CARE HOMES FOR OLDER PEOPLE
Abbey Lawns Limited 3 Anfield Road Anfield Liverpool L4 0TD Lead Inspector
Jeanette Fielding Key Unannounced Inspection 10:20 22nd August 2007 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 Abbey Lawns Limited DS0000063109.V343582.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. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Abbey Lawns Limited Address 3 Anfield Road Anfield Liverpool L4 0TD 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) 0151 263 5930 0151 263 5814 info@abbeylawns.com Abbey Lawns Ltd Luna Yvonne Skeete Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (10) of places Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 61 nursing care and 13 personal care within the overall total of 61 10 adults with a physical disability within the overall total of 61 Date of last inspection 6th July 2006 Brief Description of the Service: Abbey Lawns is a privately owned care home providing both nursing and personal care for 61 residents. The home is set in a residential area of the city close to both Everton and Liverpool football grounds. The home backs onto Stanley Park. The area is due for regeneration and many of the residential streets around the home are to be demolished or refurbished. The building is spacious and well maintained. The home is made up of two units, each with its own group of staff. Resident’s rooms are located on two floors and there are lounges and communal areas around the home. The home benefits from a large patio area and lawns to the rear. A car park with flowerbeds along the building is located at the front of the home. The area is well served by public transport and is fairly close to the city centre. The home has its own mini-bus. Fees range between £315 and £495 per week dependent on care needs. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted on one day over a period of seven hours. It involved meeting with the homes manager, the examination of records, discussion with trained nurses and care staff, meeting with service users and visitors to the home and a tour of the building. The manager had completed a questionnaire giving information about the current stats of the home prior to the inspection. What the service does well: 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. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 6 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 Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 7 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed pre-admission assessments are undertaken to ensure that the home can meet the individual needs of the service users. EVIDENCE: The home’s Statement of Purpose and Service User Guide have recently been reviewed and updated. These documents are detailed and contain all necessary information to inform prospective service users about the facilities and services offered by the home. Prospective service users are assessed by the manager or deputy manager prior to admission. This is to ensure that the home is able to identify the service users specific needs to enable a plan of care to be prepared.
Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 8 Information is gathered from the service user, their family and any other healthcare professional involved in their care. Copies of the pre-admission assessments are held on service users files and give full information about the health, care and social needs of each individual. Any necessary equipment to meet the service users needs is identified at this assessment to give the home the opportunity to have this in place prior to admission. Prospective service users and their families are encouraged to visit the home and to spend time their before making a decision to move in. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 9 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans are in place and are regularly reviewed to ensure that staff have full information and can give the appropriate level of care and support. EVIDENCE: Care plans are generated from the information received at the initial assessment and are reviewed and updated on a regular basis to ensure that the changing needs of the service users are met. This review is undertaken on a monthly basis or more frequently as required. The care plans also include risk assessments together with risk management plans on how to remove or reduce any identified risks. The information held by the home is detailed and informative. Care staff are encouraged to read the plans to give them full information regarding the care needs of each service user. The care plans also include individual social preferences to enable an appropriate social and
Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 10 activities plan to be prepared. Evidence of the individual care given to service users is recorded in the daily report completed by staff. The records held in the home give details of visits to and by GP’s and other health care professionals. This includes Tissue Viability Nurse Specialist, Speech and Language Therapist, Occupational Therapist, Dietician, Physiotherapist, Chiropodist, Dentist and Optician. Specialist therapies including Reiki and Reflexology are provided to service users identified as needing them and funded by the PCT. Other service users can purchase complimentary therapies for a small charge. The manager undertakes regular audits of the care files to ensure that all documentation is in place and up to date. Discussion took place with the manager and two qualified nurses regarding the different methods of recording information which may assist the staff in identifying changes to care needs without referral to additional files. Medication Administration Record sheets (MAR’s) are completed and were found to be up to date and accurate. Medications inspected were found to be in order and correct with no discrepancies. Medications are ordered on a monthly basis and the dispensing pharmacist also provides pre printed MAR’s to ensure accuracy of recording. Monthly audits of medications is undertaken to ensure that medications are administered and recorded safely for the protection of service users. All staff were observed to knock on doors prior to entering and were fully aware of which service users would not wish to be disturbed. All service users are accommodated in single bedrooms, some of which having en-suite facilities. Personal care is given in bathrooms or in the service users own bedroom as appropriate. Service users spoken to confirmed that their privacy and dignity were respected by all staff. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 11 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 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A high level of social activity takes place to provide service users with stimulation and social interaction to enrich their lives. EVIDENCE: The home employs two activities co-ordinators, one on a full time basis and one part time. In addition, staff ex students and relatives assist on outings. The home has its own minibus. An extremely high number of activities are arranged for service users and service users confirmed that they were able to choose whether they participated. The home produces a monthly newsletter for service users and their families. It recognises service users birthdays and identifies all planned activities. Recent activities include film shows, parties, barbeques, quizzes, bingo,
Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 12 exercise to music, card and board games and trips to shops, a farm and local events. Pub and restaurant lunches are always popular. Six monthly meetings are held for service users and their families but these are not well attended. Family members are actively involved with the activities and the manager is looking to make the meetings into more of an event to encourage participation. The activities co-ordinators maintain comprehensive records of the activities that each individual service users participates in including one to one activities. Relatives are welcome to visit the home at any time and may meet with the service users in the privacy of their bedroom or one of the communal areas as preferred. A choice of cereals and/or cooked breakfast is offered each morning. A cooked meal is offered at both lunch and dinner, with alternative hot, cold and snack meals being available. Menus provide evidence that a good selection of meals are available to provide a balanced diet. Special diets can be provided on request or on the advice of the GP or dietician. Service users spoken to during the inspection were extremely complimentary about the meals and all said that they would feel comfortable speaking with the staff or the chef if the meals were not to their liking. The kitchen was clean and organised and a good supply of fresh foods were available. These are supplemented by tinned and frozen foods to enable a range of meals to be provided out of season. Discussion took place with the chef who was able to provide evidence that all safety checks are made to ensure the protection of service users. The chef is qualified to train staff on Food Hygiene and provides this training to all staff within the home. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 13 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure to protect service users. EVIDENCE: The home has a comprehensive complaints procedure which is detailed in the Statement of Purpose and Service Users Guide and is also displayed in the foyer of the home. No complaints have been received by the home since the last inspection. Visitors to the home said that they were completely happy with the care given to their relatives. The records held on the staff files show that training on abuse has been given. Discussion with staff demonstrated that they were aware of the different types of abuse and of the action that would be taken if it were suspected. All staff have had appropriate checks made on them to ensure that service users are protected within the home. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is furnished and decorated to an extremely high standard to provide a pleasant environment for service users to live. EVIDENCE: Abbey Lawns is an adapted and extended property with Grade 2 Listing which provides accommodation for service users on two floors and in two areas, Anfield and Goodison. A passenger lift is provided to give full access to the upper areas of the home. All of the bedrooms are used for single occupancy, and many of these are large and spacious. The home provides three lounges, a dining room and an activities room. The grounds are well maintained with a large patio and lawns to the rear and flowerbeds to the front. Parking space is available at the front of the home.
Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 15 All communal areas were decorated and furnished to a good standard and with domestic style furniture to provide a homely environment. The Goodison lounge is also used as a dining room and has a side kitchen were breakfasts are prepared and from where meals, cooked in the main kitchen, are served. Staff are also able to make hot and cold drinks from the side kitchen. Bedrooms are pleasant and bright and service users are encouraged to personalise their rooms with pictures, ornaments and items of memorabilia. The work to replace windows in the home has now been completed. It was noted that the water pressure in some areas of the home is extremely low, resulting in considerable time being required to fill baths. Consideration should be given to reviewing the hot water system within the home and measures put in place to improve the water pressure. The décor in some bathrooms would benefit from upgrading. A call system is in place to enable service users to contact staff and this system was working effectively. The home was maintained to a good standard and was extremely clean throughout. Contracts are in place for the disposal of general and clinical waste. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 16 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust recruitment policy and procedure to ensure that service users are protected. EVIDENCE: The staff rota shows that sufficient staff are employed and deployed throughout the home at all times. On Goodison unit, one registered nurse is supported by six care staff in the morning and one registered nurse with five care staff during the afternoon and evening. In Anfield unit, one registered nurse is supported by seven care staff during the morning and one registered nurse with five care staff during the afternoon and evening. At night, two registered nurses and five care staff are provided to cover the whole home. The home has a robust recruitment procedure and inspection of staff files showed that this procedure is followed. Prospective staff are required to complete an application form prior to being called for interview. Two references are taken and Criminal Record Bureau and Protection of Vulnerable Adults registers are checked to ensure the protection of the service users. Evidence of experience and qualifications are required to be produced and these are verified by the home.
Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 17 New staff are required to complete a comprehensive induction and foundation training programme within designated timescales. Evidence is held on the staff files of additional training and the records inspected showed that extensive training opportunities have been offered and accepted by the staff. Core training courses which include fire protection, first aid, health and safety, moving and handling, basic food hygiene and the protection of vulnerable adults are updated on a regular basis. Regular supervision is given to all staff to give them the opportunity to speak with their line manager on a one to one basis and to identify further training needs to meet the needs of the service users. All care staff have been encouraged to undertaken NVQ training and the home now employs 87 of staff with this qualification. Additional staff are working towards this qualification. Staff spoken to during the inspection were able to demonstrate their knowledge and understanding of adult protection procedures, the care needs of the service users and health and safety issues. Staff spoke highly of the manager and said that she was supportive towards them and protective of the service users. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 18 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of service users, relatives are sought on a regular basis to enable improvements to continue. EVIDENCE: The manager of the home is a qualified nurse who has considerable experience in the management of a care home for elderly people. She holds an NVQ in care at level 4 and has a Certificate of Supervisory Management. Records are held in the home of further training and qualifications in care practice to enable her to manage the home to a high standard.
Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 19 Policies and procedures are reviewed and updated on a regular basis and all inspected were found to be in order. These are available to all staff. During the course of this inspection interactions between the managers and staff were observed to be open, friendly and professional. Service users spoke extremely highly of the managers and staff within the home and one relative said that she would move into the home now, but was not old enough. She said that the managers and staff were extremely caring and did all they could to provide a good quality of life for her relative. Service users and their visitors are consulted about the performance of the home on a six-monthly basis. Compliments and complaints forms are provided in the foyer of the home. The majority of service users have their finances dealt with by their family or an advocate. Records of monies held on service users behalf are well maintained. Secure facilities are provided within the home for the storage of personal items. All of the records seen during the inspection were well maintained and up to date. Safety certificates and checks on equipments were all evidenced. The record keeping within the home is of a high standard and all records requested were readily available. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 20 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 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 4 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP21 Good Practice Recommendations Consideration should be given to reviewing the hot water supply within the home to improve the water pressure in bathrooms. Abbey Lawns Limited DS0000063109.V343582.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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
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