Inspection on 05/10/05 for Lawfords House

This inspection was carried out on 5th October 2005.

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

The inspector 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 14/03/06

Lawfords House 20/01/05

Lawfords House 02/08/04

Lawfords House 28/03/04

Lawfords House 05/02/04

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

CARE HOMES FOR OLDER PEOPLE Lawfords House Walford Road Ross-on-wye Herefordshire HR9 5PQ Lead Inspector Denise Reynolds Unannounced Inspection 5th October 2005 14.10 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.V256233.R01.S.doc Version 5.0 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.V256233.R01.S.doc Version 5.0 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.V256233.R01.S.doc Version 5.0 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. The Registered Manager will undertake moving and handling training at a level that equips her to monitor the competence of staff practice and undertake service users` moving and handling assessments - within 4 months of rgistration. 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. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 5 Date of last inspection 20th January 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.V256233.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection on a weekday afternoon. Resident and relative comment cards were left with the manager to distribute. A small number were received before the report was written, any others received will contribute to the planning of the next inspection and the subsequent report. Similarly comment cards have been sent to health and social care professionals in preparation for the next inspection. During the inspection, care records were looked at and there was discussion with the manager. One resident was spoken to individually and others seen whilst they were taking part in a game of bingo. Two resident were invited to speak to the inspector but did not wish to do so. Being unannounced, the range and depth of the things looked at during this inspection were to some extent limited by other demands on staff time. The manager was just going off duty when the inspector arrived and very helpfully stayed to assist with the inspection. What the service does well: What has improved since the last inspection? A Statement of Purpose and Service User Guide have now been produced and are available to current and prospective residents. Residents have also now been given updated terms and conditions documents. Care plans have been improved a lot as has the information gathered about the care needs of prospective residents. Provided that this work continues to develop, the quality of the service provided will be enhanced. Overall there are indicators that the Home is benefiting from a period of increased stability arising from the current manager staying in post longer than most of her predecessors. The manager is being supported in improving standards by the deputy manager and the staff team. The Providers have stated their intention to build on recent improvements. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 7 What they could do better: Care plans are not all being reviewed monthly – this is important to make sure that the content always reflects the current care needs of residents. Staffing in the afternoons needs to be improved so that care staff do not have to leave their care duties to prepare tea and clear the kitchen up afterwards. This not only takes their time away from residents but also increases the risk of cross infection. Clear recruitment procedures need to be produced and implemented to make sure that residents are protected from unsuitable staff being employed. The premises need to be improved in a number of ways. General upgrading and refurbishment of the building and furnishings is needed as well as some specific things that need structural work. Briefly, these are – • Provision of suitable laundry facilities (temporary improvements have been accepted by CSCI and Environmental Health as a short term solution only) to ensure good infection control arrangements and a safe working environment. Provision of an office to replace the current location in a main thoroughfare through The Home. The current arrangement means that some residents and their visitors have to use it as a corridor between their bedrooms and the communal rooms. The space to walk through is limited and at the same time the working space is restricted. There is no privacy for discussion about things that may be confidential and limited security for records. Suitable accommodation for staff on call at night who in the past have had to sleep on a sofa in a sitting room. As a short-term measure while the Home has vacancies, staff are using a vacant bedroom. • • The Providers need to use their visits and reports under the requirements of Regulation 26 more effectively to ensure that they identify shortfalls and work with the manager to address these. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 8 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.V256233.R01.S.doc Version 5.0 Page 9 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.V256233.R01.S.doc Version 5.0 Page 10 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): 1, 2 and 3 Prospective residents are provided with information about the Home to help them decide if it is the right place for them. The Home gathers suitable information to enable them to decide if they are able to meet the needs of people referred to them. EVIDENCE: A satisfactory statement of purpose and service user guide have been completed. These are written in a friendly, easy to read style and are designed to answer the questions that prospective residents are likely to have to help them decide if the Home is the right place for them. The Manger has reviewed the standard contract for residents and she confirmed that every resident (or, where necessary, their next of kin) has been given a copy to sign and also has a copy in their file. The records for the most recently admitted residents showed that social services and/or the Home’s own assessment had been used in deciding whether the Home was able to meet the needs of the people concerned. A review had already been held for one person who had expressed their Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 11 satisfaction with their first few weeks at the Home and had decided that they wished to stay. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 12 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): 7, 8, 10 Considerable improvements in the standard of care planning and recording have taken place; continued developments in this area will help to ensure that residents’ care needs are met consistently and to a high standard. EVIDENCE: The manager has streamlined the care plan documentation so that each resident’s records are now in the same format making it easier to find information needed. Risk assessments in relation to topics such as moving and handling, pressure area care and nutrition are being established and whilst there is further work needed the progress is good. The introduction of sheets to record healthcare visits improves the information available about how healthcare issues are being dealt with and during this inspection provided evidence of good reporting and follow up by staff. It was noted that some parts of the care plans have not been reviewed for several months; it is important that the improvements made overall are not let down by the plans becoming out of date due to this. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 13 It was noted that some social needs recorded in the pre admission assessment seemed not to have been acted upon; however, in discussion the manager was able to confirm that was in hand but had not been written in the records yet. She acknowledged the benefits of doing so to inform staff of work going on ‘behind the scenes’ to organise things for the resident’s benefit. Staff were seen to be polite and caring towards residents and there was a very friendly and relaxed atmosphere. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 14 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): 12 Progress is being made towards providing group activities, this is helping residents build relationships with each other and staff; further work on enabling residents to enjoy individual activities will further enhance their quality of life. EVIDENCE: On the afternoon of the inspection 2 staff organised a game of bingo. About half the residents joined in with this. Staff worked very hard to make this an enjoyable session. One of them did the ‘calling’ while the other went from resident to resident helping them check their numbers but also encouraging them to join in with the ‘calls’, and teasing the ‘caller’ when she got in a muddle. As a result the room was full of chatter and laughter and the residents were all playing an active part in the activity. A resident who in the past spent most of her time in her room is now coming down to the sitting room for part of each day. She watched from a distance but was also drawn in by staff who involved her in the conversation and patiently answered her questions about the game. In comparison with previous inspections residents appeared more alert and interested in their companions and surroundings. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 15 Steps were underway to obtain ‘talking books’ for a resident – progress towards this was not noted in the care records and the importance of doing so to keep people informed was highlighted with the manager. Staff had bought a birthday present for a resident that reflected the person’s love of horses; it would be good to see the person’s care plan developed to reflect this more, e.g. by setting up plans to make sure she knows when a horse related TV programme she might enjoy is on, by renting a video with a horse related theme or by seeing if she would like a relevant magazine delivered to the Home. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 16 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): 16 Residents and/or their relatives are provided with information about who to contact if they have a concern. EVIDENCE: Each resident’s file now contains a copy of the complaints procedure and a complaints record form for completion by staff in the event that a concern is brought to their notice. The manager confirmed that no complaints have been received since she has been in post. No complaints have been received by CSCI during this period either. Comment cards received from residents confirmed that they know who to speak to if they have a concern. Comment cards from relatives gave mixed responses about whether or not they know about the Home’s complaints procedure. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 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: There are a number of outstanding premises improvements that have been the subject of negotiation with the providers for more than 5 years. To date they have failed to act on undertakings they have made to start work on these. The areas that require structural work to put them right are – • Provision of suitable laundry facilities (temporary improvements have been accepted by CSCI and Environmental Health as a short term solution only) to ensure good infection control arrangements and a safe working environment. Provision of an office to replace the current location in a main thoroughfare through The Home. The current arrangement means that some residents and their visitors have to use it as a corridor between DS0000024721.V256233.R01.S.doc Version 5.0 Page 18 • Lawfords House • their bedrooms and the communal rooms. The space to walk through is limited and at the same time the working space is restricted. There is no privacy for discussion about things that may be confidential and limited security for records. Suitable accommodation for staff on call at night who in the past have had to sleep on a sofa in a sitting room. As a