Inspection on 04/09/06 for Lavender House

This inspection was carried out on 4th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Lavender House 21/03/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lavender House Newtown Road Woolston Southampton Hampshire SO19 9HR Lead Inspector Clare Hall Unannounced Inspection 4th September 2006 09:00 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 Lavender House DS0000066534.V311261.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. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lavender House Address Newtown Road Woolston Southampton Hampshire SO19 9HR 02380444234 08712248456 richardkitchen.com 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) Mr Richard Edward Kitchen Mrs Elizabeth Kitchen Mrs Elizabeth Kitchen Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One service user in the category DE may be accommodated under 55 years of age One service user in the category MD may be accommodated above 55 years of age New service Date of last inspection Brief Description of the Service: Lavender House is a care home providing personal care and accommodation for up to 18 older service users, some of whom have dementia. It is owned by Mr and Mrs Kitchen, who have several years experience of owning care homes. The home is located in Woolston on the outskirts of Southampton, and the nearest shops and other public amenities are relatively accessible. The home comprises a detached property with on street car parking for several vehicles to the side of the building and an accessible garden to the front. Eight bedrooms are occupied on a single basis, two of these having an en-suite facility, and there are five double bedrooms, with, again, two having en-suite facilities. The bedrooms are situated on both ground and first floors. There is a lounge on the ground floor, which includes a dining area. The home does not have a shaft lift. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook a visit to the premises and during the time spent there spoke with service users and the care staff, cook and deputy manager. A full tour of the premises was undertaken. Comment cards were provided to service users, relatives, visiting health and social care professionals and all of the home’s staff were provided with comment cards pre-inspection. Feedback has been considered and reflected in this report. Staff practice was observed throughout the day assisting and supporting clients. Service users were observed making use of shared facilities and taking breakfast and lunch. Case tracking was undertaken as part of the evidence gathering process, with the involvement of service users. Information was requested from the manager eight weeks prior to inspection to evidence whether the service was operating in line with the National Minimum Standards. This information was not provided. Additional information considered was all recorded contact with the home, including events and Regulation 37 notifications. Regulation 26 reports have also been considered to inform this report. Sixteen requirements have been raised as a result of this inspection. What the service does well: Observing care delivery and talking with service users and care staff it is very clear that the principles on which the home’s philosophy of care is based ensure that residents are treated with respect, that their dignity is preserved at all times, and that their right to privacy is always observed. This is a home that is clearly run in the best interests of the service users. Comments received in respect of the service were very complimentary and these are but a few: • I have found this home to be a very caring and welcoming and a warm welcome by all members of staff is made to each visitor. DS0000066534.V311261.R01.S.doc Version 5.2 Page 6 Lavender House • • • • • • The carers are fully co-operative and helpful at all times. Staff always listen with great interest. We are fully informed with every aspect of the care and leisure. We are encouraged to know all staff by name and become friends. The staff gives so much of themselves with love and kindness that I am so grateful. It was lovely to see a care home which really epitomises all that should be done for the elderly and infirm-so often lacking these days in too many homes. We were delighted at the warm welcome we received on visiting our dear friend, as this was our first visit, the care home seems excellent. We were aware of a great deal of real affection and loving care. From day one we have been more than satisfied with the amount of love and care that the staff give to residents. • • • Observing the staff throughout the day communicating with service users identified that there is a very high commitment by the staff to treat all service users as individuals with desires, hopes and expectations. Clients with shortterm memory loss were dealt with sympathetically, respectfully and with dignity. Observation and discussion identified that the home is very welcoming and any prospective service user with an interest to see how the home is run is welcome to visit regularly, stay for lunch and meet and develop a rapport with staff before under taking a commitment to stay. Some of the comments received from care staff in respect of the service were, • I have just started working here and there is a great working atmosphere and great teamwork. • • • The residents have a really high level of care. The manager is doing a great job in running the home. There is great team of care staff. Two staff reported: • The home is really wonderful especially on residents well being, they have the best of everything they are our family unit. