Inspection on 22/08/07 for Lawfords House

This inspection was carried out on 22nd August 2007.

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 15/02/07

Lawfords House 19/06/06

Lawfords House 14/03/06

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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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 Denise Reynolds Key Unannounced Inspection 22nd August 2007 08:05 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.V342313.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. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 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 F/P 01989 566811 lawfordcarehome@yahoo.co.uk 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.V342313.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate 3 named service users who have needs that fall outside the scope 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. 15th February 2007 Date of last inspection Brief Description of the Service: Miss M Wilson and Mr P Vine (the service providers) and Mrs J Madley (the manager) are registered in respect of Lawfords House to provide accommodation and care for 15 older people whose main care needs are due to the physical ageing process. They may not accommodate people whose main needs are due to the effects of dementia illnesses or mental health problems. The accommodation is provided in a medium sized period house about a mile from Ross on Wye town centre. The town is within walking distance for people living there who have good mobility or use mobility aids such as motorised scooters. However, as in most of Ross, the route is not level. The house is a converted building and is in need of refurbishment and upgrading. Two of the bedrooms have been set aside for use as an office and an on-call room for staff. This means that no more than 13 residents can be accommodated at present. Ross-on-Wye is a market town and most of the people who move to Lawfords House are local people who have lived in the area for many years or have moved there to be nearer to relatives. The current range of fees for Lawfords House is from £365 to £395. Additional charges are made for transport, hairdressing, chiropody, magazines and newspapers. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection – this is an inspection where we look at a wide range of areas covered by the National Minimum Standards. A specialist pharmacy inspector also went to the Home to inspect the way staff manage medication. To help us plan the inspection we looked at information in the Annual Quality Assurance Assessment (AQAA), which Mrs Madley had filled in and improvement plans sent to us after the previous two inspections. We also took into account what people told us in survey forms; we received these from eight people who live at the Home, four relatives and four professionals who visit the Home. During the visit we spoke privately with three people in their rooms. We looked at the accommodation and spoke with Mrs Madley and some staff. We inspected various records including a sample of care records and staff records. What the service does well: People receive clear information about Lawfords House to help them decide if it is the right place for them to live. They are encouraged to visit the Home as often as they want before they move in and feel that the staff are welcoming and helpful. People living at Lawfords House feel well looked after by staff and have their health care needs attended to. They feel that they are treated as individuals and enjoy the friendly atmosphere. ‘They are really wonderful and look after my parent really well and my family and friends are always welcome whenever we go it is really clean and tidy with no smells of any kind and my parent is always clean hair cared for and we could not wish for better care.’ ‘The general atmosphere is warm and happy and the staff always pleasant………. The meals are varied and very good.’ ‘The staff create a friendly relaxed atmosphere. There is often laughter and a cup of tea.’ They are encouraged and helped to stay in touch with people they know outside the Home and their visitors are made welcome. People are given Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 6 opportunities to make choices, this includes having a choice of food and whether to eat privately or with other people. ‘I feel very happy here staff are always willing to help.’ ‘The carers are prepared to spend time playing cards, bingo etc with the residents. Visitors are always made to feel welcome.’ ‘If they ask we try to oblige .. it’s one of the good things about it being a small Home’ People told us they know how they can complain if something is wrong and would not worry if they needed to do this because they have confidence in Mrs Madley. Staff are trained to understand how to recognise abuse and neglect and how to use adult protection procedures to report this. ‘I have not found need to raise concerns.’ ‘It is always possible to discuss any problem with staff.’ People can personalise their rooms and feel that the house is clean. What has improved since the last inspection? What they could do better: Miss Wilson and Mr Vine need to be better at identifying things that need to be done and dealing with them quickly. They could do this by making better use Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 7 of the monthly visits that the law requires them to make and combining this with other quality assurance measures. They need to have a financial plan to make sure resources are used effectively. Staff need to continue to improve the care records so that these provide a strong foundation for the care that people living at Lawfords House receive. Arrangements for the management of medication need to be improved to make sure people are safeguarded from the risk of errors. The furnishings, décor and garden need to be improved so that people do not have to ‘make do’ with inadequate facilities. Poor facilities in the kitchen and unfinished alterations in the laundry make it harder for staff to maintain food safety and hygiene standards. We have informed Herefordshire Council Environmental Health Officers about this. Miss Wilson and Mr Vine must act promptly when staff tell them that equipment is faulty. Because two former bedrooms have been allocated for use as an office and a staff on call bedroom, the maximum number of people that can live at Lawfords House is 13. Miss Wilson and Mr Vine do not want to apply for their registration to be reduced because they plan to build an extension to compensate for the lost rooms. They need to give us firm, detailed proposals with this with timescales for the work to be done so that we can consider this. 