Inspection on 26/04/07 for Elstree Lawns Nursing Home

This inspection was carried out on 26th April 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elstree Lawns Nursing Home 10/06/08

Elstree Lawns Nursing Home 27/11/07

Elstree Lawns Nursing Home 30/01/07

Elstree Lawns Nursing Home 26/07/06

Elstree Lawns Nursing Home 01/11/05

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 Alison Jessop Unannounced Inspection 26th April 2007 10:00 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.V339098.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. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 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 www.bupa.co.uk BUPA Care Homes (CFC Homes) Limited Manager post vacant 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.V339098.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate people (aged 50 or over) with a diagnosis of pre-senile dementia who require nursing care. 30th January 2007 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. The current accommodation charges range from £550 to £900 (£1000 for respite) per week. A copy of the homes most recent inspection report, Service user Guide and Statement of purpose is displayed in the foyer of the home. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Regulatory Inspectors carried this unannounced inspection out over one day. The majority of time was spent with the people who live in the home, some of who were able to offer feedback. Care practice was observed and records were scrutinised. Time was also spent with the new acting manager of the home. The second inspector spent from 11am to 1pm in the sitting room with very vulnerable residents to get an impression of what life is like in the home. The inspector made notes every five minutes on the state of being (mood) of the residents, their interaction with their surroundings and other people including other residents and staff. The inspector noted the best interaction observed, details of this are incorporated in this report. Feedback was also gained from a visiting GP and three relatives. Many improvements were observed and the outcome of the inspection was generally very good. What the service does well: What has improved since the last inspection? People who use the service appeared to be well cared for. One relative said ‘I have seen some improvements lately and I’m generally happy with my mothers care.’ Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 6 Staff have been supported and supervised more on a day-to-day basis, this has improved the outcome for people who use the service. Moving and handling techniques are better and residents look clean and tidy. Residents are being treated in a more dignified manner than previously. A second activity co-ordinator ensures that a more individually tailored activity programme is available. People who use the service have access to a wide variety of finger foods and staff were observed offering this to those that could not help themselves. A night bite menu is also now available. The ground floor communal areas have been redecorated and offer a brighter, cleaner atmosphere. The manager stated that new furniture and carpets have also been ordered. 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. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission are not made to the home until a full needs assessment has been undertaken. The service is then able to confirm that they can meet the needs of the individual through the service they deliver as detailed in the Statement of Purpose. EVIDENCE: Each prospective resident is given the information they require to make an informed decision about moving into the home. No one moves into the home without having their needs fully assessed to ensure that their needs can be met. The home does not provide intermediate care. Elstree Lawns Nursing Home DS0000019344.V339098.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Interaction between staff and the residents who have dementia has improved since previous inspections. Kind and caring interactions were observed and people who use the service appeared to be respected by staff. EVIDENCE: A review of all care plans has been carried out and information contained is much more easily accessible. The manager stated that more work is being done to improve information on individual risk assessments. People who use the service receive appropriate health care as required and feedback was gained from the visiting GP who stated that communication between the home and the staff is very good and that service users healthcare needs appear to be met. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 10 People who use the service are being treated in a more dignified manner. Residents clothing did not look creased, hair looked nicely groomed and staff have taken key working responsibilities to ensure that residents are well cared for. Staff must ensure that they support residents to carry out regular oral hygiene. Staff carried out moving and handling in a dignified manner. One resident being hoisted appeared to be enjoying the occasion as staff shared jokes and put the resident at ease whilst carrying out the procedure. Staff must however be aware that they may walk alongside residents too quickly who tended to be outpaced. Elstree Lawns Nursing Home DS0000019344.V339098.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are more person centred and offer all residents the opportunity to participate in social interaction in various forms. Staff now realise that small gestures can make a big difference to someone who is living with dementia. EVIDENCE: Activities appear to be more meaningful and staff now recognise the importance of appropriate social interaction. One resident was observed enjoying a staff member reading from a book, (the resident was blind and therefore benefited from this one to one interaction). The service has employed a second activity co-ordinator who can also provide meaningful activities to the people who use the service. One of the activity coordinators stated, “We have been spending a lot of time outside and have been on some outings too”. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 12 People who use the service have access to more appropriate finger foods and staff were observed offering fruit, biscuits and other snacks to those who cannot help themselves. Feedback about the lunch was positive and a choice of options was available. The chef stated that three hot meals are available every day, as some people prefer to eat a main meal in the evening rather than at lunchtime. The service is currently introducing a night bite menu. A large poster with pictorial menu cards will be available for residents to choose a nighttime snack. This included hot and cold drinks and food. The food taken is then recorded so that food intake can be closely monitored. Elstree Lawns Nursing Home DS0000019344.V339098.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaint procedure that meets the national minimum standards and Regulations. The complaint procedure is available within the home. The policies and procedures regarding protection of residents are satisfactory and are reviewed and updated in line with regulations and other external guidance. EVIDENCE: The home received a complaint from a relative whose mother has now been moved out of the home. The complaint had not been fully investigated by the previous manager, however the new acting manager has now carried out a full investigation and is currently responding. No new complaints have been received by the service since the previous inspection. Staff spoken to had a basic awareness of Safeguarding procedures however one member of staff appeared to be reluctant to follow the procedure. The manager stated that all staff are due to receive further training on Safeguarding in the near future. Elstree Lawns Nursing Home DS0000019344.V339098.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, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although more improvements are being made to the home in the future, the areas that have been redecorated offer a brighter, more homely environment to the people who live there. EVIDENCE: The home has undergone some redecoration since the previous inspection and new carpets and soft furnishings have been ordered. The ground floor entrance hall looks brighter and less institutionalised. Some of the resident’s bedrooms require redecoration and new flooring, as they are looking tired and unsightly. It was noted by the inspectors that some of the resident’s bedrooms looked bare and didn’t offer a homely environment. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 15 The carpet that has been fitted to the first floor lounges are heavily patterned. One service user was observed trying to pick up something from the floor and was becoming agitated. It is recommended that this replaced with a more suitable carpet, which does not have patterns. New equipment such as wheelchairs has been purchased and staff reported that this has improved their moving and handling procedures. Service users and staff said that they are using the garden much more and photographs residents enjoying the nice weather were seen on the notice board. The home looked clean and tidy throughout and no malodours were detected. Some of the bedrail protectors looked unclean and unhygienic and must be either thoroughly cleaned or replaced. Elstree Lawns Nursing Home DS0000019344.V339098.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The outcomes for people who use the service has improved as staff are receiving more support and supervision whilst carrying out their role. EVIDENCE: Staffing levels appeared to be appropriate to the needs of the people who live there. One member of staff stated, “I have worked here for many years, I really like working here and recent changes are for the better”. Although more formal training has been arranged, staff appear to benefit from more day-to-day supervision. Dementia care awareness and moving and handling techniques appear to have improved a lot since the previous inspection. Recruitment records were not inspected on this occasion, as there has been no issues or concerns on previous inspection reports. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The interim manager works to continuously improve services and provide an increased quality of life for residents. There is now a strong ethos of being open and transparent in all areas of running of the home. EVIDENCE: The new acting manager has been in post for one month and many improvements have been identified. Staff have responded well to the manager who will work at the home until a permanent manager is recruited. The organisation appears to be undertaking a thorough recruitment process to ensure that the right person is employed. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 18 Where the home manages money on resident’s behalf a system is in place to record transactions and accounts for spending. The service has a policy that meets health and safety requirements and legislation. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X 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 2 3 X 3 X X X 2 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 2 X X X X X X 3 Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 12(4)(a) Requirement Service users must not be outpaced as staff sometimes walk too quickly when guiding residents. Carried forward from inspection report 30/01/07 Staff must assist service users to maintain their personal and oral hygiene. Carried forward from inspection report 30/01/07 Service users bedrooms must be refurbished as identified. A rolling programme of redecoration is required to ensure that bedrooms are of a reasonable standard. Satisfactory standards of hygiene must be maintained in the home. Bedrail protectors must be thoroughly cleaned. The home must be managed by a person fit to do so at all times. This has been carried forward from inspection report 30/01/07. The service must ensure that the registration of the new and permanent manager is submitted within a reasonable timescale. DS0000019344.V339098.R01.S.doc Timescale for action 26/05/07 2. OP8 12(1)(a)& (4)(a) 26/05/07 3. OP19 23(2)(b) 26/05/08 4. OP26 16(2)(j) 26/05/07 5. OP31 9(1) 26/05/08 Elstree Lawns Nursing Home Version 5.2 Page 21 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 OP19 OP19 Good Practice Recommendations It is recommended that the carpet in the first floor lounges be replaced, as it is unsuitable for people who have dementia. It is recommended that some of the service users bedrooms are made more homely. Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Elstree Lawns Nursing Home DS0000019344.V339098.R01.S.doc Version 5.2 Page 23 - 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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