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 7 Further comments were: • We are all happy and his is a fabulous place to work, we are a good team. The residents are wonderful and appreciate us. • • We always put clients’ need first, client’s well-being comes above anything else. It’s the friendliest home I have ever worked in, plus it is nice to spend some quality time with the residents. Other members of staff are very nice and helpful and it’s nice to work as a team. What has improved since the last inspection? What they could do better: The atmosphere during the visit and the observations made have identified this is a good home providing good care by caring staff but the lack of managerial input has significantly affected the outcome overall. There are shortfalls in a number of areas in the home. The home’s current statement of purpose does not truly reflect the services and standards of the services provided and a requirement in respect of this has been raised. The manager will have to ensure that this information is provided in a suitable format. The manager must also ensure that service users are provided with terms and conditions regarding their stay and that all new service users are only admitted on a basis of full pre–admission assessment as the home is not demonstrating it’s capacity to meet the assessed needs of individuals admitted to the home. The staff are currently supporting clients with a number of identified needs and the training records do not indicate they have received the training to support their role. The current care planning documents are not informed by the details taken during assessment and are not being regularly reviewed. Care records are fragmented and they are not used as a working tool or developed in consultation with the service user or their representative. It has been established that the home needs to expand and develop its current medication procedure and policy to incorporate best practice and staff must receive training in medication administration. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 8 The home’s recruitment practices are very poor. Staff have not had robust checks undertaken prior to employment and the files lack evidence to indicate the process of how suitability is established, as there are no interview records. Files also lacked staff job descriptions and terms and conditions of employment. Further areas of concern are that the manager has not implemented adequate infection control methods and the home’s laundry facilities need significant improvement. Water regulation guidance needs to be undertaken in lines with best practice, as the current water waste system in the laundry is unacceptable. Consultation must be undertaken with the health protection nurse and environmental health to address concerns identified regarding the laundry. Requirements have been raised in respect of staff training, supervision and induction. The registered manager will be required to ensure she manages the home and be responsible for the daily running of the home and cannot leave the daily running of the premises to staff not registered or qualified to undertake the role. The manager needs to demonstrate that she informs staff and relatives and service users of any changes and she must implement a process of quality review on all aspects of the service she is providing ensuring it encompasses all areas of practice and procedures. The service also needs a continuous method of quality audit developed and undertaken to ensure all standards are met and the manager can then address the shortfalls. Views of all parties need to be included in the monitoring of the quality. The homes policies and procedures need to be reviewed to ensure they reflect best practice and record keeping needs improvement. The registered person will have to ensure she admits service users only within the home registration and anyone admitted outside of the categories must have an application made to support their admission if the manager thinks their needs can be met. . Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 9 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. Lavender House DS0000066534.V311261.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 Lavender House DS0000066534.V311261.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The homes pre admission process needs considerable improvement for the assessment of clients needs to ensure they are admitted to the home and knowing their needs will be met. Service users are not currently being provided with the correct information necessary for making an informed decision because the guide indicates a standard of service that clearly it isn’t Service users do not have terms and conditions of stay on their files. EVIDENCE: The provider and manager have developed a new service user’s guide and statement of purpose, which now need to be developed to ensure they reflect accurately the provision and services provided and gives the service users all the necessary information regarding the home. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 12 The current guide does not truly reflect the current managerial arrangements nor does it make clear when providing services to people with dementia how this is done with regards to small group living and structured activities, and availability of appropriate décor or signage which may be helpful to support people with dementia. When case tracking service users it was evident that not all service users have a written contract or statement of terms and conditions for the home. When asked, two service users stated they could not recall signing a contract, but one could. The home’s statement of purpose clearly states that: ‘All residents are assessed prior to admission to ensure that as far as possible we can meet all the individual needs and requirements to guarantee a comfortable and happy stay’. ‘This will be confirmed in writing prior to admission to the home in a letter from Ms Rotin or Mrs Kitchen who will confirm the room is available and that care can be offered’ Records in the home identify that new service users are not always admitted on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his or her representatives (if any) and relevant professionals have been party. Further audited records did not identify a good process of assessment and clearly identify who undertook the assessment. Records were either incomplete or not available. Discussions identified that due to lack of pre-admission assessment information a client with clear palliative nursing care needs was admitted. The inspector did not feel this would have been an appropriate admission despite all arrangements having now been made to meet the individual needs. Staff are not trained in end of life pathway care. The inspector discussed the rationale for placing one service user’s bed mattress on the floor. There was no risk assessment in place to indicate the process undertaken to come to this conclusion that this would be the best intervention nor was there evidence of consultation. There appeared to be a number of service users whose needs currently fall outside of the home’s categories for registration. Observation and discussion identified that the home is very welcoming and any service user with an interest to see how the home is run is welcome to visit regularly, stay for lunch and meet and develop a rapport with staff before under taking a commitment to stay. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 13 Lavender House DS0000066534.V311261.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. This is a service that respects the individuality service users, and their personal choices are respected. Staff were seen throughout the visit dealing with service users in dignified and respectful manner and supporting them sensitively. The standard of record keeping in the home requires improvement, and lets down the overall quality rating in this area. EVIDENCE: Service users were case tracked and it was clearly evident that the staff aim to meet all needs of their clients and appropriately refer any issues to the relevant health or social care personnel. The care staff though would benefit from a program of development to equip them to support the needs of their service users. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 15 The homes Statement of purpose states “a care plan will be formulated individually to support each residents needs allowing independence and privacy and upholding their dignity”. It further states,”helping our service users with intimate needs and situations discreetly, allowing and helping residents furnish and equip their rooms to their own wishes and enabling them to use them for their own choice of meals, leisure and entertaining .To offer residents the choice of where and with whom they spend their time. Giving privacy to receive and make telephone calls if they wish to open and read their mail and see visitors and advisors and ensuring information regarding each resident remains confidential. We produce with each resident a plan of care based on the initial assessment and which is then by continuing assessment updated monthly” These statements were assessed during the visit. The care planning system requires further development. Documentation available on service users files to record the information would be very informative if they were completed. There was a lack of assessment, and care plans were not therefore based on thorough assessment. Regular review had not been undertaken and therefore changing needs have not been reflected. Due to the lack of monthly review and reassessment it was not established that service user’s psychological health is monitored regularly and preventive and restorative care provided. The staff have access to the care records in a number of formats,and these are therefore fragmented. There are three systems in use to provide care staff with the necessary information regarding the service users needs and preferences. The majority of the service users have mental health needs, however these were not being recorded in the assessment documentation. The plans are not currently drawn up with the involvement or agreement of the service users and their representative, nor are they recorded in a style accessible to the service user and staff. This is contrary to the information provided in the service user guide. The staff are not aware of the recent guidance by CSCI regarding standard 15 and nutrition and nor do staff undertake nutritional risk assessments on service users despite there being an identified need for those service users case tracked. It was noticed that since coming into Lavender House a number of service users have put on weight. Records seen identify that service users are enabled to have access to specialist medical, nursing, dental, pharmaceutical, chiropody and therapeutic Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 16 services and care from hospitals and community health services according to need. Observing care delivery and talking with service users and care staff it is very clear that the principles on which the home’s philosophy of care is based ensure that residents are treated with respect, that their dignity is preserved at all times, and that their right to privacy is always observed. Comments received in respect of the service were very complimentary and these are a few examples: • • • • • • • I have found this home to be a very caring and welcoming and a warm welcome by all members of staff is made to each visitor. The carers are fully co-operative and helpful at all times Always listen with great interest We are fully informed with every aspect of the care and leisure. We are encouraged to know all staff by name and become friends The staff gives so much of themselves with love and kindness that I am so grateful It was lovely to see a care home which really epitomises all that should be done for the elderly and infirm-so often lacking these days in too many homes We were delighted at the warm welcome we received on visiting our dear friend, as this was our first visit, the care home seems excellent. We were aware of a great deal of real affection and loving care. From day one we have been more than satisfied with the amount of love and care that the staff give to residents. • • • Observing the staff throughout the day communicating with service users it is clear that there is a very high commitment by the staff to treat all service users as individuals with desires, hopes and expectations. Clients with shortterm memory loss were dealt with sympathetically, respectfully and with dignity. On case tracking service users medication records it was observed that staff are altering the medication administration records with correction fluid and labels, which is poor practice. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 17 Despite this the records were clear and medicine administration records were well recorded. The deputy manager demonstrated a good awareness of the procedures and through reflection demonstrated how she had intercepted a service user receiving Warfarin after coming out of hospital when it should not have been ongoing. The home does have its own medication policy but this needs to be further developed to include all the necessary information to relect the Royal Pharmaceutical guidelines. Staff need to be trained and deemed competent to undertake medication administration. They have not received any accredited training in medicine administration. Discussions with staff and spending four hours in the main lounge and dining areas observing the events of the day it was clearly apparent that the staff team were very aware of the importance of the core values. All aspects of valuing privacy, dignity, choice, rights, independence and fulfillment were observed. One particular service user who has nursing and palliative care needs was visited. The inspector managed, with assistance of staff and non-verbal cues to establish that this lady was comfortable and happy with the care provision. Staff were observed interacting with this lady and it was clear a lovely rapport had been established. All this lady’s needs were being met to a very high standard, despite the staff having not received any appropriate training or having relevant references to the end of life pathways. Discussions with the deputy manager also identified that care staff were making every effort to ensure that the service user received appropriate attention and pain relief and that all relevant healthcare personnel were involved. The quality of the care for this resident was encompassing her physical and emotional needs for comfort and well being and the staff were acknowledging her wishes in respect of further intervention. This was also being shared and supported by the skills of the palliative care team. Care staff showed insight and respect for the preferences and capacities of individuals regarding their social activities. They were observed being supportive according to the individual needs, and many residents needing special support and assistance in engaging in the activities of daily life were having their needs met. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 18 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): 12,13,14,15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Conversations with residents, staff and relatives identified that 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. The home encourages the service users to exercise choice and control over how they spend their time and encourage them to maintain contact with family, friends and the local community as they wish. Service users receive quality food in pleasing surroundings at times convenient to them. EVIDENCE: Care in the home is underpinned by a clear philosophy that disabilities can undermine dignity and to avoid this it will ensure that each resident is treated as a valued individual by assisting them to maintain as close a lifestyle to their own as possible. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 19 Service users are able to take risks and were encouraged to participate in the daily routines and chores within the home. During the visit care staff showed insight and respect for the preferences and capacities of individuals regarding their social activities. Residents were observed being supported according to the individual needs. Individuals were supported when engaging in the activities of daily life but were also able to undertake tasks for the promotion of independence. The inspector was able to observe two meal times and joined the staff and service users at the table for lunch. Staff were observed seeking the preferences of services users and discreetly dealing with service users who changed their minds regarding what they would eat. One staff member was seen dealing very well with a lady who wouldn’t eat her lunch, showing patience and understanding regarding her needs and the staff member managed to get her to eat some cheesy toast finger foods which she explained were her favorite. Meals were of a very high standard. Service users were receiving a wholesome, appealing and nutritious diet at flexible times during the day. The food served was of high quality and the inspector saw that the best ingredients were being used. Mashed potatoes were made with butter and the chicken was cooked well in a white wine sauce. The puddings on offer were homemade and the fruits offered were fresh berries. Care staff was monitoring the diet and fluid intake of one service user and the records were up to date and complete. Throughout the day it was evident that the availability, quality and style of presentation of food, along with the way in which staff assist residents at Staff were also aware of the needs of some residents to participate in giving meals out, tidying up and helped with the other domestic chores under the supervision of staff. It was very apparent that the routines of the day and the activities made available to service users are flexible and varied to suit service users’ expectations, preferences and capacities. The inspector observed the functioning of the home directly and observed that service users had the opportunity to exercise their choice in relation to leisure and social activities, meals and mealtimes, the routines of daily living, and personal and social relationships. The home does need to improve the recording of the psychological, social needs of residents as despite the high quality of intervention there is very little record keeping. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 20 One member of staff spoken to and observed interacting with clients who were reading painting watching television identified a genuine interest for the provision of activities and stated she would like to go on a relevant course. It was clear during the visit that service users are able to have visitors at any reasonable time and links with the local community have been developed and maintained in accordance with service users’ preferences. Lavender House DS0000066534.V311261.