be satisfied with the quality of care and some were particularly positive. Comments included “(My relative) is a different person”, “we are very pleased with the home”, “ I feel my (relative) is safe”, “we are very happy at the thought that this is where she/he will live”, “it’s a good home, there is visiting anytime”, “it’s a very nice home”, “I am kept informed of my (relative’s) progress”, and “staff are very helpful”, “staff are very friendly”, “we are very pleased with the care”, “overall the care is good”, “I am happy that this is the chosen home for my aunt”. The home is well maintained and clean. People using the service spoke highly of the meals provided. A person using the service commented that ‘the food is nice’, and that “I can choose” what to eat. Staff received varied and appropriate training. Most staff have now achieved a National Vocational Qualification (NVQ) level 2 and/or 3 in care. The registered manager is experienced, competent and keen to put into place, systems and practice to continue to improve and develop the quality of the service provided for people using the service. What has improved since the last inspection? What they could do better: The number and variety of activities (including community based activities) particularly for those with dementia care needs could be improved and developed to ensure that all residents have the opportunity to participate in Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 9 activities of their choice, including those leisure pursuits that they enjoyed prior to moving into the care home. Some recorded staff guidance for meeting the assessed needs of people living in the care home could be improved and better developed. There could be more evidence in the care plans of knowledge and understanding by staff of all numerous characteristics (communication, wide variety of dementias, and wide variations in the experiences of people with dementia) of dementia care. Spiritual and religious needs are generally recognised by the service, but further development of assessment of some equality, and diversity needs could be more evident to ensure that the care home shows a comprehensive understanding and respect for all aspects of diversity including gender, age, sexual orientation, race, and disability. 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. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 10 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 Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 11 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): Standards 1,3 and (6 is not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information that they need to make an informed choice about where to live. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Some equality and diversity aspects of this assessment could be further developed. EVIDENCE: During the inspection the manager supplied me with a copies of the up to date documentation about the service provided by the care home. These documents give details about the owner, (Methodist Homes for the Aged (MHA) Care Group), and the home’s facilities and services, objectives, accommodation, complaints, and last inspection report (from when the home Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 12 was under previous ownership). The previous inspection report was displayed prominently in the home. The service user guide is recorded in pictorial, and written format. Annual Quality Assurance Assessment (AQAA) documentation, and the registered manager confirmed that prospective residents, and others are supplied with a copy of this guide. The manager reported that he had plans to ensure that all the people using the service be supplied with an up to date version of this document. In the service user guide, there is some information with regard to how the home meets the needs of those with dementia care needs. The statement of purpose could define activities and ways of working that are specific to meet the needs of people with dementia. The home has an admission procedure, which includes details of the assessment and admission criteria for people using the service. A summary of this is recorded in the statement of purpose. The manager confirmed that a full assessment (using Methodist Homes for the Aged Residential Assessment) of the prospective resident’s needs (including specific care needs, medical, physical, social and emotional needs) is carried out by trained, competent staff members. The person who generally carries out this assessment is the manager and/or deputy manager. I was informed that the prospective resident is supported in being as involved as much as they can in this process of assessment. Prospective residents also receive an assessment of their needs from the funding Local Authority. Care plans, and a relative corroborated that these assessments take place. A family member informed us that their relative had received an initial assessment of her needs, which was carried out by the deputy manager. Assessments recorded within five care plans were inspected, this showed that spiritual and religious needs are generally recognised by the service, but further development of assessment of some equality, and diversity needs could be more evident to ensure that the care home shows a comprehensive understanding, and respect for all aspects of diversity including gender, age, sexual orientation, race, and disability. Annual Quality Assurance Assessment (AQAA) documentation confirmed that prospective residents are encouraged to visit the care home. During the inspection, staff reported that prospective residents visit the home if they can, and are generally accompanied by relatives, and or a social worker. We were told that if a person is admitted from hospital the prospective resident’s relatives tend to visit the home on the person’s behalf. A relative of a resident reported to us that she/he had the opportunity to visit the home before their family member moved into the home. The manager confirmed that resident’s have a ‘settling in’ period, before a review of their needs takes place, and the placement is then confirmed. This enables people using the service to make up their mind in deciding if they Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 13 would be happy living in the home. A relative informed me that she/he had recently attended a meeting with his/her family member, and that at this meeting their relation had their placement at the care home was confirmed. This meeting took place six weeks following the resident having moved into the care home. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 14 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): Standards 7,8,9, 10,11 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each person using the service has a plan of care, in which residents’ health, personal and social needs are set out. Some recording in the care plans could be improved to ensure that it is evident that all residents’ needs are identified, and met. People using the service are respected and their right to privacy upheld. People using the service are protected by the home’s policies and procedures for managing and administrating medication to people using the service. EVIDENCE: All the people using the service have a plan of care. Five care plans were inspected. These had been signed by the people using the service. Since the registration of the new owner, staff have implemented the owner’s (Methodist Homes for the Aged) care plans. These include a photograph, a personal profile, living skills and support plans. These plans recorded evidence of assessment of personal, health, communication, social, spirituality/religious, sexuality and emotional needs, and mobility needs. It was evident in these Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 15 care plans that residents had been asked questions about some of their individual needs. ‘Life Story’ books could be looked into for people using the service particularly those with dementia care needs. The manager told us of the plans to develop understanding of equality and diversity needs within the home, by providing more staff training in this area, and further developing this in the care plans of people using the service. The manager reported that the Organisation employs an Equality and Diversity manager. Annual Quality Assurance Assessment (AQAA) documentation informed us that the care plans have been developed to include a Person Centred Approach, which ensures that each resident has a care plan that ensures that they are central to their own plan of care, and that each of their needs is acknowledged, and supported by staff. The care plans inspected indicated some evidence of this, but some aspects (staff guidance to meet identified needs of individuals) of these could be of better quality, and more detailed. Though there were detailed recorded information relating to each assessed need documented on the template of the care plan, such as behaviour needs, it was not always clear that staff had comprehensively recorded appropriately detailed staff guidance to meet each identified need of people using the service. This was discussed with the manager, who confirmed following the inspection that action had been taken promptly to improve this guidance in the care plans inspected. He reported that these care plans were still in the process of development and spoke of his plans to regularly review a random selection of care plans. This is strongly recommended. Records confirmed that the care plans were reviewed by team leaders regularly, and generally updated to reflect changing needs and current goals of the person. More detailed reviews of the care plans also on a regular basis take place. These meetings include the resident, relatives/significant others, care and management staff, and care managers. Two relatives who kindly spoke with me during the inspection confirmed that they had attended meetings in which their family member’s progress was discussed. Care plans include risk assessments, such as risk of falls, nutritional needs, mobility, and health and safety risk assessments. Daily’ and night resident’s progress records are documented. People using the service have access to care, and treatment from a variety of healthcare professionals, and specialists. GPs visit the home at least weekly. A GP saw several residents during the inspection. A resident told me that he/she had ‘seen the doctor’. Other health appointments include, optician, dentist, district nurse, chiropody care, and treatment, and psychology support. Records confirmed that an optician had recently visited the care home. Residents as needed, access additional specialist support and advice, from community nurses and from other health care professionals. Records and staff confirmed that each person using the service have their weight monitored Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 16 closely. A relative told us that he/she attends to the hospital/health appointments of his/her family member. A staff member commented ‘service users who are not well always get prompt treatment’, and ‘when service users are sent to hospital or any health setting they are always accompanied by a member of staff’. From speaking to residents, staff and from inspection of records it was evident that people living in the home are having the support and care they need to meet their personal care needs. The manager reported that no residents have pressure sores. During the period of Short Observational Framework for Inspection (SOFI) observation, staff were observed to frequently ask residents if they wanted to use bathroom/toilet facilities. Staff provided assistance and support to residents in a sensitive and respectful manner, and have an understanding of the importance of upholding their right to privacy. A resident spoke of making choices, which included choosing his/her own clothes, and of the time he/she wished to go to bed. He