Inspection on 07/12/06 for Lavender House Retirement Home For The Elderly

This inspection was carried out on 7th December 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lavender House Retirement Home... 22/06/06

Lavender House Retirement Home... 12/12/05

Lavender House Retirement Home... 10/10/05

Lavender House Retirement Home... 10/05/05

Lavender House Retirement Home... 29/11/04

Lavender House Retirement Home... 12/07/04

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

CARE HOMES FOR OLDER PEOPLE Lavender House Retirement Home For The Elderly 69 Welton Road Brough Hull East Yorkshire HU15 1BJ Lead Inspector Mr M.A. Tomlinson Key Unannounced Inspection 7th December 2006 09:30 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 Retirement Home For The Elderly DS0000019688.V321563.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 Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lavender House Retirement Home For The Elderly 69 Welton Road Brough Hull East Yorkshire HU15 1BJ 01482 666013 F/P01482 666013 Address 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) Quality Care UK Limited *** Post Vacant *** Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one service user under 65 years Date of last inspection 22nd June 2006 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 twenty-four single bedrooms, eight of which have en-suite facilities, and four shared rooms; three have en-suite facilities. There are flowerbeds and parking to the front with a small garden to the side of the building. Local amenities are close by, including shops, pubs, and rail and bus services. The home is registered to provide care and accommodation for 32 older people, some of whom may have dementia. Nursing care is not provided. Should such care be required on a short-term basis the Community Healthcare Services will provide it. The fees for the home ranged from £300 to £500 depending on the assessment of need and room chosen for occupancy. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second ‘key inspection’ undertaken by the Commission for Social Care Inspection on Lavender House during this calendar year. This was considered necessary due to the number of requirements and recommendations made during the previous inspection that raised concerns regarding the quality of the care provided for the service users. Whilst this inspection visit primarily looked at the shortfalls identified during the previous inspection, all key standards were looked at along with several supplementary standards. The inspection consisted of discussions with the more able service users, observation of the less able, discussions with the staff and manager and discussions with relatives of service users who were visiting on the day of the inspection. Comment survey cards were sent to health and social care professionals as well as a number of service users’ relatives. The inspection also incorporated an ‘thematic probe’ that involved looking at pre-determined areas such as pre-admission information provided for service users, fees and increases in fees and service users terms and conditions of residence. The findings of this ‘probe’ are incorporated into the body of the report. An inspection of the premises, including the service users’ rooms, was carried out and a number of statutory records were examined. Information on the home received by the Commission for Social Care Inspection prior to the inspection visit was also taken into account. What the service does well: What has improved since the last inspection? Since taking over, the current manager has made a considerable number of improvements. These have included updating and revising the records, improving staff support and training and improving the standard of care provided for the service users. She acknowledged that this improvement has been primarily due to a marked improvement in the staff to service user ratio and she was adamant that this ratio should not regress with future admissions into the home. She has also placed considerable emphasis on the need for staff training. This approach has had a positive effect on staff morale and their overall enthusiasm. The manager has endeavoured to improve relationships Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 6 between the home and health and social care professionals particularly by improving the standards of communication. The manager has a clear vision of the quality of care that Lavender House should, and must, provide and those elements of care such as independence and choice that go to provide the service users with a good quality of life. The majority of the concerns identified during the previous inspection either have been, or are in the process of being, addressed. The manager has delegated the responsibility for overseeing specific tasks to senior members of staff. By this approach she is able to spend more time supervising and supporting staff and developing the overall service. The introduction of a deputy manager has also been beneficial for the manager and the service users. Considerable improvement has also been made to the standard of the physical environment particularly in terms of cleanliness and the absence of unpleasant smells. Several relatives of the service users confirmed this improvement. 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. Lavender House Retirement Home For The Elderly DS0000019688.V321563.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 Lavender House Retirement Home For The Elderly DS0000019688.V321563.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): 1, 2, 3 and 6 Quality in this outcome area is good. An appropriate process is in place to provide prospective service users with a full assessment prior to their admission into Lavender House in order that a considered decision can be made regarding the appropriateness of the proposed placement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users had been provided with a copy of the Service Users’ Guide as part of the admission process. To ensure that they had ready access to the Guide, a copy had been left in the service users’ rooms. In the majority of cases the guide was hung on the inside of the entrance door to each room. Three service users were asked about the Guide and its location. One confirmed that it was hanging on the door to her room, another remembered receiving it but couldn’t locate it and the third had no recollection of receiving Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 9 the Guide. From a brief examination of the Guide it was evident that it contained the required information. There