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. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 8 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.V342313.R01.S.doc Version 5.2 Page 9 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, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are given information about the Home to help them decide if it is the right place for them to live. People are able to visit as often as they want before making a decision and feel that the staff are welcoming and helpful. EVIDENCE: People are given clear information to help them decide whether to move in to Lawfords House. We spoke to a new resident who told us she had been given a copy of the service user guide and had received a contract. She had visited the Home before making a decision about moving in and told us that to begin with she is staying for six weeks so she can be sure it is what she wants. At previous inspections people have told us that they were made very welcome by Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 10 staff when they arrived and the new person we spoke to this time was also very happy with how staff had helped her to settle in. Mrs Madley told us in the AQAA and when we spoke to her at the Home that she always meets people to find out about the care they need and encourages people to stay for a six week trial stay “before they make any big decisions on their future”. A relative told us that communication was good – ‘Very good communication.’ And a social care professional commented ‘We have found that provided people are placed appropriately and enjoy the close proximity and cosy environment they enjoy Lawfords House.’ Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 11 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, 9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Lawfords House feel well looked after by staff and have their health care needs attended to. People at the Home are treated as individuals by staff who are polite and respectful. EVIDENCE: People living at Lawfords House told us that they feel well looked after by the staff there. One person told us that something she really appreciates is that when she rings her call bell for assistance the staff always come quickly. She said this makes her feel better. Another person told us about how hard Mrs Madley and the staff work to make sure he and other people are looked after. During the inspection we saw that staff had time to spend with people and that they did not rush them to do things. We spoke to Mrs Madley and two care Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 12 staff about the care people need; they were well informed and spoke about each person with emphasis on them being individuals with different needs. They also showed the sort of caring attitude that people living in the Home told us about. The survey forms also gave us information about how people are looked after. Peoples’ answers to the questions asked about the care given gave us more evidence that people feel well looked after, for example – ‘Very caring if there is a problem.’ ‘The staff appear to have a good working rapport with GPs chiropodists, support workers etc. They also spend time listening to family and friends of the individuals residing there.’ ‘I can only comment on the two individuals with whom I am involved, who are supported, reminded and helped to take their medication, it is administered but in a very gentle and respectful way.’ ‘It would appear that individuals needs are the core of the care packages devised, seeking the individuals input wherever possible.’ One professional commented that at times they are not consulted early enough but this was not reflected in the other information we found. There are systems for making sure that people have their own clothes returned to them when they have been washed and we saw that people looked clean and well cared for. During the July floods the Home accommodated two people who had had to leave their homes; some clothing was bought for them at this time. We saw that this was being stored in a drawer that contained some other miscellaneous items of clothing. Mrs Madley assured us that this is only used ‘for emergencies’ such as the flood situation and never as general stock. As well as observing and talking to people we also looked at the written records about the care each person needs. Some of these records are very good, for example we saw some good descriptions of the care people need, their likes and dislikes and the contacts they have with family and friends. This is an area that Mrs Madley and the staff have worked hard to improve. We saw that some elements of the care records need to be improved further as recognised by Mrs Madley in the AQAA. We pointed out to her some of the things we found – Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 13 We noted that there were good risk assessments about specific things staff need to know to provide safe care but these could not always be cross referenced with the main care plan. Some of the care plans have not been reviewed recently, for example, we saw one that was last reviewed in November 2005. We found a guidance sheet in a care record for a medical condition the person does not have. We saw that the manager has created a form to help assess the level of help each person needs if the building ever needs to be evacuated. The staff we spoke to could describe