Inspection on 01/11/05 for Elstree Lawns Nursing Home

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Elstree Lawns Nursing Home 10/06/08

Elstree Lawns Nursing Home 27/11/07

Elstree Lawns Nursing Home 26/04/07

Elstree Lawns Nursing Home 30/01/07

Elstree Lawns Nursing Home 26/07/06

Elstree Lawns Nursing Home 21/12/04

Elstree Lawns Nursing Home 30/06/04

Similar services:

Claremont House

Firstlings

Fen Road

Dial House Nursing Home

Croxley House

Eversley Nursing Home

Cresta Lodge

Chilton Meadows Residential & Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elstree Lawns Nursing Home Barnet Lane Elstree Hertfordshire WD6 3RD Lead Inspector Pat House Unannounced Inspection 1st November 2005 10:45 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 Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 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. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elstree Lawns Nursing Home Address Barnet Lane Elstree Hertfordshire WD6 3RD 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) 0208 207 3255/3271 0208 207 1149 BUPA Care Homes Limited Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Mental registration, with number disorder, excluding learning disability or of places dementia (1) Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home may accommodate one (named) service user under the Mental Disorder category. The home manager must inform the CSCI when the (named) service user admitted under the Mental Disorder category is discharged. This home may accommodate people (aged 50 or over) with a diagnosis of pre-senile dementia who require nursing care. 12th July 2005 Date of last inspection Brief Description of the Service: Elstree Lawns Care Home is sited in a large, three-storey building, which has been converted and extended to provide nursing care for those over 50 who have a diagnosis of dementia. The top floor of the building is no longer used for accommodation. All bedrooms are for single occupancy and 29 have en-suite facilities. Each floor has its own lounge and dining area and there is a hairdressing room for the residents’ use. The home is reached at the end of a long, secluded driveway and there is ample parking available in front of the building. There are gardens and patio areas to the rear of the home and these have been modified for the safe use of the residents. The home is set back from a busy road and is near to the village of Elstree and the town of Borehamwood. Facilities for shopping and leisure are within a short drive and there is a nearby bus service. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day with two inspectors. The Home’s Manager was present during the visit and the Company’s Operations Manager, visiting the home on the day, also spent time with an inspector. Staff, service users and one visitor were spoken to. Time was spent on both main floors and checks were made in the laundry and kitchen. No decision has yet been made by the Company about the use of the second floor of the home where there are 13 registered bedrooms, which are not being used at this time. There was a hairdresser working in the home on the day and the mid-day meal was served during the visit. Care plans were checked for some of the service users seen and spoken to and some staff files were examined. Other records were examined and general points were discussed with the Manager, before feedback was given about the inspection. What the service does well: What has improved since the last inspection? What they could do better: A requirement has been carried forward that the dining area on the first floor needs extending and bathrooms must be cleared for use, as not enough bathrooms are available for service users at present. Some care staff would like more involvement in reviewing and updating service users’ plans, and the Manager should review how key workers are used in the home to maximise their skills. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 6 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. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5. Standard 6 does not apply to this home. Full assessments are completed for every potential resident and trial visits are offered to ensure that all care needs can be met by the home. EVIDENCE: appropriate written information is available and each service user is provided with a written contract. However, these documents are currently being reviewed by the Manager and will be checked at the next inspection. All service user records examined had written assessments in place from referring agencies, as well as full assessments completed by senior staff in the home. Care plans for the residents reflected the needs outlined in the assessments and details included both the nursing and social needs of the individuals. There were behaviour plans in place for responding to challenging behaviour and one plan contained entries on an “Aggression chart”. Medication reviews had taken place and details of accidents were recorded in care plans and also in the Accident Book. Most plans had signed lists of the property brought in to the home by service users. The Manager said he is currently looking at ways to build more service user involvement into care planning. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 9 The Manager confirmed that all prospective residents are invited to visit the home prior to entry and that there is always a minimum four week trial assessment period to ensure the home is suitable for the service user. The staff spoken to felt they were offered good levels of training in the home and felt confident that they could meet the specialist needs of the residents they provide services for. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10 and 11. Procedures in the home for maintaining care plans, for involving other agencies where appropriate and for administering medication, all ensure that service users’ health care needs are met. Policies and staff practices support service users and promote their dignity at all times. EVIDENCE: All care plans checked reflected the needs of the service users who were spoken to. Risk assessments were in place but staff were reminded that these needed to be reviewed as part of the care plan on a regular basis. It was also suggested that more detail should be recorded on the manual handling plans, such as the exact sling to be used and whether two care workers should perform the transfers for safety. Monthly updates of care plans were being completed but it appeared only the registered nurses were completing these. At the last inspection, plans to involve all care staff in up dating service users’ plans were applauded and it was disappointing that this was not happening. Care staff spoken to indicated that they wanted to be involved in this way and felt they had been trained to do this and that they would feel more involved with the care provision if they, as key workers, could make entries in the care plans. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 11 This issue was discussed with the manager. Records showed that all the health needs of the residents were monitored and there was evidence of regular input from Health professionals. Records were seen of one resident whose needs, staff felt, could no longer be met at the home. This individual was being assessed for another placement and it had been agreed that she would not return to Elstree Lawns. During the visit service users were being weighed and specialist scales for wheelchair users were being used. Equipment for the prevention of pressure sores is in use all around the home. Staff were aware of the need to promote fluid intake to the residents and drinks were seen offered throughout the day. Medication storage and administration was checked and no errors were found in the system. The temperatures for storage were at safe levels and the Controlled Drugs were being handled appropriately. The pharmacist makes monthly visits and the home has a contract with a registered company for the disposal of medicines. Service users spoken to confirmed that the staff always treat them with respect, and individual preferences as to terms of address are recorded on care plans. The Manager said there is a telephone available for the use of the residents and staff said that medical examinations always take place in private and that service users always wear their own clothes. The home has a written policy on Death and Dying and staff said they felt that all possible care and support were given to service users and their relatives at times of illness. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The provision of activities in the home and the promotion of family contact, both help to provide stimulation for the residents. The meals provided are enjoyed and promote the well being of service users. EVIDENCE: The range of activities in the home was fully assessed at the last inspection when records were seen of individual service user histories being used to develop the activities offered. There are different activities on each day of the week in the home, with a co-ordinator working on each floor. The hairdresser was working in the home during the inspection and service users were able to go to the hairdressing room or have their hair done in their own bedrooms. The care staff also assist with providing activities for the residents and most service users, who could express an opinion, thought the range of activities in the home was good. Residents confirmed that visitors were welcomed in the home at all times and could stay in the communal rooms or visit in private in their bedrooms. The Manager said that the home had made contact with two local agencies who offered advocacy services to anyone who needed this service but that most residents had family involvement and mostly it was relatives who handled service users’ finances. The relative of one service user who had lived in the home had been granted access to the service user’s records, and the CSCI had been kept informed of all the proceedings. Menus were seen displayed on both floors in the home. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 13 Service users were seen eating the mid-day meal, both in the dining rooms and in bedrooms. The meal was hot and looked nutritious and the residents had made their choice of two meals the previous day. Some service users were assisted to eat and this assistance was given discreetly and professionally. Although the main kitchen in the home is small, the kitchen staff felt it was adequate for their needs and no shortfalls were found in the procedures seen taking place. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. Policies and procedures in the home help to protect service users from abuse, protect their legal rights and help to reassure residents and families that concerns will be listened to. EVIDENCE: There are written policies on Complaints and Adult Protection and staff were aware of the home’s Whistle Blowing policy. Care staff have received recent training in Adult Protection and a further course has been arranged for those who missed this course, and for the ancillary staff in the home. The Manager has been dealing with one issue linked to Adult Protection and the CSCI has been kept informed of proceedings. Service users in the home are registered to vote in elections, and the manager is currently checking the list of names of voters against current service user names. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. The home is clean and provides a well maintained environment for service users to enjoy but more dining space must be provided so that all residents are able to eat at a table together. More bathrooms must be made available to meet service user needs. EVIDENCE: It was noted at the last inspection that the ground floor of the home was well presented, but that the first floor was in need of decoration and refurbishment. The first floor has now been redecorated and some new carpets have been provided. A wall heater and radiator cover have been repaired but one bedroom window was broken, and the Manager has arranged for this repair to take place. The home has a maintenance plan and the need to extend the first floor dining room has been noted together with plans for a new lounge area for the residents. However there were still three service user bedrooms with no curtains or blinds at the windows. The Manager said that blinds had been provided but were inappropriate. The Manager is aware that these windows must be curtained immediately. Requirements for dining facilities and curtains have therefore been carried forward from the last inspection report. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 16 All bedroom radiators seen were covered to ensure service users are not at risk of scalding if they fell against them. There were locks available on bedroom doors and lockable space provided in bedrooms to ensure privacy is maintained. Currently one of the bathrooms in the home is used to store wheel chairs and equipment and there is only one bathroom in use for service users on the first floor. This means that the home does not have sufficient numbers of bathrooms for the residents’ use. This situation must also be resolved immediately. There were also two areas in the home where unpleasant odours were apparent, despite new carpeting being fitted. It is company policy that carpets, rather than vinyl flooring is fitted in the home, but consideration should be given to solving the problem of odours where incontinence is a problem. Domestic staff are continuing to target these areas for shampooing and the situation will be checked at the next inspection. There are sufficient aids and adaptations around the home to meet service user needs and all bedrooms have call alarms fitted. The home meets the space requirements for the numbers of service users accommodated and all parts of the building and grounds are accessible to residents. It was noted at the last inspection that the gardens have been re-designed to provide safe and interesting recreational space for all service users. Hot water was being delivered at safe temperatures and the laundry is appropriately situated, clean and hygienic. Staff confirmed that there were always good supplies of disposable gloves and aprons available. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29. Standards 27 and 30 were assessed and met at the last inspection. The home’s recruitment and staff training policies and practices ensure that service users are supported and protected at all times. EVIDENCE: Recent staff recruitment files were seen and evidence was in place of all appropriate checks and references. All staff had CRB clearances in place before starting work. Adequate numbers of staff were on duty on the day and care workers confirmed training had been continuing and that further courses were planned. Currently 25 of care staff in the home have completed training to NVQ level 2, or above. There are also another ten care workers doing NVQ training and when qualified, the home will have at least 50 of its care staff trained to this level. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38. The home is being managed well and staff are well supervised and motivated to provide meaningful support to service users. Procedures in the home generally protect service users and staff. EVIDENCE: The Manager of the home is about to apply for registration with the CSCI and staff spoken to praised the home’s management and said that they felt supported and listened to and that the Manager was always available to speak to, when in the home. The Manager has nursing qualifications and is currently studying for the Registered Manager’s award. He also has many years experience of Care Home management. Staff said they had meetings, usually monthly, where they felt free to voice opinions or concerns. The domestic staff spoken to said they attended the main staff meetings but also had their own housekeeping meetings. The home has a Quality Assurance system but the Manager is currently reviewing this and further assessment will be made of this, and the business plan, at the next inspection. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 19 The home has the certificate of insurance cover displayed in reception. Records of service users’ money were checked during the visit. An electronic system is used to manage the residents’ personal allowances and receipts are provided for all transactions. The system is thorough and all areas checked were in order. Regular staff supervision takes place and is recorded. There are also formal appraisals for staff every six months. All records examined were being appropriately completed and were kept locked in filing cabinets when not in use. Staff confirmed that regular fire drills took place in the home and were aware that fire doors must not be held open. Up to date servicing records were seen for equipment used and there were no dangerous substances left out in the home during the visit. The Manager is aware that an electric recliner chair must be risk assessed and most general risk assessments for the home had been reviewed. The Manager is currently reviewing the home’s Health and Safety Statement and this will be checked at the next inspection. Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 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 x x 3 3 3 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 3 18 3 3 2 2 3 3 2 3 3 STAFFING Standard No Score 27 x 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 OP20 Regulation 23(2)(a)& (g) Requirement The Registered Provider must provide adequate dining facilities for all service users in the home. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT.THE PREVIOUS TIMESCALE OF 30/09/05 WAS NOT MET. The Registered Provider must provide adequate bathroom facilities for service users in the home. The Registered Provider must provide appropriate curtaining in all service users’ bedrooms. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. THE PREVIOUS TIMESCALE OF 20/08/05 WAS NOT MET. Timescale for action 31/01/06 2 OP21 23(2)(j) 30/12/05 3 OP24 16(2)(c) 15/12/05 Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elstree Lawns Nursing Home DS0000019344.V262896.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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