Inspection on 12/03/08 for Lawn House Care Home

This inspection was carried out on 12th March 2008.

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

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

Other inspections for this house

Lawn House Care Home 13/02/07

Lawn House Care Home 22/11/05

Lawn House Care Home 21/07/05

Lawn House Care Home 17/02/05

Lawn House Care Home 07/10/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Lawn House Care Home 4 Lawn Road Portswood Southampton Hampshire SO17 2EY Lead Inspector Jan Everitt Key Unannounced Inspection 12th March 2008 10:00 Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 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 Lawn House Care Home DS0000037558.V360814.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 Adults 18-65. 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. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawn House Care Home Address 4 Lawn Road Portswood Southampton Hampshire SO17 2EY 02380 584911 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) lawn.house@craegmoor.co.uk Craegmore.co.uk Park Care Homes (No 2) Ltd vacant post Care Home 10 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 10. Date of last inspection 13th February 2007 Brief Description of the Service: Lawn House is a large detached home which provides long term residential care for up to 10 adults who have a learning disability. The home is close to local shops and amenities, there is also good public transport links to Southampton city centre. Lawn House is run and owned by Park Care Homes (No2) Ltd of Craegmoor Healthcare who provides services to vulnerable children and adults across England and Wales. The accommodation is organised over two floors with a third floor that is not used for service user access. There are 10 single bedrooms all with en-suite WC, shower or bath. Three bedrooms are on the ground floor and seven on the first floor. On the ground floor there is an entrance lobby and hall leading to the kitchen and dining room, which leads to the lounge area where there are French windows onto the garden that can accommodate people who have mobility difficulties. To the rear of the lounge is a small activities area. There are four shared toilets for service users, one bathroom and one wheelchair accessible shower on the ground floor. The home has stairs and a shaft lift to the upper areas of the accommodation. There are also two small Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 5 mezzanine areas. Staffing is provided 24 hours a day, with currently one awake staff and one sleep-in staff at night. The lowest fee for a week is £832:93 and the highest fee being paid is £1907:00. The actual fee charged depends on the assessed needs of individual service users and levels of support required. Service users pay extra for their personal items and any outside entertainment they wish to attend. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 star. This means the people who use the service experience good quality outcomes. The site visit to Lawn House took place on the 12th March 2008 and was carried out over one day by one regulatory inspector. The current manager, Lucy Chidothe, assisted throughout the inspection. Most of the service users were at home at the time of this visit and were able to be spoken with. Those not were at day centre. Three relatives were visiting the home and were spoken with. A tour of the home took place with the permission from the service users, who were happy to allow us to view their bedrooms and communal areas. Surveys ‘Have your Say’ had been distributed to 8 service users, 8 relatives, 8 staff and two visiting health professionals. On this occasion 6 service user surveys, 3 relatives, 5 staff and one visiting professional, returned them to the CSCI and information from them is used for this report. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally people living in the home consider their needs are met and are very satisfied with the service. A sample of records was looked at. At the time of the inspection the home was accommodating 9 residents. One service user was from an ethnic background. What the service does well: This service offers a relaxed and supportive home to service users with friendly and caring staff who treat service users respectfully. The home does well to support its residents with dedicated hardworking and skilled staff and a manager who are very caring and sympathetic to the needs of people with mental health and learning difficulties. Each resident has a personal plan that identifies their strengths and needs and provides clear information for staff on how to meet these needs. The residents are supported to develop their independent living skills and are encouraged to access the community for educational, occupational and leisure pursuits. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 7 The home provides an open and inclusive environment for the residents to live, where they can express their views and are encouraged to make choices and decisions about their daily lives and participate in the decision making of the home in general. The home as far as feasibly possible and when the residents will allow, assists them to maintain a healthy lifestyle and supports them when required to attend health care appointments. The home provides a comfortable, clean and safe environment for the people who live there and they say they are able to have their rooms decorated with the colour of their choice. Resident’s bedrooms reflect their individuality and hobbies and interests. Staff are well managed and trained, and provide a good standard of care for people, some of whom have high care needs. The interactions between the staff and the residents are warm and friendly and staff pay a good deal of attention to respecting peoples’ dignity and Comments on the surveys said: Its good here. Nice and quiet sometimes but not all the time because people are playing up. I like doing shopping and going out with staff. I like it when people take me out and push my wheelchair. I would like the house redecorated and have new settees. A survey received from a