how one person would need to be helped if there was a fire. This information had not been filled in on the form; adding this would help make sure that other staff are just as aware of what to do. We asked staff about the care given to a person who has specific nutritional care needs and found that they could tell us about these with confidence. WE saw that the person looked well nourished. The written information about the person’s care, nutrition and weight needs to be more detailed. This is to make sure that all of the staff are fully aware of the care the person needs. Pharmacists inspection 20/8/07 Lawfords House receives most medicines in a monitored dose system with printed charts for staff to record the medicines administered. There are generally records of medicines received, administered and disposed of to help make sure there is no mishandling. When staff make handwritten changes or additions on the charts they sign that they have done this and a second person checks and also signs. Some changes had not been signed in this way and the dates of these changes or additions were not always recorded. With one exception medication was in stock. We found a small number of gaps in the medicine administration records. We counted a sample of peoples’ medications and found the correct amounts were there. This indicates that although staff had not signed they had given the medication correctly. Most medicine containers seen had opening dates written on the labels, this is good practice to make sure stock is rotated properly and helps with audit checks. The correct arrangements are in place for the disposal of medicines no longer needed. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 14 There are safe storage arrangements and staff keep records of the temperature in the medicine fridge. There are suitable arrangements in place for storing and recording controlled medicines. After some investigation (as some of these medicines had been put in another safe) we found that the medicines in stock balanced correctly with the entries in the record book. Staff assist one person to self-administer all medication and there is a written risk assessment about this. We spoke to this person who showed us the suitable storage arrangements in his room. He said ‘Jill (the manager) looks after me very well’. Mrs Madley told us that nobody had dietary, fasting or religious needs that could affect the administration of medicines. Only staff who have attended training about the safe handling of medicines administer medicines. One carer had recently attended a course and described suitable procedures for the measurement and administration of medicines. This person was not on the list of staff authorised to administer medicines so this needs updating. There is a medicine policy and procedures so staff know how the Home expects medicines to be managed. Discussions with one carer confirmed this. Mrs Madley said she reviewed this policy recently; the new date should therefore be added. Mrs Madley said she checks the medications at various times but there was no written evidence of these audits. This would be good practice to follow. The following points are noted for attention – • There were missing records for the receipt of some medicines found in stock. • Medicines that remain in the monitored dose system packs are not recorded if they are not used and returned to the pharmacy. • The medicines sent into hospital recently with one person had not been recorded in detail. These records are needed to provide a complete audit trail to demonstrate correct handling. • On the morning of the inspection there appeared to be no paracetamol tablets in stock for one person following the morning dose. We made Mrs Madley aware of this. • There appeared to be records of 34 more tablets administered than had been received in stock, which indicates some inaccuracy in these particular records. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 15 • • • • • • • • The times when paracetamol containing medicines are given must be reviewed, as there must be at least a four-hour interval between doses. The times for administration printed on the charts do not always allow a 4 hour interval particularly at night when the printed times are 1800 and 2100 which is too short. We found two examples where the full name was missing or the wrong dose was written on handwritten medicine chart entries, which means that although people were receiving the right medicines in the future if needed it would not be possible to know exactly what was given. Make sure that the description of the medicine is copied exactly from the medicine label so that it is always clear what medicine is being used. We saw no information describing to staff how to use medicines prescribed to use ‘as required’ or with a variable dose. The manager described how one particular medicine was used but this needs to be in a written form so that all staff are quite clear about how the medicines should be used. Records and care plans for application of treatments to skin areas needs improving. This is so that it is clear what treatment needs applying and when and there is then a clear record of when this has been applied by carers. Records should be kept of when medicines are handed over to the person who self medicates to look after himself, again as part of the audit trail to show that medicines in the home as looked after properly. Records for the receipt of these medicines must also be made. The pages in the controlled medicine record book need to be headed up with the name of the person as well as the full medicine name and strength. Where liquid medicines are recorded it is better to keep one page per bottle rather than keep adding on new stock volumes to the existing stock balance. This makes it easier to reconcile the correct stock balance. There was more of one liquid medicine in stock than the records indicate but this was an accumulation over several weeks of measuring 5ml doses. Correction fluid should not be used in this book any changes necessary being made by explanatory notes. The keys to the medicine storage areas must always be kept safely on the person of an authorised staff member. On the inspection morning these were in a box of dressings by the medicine trolley, which is not safe. The medicine reference book was the March 2004 edition. Staff need access to an up to date reference source about the medicines they administer. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 16 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Lawfords House feel they are treated as individuals and enjoy the friendly atmosphere. They are encouraged and helped to stay in touch with people they know outside the Home and their visitors are made welcome. People are given opportunities to make choices; this includes having a choice of food and whether to eat privately or with other people. EVIDENCE: People have the opportunity to take part in a range of activities that the staff arrange such as sing-alongs, bingo, and craft sessions. We also saw that staff spend time with individual people having conversations with them and helping them go out for walks. We were pleased that staff asked us to wait before we spoke to them because they had promised to take someone out for a walk. Mrs Madley has arranged for one person to continue with a regular social activity Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 17 by hosting this at the Home once a fortnight. We also found examples of people being supported to keep links with the local community. In our surveys people told us that they are mostly happy with the things provided to help pass the time and made some comments about this. These are the comments written in the surveys about activities at the Home ‘There is but I don’t always want to take part.’ ‘I choose not to take part in most of the activities except Bingo.’ ‘The carers are prepared to spend time playing cards, bingo etc with the residents. Visitors are always made to feel welcome.’ ‘It would be nice to have a little more entertainment for residents such as a visitor from outside for people who have no family visiting and a little shopping or help if needed.’ Mrs Madley would also like to increase the variety and frequency of things they can offer people and would like to have an activity organiser to help with this. We saw that the cook works hard to give people a choice of foods. The daily menu is displayed on the dining tables for people to see and each morning care staff ask them what they would like to have. We saw that staff take time to explain what is on offer and give people time to think what they want. The cook meets new people to find out about their likes and dislikes and endeavours to provide what people like. She told us ‘if they ask we try to oblige .. it’s one of the good things about it being a small Home’. At present there isn’t anyone at the Home who needs different food because of their culture or religion; the cook said if someone did she would ask them about this and would go to the library to get any information she needed. Recently, a person staying for a short stay asked for a breakfast cereal they did not have so they bought this for her. Another person has specific cold drinks provided because she doesn’t like hot drinks. People choose whether they eat in the dining room or privately in their own room. People also have a choice about the time they eat, for example, on the day we were there we saw people having breakfast from 8am until after 9am. One person said she likes being able to see how she feels each morning before she decides what time to have breakfast and whether to have it before or after she gets dressed. The cook has recently done an NVQ level 2 in cookery and would like to do more training. She understands that older people need good nutrition and is aware of people in the Home who have specific dietary needs. Adequate arrangements are in place for the cook to order food. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 18 People we spoke to were very positive about living at Lawfords House; one person told us he feels comfortable and safe and has his needs met, he is able to have the food he wants and take part in activities if he wants to. All of the people who sent a survey form back to us said they ‘always’ enjoy the food and one person commented – ‘They are very good, I really enjoy them.’ One person who visits the Home felt the regime is regimented but we saw no signs of this and people who live at the Home told us that things are very relaxed there. People who live at the Home told us they think it is a friendly place and that they like the staff a lot. The staff also told us they are happy there. One new staff member told us that she had been made very welcome when she started. In the surveys, people made these comments – ‘The general atmosphere is warm and happy and the staff always pleasant………. The meals are varied and very good.’ Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 19 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, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People feel safe living at Lawfords House and are given clear information about how they can ask for concerns to be looked into and put right. Staff are trained so that they understand how to recognise abuse and neglect and how to use adult protection procedures to report this. EVIDENCE: People living at Lawfords House and their relatives know that they can speak to Mrs Madley if they have a concern and know about the written complaints procedure. Most people told us that they have had no need to use this ‘Don’t need to complain.’ ‘Jill the care manager is always available to talk to.’ ‘It is always possible to discuss any problem with staff.’ ‘I have not found need to raise concerns.’ ‘We have had no concerns about my parent’s care, as they are wonderful and she could not be better looked after.’ Professionals who have contact with the Home wrote in their surveys that problems are put right willingly - Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 20 ‘There have been various initial hiccups ie bed height for one individual, meal preferences, own newspapers – these have all been successfully resolved.’ ‘Obviously there have been service users who have voiced dislikes or problems but we have not encountered any major issues and the home has made every effort to resolve any problems.’ We told Mrs Madley that it is important to use the complaints record for things that are sorted out in this constructive way because it can contribute to their quality assurance and provides evidence of good management. All of the staff have annual training to understand the signs of abuse and neglect and how they can report things that concern them. We asked the two care staff we interviewed about this training. Both had really enjoyed it and said it had really made them think. They told us about one of the scenarios they were given on the course and about the rights and wrongs of the situation they were asked to discuss. Both were able to correctly tell us what they would do if they felt they should report a concern about the safety of a person living in the Home. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 21 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): 19,16 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People can personalise their rooms and feel that the house is clean. Some redecoration and refurbishment has been done but more work is needed to the house and gardens more attractive, comfortable and safe for the people who live there. EVIDENCE: People who come to live at Lawfords House are able to bring their own things with them if there is space in their room. They like being able to have their own belongings and we saw lots of photographs, pictures and other belongings used by people to make their room their own. One person has bought new furniture for his room to make it how he wants it. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 22 In the surveys people who live at the Home told us that the Home is ‘always’ or ‘usually’ clean and fresh. Relatives contributed the following comments – ‘Lawfords House is well run and kept fresh and clean.’ ‘Whenever we go it is very clean and tidy with no smells of any kind.’ Although there was one area where we noticed an unpleasant odour we also saw that cleaning staff were working hard and that regular shampooing of the carpets is included in the cleaning regime. Miss Wilson and Mr Vine arranged for an electrical check of the wiring in 2006 in response to a requirement by us. Rechargeable torches are available in the event of a power cut. The outside of the house has been repainted and repairs made to an area of roof that had been leaking. Inside, the manager and staff have recently redecorated the main sitting room and the dining area. They told us that visitors had commented on how much better it looked; people living at the Home also said they liked it and appreciated the hard work of the staff who had done the work. Mrs Madley told us that ten new beds and headboards have been purchased and that all the beds have new mattresses. Two rooms have second hand hospital type bed frames. We saw one of these and pointed out that the mattress was several inches shorter than the base. Further work is needed to improve the standard of décor and furnishings throughout the building. For example, some of the chairs in the sitting room are quite worn, especially on the arms. Staff have recently shampooed these to improve their appearance and make sure they are clean. In their improvement plan in January 2007 Miss Wilson and Mr Vine told us they would buy two new chairs each month. They have not acted on this. There is an adequate supply of linen which is stored in a wardrobe on the first floor landing; Mrs Madley is hoping that this will soon be replaced with a purpose built cupboard. She also wants a cupboard on the first floor to be converted into a utility room with a sluice facility so that they can improve infection control measures in the Home. We saw that there is a large pile of rubbish in a corner of the garden; this looks unsightly this needs to be safely disposed of. Two dilapidated benches Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 23 were seen in the garden – we considered that they would not be safe for people to sit on. The entrance hall has been used to display information about food and activities in the Home and photographs of the staff with their names. This has been done attractively and helps give an impression of a friendly place on entering. Some of the photographs and information about staff is out of date and needs to be changed. When we went into the kitchen to talk to the cook about meals we saw that there are several things that need to be put right quickly, these are – • • • • • The records for June, July and August showed that fridge has been running at a temperature too high to be sure that food is stored safely The inside of the microwave is rusty The fly screen is torn leaving a hole that flies can get through Some of the cupboard doors are loose and ill fitting An island table used for food preparation has a hole in the laminate surface Records in the kitchen showed that these have been reported to Miss Wilson and Mr Vine. Mrs Madley was not able to tell us what plans there are to correct these things. We have referred these concerns to Environmental Health Officers at Herefordshire Council. There have been lengthy negotiations with Miss Wilson and Mr Vine about the inadequate laundry. During 2006 we involved Environmental Health Officers from Herefordshire Council and an infection control specialist from the Health Protection Agency in these discussions. Since then the laundry has been altered and instead of building a new laundry as they said they were going to do they have decided to build a new office and bedroom. Herefordshire Council and the Heath Protection Agency have informed us that the changes made to the laundry make it safe, although both recommend that a new purpose built laundry would be preferable. We observed that some of the work needed to ‘make good’ following the alterations has not been finished. Paintwork