spoke of his independence, “I wash myself”, and “get dressed myself”. Staff were observed to offer people using the service various choices throughout the inspection. Residents have access to a telephone. People using the service were observed to be dressed appropriate to their culture and age. Feedback from relatives/visitors informed us that they felt that the home meets the varied needs of people, and that the care home gives the care that they expect. Comments from relatives/friends included I am ‘very happy that my aunt is in this particular home’. Feed back from relatives/friends informed us that they are kept up to date with important issues affecting their family member/friend. Comments included we are informed ‘very promptly, as soon as the situation happens’. Annual Quality Assurance Assessment (AQAA) documentation informed us that the care home has a comprehensive medication policy/procedure, including a separate ‘Controlled Drug’ procedure. Medication is stored securely. Medication is administered by the team leader or management staff. These staff all have registered nurse qualifications. I was shown the medication storage and administration systems. Receipt, administration and disposal of medication including controlled drugs were fully recorded. I was informed by the manager and records that the end of life wishes of people using the service are discussed as appropriate, and that these needs are documented. The manager told us that each person using the service will have his or her individual ‘end of life’ plan. Relatives/significant others of a loved one who is dying, can stay overnight if they wish. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 17 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): Standard 12,13 14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have the opportunity to take part in activities, but there could be further development in the provision of daytime activities, particularly for residents who prefer not to participate in ‘group’ activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Meals provided are varied, nutritious and attractive. The menu could be more accessible to people using the service. EVIDENCE: Records confirmed that people living in the home had the opportunity to participate in some preferred activities. Some information with regard to activities is displayed in each unit. This information could be more accessible to people using the service, it is displayed outside the sitting room, fairly high up, in print. Two planned daily activities, including ball games, music Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 18 appreciation, bingo, and quiz sessions are held on one unit, and residents from other units have the opportunity to attend these activity sessions if they wish. During the inspection it was observed that several residents chose to remain on the unit on which they lived, rather than participate in the bingo session taking place on another unit. Activities for these residents included watching television, talking to staff and each other, or playing dominoes. A resident spoke of his/her enjoyment of going to the local library, and of being an avid reader. Another resident spoke of some of the television programmes that he/she enjoyed. Staff spoke of occasionally accompanying residents into the community to go for a walk and/or shopping. It was noted that during lunch the television in the dining/sitting room of a unit was switched off and some music was played. Residents could have been asked what music that they wished to listen to. Records and staff confirmed that people using the service have the opportunity to attend religious services within the care home. A relative commented that ‘it would be nice if for residents (who used to worship prior to living in the care home) ‘to be taken to the local church once a week’, ‘I feel that it would be quite uplifting and most enjoyable for them’. The manager reported that religious festivals are of various faith and denominations are celebrated in the home. Other comments from relatives told us that they felt that the residents should have more opportunity to go to ‘the local park so that they can enjoy nature, and fresh air’. Relatives felt that the number and kind of activities could be better, suggestions were, a ‘range of films to watch, art/craft classes, board games, mental games with flash cards, and gardening’. A comment from a relative/visitors feedback form informed us that ‘there should be more appropriate activities’ and ‘residents want to go for walks but staff cannot take them’. Other activities that could particularly support those with dementia care needs are involvement in basic everyday activities, such as being involved in `making snacks, and making cakes. The home could take these suggestions from relatives and others on board to discuss and possibly put in place. The home could examine ways to develop activities for those with dementia care needs and include understanding and incorporating the role of sensory stimuli (colour, smell, touch and sound) in helping to improve communication with them. This could mean for example having available soft cuddly toys, and a scented garden We were informed by a relative that a ‘yearly’ coach trip takes place. Comments included, staff ‘seem to care for each person in their own special way’, and that this trip ‘is a laugh a minute, ‘it is fantastic and they make sure the residents are having as much fun as possible’. There could be further development in ensuring that it be evident that residents have the opportunity to participate in social/activity preferences communicated by them during the process of their assessment by the care home. For example in one care plan a resident had communicated a wish to go to a pub on occasions, and it was not clear from the records that this Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 19 preference was met by the home, and of reasons as to why it could not be met. The manager spoke