short-term measure while the Home has vacancies, staff are using a vacant bedroom. In addition the premises are in need of refurbishment and the much of the furnishings and décor needs updating. Following 3 meetings between CSCI and the Providers this year the current position is as follows – • The Providers have informed CSCI that they are submitting a planning application to Herefordshire Council for an extension to address the structural changes described above and to provide 5 additional bedrooms. This application is based on plans drawn up in 1999. These will need to be revised to reflect current National Minimum Standards for Care Homes for Older People. CSCI has not yet received revised plans. The Providers have stated their intention to upgrade the premises in conjunction with the construction of the extension. • The Providers have been asked to submit their business plan for the next 3 years indicating the arrangements in place for financing the extension to the premises and the expected start date for the extension by 31st October 2005. This is included as a requirement in this report. Current staffing arrangements increase the risk of cross infection due to care staff moving from care to kitchen duties during their shift Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Involvement in some catering duties reduces the amount of time that staff have for looking after the residents. There are no clear written recruitment procedures to ensure that residents are protected by the expected checks on their suitability. EVIDENCE: Attempts to recruit staff to prepare, serve and clear up after the afternoon meal have been unsuccessful. This means that the care staff on duty have to undertake this work. This has implications for their availability to attend to residents and also gives rise to risk in relation to infection control because they have to prepare food having previously been helping residents with personal care. Requirements are again made regarding this aspect of the service – an enforcement notice is not being served this time because the manager had tried, unsuccessfully to recruit kitchen staff. The reasons why this was unsuccessful need to be looked at and a solution found. A realistic timescale has been given to allow enough time for this to be resolved; the possibility of enforcement action will be reviewed if this timescale is not met. The Manager had not had time to start work on a recruitment policy for the Home – this was a requirement in the previous inspection report. The Providers had not picked this up in their reports under Regulation 26. However, no new staff had been employed in the meantime and in fairness it may have been that correct procedures would have been followed. In recognition of this, the Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 20 requirement has been repeated but on this occasion an enforcement notice is not being served. If the new timescale is not met this will be reviewed. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 The manager is working hard to establish effective systems to enhance and support the friendly atmosphere at the Home. Development of the newly introduced quality assurance system is needed to make sure that areas for improvements are acted on. The Providers need to be more proactive in fulfilling their responsibilities so that the manager is better supported. EVIDENCE: Positive areas written about in other sections of the report are an indication that the manager, supported by the deputy and staff team are working hard to improve the standard of the service provided at the Home. It is positive that the current manager has stayed longer than most of her predecessors over the last 10 years; this has provided the Home with a period of stability that it has not had before. There are still areas to be dealt with as already written about in this report and whilst it is acknowledged that the current manager is moving forward the Providers must also take responsibility for monitoring progress. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 22 For example, it is concerning that the lack of progress with producing a recruitment policy for the Home and the slippage in reviewing care plans had not been addressed by the Providers in their Regulation 26 reports. They should have been working with the manager to find the reasons for these shortfalls and discussing how they could support her in this work. Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 x 29 1 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.V256233.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 13 Timescale for action Arrangements for kitchen 31/10/05 staffing must ensure that the risk of cross infection is minimised. Afternoon staffing levels must 31/12/05 allow for – • A minimum of 2 care assistants being available exclusively for residents’ personal care • Designated kitchen staff The Manager must integrate the 31/12/05 2004 amendments to Regulation 19 and the guidance in annex C of the DofH POVA guidance into the Home’s recruitment policy and procedures. All of the staff related 31/12/05 information detailed in Shedules 2 and 4 must be available for each person employed at the Home. (Not reviewed during this inspection – brought forward with new timescale) Requirement 2 OP27 18 3 OP29 17 and 19 4 OP29OP27 17 and 19 Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 25 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 OP33OP37 Good Practice Recommendations The Providers need to make more effective use of their responsibilities under Regulation 26, for example by monitoring compliance with requirements and recommendations. It is important to keep on top of the monthly reviews of residents care plans so that they are kept up to date and reflect residents’ current needs. 2 OP7 Lawfords House DS0000024721.V256233.R01.S.doc Version 5.0 Page 26 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.V256233.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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