health professional who visits the home commented that: The staff will seek advice if a skill deficit is identified by them as a training need and will seek advise when required. The staff support clients well in their activities. The staff surveys returned indicates that the staff enjoy their role and are positive about the care the residents receive and about the service in general. However, at the time of the surveys going out, the home did not have a manager to lead them and this was supported by some of the comments made on the surveys. Comments on staff surveys say: The standards of care are high and there is a low turnover of staff which means continuity of care, we are like a large family. The service could do better by having a good manager. We are very short staffed but still support the service users to do most of the activities they wish to do. The service supports me to work well. The home is a very happy environment and feels welcoming to come to work. The staff need to be listened to and supported better. The home needs a good manager who will listen to staff. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 8 We try to make the residents feel at ease and happy. Allow us to spend more time working with service users and not doing paperwork. Listen and support staff better. I sometimes feel unsupported by managers. I have never had supervision with manager. The service does well in listening to the service users and giving them choices on what they want and promotes service users . However, the staff spoken with at this visit now say they feel well supported by the manager and she is always available to speak to. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to assess the needs of service users before admission to the home. EVIDENCE: The AQAA stated that a new assessment tool and personal centred planning is now in place and that the home invites potential service users to visit the home and stay overnight, before they make the decision about becoming a resident in the home. Three service users’ care plans and records were viewed. This included the most recently admitted service user from two years previously, as most of the service users have been living at Lawn House for some considerable time. The records viewed evidenced that assessments are undertaken prior to the person coming to the home to live. The manager said that she would undertake assessments following referrals from care managers. Ideally information and a care needs assessment are received from the care manager prior to the manager assessing the person, but this is not always possible. She reported that she had recently been to assess a potential service user for the home but it was decided that the home could not meet their needs. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 11 For one of the residents with complex needs, there was evidence in the records that his care needs are reviewed frequently by a multi-agency team to ensure the home can continue to meet his needs. Three relatives were spoken with at the time of this visit and they said they were very happy with how their relative was being cared for. He had been a resident in the home for seven years and that they had been involved with the decisions about his care and where he was to live, and that he was very happy living there. The AQQA states that the home accommodates people from a mixed religious and culture background. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from their needs and wishes being reflected in their care plans and risk assessments. Service users make decisions about their lives with consultation and support. EVIDENCE: A sample of three service user’ care plan records was viewed. These contained a substantial amount of information for each service user detailing a thorough assessment, care plans, to meet their needs, and risk assessments were also in place. There was evidence of service user involvement, the service users they, or relatives, had signed the care plans. In the files viewed, information recorded was based on service user’s needs and wishes. Staff told us that the care plans were informative and reflected the needs of the service users. The care planning is person centred and covered all aspects of the service user’s daily lives. The records also contained an excellent life story for each person, their likes dislikes and preferences. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 13 The care plans also demonstrated that they were reviewed monthly or if the service user’s situation or condition changes. The outcome of the reviews were documented on the daily notes records and also identified in the care plans. The AQAA states that the home has introduced key worker monthly summary reports for each service user. These were evidenced in the care plans and are a summary of the service users needs and any changes through the previous month and are written by the key worker. These together with what service users say at their monthly meetings, enable the staff to identify changing needs more effectively. For the service user with more complex needs, the care plans detail information and risk assessments associated with moving and handling, eating. It also records the environmental changes that have been made to accommodate the moving and handling and mobility risks. The manager said that she is monitoring the risks associated with this resident to ensure that the environment and appropriate equipment, to meet his needs, is in place and to ensure the safety of the service user and staff. The care plans documented any restrictions on choice in the service user’ s daily life. These would be identified in order to keep them and others safe e.g. restrictions on the number of cigarettes per day. This is undertaken within a risk assessment framework with the involvement and agreement of the service user. It was observed that one set of records was recorded in a graphic format to enable the service user, who has communication problems to participate in his care planning and enable him to understand how his needs would be met. Service users were observed to be getting on well together and making choices