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The home has a complaints procedure, which identifies stages, and timescales for addressing issues raised. The home’s practices for handling service users monies are robust and protect the individual from potential abuse, but staff have not been provided with quality abuse training. EVIDENCE: Surveys identify that relatives and service users are aware of the complaints procedure and what to do if they wish to make a complaint. One complaint has been received by the home since the last inspection and a record had been kept including details of the action taken. One staff member was asked what she would do if someone wanted to make a complaint and said “I would ask them to fill in a complaints form because all complaints need to be documented no matter how small and forward it to the manager”. The home’s policies and practices regarding service users’ money and financial affairs do ensure service users’ access to their personal financial records and the safe storage of money and valuables. The home has policies on staff involvement in assisting in the making of or benefiting from service users’ wills. Staff have not received training in abuse procedures, and this should be addressed. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 22 Lavender House DS0000066534.V311261.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,24,26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The provider undertakes steps to ensure that the quality and upkeep of the environment and décor is maintained to a good standard but there are issues in respect of the laundry equipment, flooring and facilities and water waste. Further concerns were in respect of hand washing facilities and a lack of best practice for the prevention of cross infection. Despite this the provider has made sure that the décor in communal areas is homely and has a nice touch with good quality furnishings, room signage and decoration. EVIDENCE: The structural work undertaken on the home has ensured it can meet their philosophy of care as it states to offer a family-like care. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 24 Internally the home has been redecorated with signage to easily identify each room. Attention has been given to the quality and detail of redecoration and refurbishment. The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well-maintained, meets service users’ individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance in most areas. The deputy manager explained that there is no recorded program of routine maintenance and renewal of the fabric and decoration and that in house maintenance men are told of issues verbally. There is an outdoor space for service users, which was seen being made use of. Some service users were seen taking their desserts out into the sunshine to enjoy. There are two toilets available to service users on the ground floor. One concern was there were no hand drying facilities and a non-disposable towel in the staff toilet. The home has two baths available to service users. The home does not have a sluice. To assist service users with dementia they have alleviated steps where possible from the internal structure of the building and have also have assisted bathing facilities for the residents who are particularity physically or mentally frail and need assistance. There is a range of equipment to assist with all aspects of daily living including adjustable beds where necessary, pressure relieving mattresses when required, bath rails, bed rails and a stair lift. All rooms are furnished but residents are said to be welcome to bring in any of their own pieces or picture that they wish. The service user guide says the home is not suitable for total wheelchair dependent persons. There is a new call systems throughout with an accessible alarm facility. Call points are provided in every room. One service user accommodated stated he would prefer not to share but the double room was the only vacancy. It was noticed during the visit that overall the premises are clean, hygienic and free from offensive odours. There is a lack of systems in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. The laundry floor was littered laundry items, dirty washing was piled high and left on the floor. There were no procedures in place so that soiled articles, Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 25 clothing and infected linen are not mixed or cross-contaminated. When the homes policies and procedures for control of infection were seen it was clear they need significant updating and review and need to encompass the safe handling and disposal of clinical waste, dealing with spillages, the provision of protective clothing and hand washing in line with the guidance from the Department of Health. The hand washing facilities do not provide appropriate soap dispensers and hand towels and there were no aprons available in the laundry. The laundry floor finishes are not impermeable and these and the wall and shelving are not readily cleanable. The policy for cleaning the commodes states to undertake this task in the sluice but the home does not have one. A further concern was that all washing was being done in a domestic washing machine, which was disposing of its dirty water through an outlet pipe hanging over the hand washing sink. This will need to be discussed with the environmental health officer to ensure it complies with the Water Supply (Water Fittings) Regulations 1999. The home current washing machine does not have a sluice facility and it could not be established that foul laundry is washed at appropriate temperatures (minimum 65oC for not less than 10 minutes) to thoroughly clean linen and control risk of infection. The washing machines should have the specified programming ability to meet disinfection standards so this will require further discussion. The homes guide states, It does state that This information was seen to reflect the situation at the time. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 26 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): 27,28,29,30 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home appears adequately staffed but staff have not been provided with the necessary training to support them in their role. The manager has not used robust procedures when employing staff and records lack information in respect of the provision for quality induction and practice supervision. Staff are happy working at the home. EVIDENCE: Training provision has been very limited and this is clearly identified in the assessment care records and record keeping in general. One member of staff clearly interested in supporting client social needs would benefit from an activities course specialist in dementia care. The statement of purpose states that all staff holds basic food hygiene certificates and undergo annual training in fire safety, first aid, abuse prevention, dementia awareness and client handling. Records did not indicate that this had been achieved. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 27 Staff questionnaires raised a few issues in respect of application forms references, job description provision and the lack of contracts of employment and also raised an issue over the training offered to staff and a lack of one to one supervision sessions for some staff. The inspector was very concerned at the lack of checks undertaken on staff prior to employment. Staff files audited lacked application forms and there was no evidence that gaps in employment were explored. References were not on file, and there was no indication that Criminal Record Bureau checks and POVA checks had been undertaken. Files further lacked statements of terms and conditions and job descriptions and one teenager employed (15years old), as a “companion” had no records. It was evident that staff are not being employed in accordance with the code of conduct and practice set by the GSCC and Schedule 2 of the Care Standards Regulations. During this days unannounced visit it was observed that all residents were having their needs met by the numbers of care staff employed and domestic staff are employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and that the home is maintained in a clean and hygienic state, free from dirt and unpleasant odours. Further discussions with the deputy manager and audit of the care staff records identified that there are no induction records for staff. The deputy manager was not aware of the TOPSS-certified training program, now Skills for Care. It was also confirmed that the home does not undertake any of the Skills for Care knowledge sets for staff in dementia care. The home has not yet developed a staff training and development program, which meets National Training Organization (NTO) workforce training targets and ensures staff fulfill the aims of the home and meet the changing needs of service users. Staff are not all receiving induction training to NTO specification within 6 weeks of appointment to their posts, including training on the principles of care, safe working practices, the organization and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. Few staff were found to hold certificates in health and safety and infection control and those that did had undertaken the training with a previous employer. Having not undertaken induction training they have not then been offered foundation training to NTO specification within the first six months of appointment, which equips them to meet the assessed needs of the service users accommodated, as defined in their individual plan of care. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 28 Staff have not all received a minimum of three paid days training per year or have an individual training and development assessment and profile. Despite this when asked one staff member stated,“There is a high level of training”. It could not be ascertained what courses the manager has undertaken to keep updated, and whether she has completed National Vocational Qualification 4 or the registered managers award as she was on holiday. Comments received from care staff in respect of the service were; • • • I have just started working here and there is a great working atmosphere and great teamwork. The residents have a really high level of care. The manager is doing a great job in running the home.There is great team of care staff. Two staff stated • • • • The home is really wonderful especially on residents well being, they have the best of everything. They are our family unit. We are all happy and his is a fabulous place to work, we are a good team. The residents are wonderful and appreciate us. We always put clients need first, client’s well being comes above anything else. It’s the friendliest home I have ever worked in, plus it is nice to spend some quality time with the residents. Other members of staff are very nice and helpful and it’s nice to work as a team. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 29 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): 31,32,33,34,35,36,37,38 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Service users live in a home which is run and managed by a person who the staff and service users relatives speak highly of. However the deputy manager appears to be running the home on a day to day basis, who neither has the experience or knowledge of the care standards. This has had a direct consequence on the service as the poor management and administration due to the absence of the registered manager has had a negative effect on the service provided. The quality and calibre of staff, the high quality of care being provided and the satisfaction reported by service users and their relatives should have resulted in an excellent service. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 30 EVIDENCE: Mr and Mrs Kitchen are the new owners of Lavender House. The registered manager is Elizabeth Kitchen and the head of care is has many years experience in the care home sector. There is a team of 13 staff including cook, gardener, handyman and care staff. The statement of purpose states indicates there is a system for quality monitoring, however there were no records to evidence and the deputy manager reported they had not yet developed a formal process of quality monitoring. Fire records were seen. It was discussed that the manager must now start to implement the new legislation in respect of fire prevention. It was apparent during inspection and a visit to the premises that the Registered Manager relies heavily on her head of care and deputy manager, as she is not present in the day-to-day running of the home. The deputy manager demonstrated a good care philosophy, good communication skills and a high standard of care provision, although