has not all been finished and new flooring has not been laid. The current flooring has areas where dirt could be trapped. During 2006, Environmental Health Officers from Herefordshire Council supported us in saying the office had to be moved. This was because the old office provided no privacy and posed a health and safety risk due to the lack of Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 24 space. The new office is located in what used to be a bedroom. It offers privacy, security for records and reasonable working environment for the manager. Another former bedroom is used for staff on call at night; previously they slept on a sofa in a sitting room and we told Miss Wilson and Mr Vine that this had to stop. Using these two bedrooms in this way means the house now has two less bedrooms. We pointed out to Miss Wilson and Mr Vine that they should request a reduction in their registration because of this. In their AQAA they have told us they have not done this because of the extension they are planning to build. They will need to give us more information about their plans and how long this is going to take so that we can decide if this is acceptable. We need this information in writing because they have often told us they are planning to make improvements but have not acted on what they have said. Mrs Madley confirmed that maintenance checks and servicing of equipment is up to date; we could not confirm this because records of some of these checks were not available. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 25 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are given enough time when staff help them with their personal care and feel safe and well looked after. Staff recognise the importance of spending time getting to know people and see each person living at Lawfords House as an individual. Recruitment practice is sufficiently robust to protect against unsuitable staff being employed. Staff training is adequate but needs further investment so that staff knowledge and skills continue to develop. EVIDENCE: Our observations during the inspection and the things people told us satisfied us that the care and domestic staffing levels are adequate to meet the personal care needs of the people who live at the Home at the moment. We noticed that staff take their time when they are helping people and talking to them, they don’t rush people or forget to come back to them if they have to go and do something else. People living at Lawfords House told us they like that staff and when we were at the Home we saw that the staff are approachable and friendly. When we talked to staff they were very knowledgeable about people living at the Home Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 26 and able to describe the things people need staff to help them with. One of the staff we spoke to described what she thought of working at the Home – ‘There is time to spend quality time with people – you can really get to know them here – what they were when they were my age’. She went on to describe the staff as ‘lovely, lovely caring people’ Comments that people added to their surveys supported this ‘The staff work really hard. Very happy with the care manager she is always happy and willing to help.’ ‘The staff create a friendly relaxed atmosphere. There is often laughter and a cup of tea.’ Four of the ten care staff have NVQ level 2 or 3 and one is planning to start this. At the previous inspection we found that staff training had improved with a programme of regular updates for staff in mandatory health and safety related courses such as first aid and moving and handling. However, the first aid training for some staff has recently expired. Mrs Madley and staff are exploring opportunities for free courses to arrange to renew this. There is no set training budget for Mrs Madley to use and no planned annual training programme. The surveys from professionals indicated good communication although one person highlighted that some staff appear inexperienced; they had not seen signs of ‘teaching’ being given. Mrs Madley is aware of the importance of broadening the range of training topics covered to include things that relate to peoples’ care needs (eg diabetes awareness) and is hoping to provide more training in future. A recruitment file was checked. These records were satisfactory. We advised Mrs Madley that it is good practice to keep written records of interviews for equality and diversity monitoring and to give her somewhere to record that she has checked gaps in employment and reasons for leaving previous care related employment. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 27 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, 33, 34, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mrs Madley works hard to improve those aspects of the service within her responsibilities and limited financial scope. Effective quality assurance measures and financial investment by Miss Wilson and Mr Vine are needed to support the manager in improving the overall quality of service that people living in the Home receive. EVIDENCE: Mrs Madley has completed the Registered Manager Award and has three years experience of managing this Home. This is the longest that a manager has Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 28 stayed at Lawfords House; this has helped to stabilise and improve the service provided. Mrs Madley has asked people for their views and comments about the Home using questionnaires; the results of these have not yet been analysed or developed into an action plan. Mrs Madley knows she needs to do this to make the exercise useful but explained that she has not had time. A comments book is available by the front door with a request for people to contribute their views but so far only one person, a visiting professional, has done so. The entry, written by a healthcare professional commented on the excellent communication at the Home. We looked at the records for the reports of unannounced monthly visits that the law says Miss Wilson and Mr Vine must do. These visits and reports