Inspection on 14/03/06 for Lawfords House

This inspection was carried out on 14th March 2006.

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

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

Other inspections for this house

Lawfords House 19/08/08

Lawfords House 22/08/07

Lawfords House 15/02/07

Lawfords House 19/06/06

Lawfords House 05/10/05

Lawfords House 20/01/05

Lawfords House 02/08/04

Lawfords House 28/03/04

Lawfords House 05/02/04

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Heathlands

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Bank House

Inspirations

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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 Lawfords House Walford Road Ross-on-wye Herefordshire HR9 5PQ Lead Inspector Wendy Barrett Unannounced Inspection 14th March 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 Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 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. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lawfords House Address Walford Road Ross-on-wye Herefordshire HR9 5PQ 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) 01989 566811 01989 566811 Miss Mary Eileen Wilson Mr Peter Donald Vine Mrs Jill Madley Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The Home may continue to accommodate the 3 named service users who have needs that fall outside the schope of the registration category OP. This is conditional on regular review by the Registered Persons to ensure the Home is able to meet all needs without detriment to other service users. 2. A minimum of 3 care staff (excluding the Manager) must be deployed on the morning shift. 3. A minimum of 2 care staff (excluding the Manager) must be deployed for the afternoon shift. 4. Sufficient ancillary staffing must be provided additional to these core care staff. 5. The registered persons must inform the Commission without delay if any of these service users move out of the home 6. The Registered Manager will complete the additional training needed to obtain the Registered Manager`s Award - within 12 months of registration. 7. (Met) 8. The Registered Providers will support the registered Manager in achieving conditions 6 and 7 by funding and faciliating attendance at courses and ensuring that suitable management cover is provided at Lawfords House. Date of last inspection 5th October 2005 Brief Description of the Service: Lawfords House provides a home for 15 people over the age of 65. The accommodation is provided in a medium sized period house about a mile from Ross on Wye town centre. The house is a converted building and is in need of some refurbishment and upgrading. The registration categories for the service were reduced during 2004 to better reflect the care needs the Home is set up to cater for. In particular this involved the removal of the categories relating to care of people with dementia illnesses, mental health needs and physical disability (other than for people already resident at the Home). Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 9am and 1.30pm. Some comment cards had been left at the home during the last inspection. There have been 4 responses received from G.P.’s, 2 from relatives and 1 from a district nurse since the last report was written. Responses were received in October so they are not particularly up to date, but they were generally positive. The Care Manager was at work throughout the inspection. The Deputy Manager, a Senior Care Assistant and a relief cook also assisted. There was an inspection of various records and documentation maintained at the home and also reference to correspondence held on the Commission’s service file. Residents were met during a tour of the home although formal interviews were not conducted this time. The inspection focused on action taken to comply with previous requirements and a number of key National Minimum Standards that were not covered at the last inspection. What the service does well: What has improved since the last inspection? The Providers have been in correspondence with the Commission since the last inspection regarding their plans to upgrade the premises. The Care Manager has made impressive improvements to everyday management. Medication management, care planning and health and safety measures have been developed well. Staffing levels have been increased to make sure the residents needs can be met at all times. The way that staff are recruited has been developed so that there are necessary checks to make sure the applicant will be suitable to work with Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 6 vulnerable adults. Existing staff have received training to help them protect residents by knowing how to recognise and report possible abusive behaviours. There is better attention to infection control procedures. 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. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 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 Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The home manages medication in a way that protects residents, including those who prefer to self-administer. EVIDENCE: The Care Manager has implemented a new medication policy and related procedures. The Commission’s pharmacy inspector, who has undertaken two inspections since the Care Manager was appointed, has approved these. There was good evidence that safe procedures were being followed. A new medication trolley and controlled drugs cabinet were fixed safely to an internal solid wall. The home also has a dedicated refrigerator for storing drugs. All staff (except two recent recruits) have completed a Boots pharmacy training course and some have completed a more extended training course. Records and stock were inspected. There were examples of good practice e.g. specimen list of staff signatures, variable doses defined on administration records, boxes and bottles labelled with ‘start’ dates, transcribed entries checked by two staff who initial the handwritten entry. A sample of controlled drugs stock was counted. The balance was accurately recorded in a controlled drugs register. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 10 Safeguards were in place for a resident who prefers to administer his own medication. These included risk assessment, safe storage in the bedroom and monitoring of usage through records of receipt and administration. An oxygen cylinder was secured and a warning sign posted. A risk assessment relating to the oxygen had been shared with the affected resident and signed by the resident. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 and 15 The Care Manager and staff have worked hard to encourage residents to build relationships with each other, their families and with the staff, and their efforts are improving the quality of life for the residents. Although the meals are served with attention to residents needs and preferences there is not enough attention to maintaining a well-equipped, clean kitchen for storing and preparing the food. EVIDENCE: A Senior Care Assistant felt that there had been progress in structuring the work routines so that residents can follow more flexible lifestyles while still receiving the help they need. The Care Manager has prepared a display of activity programmes and was waiting for a notice board to be fixed up. The programme showed a variety of opportunities for residents to pursue group or more individual activities. When the inspection started two residents were eating their breakfast in the dining room. One was enjoying a boiled egg and the other was eating a cereal. This suggests a relaxed approach to the start of the day with a choice of breakfast menu available at a time to suit the individual. A letter of appreciation was pinned to the office wall. It had been written by the relative of a resident who had been cared for at the home until death. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 12 The Care Manager led a tour of the home. During this time at least two residents were observed welcoming her presence and seeking reassurance e.g. a recently bereaved resident and a blind resident. They obviously knew the Care Manager well and trusted her. A relief cook was at work and helped with an inspection of the catering arrangements. There were records showing that residents are offered alternative choices of meals. Some records of temperature checks were available but others were not being kept up to date. This is particularly concerning since one of the refrigerators was known to be faulty although it was still being used to store milk. All the records kept in the kitchen need to be more tidily stored so that they are readily accessible to all staff who may need to use them. The cook was familiar with residents’ individual dietary needs and preferences e.g. one resident would prefer a salad for lunch rather than savoury mince. Another resident was observed having lunch in her bedroom. Fresh vegetables were being used for lunch. Opened foods were being properly covered and date labelled. The kitchen furnishings and equipment were not being maintained well. (see Environment section of this report). Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The staff have received instruction to help them protect residents from abuse. EVIDENCE: Written guidance on adult protection procedures was displayed on the notice board in the office. A Senior Care Assistant had received written information from her employer. She, and other staff, had also attended a training session provided by the local authority co-ordinator for the protection of vulnerable adults. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The premises are homely due to the small size of the home but require improvement and refurbishment in a number of ways to improve the comfort and privacy and quality of life of residents and the working conditions of staff. EVIDENCE: The Commission has been in discussion with the Providers for over 5 years regarding necessary improvements to the premises. As part of this negotiation the Commission has required the providers to present a business plan for the next three years indicating the arrangements in place for financing an extension to the premises and the expected start date for the extension. There continue to be examples of a need to invest in improvements to the premises and furnishings. Temporary arrangements for laundry facilities, agreed with the Commission and Environmental Health Department, have not received further attention. The office continues to include a main thoroughfare through the home. This seriously affects privacy and confidentiality. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 15 External doors to the home were in need of attention to woodwork and paintwork. It was difficult to identify the main entrance door into the home because there is no signage. The poor condition of the entrance doors does not offer a positive introduction to the home. One of the floor cupboard doors in the kitchen was missing when this inspection took place. Unit surfaces, cutlery drawers, the microwave, window paintwork and blind were in need of cleaning. The cook explained that one of the refrigerators was faulty and was only being used to store milk. The fridge should either be repaired or replaced. An Environmental Health Officer had inspected the home in December 2005. Some recommendations were made in a report that was seen at the home. The deficiencies identified at this inspection indicated that at least some of the necessary work has not been addressed. The Commission has notified the