she lacks the experience and knowledge in relation to the care standards and responsibility of registration. The lack of the registered manager on the premises has led to a serious shortfall in the standards of care recording, assessments and management and administration. Significant improvement is necessary in the standard of record keeping. Records were not up to date or completed and were fragmented. The deputy manager confirmed that formal staff supervision sessions have not yet been started and therefore staff had not had records maintained in respect of their practice, philosophy of care in the home and career development needs. It was established that formal staff meetings are not held. The lack of attendance by the registered manager on the premises undermines a clear sense of direction and leadership, which staff and service users need so as to ensure the aims and purpose of the home are met. There is a lack of effective quality assurance and quality monitoring system, based on seeking the views of service users and measure success in meeting the aims, objectives and statement of purpose of the home. The inspector could not be provided with an annual development plan for the home, based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 31 Considerable work needs to be undertaken in reviewing the homes policies, procedures and practices in light of changing legislation and of good practice advice from the Department of Health, health authorities, and specialist or professional organizations. The inspector randomly checked the financial record regarding monies kept on behalf of service users and observed written records of all transactions are maintained and receipts are kept. The areas of concern regarding health and safety during this visit were for the homes practices in the prevention of cross infection. A further concern is that the staff office is also the food larder and staff smoke in there. Lastly, the COSHH cupboard was open and unlocked, access to the laundry was open and there were cleaning materials in the upstairs bathroom cupboard, posing a risk to residents. The registered manager has provided a written health and safety policy but it is does not reflect the details necessary to address aspects of health and safety in lines with legislation and guidance. Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 32 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 2 1 1 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 1 3 X 2 3 3 3 X 1 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 3 3 1 2 2 Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? New service 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 OP1 Regulation 4(1) Requirement The registered person must ensure the statement of purpose and statement truly reflects the service and standards of the services provided. This information must be provided in a suitable format. Please forward a copy to the Commission by the given date. Service users must be provided with terms and conditions regarding their stay, signed by the residents or their representative. New service users must only be admitted on a basis of a full assessment, which ensures their needs can be met and are described by the conditions attached to the certificate of registration. The registered person must be able to demonstrate the home’s capacity to meet the assessed needs of individuals admitted to DS0000066534.V311261.R01.S.doc Timescale for action 10/12/06 2. OP2 5(1) 10/12/06 3. OP3 14(1) 10/12/06 4. OP4 12(1) 10/12/06 Lavender House Version 5.2 Page 34 the home and ensure staff are supported and trained. 5. OP7 15,12 The care planning process must be reviewed to ensure that the care plans are based on assessed individual needs. These records must be completed in full, accessible, agreed with the service users/representatives used as working tools for staff, reviewed, updated and streamlined. Written daily records should be informed by the care plan and the actions identified within the plan evaluated recorded. Assessments regarding nutrition, continence, mental health must be undertaken as part of the admission and review process. The home must have a medication policy, which reflects all aspects of medicine administration as per the Royal Pharmaceutical guidelines. Staff must be trained to undertake medication administration. 10/12/06 6. OP9 13 10/12/06 7. OP26 13,12,16 The manager must implement 10/12/06 infection control procedures in line with best practice. Consultation must be undertaken with the infection control nurse to address concerns identified regarding the laundering of clothes. The manager must consult with the environmental health department of the local authority and ensure that appropriate arrangements are made for the disposal of wastewater from the washing machine by the given date. Advice must be taken about the suitability of the DS0000066534.V311261.R01.S.doc 8. OP29 16 16/10/06 Lavender House Version 5.2 Page 35 9. OP29 19 Schedule 2 washing machine for its purpose. All required checks must be undertaken on staff prior to employment in the home. All required information must be gained for all staff by the given date, including evidence that checks have been undertaken. Staff must receive appropriate induction, foundation and service user related training. Please forward a training plan to the Commission by the given date. The registered manager must implement a system for quality assurance and quality monitoring, based on seeking the views of service users. Policies and procedures must be reviewed to ensure they are in line with best practice. Records required under Schedule 3 must be maintained. COSHH procedures must be improved and all substances hazardous to health stored appropriately. 16/10/06 10. OP30 18 (1) 9 10/12/06 11. OP33 12,15,24, 10 10/12/06 12. OP33 10,12 10/12/06 13. 14. OP37 OP38 17 Schedule 3 13 10/12/06 10/12/06 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 Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. Extracts may not be used or reproduced without the express permission of CSCI Lavender House DS0000066534.V311261.R01.S.doc Version 5.2 Page 37 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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