are an important way for them to make sure they are fulfilling their responsibilities by identifying and acting on things that need to be put right. The most recent report they had written was for May 2007. There were no reports in the file for March, April, June or July 2007. We were unable to check if they had done their monthly visits for these months. We found that Mrs Madley was finding it hard to do all of her work. For example, the records in the fire log were not up to date and some other records were not available or took time to find. A comment made in one of the surveys suggested that some administrative support is needed at the Home and we would tend to agree with this. There is no evidence that Miss Wilson and Mr Vine have a working business and financial plan that they keep under review to help them prioritise spending. For example, we asked them to include information in their AQAA about their intentions for upgrading of the accommodation. Apart from the following entry, made by Mrs Madley, they did not do this – ‘Miss M E Wilson has also stated that their intentions of more refurbishments of the home is ongoing.’ It has been our experience that Miss Wilson and Mr Vine only improve things when we or other regulators tell them they must. Mrs Madley’s ability to act on her own initiative is limited by having no direct control over spending at the Home other than a weekly petty cash allowance. We saw records indicating that this amount is just under £50 a week. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 29 Accident records at the Home confirmed that Mrs Madley has informed us of events such as accidents and serious illness that the law says we must be told about. Staff training in health and safety related areas is arranged but we found that updates for first aid training are overdue. Protective clothing and hand gel is provided to staff to help in the prevention of cross infection. Liquid soap dispensers and paper towels are in place in the communal toilets. As described in the environment section, Mrs Madley wants a utility room installed on the first floor so that staff do not have to wash commode pots in hand basins. We asked Mrs Madley how they deal with people’s spending money. She told us that relatives help most people with this. If people want to keep money in the office it is kept in the safe and a record kept of any spending on the person’s behalf. We saw that there is a current insurance certificate at the Home. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 30 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 1 3 X X 2 Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 31 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 OP9 Regulation 13(2) Requirement When any medication is administered or applied to people who live in the Home this must be at correct dose intervals and clearly and accurately recorded. There must be written information in place to clearly describe how to use any medicines prescribed to use ‘as required’. This will help to make sure people receive the correct levels of medication. There must be complete and accurate records off all medication received into or leaving the home so that there is a complete audit trail to help make sure there is no mishandling. Timescale for action 30/09/07 2 OP9 13(2) 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000024721.V342313.R01.S.doc Version 5.2 Page 32 Lawfords House 1 2 3 4 5 6 7 8 9 10 Standard OP7 OP7 OP7 OP7 OP9 OP9 OP9 OP19 OP19 OP19 11 12 13 OP26 OP30 OP33 14 15 OP34 OP38 You need to make the information in the risk assessments and care plans consistent with each other to make sure staff have clear information to refer to. You should make sure that regular reviews of each persons’ care take place and that this is noted in the written records for staff to refer to. Only guidance relating to the individual needs of a person should be included in their written records. Information in the care plans needs to be detailed enough to explain to staff the specific care a person needs. You should keep records of medicines given to the people who look after their own medication. You should improve the way records are kept in the controlled medicine record book as described in the report. You should provide access to an up to date authoritative medicine reference so that staff have up to date information about medicines they use. You need to develop a structured plan for upgrading the premises with an allocated budget and timescales so that the standard of the accommodation improves. You should replace or repair the furnishings and equipment in the kitchen that are faulty and/or damaged. You need to make the garden tidier and more accessible to people who live at the Home; you need to remove rubbish and replace garden furnishings that are in a poor state of repair. You need to finish the outstanding work in the laundry to make it easier for staff to keep clean and hygienic. You should have a planned annual training programme supported by a budget identified for this purpose so that staff training is kept up to date. Miss Wilson and Mr Vine should support Mrs Madley in developing effective ways to monitor quality in the Home. They should use the information obtained to help them improve the accommodation and service they provide. They should be making their monthly visits and reports an integral part of this process, particularly for the things that have a direct impact on the health, safety and welfare of people who use the service. Miss Wilson and Mr Vine need to have a business and financial plan for the Home so that improvements to the service are planned and financed effectively. You need to make sure that records of maintenance work, safety checks and servicing of equipment is available at the Home and readily accessible. Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park Worcester WR3 7NW 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 Lawfords House DS0000024721.V342313.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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