Environmental Health Officer regarding the condition of the kitchen at the time of this inspection. Some of the furnishings provided in communal areas at the home are not best suited for residents who have mobility or continence difficulties e.g. height of seats, soft coverings. The recent introduction of separate staff to prepare teas reduces the risk of cross infection. This was not the case when care staff had to deal with care and catering duties at the same time. There were other examples of good attention to hygiene e.g. a senior care assistant had completed an Infection Control course, paper towels, liquid soaps and protective clothing were available at the home. A new dishwasher had been purchased since the last inspection. The general condition of the kitchen at the time of this inspection, and the shortfalls in the premises already described, indicate further work is necessary to meet the required standards. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 There have been changes in staffing and recruitment arrangements since the last inspection that have ensured there are enough staff to respond to the needs of the residents and new staff are thoroughly checked to make sure they are safe to work with vulnerable adults. EVIDENCE: Staffing levels have now been improved in compliance with a requirement arising from the last inspection. Care assistant and kitchen/general domestic staff levels have been increased to provide a minimum of 2 care assistants available for personal care at all times through the day. A kitchen domestic is now employed on 6 days a week for tea preparation. Sundays were not covered in this way but this is reasonable given that this tends to be a quiet day at the home e.g. no scheduled baths for care staff to deal with. The Provider submitted copies of recruitment policy and procedures as part of a response to the last inspection report. These properly addressed current legislative requirements regarding the protection of vulnerable adults (POVA). The personal file of a recently recruited staff member was inspected at the home. The documents seen in the record confirmed a satisfactory process of selection e.g. completed application form containing declaration of criminal convictions, written references including one from most recent employer, criminal records bureau and POVA register check. The employee had received copies of a job description, terms and conditions statement and person specification. This evidence indicates a satisfactory process of recruitment. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31and 33 The Care Manager has established some effective systems to improve the way the home is run. The Providers need to be more proactive in supporting the Care Manager with this work to improve the quality of the service. EVIDENCE: The Care Manager has completed a course that equips her to assess individual manual handling situations. This shows compliance with a condition of her registration. She has also started work on her Registered Manager’s Award. There are references in this report of work undertaken by the Care Manager to improve the overall service. There has been significant improvement as a result of her efforts. The last inspection report states ‘the Providers must also take responsibility for monitoring progress’. This view is repeated on the basis of evidence reflected in this report. There were documents to confirm routine servicing of essential equipment at the home e.g. fire system, stair lift, and call bell system. The Care Manager Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 18 had arranged these since her appointment. She had also written a new Health and Safety policy and introduced regular audits of the premises safety and infection control arrangements. A report of her findings had been sent to the Provider. Testing of portable electrical appliances at the home was being done but it was unclear when a check of the hard wired electrical installation had last been done. There is a requirement made for the Provider to confirm that this has been done within the last five years. Accident records at the home confirmed that the Commission had been kept informed of all events that are notifiable under the Regulation 37 of the Care Homes Regulations 2001. The Provider has submitted reports of monthly visits to the home (Regulation 26) for December and January. There are, therefore, reports for November 2005 and February 2006 missing for the period since the last inspection. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 1 x x x x x x 1 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x x x x Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 20 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. 2 3 Standard OP15 OP15 OP37 Regulation 23(2)d 23(2)c 26 Requirement A cleaning rota must be introduced to ensure the kitchen is kept clean. The missing kitchen cupboard door and the faulty refrigerator must be repaired or replaced. The Providers must supply the Commission with regular monthly reports of visits to the home to show how they are fulfilling their responsibilities to oversee the service. Freezer and refrigerator temperatures must be checked and recorded daily. The Provider must provide the Commission with evidence of the most recent check of the electrical installation at the home. Timescale for action 31/03/06 31/03/06 31/03/06 4 5 OP38 OP38 13(4)c 23(2)b 31/03/06 30/04/06 Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations Any programme of refurbishment should address the replacement of soft furnishings e.g. suitable height seats, easily cleaned coverings. Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lawfords House DS0000024721.V286701.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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