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Inspection on 10/05/05 for Lavender House Retirement Home For The Elderly

Also see our care home review for Lavender House Retirement Home For The Elderly for more information

This inspection was carried out on 10th May 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents expressed their satisfaction with the care received. One resident said the home is as nice as you can get anywhere, the food is good and staff are kind. Another said she was underweight when she came into the home and has now put on two stones in weight which reflects the care and food provided. Residents are encouraged to retain a level of independence and are supported to go out for visits to family and friends or to the local shops. The home has a homely atmosphere and relatives and friends are made welcome.

What has improved since the last inspection?

The manager is making progress with training needs and staff appear happier and more motivated as a result. Records being kept now include for maintenance, staff and resident meetings, monthly entertainments taking place in the home, manager audits of the home and residents` questionnaires. The manager is changing staff routines which is proving beneficial to residents.

What the care home could do better:

The procedures for recruiting staff must improve to ensure the safety of residents. Offensive odours must be eliminated and the standard of cleanliness and hygiene improved. Equipment must be regularly maintained, examined and serviced to ensure the safety of residents and staff.

CARE HOMES FOR OLDER PEOPLE Lavender House Retirement Home for the Elderly 69 Welton Road Brough East Yorkshire HU15 1BJ Lead Inspector Pam Dimishky Unannounced 10 May 2005 at 9:00 am th 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 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 Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lavender House Retirement Home for the Elderly 69 Welton Road Brough East Yorkshire HU15 1BJ 01482 666013 01482 666013 Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quality Care UK Limited Care Home 32 Category(ies) of OP Old age (32) registration, with number DE(E) Dementia - over 65 (32) of places Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: To admit one service user under 65 years Date of last inspection 29TH November 2004 Brief Description of the Service: Lavender House is a Georgian style care home on two floors, set in the heart of the village of Brough. There are seventeen single bedrooms, seven of which have en-suite facilities, and four shared rooms; one has en-suite facilities. There are flower beds and parking to the front with a small garden to the side of the building. Local amenities are close by including shops, pubs, rail and bus services. The home is registered to provide care and accommodation for 32 older people, some of whom may have dementia. A variation to the registration has been made to accommodate one service user under 65 years of age. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8 hours (including preparation and travel), and also included investigation of an anonymous complaint, the findings of which are detailed in the body of the report. Progress has been made on all the previous inspection’s requirements. Twelve immediate requirements were made at this inspection. The inspector looked round most parts of the home and a number of records were inspected. Eight of the twenty-five residents, two of the staff on duty and one visitor were spoken to. What the service does well: What has improved since the last inspection? The manager is making progress with training needs and staff appear happier and more motivated as a result. Records being kept now include for maintenance, staff and resident meetings, monthly entertainments taking place in the home, manager audits of the home and residents’ questionnaires. The manager is changing staff routines which is proving beneficial to residents. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 6 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. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 standard(s) 1, 3,4 and 6 Residents’ are given information about the home but this is not always up to date. The home is unable to fully meet the needs of one resident and this is affecting the quality of life experienced by other residents’ in the home. EVIDENCE: The statement of purpose and service user guide has been amended in line with a requirement from the previous inspection, but the updated version has not been given to the residents and a copy has not been forwarded to the Commission for Social Care Inspection. The proprietor assesses prospective residents before being admitted to the home to ensure their needs can be met. All residents who have been placed through social services have a care management assessment and care plan. One resident has care needs which are becoming problematical and may not be fully met by the home. Advice and staff training for caring for this resident must be sought from the community psychiatric nurse to ensure needs can continue to be met by the home. The home is not registered for intermediate care, therefore no residents’ enter the home for this type of care. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents’ health care needs are being fully met. However, personal support is not always offered in such a way as to promote and protect residents’ privacy, dignity and independence and medication records did not always indicate a true record is being kept of the drug administered. EVIDENCE: Three care plans were examined and daily records are made, usually from staff on each shift. Care plans are comprehensive and there is evidence of the plan being reviewed monthly and risk assessments being made. Care plans are signed by the resident indicating their involvement in its development. One resident who was underweight when she came into the home said she has now put on two stones in weight and is feeling much better. The home works closely with the local general practitioners’ surgery. All residents are registered with the NHS chiropody services, however, appointments are very lengthy and some residents pay for the service privately. Diabetics all see the chiropodist regularly. A policy and procedure is in place for self-medication but none of the residents’ are presently self-medicating. A monitored dosage system is operated for Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 10 medications and the storage is secure and appropriate. One resident’s medication administration record indicated on one day the drug had been given but the tablet was still in the pack. Staff were observed to treat residents with respect and dignity. However, two resident’s expressed concerns in this respect; one stated he would like to go to the toilet when he wants and in private and another stated she does not always get her own clothes returned from the laundry. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Daily activities and interests are taking place in the home which suit the majority of the residents’ but these are not based on the individual choice of all residents. Links with family, friends and the local community are being maintained and enrich residents’ lives. EVIDENCE: All the residents’ spoken to spoke highly of the home, the staff and their care. Activities take place daily according to individual choice and entertainers visit monthly, although one resident said the activities were not always suitable for people without dementia. At the time of the inspection, taped music was being played and some residents’ were singing-along. Dominoes had been scheduled for later in the day. Some residents’ prefer to spend time in their room, quietly reading, listening to music, or watching television Residents’ are able to keep in touch with relatives and friends either by using the home’s cordless telephone, or three residents’ have had their own telephone installed. One resident stated her visitors’ are always made welcome and are offered a cup of tea. Residents’ are encouraged as far as possible, to exercise choice and control over their lives. One resident goes home three days a week, another has highly personalised his room with all modern comforts including a fridge and Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 12 freezer. His sister takes him to the supermarket where food is obtained and which the home prepares for him; he had bought some smoked fish but the cook was not on duty and staff did not know how to cook it. It was prepared for him when the cook returned. To cover sickness absence an advertisement is being placed for a temporary cook but in the meantime staff, along with the manager, are rostered to do the cooking. Lunch at the time of the inspection was either sausage and liver casserole or lamb chops. The menu board had not been completed for the day, but two residents’ spoken to knew what was being offered for lunch. One resident said the home is as nice as you will get anywhere, she enjoys the food and staff are kind. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints procedure available to residents’ and their families. Residents’ are protected from abuse by the awareness training provided by the home and covered in units of NVQ II and III which are being undertaken by most of the staff. EVIDENCE: The home has a complaints procedure which has been given to all residents. A comments book, available next to the visitors’ book, includes entries expressing grateful thanks to the home. No complaints have been recorded by the home since the last inspection, however, an anonymous complaint received by the Commission was investigated as part of this inspection and partly upheld. (See Environment). Staff have seen a video to raise awareness of adult abuse, although one member of staff interviewed stated she had not seen the video but had read the policy; the subject is also covered in one of the units of NVQ III which she is currently undertaking. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,22,25 and 26 Residents’ live in a homely environment which is generally well maintained. However the home was not clean and free from unpleasant odours. EVIDENCE: The above standards were looked at whilst investigating an anonymous complaint received by the Commission. Elements of the complaint 1. Commode pots are not emptied on a regular basis and commode pots are left full. This was upheld as three bedrooms had commode pots which were full. 2. Faeces stains on bedroom carpets, beds are not changed regularly and sheets have urine and faeces marks on. This was upheld as faeces stains were seen on one bedroom carpet and one bed was noted to be wet. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 15 3. Staff are made to do manual lifting of two residents as the hoist was not working properly, and does not have the right straps as the hoist is too small. The proprietor has informed staff they could lift with their arms and the district nurse has said lifting was out of date. Staff are taught to lift by other staff. Two members of staff and manager independently confirmed two residents’ are lifted using a hoist. The same staff also confirmed they have received training in using a hoist and have had moving and handling training through Konnect Care. The manager also has a video which is used for in-house training. The home has two mobile hoists. This part of the complaint could not therefore be upheld. The manager is to discuss with the district nurse any further aids which would assist in the moving and handling of residents. In addition to the above, four toilets were dirty or in need of flushing, there was an offensive odour in three rooms, faeces on the wall of one bedroom and high dusting necessary in other bedrooms. A faeces soiled towel in one bedroom had not been changed. (The cleanliness of the home could, in part, be due to the cleaner being sick on the morning of the inspection. However, care staff must be instructed with regard to their part in keeping the home clean, pleasant and hygienic.) The downstairs bathroom does not allow opening from the outside when locked inside and the hot water outlet to the bath was running in excess of 43 degrees C; (the handyman adjusted the temperature during the course of the inspection). Most pillows need replacing and some towels. Since the last inspection there is evidence of on-going maintenance of the home including ten areas of the home having been redecorated, a new door fitted to the lift, a new television in each of the two lounges, new organ in the large lounge, one bedroom has a new carpet and the small lounge new curtains. A handyman is employed to undertake general maintenance tasks in the home. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 The home cannot be sure residents’ are in safe hands at all times until training is complete and the home’s recruitment practices improve. EVIDENCE: Twenty-five residents living in the home, have their care provided by three staff on duty on the early and late shift and two staff at night. In addition a part-time cleaner and a part-time cook are employed. The number of staff on duty is sufficient to meet the current care needs of the residents’ and meet the requirements made by the previous registering authority. The manager now has her own training budget and quality training is being accessed for staff. There is evidence that staff training is improving which can only improve their ability to do their jobs. Seven staff are attending a certificated course at Hull College for the administration of medicines and other staff will be attending the same course later in the year. The manager is planning to access other health and safety training courses in the near future including basic food hygiene, moving and handling and a course covering dementia. A range of videos have been obtained and used for staff training during the interim period and these include moving and handling, food hygiene, medications, continence, first aid, and adult abuse. The manager is qualified in first aid and staff have received video training. Four members of staff are taking NVQ II and three members of staff are taking NVQ III; one member of staff has a NVQ II qualification. Staff interviewed stated the Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 17 training they are now receiving is helping them with their tasks and they are feeling more confident as a result. Seven members of staff have received Criminal Records Bureau (CRB) clearance. Application has been made through an umbrella body for other staff but these had not been returned at the time of the inspection. New staff only work under supervision and only commence working having had a POVA 1st clearance. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35 and 38 The management of the home has improved which, in turn, is enhancing residents’ quality of life and staff morale. Further improvements need to be made in regard to the health, safety and welfare of residents’ EVIDENCE: The manager has been in post for a year having previously worked as a manager of another home. She has completed NVQ IV in management and is shortly commencing NVQ IV in care. Application has been made to the Commission for Social Care Inspection for registration as the manager and this is being processed. The administrator acts as appointee for one resident and has tightened up her procedures in line with advice given at a previous inspection. No monies are kept on behalf of residents’ and arrangements for this are made with their family. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 19 A health and safety poster is displayed in the office and can be seen by staff. However, a number of health and safety issues were identified during this inspection and an immediate requirement form was left with the proprietor for these to be dealt with. These included fire extinguishers not being checked since July 2003, certificates for a thorough examination of the passenger lift, mobile hoists and bath hoist were not available, commode cleaner had been decanted to a spray container but not labelled and emergency lighting had not been checked since December 2004. A fire risk assessment is now in place following a requirement made by the Fire Brigade. Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 1 3 x x x 1 STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x 3 x x 1 Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 21 Yes 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. 2. 4 12,14 The assessment of service users needs must be kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances Ensure accurate records are kept of the medications administered Ensure suitable arrangements are made to respect the privacy and dignity of service users and take into account their wishes and feelings Ensure hot water outlets in areas used by service users do not exceed a temperature of 43 degrees C Ensure pillows and towels are replaced as needed The home must be kept free of offensive odours, clean and satisfactory standards of hygiene maintained at all times Ensure service users are protected by the homes recruitment policy and practice. (Outstanding from the previous inspection) On receipt of this report Standard Regulation Requirement Timescale for action 3. 4. 9 10 13 12 Immediate On receipt of this report 5. 6. 21 13 Immediate 7. 8. 25 26 16 13,16,23 Immediate Immediate 9. 29 19 Immediate Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 22 10. 30 13 11. 12. 38 38 23 13 13. 38 13 Ensure the progress made so far with staff training continues to guarantee they are competent to do their job Ensure fire extinguishers are checked annually and emergency lighting checked monthly Provide evidence to the Commission that the passenger lift, bath hoist and two mobile hoists are having six monthly thorough examinations by a competent person Ensure COSHH requirements are met at all times On going Immediate Immediate Immediate 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. 3. 4. Refer to Standard 28 31 1 12 Good Practice Recommendations A minimum of 50 trained members of care staff (NVQ II or equivalent) should be achieved by 2005 The registered manager should have NVQ IV in care by 2005 or equivalent A copy of the updated service user guide and statement of purpose must be given to residents and a copy sent to the Commission Ensure the programme of activities in the home includes as far as possible the interests of all residents Lavender House Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Retirement Home for the Elderly J53_S19688_Lavender House_v225518_10 May 2005_Stage 4.doc Version 1.30 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!