had been no service user admissions into the home since 2005. The three care records examined, however, indicated that the service users had been fully assessed by a representative of Lavender House prior to their admission although none of the service users spoken to could recall this. This assessment was in addition to any assessment undertaken by a placing authority. The assessment process ensured that sufficient information was made available to ensure that the home was capable of meeting the service user’s needs. It also enabled the manager to make an informed decision as to the appropriateness of a planned admission. The manager demonstrated a good understanding of the admission process and emphasised that it was very important that any admission is within the capability of the staff. She confirmed that no person would be admitted without a full assessment and that the assessment would, unless circumstances dictated otherwise, take place in a prospective service user’s current accommodation. The manager was of the view that a further assessment of a service user would be required shortly after their admission into the home to ensure that the initial assessment remained accurate following the service user’s change of environment. It was evident from an examination of the associated care plans that they had been based on the initial assessment. Whilst the assessment process was considered satisfactory, it will only be possible to fully validate its effectiveness through future service user admissions. There was recorded evidence that prospective service users had been provided with a contract and/or terms and conditions of residence. In the majority of cases a service user’s family had dealt this with. None of the service users spoken to could recall having received a contract and the general response was ‘I don’t deal with things like that, I leave it to my (relative)’. A copy of the terms and conditions of residence was incorporated in the Service Users Guide. A relative of a service user stated in the Comment Card, ‘(She) has settled in very well at Lavender House. The move from her own home and the loss of her independence was traumatic. But the staff have been so caring and friendly that she thinks of them with great affection, like members of her family’. Intermediate care is not provided at Lavender House. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. The service users are provided with good levels of support from health and social care professionals thereby ensuring that their health and social care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users had been provided with a care plan, which was in addition to any care plan developed by a placing authority. Three care plans were examined as part of the case tracking process. They were reasonably comprehensive and clearly identified the primary needs of the service user concerned along with the action required by the staff in order to meet those needs. The care plans also included a profile of the service user and a summary of their life history. In addition to this written risk assessments had been undertaken with relation to nutrition, mobility, oral care and pressure sores. There were also records relating to bowel and bladder functions. The Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 11 need for these latter records, and their accuracy, was discussed with the manager. Regular checks of the service users’ weight was made and recorded. The manager saw this as being a vital action to monitor the service users’ general state of health. Sit-on weighing scales were available for those service users who were not weight bearing. There was some evidence that the service users and/or their representative had been involved in the review, development and implementation of the care plans. A relative of a service user confirmed this. The more able service users spoken to were generally aware of their care plans but did not wish to be involved with them. The home used a system of ‘key workers’ to ensure that the needs of the service users were closely monitored. There was a requirement that the key workers spend dedicated time on a one-to-one basis with the service users allocated to them. This enabled the key workers to undertake a weekly review of the service users’ needs as well as spending ‘quality time’ with them. The more able service users spoken to confirmed this. The key worker concerned had recorded these one-to-one sessions. There was evidence in the service users’ care records that the care plans had been reviewed formally on a monthly basis and the relevant care plan updated as necessary. These reviews were in addition to reviews undertaken by a placing authority. A record had been maintained of all visits to the home by health and social care professionals. From these records, and discussions with the service users, it was concluded that the service users’ health and personal care needs had been met through good external support. Evidence was provided by the manager of input from medical practices, District Nurses and specialist input from a Continence Advisor and a Dietician. It was the manager’s stated intention to hold discussions with the local medical practice in order to improve communication with the home. Whilst a number of the service users were incontinent, from the use of good toileting and cleaning programmes there was little evidence of this. Following the requirement made during the previous inspection, the manager had reviewed the medication administration and storage procedures. This had included delegating responsibility for the procedure to the deputy manager who monitored the process. Named staff responsible for the administration of the medication had undertaken a distance-learning course in the Safe Handling of Medication as well as being provided with training by the local pharmacy. The description of the administration process provided by a member of staff indicated that it was appropriate and minimised the chance of error. It was observed that the medication was administered directly to the service user concerned primarily through the use of a monitored dosage system. The medication was stored in a locked room in a locked drugs container. The key to the medication facilities was kept in a mini-safe that was only accessible to specific staff. The medication records were complete and up to date. A Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 12 limited audit was undertaken on some prescribed medication and this proved to be satisfactory. Storage and recording facilities were also available for the