Inspection on 19/01/09 for Lavenders

This inspection was carried out on 19th January 2009.

CSCI found this care home to be providing an Excellent service.

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

Lavenders 06/02/07

Lavenders 19/01/06

Lavenders 12/10/05

Lavenders 01/09/04

Lavenders 04/05/04

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Old Hastings House

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Springfield House

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St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lavenders Lavenders Road West Malling Kent ME19 6HP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Lavenders Lavenders Road West Malling Kent ME19 6HP 01732844744 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Keith Robert Webb,Mrs Madeleine Ellen Webb care home 59 Number of places (if applicable): Under 65 Over 65 59 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Up to 59 older people can make their home in Lavenders (the Service). The property is a detached older house, to which large extensions have been added. The accommodation is divided into wings. These are called Regency, Lavinia and Boswell. Each wing has two lounges and two dining rooms. There are a number of bedrooms on each wing. People will usually use the lounges and dining rooms nearest to their bedroom but they dont have to. Everyone has their own bedroom. All of the bedrooms have wash hand basin. All but two of the bedrooms have a private toilet. Nine bedrooms also have their own walk in shower. Each of the wings has got shared use bathrooms and toilets. One of these bathrooms has got a walk in shower. Care Homes for Older People Page 4 of 36 Brief description of the care home Ten bedrooms are on the first floor. There are stair lifts that give step free access to these areas. There is also a call bell system. This has call points in each of the bathrooms and toilets. There are also call points in all of the bedrooms and their private bathrooms. This means that people can ring for assistance. The Service is in a quiet residential street. Its within normal walking distance of West Malling high street where there are various shops and public transport services. The Service doesnt have its own vehicle. The Registered Providers are private individuals. If you want to find out more about the Service and about the fees charged, you can phone the Service and speak with the Business Manager or the Manager. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 3 Star. This means that the people who use this Service experience excellent quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was Key Inspection. We arrived at the Service at about 9 oclock and were there for about nine hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Providers in their self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with eight of the people who live in the Service. We also spoke with one of the Care Homes for Older People Page 6 of 36 Business Manager. He represents the Registered Providers and the Manager reports directly to him. We spoke with the Manager, with the deputy care manager and with two care workers. We also spoke with the assistant chef and with a kitchen domestic. When were looking at financial things we worked with the Office Manager. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Lavenders. Seven of the people who live there and eight members of staff kindly sent them back to us. Later on in our report, well tell you what people say in these questionnaires. The Registered Providers have done their own questionnaires. They have asked the people who live in the Service and their relatives to say what they think. This process was ongoing at the time of our visit and not all of the questionniares have been received back yet and collated. As we go through our report well tell you some of the things that people who live in the Service are saying to the Registered Providers. What the care home does well: What has improved since the last inspection? What they could do better: The way in which the care plans are currently presented may make it difficult for some people who live in the Service to access them and to know whats in them. The recruitment system is generally robust. However, some additional references need to be held for one care worker to comply with updated regulations. Most care workers have done a good deal of training. However, there are some gaps. This means that some care workers have not done training courses that the Registered Providers have said are necessary. A better system to monitor staff training would Care Homes for Older People Page 8 of 36 ensure that all staff have the training updates they require. There are shortfalls in the fire safety training for a few staff and some records on checking fire safety equipment have not been completed . These might reduce the level of protection available in the Service. The above issues were discussed with the Business Manager. He has said that they will be addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to Lavenders is the right thing for them. She also talks with family members and with people like care managers (social workers). All of this information is collected so that the Manager can build up a really good picture of how the person can best be supported. After shes got all of this information, she can then decide if Lavenders can meet the persons needs for help. Care Homes for Older People Page 11 of 36 Evidence: We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things are being considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person needs to be helped to say what they want. The Manager says that when she gets the information she shares it with care workers. This is done so that care workers know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential care setting is a big step. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit Lavenders. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because they been in hospital and arent quite ready to go home yet. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. The Manager is aware of this. She says that people are helped to make any arrangements that are necessary for them to go home as planned. This has recently been done for one person who is due to go home quite soon. The Manager has been working with a relative so that when the person goes home they will have the support they need to manage okay. Care Homes for Older People Page 12 of 36 Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Some people might need more help to read and understand their individual plans of support. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person needs special help to Care Homes for Older People Page 14 of 36 Evidence: use the toilet and another person is having to be cared for in bed. A third person likes to have their bed arranged in a particular way so that they can display ornaments on it. We asked two care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it. In our questionnaire, we ask, do you receive the care and support you need? Three people say that they usually do and four people say that they always do. The former people dont say anything about why they are answering in this way. One of the latter people says, this is a kind and caring home. The Registered Providers questionnaire asks, how do you rate the quality of care? Most people, who have returned questionnaires so far, say that its good or excellent. The support plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews. This is when the Manager checks out with the care workers how things are going and what might need to be changed. As weve already said the support plans are very detailed. While this is useful for members of staff it can make it difficult for the people who live in the Service to fully appreciate whats being said about them. The Manager recognises this to be an issue. Shes going to look into what can be done to make the whole process more straightforward and more user friendly without loosing the detail that leads to good quality individualised care. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been visits by other professionals such as district nurses. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire we ask, do you receive the medical support you need? Six people say that they always do. One person says that they usually do. Five people handle their own medication. Care workers help them to do this. They order medication for them and they make sure that theyre not running out. Also, they check out with them now and then that things are going okay. Most of the people who live in the Service prefer to have members of staff to manage medication for them. Care Homes for Older People Page 15 of 36 Evidence: There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a system to make sure things like eye drops dont go beyond their use by date. Also, there are special security arrangements for some medicines. The Assessment says that all members of staff who give out medication have been trained so that they know what theyre doing. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. We asked a senior care worker about bits of this procedure to see if they know what it says. They do. There is a record that is completed on each occasion that a medicine is given. We examined six sets of these records for a period of four recent days. They are correctly completed. We looked at five medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. We found that medication is managed and recorded in a safe way. People say that the care workers are courteous and attentive. In our questionnaire we ask, do the staff listen and act on what you say? Everyone says yes. In more detail, one person writes, the staff listen to what you have to say and are helpful. When we were in the Service we talked with people a lot about this. They are very positive about the care workers. One person summarises the general mood in their comments to us. They say, the girls are really, really kind and helpful. You wonder what a place is going to belike before you come in, dont you? But I neednt have worried. Ive only ever experienced kindness. I feel quite safe here and well cared for. The Registered Providers questionnaire asks, what are your overall impressions of the home? Most people, who have returned questionnaires so far, say that theyre good or excellent. Care workers are relaxed and informal in how they are. Things are orderly without being too much so. For example, we were around when afternoon tea was being served. We saw a care worker not rushing at all. Instead, she stopped to chat with each person as she gave them their tea. She talked about everyday things such as the weather and whats on television. It was reassuring to see the same care worker going into the kitchen specially to get some skimmed milk. She did this because one person only likes their tea this way. Its little things like this that can make a real difference to peoples everyday lives. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People Care Homes for Older People Page 16 of 36 Evidence: can use the phone if they want. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Manager says that the plan is that on most weekdays there is a social thing that people can do. These events are organised by the activities coordinator. She is around most weekdays. She invites people to join in with a number of small group activities such as doing quizzes, games and craft work. She also sees people on a one to one basis. At these times she will do things such as manicures. The Assessment says that the activities coordinator is involved in the recreational/activities part of the care planning process and (that she) ensures that new residents wishes regarding social activities are accommodated where possible. She assists new residents to feel part of the home by introducing them to other residents and including them in regular activities. There are also outside entertainers who come in every week or so. They do things such as playing music and dancing. Care Homes for Older People Page 18 of 36 Evidence: Each month there is a newsletter called Down Lavenders Way. This gives a summary of news about the Service and it says what social activities are coming up. Its well written in a pleasant easy to read style. We think its a very good idea. Theres a record kept of the social things each person has chosen to do. We had a look at two of them to see what sorts of things the people concerned did during last December. They seem to have done quite a lot of things. These include things like watching Scottish dancing, watching a slide show, doing some exercises, listening to music and playing games. In our questionnaire we ask, are there activities arranged by the Service that you can take part in? Six people replied. Three people say that there usually are things for them to do and three people say that there always are. The former people dont say any more about it. One of the latter people says, this is varied and meets most peoples needs. From entertainment to mental and physical exercise. Another person says, (there are activities) regularly three days each week. The enlisting of the activities coordinator has resulted in a wide range of activities and hired entertainers. The Registered Providers questionnaire deals with this subject too. It asks, how do you rate the social activities? Most people, who have returned questionnaires so far, say that theyre good or excellent. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Providers dont get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Instead, most people get help from members of their family. The Assessment says that people are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like being home. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. Some people chose to dine in the privacy of their bedrooms. One of the questions we ask in our questionnaire is, do you like the meals? Six people say that they usually do and one person says that they always do. Most of the former people dont say much more about this subject. However, two of them do. One says, (there is) a wide and varying range of dishes, but naturally some appeal to me more than others. The second person says, Care Homes for Older People Page 19 of 36 Evidence: the menus are varied and the kitchen staff always will arrange a personal choice. The Registered Providers questionnaire also asks about this subject. It says, how do you rate the choice of meals provided? Most people, who have returned questionnaires so far, say that the choice is good or excellent. Theres another question that asks, how do you rate the quality of the meals provided? Again, most people answer good or excellent. We asked people about the meals when we were in the Service and the answers are positive. One person sums it up when they say, the meals are really good here and its all really well cooked. We have a good cook and that makes all the difference. Some people have asked the Registered Providers to change particular things about the catering arrangements that dont suit them. Two people have asked to have their plates warmed before their meal is served. Two other people have special dietary requirements. Theyve asked to have a wider selection of special puddings that meet these needs. The Business Manager says that both of these requests will now be met. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is reasonable balance. The dishes include things like barbeque chicken, vegetable pasta bake, fish fingers, soup and a variety of omelettes. Care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. There is a complaints procedure but it needs to be strengthened. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place that are designed to safeguard people. Evidence: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. In our questionnaire we ask, do you know how to make a complaint? Six people say yes and one person says no. One of the former people adds, I have no complaints and requests are usually acted upon. The Registered Providers questionnaire asks, how do you rate our response to any complaints or comments you may have had cause to make? Most people, who have returned questionnaires so far, think that its been good or excellent. The Registered Providers also ask, how do you rate the ease of contacting the manager or a senior member of staff? Again, most people say that its good or excellent. There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Its the Registered Providers responsibility to sort out complaints. However, people can also tell us about things that are concerning them so we can, if appropriate, ask the provider to investigate their concerns. . This isnt clearly explained in the current Care Homes for Older People Page 21 of 36 Evidence: procedure. The Business Manager is going to sort this out by 1 March 2009. Its very important that people are confident that theyre safe. We asked some care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. The people who live in the Service say and show us that they feel safe in Lavenders. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. The accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building is well maintained on the outside and the gardens are neat. They are on the level and so theyre quite easy to get around in the summer. On the inside, the accommodation is well decorated and furnished. Although its a large building that has some quite long corridors, the place has a homely, lived-in feeling to it. The Registered Providers questionnaire asks, how do you rate the cleanliness of the home? Most people, who have returned questionnaires so far, say that its good or excellent. At the moment, there are various training certificates and posters put up on some of the walls. Some people find it reassuring to know that these things are in place. However, we think that they take away from the homely feeling of these areas. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system meets the national standard. The Registered Providers have a system of doing Care Homes for Older People Page 23 of 36 Evidence: regular fire safety risk assessments. This is where someone goes around the place to check out that everything is still working in the right way. We looked at the record of the most recent one. It says that one or two things needed to be sorted out. We understand that since then, theyve all been done. Its a good idea for the assessment to be sent to the fire brigade people. This is so that they can have a look at it to check that its detailed enough. The assessment is due to be updated quite soon now. After this is done, the Business Manager is going to send it to the fire brigade. This is going to be done by 1 March 2009. The people from the local Department of Environmental Health called to look at the kitchen in 2007. We looked at their report. It says that the kitchen has got five stars out of possible five. This is an excellent rating. The report says that this means that there is, a very high standard of food safety management. It looks at things such as the cleanliness of the kitchen and the way that food is handled and prepared. We looked in the kitchen too. Its well equipped, clean and well organised. People who need it are helped to get about. There are baths with hoists. This means that there is a seat that goes up and down. With some of them you can sit on the seat outside the bath, then it can be raised to go over the side of the bath before its lowered once youre over the bath. There are two mobile hoists that can be used in the bedrooms. They might be needed if someone cant manage at all to get out of bed. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. There are no banister rails in the corridors. The Business Manager and the Manager say that they arent necessary. They also say that if they were fitted they would take away from the homely atmosphere they are trying to create. We accept that banister rails can take away a bit from the appearance of an area. However, our experience is that some older people find them to be very helpful and reassuring. The Business Manager says that he is going to ask everyone who lives in the Service if they would like to have banisters fitted. When someone moves into the Service, the Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what Care Homes for Older People Page 24 of 36 Evidence: theyre doing. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has two commercial grade washing machines. These have an extra cycle for items that need an especially hot wash. There is a large dryer. We looked in the laundry and its well organised and clean. New rules have been introduced to help make sure that used water doesnt leak back from things like washing machines into the drinking water supply. It looks like the Service already meets these rules. However, just to be on the safe side the Business Manager is going to contact the local water supply company to find out. Hes going to do this by 1 March 2009. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are enough care workers around. Care workers know what theyre doing. However, some care workers have not had the training thats planned for them. There are some gaps in the security checks that have been completed for a new care worker. Evidence: Its a big service and so telling you about how its staffed can be a bit involved. Basically, there are six or seven care workers on duty from early in the morning until the night staff come on duty. The care workers are divided up between the wings. However, they can work in another of the wings if someone needs them there. There is always a senior care worker on duty. They are in charge of each shift. In addition to the care workers, there are other people around. They do most of the housekeeping or they work in the kitchen. There is a waking staff presence on each wing at night. There are special security arrangements at night. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Everyone says that they always are. In our questionnaire for staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Six people say usually and two people say always. One person Care Homes for Older People Page 26 of 36 Evidence: adds, I think the level of staff is good. The only day where we have been really short staffed was due to sickness that was not foreseeable. When we were in the Service we kept a look out for things that might give us a clue about how well the place is being staffed. We noticed that two people who asked to be helped to use the toilet were assisted straight away. Another thing we looked at was the time taken to answer the call bells. We looked at two occasions when it went off. On both times it was answered in less than half a minute. Thats good. The Manager says that all of the shifts are being reliably filled. We looked at the written roster for a recent week to check this out for you. The roster confirms what the Manager is saying. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Providers complete a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for two care workers who have been appointed since our last inspection. Most of the checks that we need to see have been done. However, two more references are needed for one care worker. This is because they have worked in care posts before they came to Lavenders and the Registered Providers need to know why they left them. The Manager is going to sort this out by 1 March 2009. More generally, she is going to check that there are no similar references outstanding for any of the other care workers who have been appointed since our last inspection. She is going to do this by 1 June 2009. The Assessment says, we continue to hold and maintain the Investors in People Award, which we attained in 2005. This award proves that we value our staff and recognise them as one of the biggest assets to our business. This Award is about how well members of staff are trained and supported in their work. The Manager says that new care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? One person says partly, two people say mostly and five people say very well. One person says, I was shown around the home, which was nice, before starting the job. However, someone else says, I had very good training. However, I still feel I should have had more training specifically moving and handling and infection control before I was left by myself. There is a checklist of the subjects that new care workers are told about. We looked at one of these checklists and that has recently been completed. It shows that important things are being covered. For example, new care workers are told about the individual Care Homes for Older People Page 27 of 36 Evidence: support plans we spoke about earlier. They are also shown how to help people get about safely. The Manager says that this initial training is just to get the care workers started and theres a lot to learn after that. The Assessment emphasises how important this is when it says, the level of training that we invest in our staff directly affects the quality of care that they deliver to our residents. Training is ongoing and reflects the changing needs of our residents. The Manager says that all care workers are expected to do regular training in important subjects. For example, in how to safely support people move about, in basic first aid, in keeping people safe and in infection control. She says that most of this training is done by trainers coming to the Service on a regular basis. We looked at the records of who has done what courses and when. The records show that most care workers have done training in how to safely help people get about. However, there is no recorded training for six care workers. The training that one care worker has done is out of date. Five care workers are not recorded to have done training in infection control. Four care workers have not done training in keeping people safe and four more have done training that is out of date. In our questionnaire we ask staff, are you being given training that is relevant to your role and that keeps you up to date with new ways of working? Everyone answers yes to this question. Several people then comment in some more. One person says, constant upgrades and training are always available. Another person says, very happy with courses and training. We think that it would be a good idea for the Manager to review who has done what training. This is so that any gaps can be sorted out. When doing this, it would be helpful for her to have a look at a new national model. This is all about how to assess what skills and knowledge care workers actually have already. When its used in the right way it gives a good idea of what additional training each person might need. Its quite a big piece of work to do. The Manager says that she is going to complete it by 1 December 2009. Theres a total of 29 care workers employed in the Service. Of this number, 17 have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. Six more are about to start studying for the Award. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Manager says that all new care workers will be encouraged to study for the award. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they Care Homes for Older People Page 28 of 36 Evidence: know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38. In general things are well managed. People are asked what they think. People are helped to buy what they want. There are sensible health and safety things. However, there are shortfalls in the system of fire safety checks. Evidence: The Manager has a good knowledge of how things are going. The Assessment says that the manager holds the relevant qualifications to run the home. This statement is not completely accurate as she has only one of the two qualifications that are required for people managing residential care settings. These qualifications are important. This is because they are designed to help managers ensure that high quality support is reliably provided. She now needs to do the other qualification. The Business Manager says that this will now be done. Care Homes for Older People Page 30 of 36 Evidence: The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every couple of months or so. We looked at the records of the sorts of things that are being discussed. Theyre practical and relevant. For example, care workers have recently talked about how they go about supporting people to maintain their continence. Also, they have noted that its important to make sure that meal times arent rushed. In our questionnaires we ask staff, do the ways you pass information about people who use the Service between staff (including the manager) work well? Five people say usually and three people say always. Only one of the former people comments further about this. They say, we are all human. Things can get missed but the procedures in place try to eradicate this. Its really important that the people who live in the Service have a direct say on how things are going. After all, theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. In addition to this informal thing, there are also house meetings. These are events when anyone can attend and can tell the Manager how they think things are going. We looked at the records of the most recent of these meetings. People raised a variety of interesting things. For example, people asked for the front door to be closed more quietly. Each year the Registered Providers ask the people who live in the Service and their relatives to fill in the questionnaires that we have already told you about. We think that this is a very useful thing to do. After our inspection, the Business Manager gave us some more information about the quality assurance system. He says that, the responses we receive are discussed and reviewed and the outcomes are communicated with everyone (residents, relatives, visitors and staff) in a number of ways including the monthly newsletter, residents forums, staff meetings, written communication and one to one meetings. The Service doesnt hold any money for anyone. Instead, it helps some people by paying for things for them and then sending a bill to their families about once a quarter. We understand that each of the people concerned and their relatives have agreed to this in advance. We looked at the records for one person. We wanted to see if the amounts claimed to have been spent are reasonable. We also wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Things are in order. Each care worker meets on a regular basis with someone senior. This is so that they can have a chat how things are going at work. They can also discuss things like Care Homes for Older People Page 31 of 36 Evidence: training needs and any new systems that have been introduced in the Service. In our questionnaire we ask, does you manager meet with you to give you support and discuss how you are working? Everyone says that this is happening regularly. The Manager says that regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. However, when we look at the records there are gaps. The Manager says that the maintenance man will put this right from the date of our inspection. She says that in future he will also record the monthly checks he is said to be doing of the emergency lights and of the fire extinguishers. At the moment, these arent being recorded at all. More detailed checks of the fire safety equipment are completed every now and then by an engineer. The Manager says that there are regular unannounced fire drills. Members of staff confirmed this account. However, the records in question couldnt be found so we cant tell you for definite when the last one was. We have asked the Manager to make sure that in future the record is easy to find. There is a system to double check that each member of staff knows how to follow the Services fire safety procedure. This training is more detailed than the things that are done in a fire drill. We looked at the records of the last training session. Most care workers were present. However, we worked out that at least three people are overdue on their annual training. The Manager is going to introduce a new system. This will involve checks being done every six months that everyone who works in the Service knows what to do about fire safety things. She is going to do this by 1 March 2009. The first people to be included in this new system will be the three people we have told you about. There are up to date reports from engineers about the gas appliances, the electrical installation, the mobile hoists and the stair-lifts. They say that everything is in good working order. We looked at the record of accidents that have occurred in the Service over the past month or so. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem that is causing the accidents. The Business Manager says that he and the maintenance man regularly check the accommodation. They do this to make sure that nothing is broken. Also, they want to see that there are no hazards that might cause someone to have an accident. They dont really have a set list of things to check and there isnt an organised way to record these checks. This is fairly unusual especially for a service as big as Lavenders. Being a bit more organised about it might help make sure that things dont get missed or overlooked. We kept our eyes open when we were walking around. We didnt notice Care Homes for Older People Page 32 of 36 Evidence: any particular hazards. Care Homes for Older People Page 33 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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