of plans to ensure that activity equipment such as jigsaw puzzles, cards, arts and crafts were accessible on each unit. He also spoke of plans to develop a more formal activity co-ordinator role, and to develop the use of volunteers, to ensure that people using the service find the lifestyle in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. This is recommended. Annual Quality Assurance Assessment (AQAA) documentation confirmed that a hairdresser visits the care home regularly. The manager spoke of plans to introduce a multi sensory room for residents to access as a leisure activity and/or for therapeutic use. I was shown the room of where this activity was planned to take place. Sensory equipment was waiting to be set up by the service. The visitor’s record book indicated that people regularly visited the home. Visitors who kindly spoke with me confirmed that they visited the home regularly at varying times of the day. They confirmed that they are kept informed of issues that concern their relative/friend living in the care home. Comments from visitors and feedback forms included, “(My relative) is a different person”, “we are very pleased with the home”, “ I feel (my relative is safe”, “we are very happy at the thought that this is where she/he will live”, “it’s a good home, there is visiting anytime”, “it’s a very nice home”, “I am kept informed of my (relative’s) progress”, and “staff are very helpful”, “I think the carers are all very patient and dedicated to their work”, “the care my (relative) receives is impeccable”. A resident spoke of the visitors that she/he regularly had. During Short Observational Framework for Inspection (SOFI) observation, people using the service were observed to interact positively with other residents and staff. A resident spoke of the personal possessions that she/he had brought into the care home. The meals provided to people using the service are now provided by staff employed by the home rather than by an outside contractor as was the previous position. Staff spoke of the positive aspects of this. These included more choice for residents and better access to culturally preferred meals, for example Afro/Caribbean meals/menus. During the inspection , two residents were observed to have chosen a meal, which included plantain and chicken stew, rather than spaghetti bolognaise. The menu was displayed in each unit and included a choice of varied and wholesome meals, which included choices of cultural, religious and other dietary needs being available on request. There were some pictures of food on the menu. The accessibility of the menu to people using the service was discussed with the manager. He spoke of plans to display clearly in each unit the planned meals of the day. Menus in leaflet form and in an accessible format place on the dining tables was also discussed. Staff confirmed that residents had choice of meals, and spoke of several people using the service, Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 20 who regularly enjoyed meals that met their cultural needs and preferences. Staff had an understanding of the various dietary needs of residents and of ensuring that they were offered a choice of meals on a daily basis, records with regard to this were accessible. The care home employs two cooks and a kitchen assistant. The Short Observational Framework for Inspection (SOFI) observation session informed us that the meals provided during the inspection were unhurried, the tables were attractively laid, and people using the service that needed support with their meal were assisted as and when they needed. Staff informed me that two residents had chosen to eat their breakfast in their bedroom. Residents spoke of enjoying the meals, and were observed to be offered choice by staff during the meal. Comments from people using the service included “ I like the meals”, “I like the puddings”, “I have choice”. A kitchen staff member spoke to several residents asking them if they had enjoyed their lunch. Hot and cold drinks were regularly provided to residents during the inspection. Jugs of squash were accessible in the communal areas of each unit. Residents were seen to help themselves to drinks. Each unit has a kitchenette; staff spoke of being able to make snacks for residents at anytime. A resident spoke of enjoying her tea and biscuits. It could be positive for some residents to have the opportunity to participate (with staff support) in making snacks of their choice. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 21 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): Standards 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service and others are confident that their complaints will be listened to, looked into and action taken to put things right. There could be development in the recording of “comments/concerns” that may be communicated to staff by people using the service and others. Residents are protected from abuse, neglect and self-harm, and the care home takes action to follow up any allegations. EVIDENCE: The care home has a complaints procedure, which is recorded in the service user guide, and is displayed near a ‘suggestion box’ in the communal area of the home. There is a system in place for recording and responding to complaints. There were no recorded complaints since the key inspection (when the home was under previous ownership) 5th September 2007. The manager confirmed that complaints, comments and compliments were welcomed by the home, and are monitored closely by the home and the Organisation. Feedback from relatives/visitors told us that they were aware of how to make a complaint. A relative confirmed that she/he felt that they ‘were listened too if they communicated a concern’. A resident said that she/he would speak to staff if she had a complaint/concern, and indicated that appropriate action is taken to respond to and resolve them. One relative felt that she has needed to put complaints/concerns in writing to ensure that