administration of Controlled Drugs. None were in use at the time of the inspection visit. A lockable refrigerator was available for the storage of specific medication. Medication for use by the staff, such as paracetamol, was stored and recorded separately to the service users’ medication. None of the service users had been assessed as being capable of fully self-administering their medication. It was observed that the staff spoke to, and assisted, the service users in a respectful, polite and patient manner. It was evident that they had developed a good relationship with the service users and conversation between the service users and the staff was natural and spontaneous. It was also evident that the service users had retained a sense of humour and natural and appropriate banter was observed between them and the staff. The more able service users spoken to confirmed this open and friendly relationship. The service users looked relaxed in their environment. They were well groomed and dressed in clean and appropriate clothing. The majority of the service users had their own room thereby enhancing their privacy. The manager had a policy that rooms would only be shared if both occupants specifically requested it. On the day of the inspection visit for example, two sisters occupied a shared room. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. The service users are provided with a basic programme of social activities but it does not particularly take into account the service users’ personal needs, wishes and abilities. The service users would benefit from having more choice and variety in the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manger had developed a limited programme of social activities for the service users. The majority of these were group activities such as bingo, quizzes and music. They were, however, supplemented by the use of ‘quality time’ by the service users’ key workers. Several of the service users said that their key worker had taken them out. The more able service users said that they could follow their own routines and that there was no pressure brought to bear if they did not want to join in organised activities. The main lounge had communal television. A semi-circle of chairs had been arranged around the television so that those who did not want to watch it could sit away from it. The more frail service users were, if possible, encouraged to spend time in the Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 14 main lounge so that they could be supervised and assisted by the staff. There were a number of sitting areas so that service users could choose where, and with whom, they wished to spend their time. One service user had practically sole use of a small lounge, which suited her preference for her own company. Other service users spent considerable time in their rooms by choice. The service users were observed to have unrestricted movement around the building. They confirmed that there were no set times for getting up in the morning or going to bed at night. One said, “I can have a lie-in if I want to”. There was a steady stream of visitors to the home during the inspection visit. Those spoken to confirmed that they were made to feel welcome by the staff. It was also observed that they were offered refreshments by the staff and could see the respective service user in private. Three of the visitors spoken to stated there had been obvious improvements made over the last few months. They confirmed that they could always speak to the manager if they had any worries or concerns. One stated in the Comment Card, ‘Our satisfaction level has varied because of the recent reports about closure or changes to the home. Fewer residents seem to have resulted in an improvement in care. Despite my (relative’s) clothing being labelled it is still not being returned always to her and other (residents) clothing is often in her room’. This issue was discussed with the manager. The relative of another service user commented, ‘She (service user) has settled in very well and is very happy there. The staff are kind and patient’. The manager and the catering staff had recently reviewed the menus. They indicated that the meals were traditional but reasonably varied and endeavoured to take into account the preferences of the service users. Whilst there was no planned choice of meal on the menu, the more able service users confirmed that they could ask for an alternative meal if they so wished. There was, however, no recorded evidence of this. No specialist diets were being provided at the time of the visit. A member of the catering staff demonstrated a reasonable understanding of the dietary needs of older people and confirmed that there had recently been input provided by a Dietician. Further to the comments made in the previous inspection report, the kitchen was reasonably clean and hygienic. It was observed that lunch on the day of the visit was relatively plain but nutritional with a good balance of fresh vegetables and meat. Consideration had been given to the service users’ state of oral health and their ability to chew and digest food. All of the service users spoken to, except one, expressed satisfaction with the quality of the meals. The one exception said that they were very fussy over their food and preferred to buy their own food from the local supermarket. The staff had enabled them to do this. As far as could be ascertained from the records, the catering facilities met the specific requirements of the Environmental Health Department. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. The service users are protected through the use of sound adult protection procedures and a good network of internal and external support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An appropriate complaints procedure was in place and there was evidence that it had recently been reviewed and amended. The complaints procedure was displayed and incorporated in the Service Users’ Guide and consequently all of the service users had a copy. Those relatives of service users who responded with a Comment Card confirmed that they were aware of the home’s complaints procedure. A record of complaints and compliments was available in the entrance hall. Those service users spoken to could not envisage making a formal complaint but indicated that they would have no hesitation in speaking with the manager or staff if they had a concern. A service user provided an example of this when they had been upset by the attitude of two staff members. They reported this to a senior member of staff who did not hesitate in addressing the problem. Since the previous inspection a concern had been formally raised by the relative of service user regarding the standard of care provided in the home. The manager had appropriately addressed this. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 16 Since the previous inspection visit the staff had received training in Adult Protection and the associated procedures. This was confirmed from an examination of the staff records and discussions with staff. The staff demonstrated a reasonable understanding of the types and indications of abuse and of the action to take in the event of witnessing abuse. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26 Quality in this outcome area is adequate. The service users are provided with accommodation that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection visit action had been taken by the manager to address those environmental shortfalls identified in the associated report. An inspection of the premises was undertaken. All areas of the property were clean, warm and reasonably decorated. The premises were free from unpleasant odours. According to the manager this had been achieved through regular and effective cleaning routines. It was evident that the service users were able to personalise their rooms. Several of the service users had their own telephones. There were adequate numbers of shared toilets and bathrooms available on each floor of the property. The majority of the baths Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 18 had in-bath hoists. Manual hoists were also available. Some of the bedrooms had en suite facilities. The occupants of these rooms said that they valued these facilities as they provided them with privacy. Occupants in shared rooms had privacy screening available. Some of the beds had safety rails fitted although only one set was in use at the time of the visit. These bedrails had been properly fitted and risk assessed. An emergency call point was available in each room. In some of the bedrooms the operating cord to the call point had been lengthened, in at least one case by using a gentleman’s tie, to enable the service user to operate it from a distance. There were no facilities in place, however, for the service user to summon assistance should they fall or not be able to reach the operating cord. Whilst the majority of the bedroom doors had locks fitted, these were of an inappropriate design and would not permit access in the case of an emergency. The communal rooms were furnished and decorated to an appropriate standard. A choice of sitting areas enabled the service users to choose where, and with whom, they wished to spend their time. Books, magazines and newspapers were readily available. The laundry equipment was appropriate. Sluicing facilities were integral with the operating cycle of the washing machine. According to the staff and the service users’ laundry was collected and returned each day. The home had a passenger lift and consequently the service users could access the upper floor regardless of disability. The property stood in its own grounds and had relatively large gardens that were accessible to the service users. There was parking facilities available for several vehicles. Externally the premises were reasonably decorated and double-glazing had been installed to minimise road noise. It was noted that the front guttering was blocked and could overflow when it rains. The Commission for Social Care Inspection had received confirmation that the property satisfied the specific requirements of the Fire Department. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The service users are well supported by a competent and enthusiastic staff team that ensures that the service users’ needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An examination of the staff roster indicated that there was generally three care staff on duty during the day plus the manager and ancillary staff. During the evenings and night there were two care staff on duty. This was considered adequate for the current number of service users being accommodated and the fact that approximately six required the assistance of two staff during the day. Subsequent to the inspection the manager has provided confirmation that an additional two care staff (72 hours a week in total) were being recruited in order to address the service users’ needs and in particular the planned increase in service user numbers. The staff records provided confirmation that they had been, or are to be, provided with training in statutory subjects such as health and safety, fire safety and food hygiene. First aid training was planned for January 2007. Approximately 50 of the care staff had achieved, or were in the process of achieving, a National Vocational Qualification at level 2 or above. Training was Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 20 also planned in dementia care and infection control. The staff confirmed that they had recently had training in adult protection procedures that included the types and indications of abuse. The staff training records confirmed that new staff had been provided with appropriate induction and foundation training. The staff presented as being enthusiastic with regards to training. Evidence was available to confirm that the staff had been provided with contracts of employment and job descriptions. The records indicated that new staff had undergone a reasonable vetting and recruitment process. Two recently employed staff had come from overseas via an employment agency. Their records indicated that references had been applied for but the one on record was addressed ‘to whom it may concern’ and had not been verified as to its authenticity. A CRB check had not been completed as the manager was still waiting for their National Insurance number. A copy of a police check from their previous country of residence was available. The manager provided confirmation that these staff were being appropriately supervised until a full check had been completed. A relative of a service user stated in the Comment Card, ‘Fewer residents appear to have resulted in an improvement in care’. The staff confirmed that they now had more time to spend with the service users. The manager was aware of this improvement and was intending to keep the staffing level/ratio under review to ensure that the improved standard was maintained. From discussions with, and observation of, the staff, it was apparent that they had a good understanding of the service users’ needs and of those elements of care, such as independence and choice, that go to provide them with a good quality of life. They also confirmed that they received regular formal supervision. The staff records also confirmed this. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 21 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, 32, 33, 35, 37 and 38 Quality in this outcome area is adequate. The service users and staff are supported by an enthusiastic and competent manager who has a clear aim to achieve a good quality service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection visit the registered manager had resigned. The role of manager had been taken over by Miss Sarah Warrington who has had considerable experience in the care of older people. She was a partner in the company that owns Lavender House. She had applied for a CRB check and was intending to apply to register as manager with the Commission for Social Care Inspection. From discussions with the manager it was apparent that she had a good understanding of her management responsibilities and in particular Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 22 the importance of joint working with health and social care professionals. Since taking over as manager she had made several important changes to the care practices in the home. She had, for example, provided the staff with improved training and had delegated appropriate tasks thereby giving them greater responsibility. It was apparent that she employed a democratic style of management that was underpinned by good standards of professionalism and determination. It was also evident that she had achieved a reasonable balance between her management duties and the need to be accessible to the staff and service users. She appeared to accept criticism in a positive sense and linked it to the quality assurance process. The manager had just successfully completed a National Vocational Qualification at level 4 in social care and was intending to start the Registered Manager’s Award early in the New Year. Without exception, the members of staff, service users and their relatives spoken to expressed confidence in the manager. A basic quality assurance process was in place. The manager was further developing this. The process included obtaining the views of service users and their relatives on the service provided by the home. The manager provided evidence that she had undertaken a quality audit of each section of the service (e.g. care, catering, laundry and activities etc.). She had then analysed her findings and had taken action to improve any shortfalls in the service. Discussions were held with three of the more able service users regarding their accommodation fees and notification of any increases. Without exception they stated that they left such matters in the hands of their family and consequently were unaware of the fees or of any increases. The manager endeavoured to have no involvement with the service users’ personal finances. In cases, however, where service users had deposited their personal money with the manager, the amount and any transactions made had been recorded. A number of statutory records, including care, medication, accident and fire prevention records were examined. These were well maintained and up to date. From an examination of the servicing records and an inspection of the premises it was evident that the manager had taken appropriate action to ensure that the service users and staff were provided with a safe environment. It was unclear, however, from the electrical wiring safety certificate whether it was in date. Consequently, the manager has made arrangements for the system to be fully checked. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 2 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 2 Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement Timescale for action All staff references must be verifiable and their authenticity confirmed. References stating ‘to whom it may concern’ are not acceptable. Confirmation must 01/02/07 be provided for the Commission for Social Care Inspection that all staff have undergone a CRB and POVA check. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Consideration should be given to making activities for the service users more purposeful to enable them, for example, to remain physically and mentally fit and reasonably motivated. The laundry process should be reviewed to ensure that it is both effective and efficient and minimises the possibility of error such as mixing up the service users’ clothing. Consideration should be to ways of making the menus DS0000019688.V321563.R01.S.doc Version 5.2 Page 25 2. RCN 3. OP15 Lavender House Retirement Home For The Elderly 4 5 6 RCN OP19 OP22 7 OP24 8 OP30 9. OP38 more varied and interesting. A genuine choice of meal should be incorporated within the daily menu. The service users should be approached on a daily basis to make a considered choice of meal. Consideration should be given to providing the service users, particularly the more able ones, with tureens during the main meal so that they can help themselves and thereby further their independence. The staff nominated as ‘key workers’ should be provided with an opportunity to have direct input into the development and review of the service users’ care plans. The guttering at the front of the property should be free of obstructions. Consideration should be given to providing service users with emergency call operating facilities that does not require making inappropriate modifications such as the use of ties. It is suggested that the call system should be accessible from anywhere in a service user’s room particularly if they are prone to falling. Consideration should also be given to the use of ‘personal pendant alarms’ for the more frail service users. The ‘deadlocks’ on the service users’ bedroom doors should be replaced with one of a more suitable design that enables staff to have access in an emergency. All bedroom doors should be fitted with an appropriate lock with the occupants of the rooms able to decide whether or not to use them. Confirmation should be provided for the Commission for Social Care Inspection that staff have received training in first aid procedures and that there is always a qualified first aider on duty at all times. Confirmation should be provided for the Commission for Social care Inspection that the electrical systems have been serviced and are safe. Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Lavender House Retirement Home For The Elderly DS0000019688.V321563.R01.S.doc Version 5.2 Page 27 - 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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