concerns are taken seriously. The manager should examine ways of ensuring Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 22 that it is evident that all verbal concerns are supported, appropriately documented, and action taken to resolve each issue, to ensure that it is evident that all residents and relatives/visitors know that they are listened to, and that all issues, including ‘concerns’ are taken seriously. This was discussed with the manager, who reported that steps were being taken to improve the recording of all ‘concerns/complaints’. Staff who spoke with me, had an understanding of the importance of taking complaints seriously and of the action that they should take in response to a complaint from a person using the service, or from others including visitors. A visitor named a staff member who she/he said “always responds to complaints”. Comments from relative’s feedback surveys “if we have a concern it is quickly sorted”. The home has a protection of vulnerable adults policy, and has a copy of the Local Authority’s Safeguarding Adults procedure. Staff who spoke with the inspector were knowledgeable of the reporting and recording procedures with regard to an allegation or suspicion of abuse, and confirmed that they had received training in abuse awareness. The care home has a consistent record of notifying the Commission and other agencies of allegations/ incidents, and of recording action taken by the service. Annual Quality Assurance Assessment (AQAA) documentation informed us that the care home has policies and procedures to ensure that verbal and physical aggression by people using the service is managed appropriately by staff. Management staff have recently received updated training in investigating allegations/suspicion of abuse. We were told that a dedicated Director of Service Improvement has been appointed within the Organisation who has responsibility to ensure that all complaints, comments and compliments are managed appropriately. Robust financial procedures are in place with regard to the management of resident’s monies. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 23 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): Standard 19, 23 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose. Residents bedrooms are individually personalised, meet their individual needs. EVIDENCE: The care home is purpose built, and fully accessible to people who have mobility needs. Adaptations, and specialist equipment is accessible to people using the service. The environment of the care home provides for the individual requirements of the people using the service, it consists of four selfcontained units. The home is very clean, odour free, and well maintained. There are some homely features, including photos displayed of residents, which were taken during community outings. A fish tanks is located on each unit. Pictures are displayed throughout the care home. There is a quiet room in each unit where residents can choose to sit and/or meet their visitors. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 24 Residents, who kindly spoke to me, confirmed that the environment is agreeable, and meets their needs. The Short Observational Framework for Inspection (SOFI) observation told us that residents were able to move about their unit, including accessing their bedrooms and communal rooms freely. The forecourt of the home has parking for several cars. The garden area is enclosed and well kept. The home is generally well maintained, but a loose tap in the bathroom of Hyacinth unit needs repair. The manager spoke of the improvements with regard to maintenance procedures in the care home. This included there being development of a maintenance team, since the home has been under new ownership. A comment in a feedback survey from a staff member told us that they felt that security of the home could be improved, the ‘two main gates which are always open allowing entrance even at night, cars drive in and out at anytime’. Security of the home could be reviewed. Though there were some pictures on some doors, the care home could examine ways of making it easier for people who use the service (particularly those with dementia care needs) to find their own rooms, such as by colour coding. All the bedrooms in the care home are for single occupancy, and each has an ensuite toilet and washbasin. A resident kindly let me view her bedroom. This room was individually personalised. She/he spoke of liking her/his bedroom. Pictures, photographs and ornaments were among the items located in the resident’s bedroom. There is a call bell located in each bedroom. The home employs domestic cleaning, and laundry staff. A member of this cleaning staff spoke of her role and responsibilities. Soap and hand towels were located in the bathrooms/toilets inspected. The laundry facility is located away from food storage, and food preparation areas. The manager reported that there was planned refurbishment of the laundry room. The home has an infection control policy/procedure. Staff were observed to wear protective clothing including disposable gloves, and aprons as and when needed. Staff receive infection control training. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 25 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): Standard 27,28 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive appropriate comprehensive training, and support from their managers to ensure that they have the skills and knowledge to carry out their roles and responsibilities in meeting the varied care and support needs of people using the service. Sufficient numbers and skill mix of staff are employed to ensure that there are enough competent staff on duty at all times to meet the needs and changing needs of people using the service. People using the service are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: The staff rota was available for inspection. The senior staff team comprise of qualified nurses who work as the team leaders. There is also a deputy manager and an administrator, as well as catering staff and staff who carry out cleaning duties. There are two care staff on duty within each unit during the day, and a team leader who covers all four units. There is also a ‘floater’ staff member who works where and when needed in response to resident’s needs. During this inspection, this member of staff carried out the duty of escorting a resident to hospital to attend an appointment. During the night there is a care staff on duty in each unit and a team leader on duty who manages the service. There is also a ‘sleep in’ staff on duty at night. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 26 Staff confirmed that the staffing ratio was flexible in meeting residents’ needs and changing needs. The Short Observational Framework for Inspection (SOFI) observation session and talking to staff informed us that care staff had a good understanding of the residents’ varied needs. Communication systems are in place to ensure that staff are kept informed of resident’s individual progress. These include, handovers, a record of ‘daily’ staff duties including staff task allocation. Staff have the opportunity to attend monthly staff meetings. Feedback from relatives/visitors informed us that they generally felt that staff have the right skills and experience to look after people properly, but one relative told us that there have been ‘some issues in the past’ but was positive about recent changes to the service and commented that ‘hopefully under new management this will improve’. Staff spoke of their key worker role in supporting individual residents. During the Short Observational Framework for Inspection (SOFI) observation, and throughout the inspection, staff were observed to interact with the people using the service in a positive and respectful manner. Residents who kindly spoke with me were positive about the staff, comments included staff “are the best that they can be” and the staff “are nice”, “ they always look after me good”, “there is always someone here to help you”, “you don’t have to worry about anything”, “the staff are fabulous”. Feedback from relatives included comments, my relative “always feels at home, and finds the staff very helpful and caring”, “if they (staff) need to know anything about (my relative), they always phone us the family”, “they (staff) are helpful in every way”, “staff are very nice”. The home has a recruitment and selection policy/procedure. Records confirmed that required and necessary checks are made on prospective staff during the process of recruitment and selection. These include an enhanced Criminal Record Bureau check to gain information as to whether potential staff have a criminal record. Annual Quality Assurance Assessment (AQAA) documentation informed us that once employed, staff all receive contracts and a staff code of conduct. Annual Quality Assurance Assessment (AQAA) documentation informed the Commission for Social care Inspection that 94 of staff have achieved a National Vocational Qualification (NVQ) at level 2 and or level 3 in care. Staff spoke positively of this training course and of the significant amount of training relevant to their role and responsibilities that they had received during their employment. This training includes food and hygiene training, medication training, First aid, manual handling, health and safety infection control, and other specialist training including dementia care training, and managing ‘challenging behaviour’. The home has a consistent record of facilitating staff members to undertake a variety of appropriate training to ensure that staff are Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 27 competent to carry out their job in caring and supporting people who use the service. The Commission for Social Care Inspection was informed that each staff member receive a comprehensive induction programme that is in line with the Skills for Care foundation guidelines. A comment from a staff member included ‘training and induction is offered to newly appointed staff’. We were informed that the staff turnover rate is low. Staff confirmed that they receive regular staff one to one staff supervision. Comments include ‘the deputy manager always holds one to one supervision, and yearly appraisals, and during these sessions support is offered or any new information imparted’. The projects manager carried out staff training during the inspection and informed me of the planned developments in staff training that are shortly to be fully implemented. This consists of e-learning modules (computer training courses) that cover key and specialist staff training and learning and development (topics include induction, health and safety, medication, food and hygiene training, dementia care, and ethnic and diversity training). I was informed that staff will be able to access these courses easily, and so update their knowledge and skills to ensure their competence in their work. The manager reported that refresher moving and handling training was planned for staff. AQAA information informed us that there were plans to provide more information to staff to develop their knowledge and understanding of religion and beliefs. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 28 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): Standard 31,33,35, 36, and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the care home appropriately. Effective quality assurance, and quality-monitoring systems are in place to monitor, develop and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected, and their financial interests are safeguarded. EVIDENCE: Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 29 The registered manager has managed this care home for several years, and prior to his present position has managed other registered care homes. He is a qualified nurse, and has management qualifications, including National Vocational Qualification (NVQ) level 4. He confirmed that he has undertaken training within the company to develop his skills and knowledge. The manager confirmed that he ensures that staff follow the policies and procedures of the home, and of the Organisation, and that staff receive an annual appraisal. The manager is aware that there are improvements to the service that could be made, such as improving the number and varieties of activities, improving recorded guidance in care plans, and developing better systems for recording ‘concerns’. He spoke during and following the inspection about the systems being put in place in response to these issues, and of working closely with senior management with regard to continuing to improve and develop the service provided to residents. A relative commented in a feedback form that she/he was contacted by the home if there are issues of concern with regard his/her relation, and also commented that she/he felt that it would be nice if she/he was contacted regularly, possibly ‘once a week’ about the general progress of their family member. This could be considered by the care home/ Annual Quality Assurance Assessment (AQAA) documentation confirmed that the care home has robust quality assurance monitoring systems in place, which include obtaining the views of people using the service and others. We were told that a ‘survey of the quality of life’ with regard to the service is carried out annually by a team who is not employed by the home. I was informed that this review was due to take place in the summer 2008. Monthly monitoring of the service is carried out by board members of the Organisation. Copies of these reports were available for inspection. AQAA information told us that monthly resident meetings take place, and that there is a resident’s committee for people using the service to join as representatives for their fellow residents. This committee meets with the manager on a quarterly basis. It was evident that the care home has appropriate and robust financial systems in place to safeguard resident’s money and personal items. Most residents monies are managed by relatives or significant others. All financial transactions are recorded. Annual Quality Assurance Assessment (AQAA) documentation and records told us that required safety checks of the systems within the home, such as gas and electrical checks as well as equipment checks are carried out. An up to date gas safety certificate was available for inspection. Feedback from relatives told us that they felt that their family member were safe living in the care home, comments “ they (staff) make them (residents) feel safe”. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 30 The home has an up to date fire risk assessment. Fire safety guidance is displayed in the home. Required fire safety checks and fire drills are carried out. A recent inspection by Environmental Health department has taken place. The manager reported that all recommendations from this visit have been carried out by the home. The home lets us know about things that have happened; they have shown us that they have managed issues appropriately. Incidents and accidents are appropriately recorded, and monitored closely. An up to date certificate of insurance with regard to the care home was displayed. Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 31 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 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 4 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 Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 33 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 OP19 Regulation 23(2) Requirement A loose tap in the bathroom of Hyacinth unit needs repair. Timescale for action 01/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP1 Good Practice Recommendations The statement of purpose could define activities and ways of working that are specific to meet the needs of people with dementia. All the people using the service should be supplied with an up to date copy of the service user guide, so that they can gain knowledge and information about the new owner of the care home, and the service provide by them Further development of assessment of some equality, and diversity needs could be more evident to ensure that the care home shows a comprehensive understanding, and respect for all aspects of diversity including gender, age, sexual orientation, race, and disability. Development of staff guidance for meeting and managing some assessed needs of people using the service could be more comprehensive, and of better quality. Life Story’ books could be looked into for people using the service particularly those with dementia care needs. It is recommended that management staff review the care plans to ensure that they meet each individual person’s Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 34 3 OP2 4 OP7 5 OP12 needs. Information about activities could be more accessible to people using the service, so they know what leisure pursuits are planned for each day. The variety and number of activities provided to people using the service could be improved following consultation with residents. The home could examine ways to develop activities for those with dementia care needs and include understanding and incorporating the role of sensory stimuli (colour, smell, touch and sound) in helping to improve communication with them. The accessibility of the menu to people using the service could be improved. Security of the home could be reviewed to ensure that it is evident that people using the service are always safe and protected. The care home could examine ways of making it easier for people who use the service (particularly those with dementia care needs) to find their own rooms, such as by colour coding. 6 7 8 OP15 OP19 OP23 Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Lawnfield House DS0000070920.V361135.R01.S.doc Version 5.2 Page 36 - 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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