about where and what they would be doing that day. The care plans document what the service users do each day within a flexible programme. Service users are encouraged to be involved in the running of the home and spoke of involvement in tasks such as shopping cooking and cleaning, some of the residents preferring to clean their own rooms. A service user spoken with described how she helps to prepare vegetables for their roast lunch on Sunday and service users are encouraged to go into the kitchen to make their own beverages independently. Staff spoken with at the time of this visit said that service users have choices of what they wish to do each day and this was demonstrated by observing staff giving choices about who they wished to go with them to the doctors surgery or going to the local shops. Staff and service users were observed to be interacting well and the staff said that they had good relationships with the service users, some of whom they have known for a number of years. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 14 The AQAA records that service user meetings take place and minutes recorded. The manager said these meetings are very useful and service users feel able to bring forward any suggestions on how they wish the home to be run. Any issues they raise, can be taken forward at the ‘Your Voice’ forum, which is a quarterly meeting arranged in different areas, by the organisation, to which a representative from each area can attend and take forward to the board any issues they wish to have discussed and for them to give the general views of the service users from their area. The area manager described these meetings and said that ‘service users are listened to and what they say is taken into account’. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are offered a range of activities based on their personal preferences. Service users are part of the local community. Service users rights and responsibilities are acknowledged in their daily lives. A healthy range of food is provided to service users. EVIDENCE: Service users are provided with a range of activities and things to do and support is given to pursue interests. There was evidence of this in service users rooms, which were personalised and reflected their interests and preferences. There were games and other activity equipment stored in the small recreation area at the back of the lounge. Service users spoke of a range of activities in the home and using the local community. External activities service users spoke of included swimming, Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 16 bowling, football matches, going to the pub or cinema, shopping, and visiting friends. Activities mentioned at the home were watching TV, listing to music, discos, BBQs, sitting in the garden, helping with jobs, friends visiting, collecting models, and watching football. Two of the service users were keen football supporters of the local team and had gone to the football game the previous evening with one of the support workers. They both reported they had had a good time, their local team winning. One service user particularly spoke of the support given from staff to have the things that they wanted and said she enjoyed music and had just acquired a new music player and preferred to stay in her room to play music. Another service user was keen to talk about his record collection. Generally the service users felt they were well supported by the staff team to pursue their interests if they wished to. Service user surveys returned said: ‘Its good here, I like doing the shopping and going out with staff’. ‘I like it when staff take me out and push my wheelchair’. A service user told us about their holiday last year and another asked the manager about their holiday this year. The manager said that a holiday is in the process of being arranged this year for the few service users who did not have a holiday last year. The AQAA identifies that the home would like to increase staffing levels to increase daily activities, but from observation at the time of this visit service users were interacting a good deal with staff. At the time of this visit three service users were out at day centre and the other six residents were choosing to stay in the home because the weather was very bad. One service user requested to go out after lunch and this was agreed and arranged, once more staff were available, another requested to go to the pub and this was also arranged with a staff member. Some service users are able to go into the community independently but this is all done within a risk framework. Service users spoken with confirmed they are able to come and go as they wish. One service user was observed to be having visitors and others were chatting to each other and staff, watching television or colouring pictures. Service users are encouraged to have visitors and maintain their friendships in the community. Staff spoken with were mindful of the rights of service users to make decisions. This was supported by conversations held with two staff members about some of the restrictions placed on service users such as smoking and access to the kitchen at night. Both staff members were aware of service users rights and their own roles in negotiation over these issues. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 17 We sought permission from service users to visit some of the bedrooms and it was observed that some were choosing to lock their doors and hold their key. This is respected fully by the home. Support is given with relationships and a statement about visiting was viewed. A service user spoke of being supported by staff to visit a friend and to have friends at the home. Service users are involved in various activities related to food. During lunch a conversation was held with staff and service users about how food is organised in the home. Service users said that they could have foods that they like and that they had helped with the menus and cooking. The main meal is served in the evenings and various choices of sandwiches had been made for lunch. The menu was viewed and this is on a three-week rota. Changes to the menu plan were observed, the manager said this was as a result of the service users requesting the changes at the service user’s meetings, at which time, food is generally discussed. Service users told us that the food is ‘good’ and that they ‘enjoy’ the meals and are given a range of foods, and are able to choose an alternative if they do not like what is on the menu for that day. Records are held of food provided, so that monitoring can take place if necessary. Weight is monitored for some service users. One service user is on a pureed diet prescribed by the speech and language therapist. The kitchen was observed to be clean and well organised. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service have their views listened to and acted upon and feel safe. The policies, procedures and staff training safeguard service users from abuse, neglect and self-harm. EVIDENCE: The AQAA states that the residents have the choice of which staff member will support them with their personal daily routines and the time of day they would like a shower or bath. Staff encourages them to choose their own clothes and are able to state what time they would like to go to bed and get up in the morning. Care plans describe the level of personal care that service users need. Most of the service users are independent with their personal care. They were observed to look clean and smart. One service user, when complimented on how nice she looked, was keen to tell us about her shopping trips for clothes and obviously took pride in how she looked, another told us that the hairdresser visits the home to cut her hair regularly. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 19 A staff member said that if and when it is necessary or the service user requests, money is drawn out of their savings accounts and they are escorted shopping to buy clothes, and they enjoy choosing their clothes. Health care needs and the support required are well documented in the care plans and records are held of the visits made to the home or clinics for consultation with various professionals and specialists and for assessment and treatment. The care plans document that all service users are registered with a GP and have access to dentist, optician and other health care professionals. Support workers do accompany the service users to appointments outside the home. This was demonstrated at the time of this visit as one service user had an appointment to see the consultant and the support worker she had requested to go with her, was arranging a taxi to transport them to the surgery. The AQAA says that only trained competent staff administer medication. The organisation has introduced a new medication policy and individual selfmedication risk assessments have been completed for all service users, most of which identified an unacceptable risk and therefore no service users were choosing to self-medicate at the time of this visit. The medication system was discussed with the manager who said that one member of staff coordinates the ordering and checking in of all medicines. Medication was found to be stored appropriately in a secure trolley attached to a wall in a room that is locked when not being attended by staff. The home uses mostly a monitored dosage system, except for those medications that cannot be stored in this system. The MAR sheets were checked and these demonstrated a clear photograph of the service user and a list of current medication. The records were signed and no gaps were seen. An incident of a medication error was reported to the CSCI last August. As a consequence of this staff have received updated training in handling of medication. Certificates and the training matrix evidenced this. The manager has arranged further training imminently for the remainder of staff who have not yet attended this training. All service users asked said that staff gave them their medication regularly. The manager says that auditing the medication charts and records is undertaken by her monthly as part of her quality assurance that she is required to undertake and report to the area manager. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service have their views listened to and acted upon and feel safe. The policies, procedures and staff training safeguard service users from abuse, neglect and self-harm EVIDENCE: The AQAA says that the staff and service users are aware of the complaints policy and procedure. Staff are aware of how to support service users if they wish to make a complaint. All complaints are dealt with in the given timeframe. There was no indication in the service users surveys, nor when service users were spoken with at this visit, that suggested service users had complaints. No complaints have been received by the CSCI since the last inspection. The manager told us that no formal complaints had been made to the home in recent months but that a logbook is available to record any complaints and the action and outcome of any complaints. Service users did agree that staff listened to them and evidence of this was noted during the visit to the home. The home has an open culture and the organisation distribute service user’s and relative’s surveys twice yearly as part of their quality assurance giving Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 21 opportunity to people to make suggestions or highlight any issues they wish to be addressed by the organisation. The home has details of the local advocacy service and two service users have their own advocate The AQAA states that staff have extensive training and knowledge about abuse and safeguarding vulnerable adults. The training matrix and the staff spoken at the time of this visit confirmed that they have an understanding of what constitutes abuse, ‘safeguarding’ and the whistle blowing procedure. Service users are encouraged to manage their own monies and the manager said that the service users all have separate bank or building society accounts and a support worker will accompany them to the bank when they need to draw monies out. The home holds small amounts of monies for service users and these and records are maintained in a secure environment and each service user’s money is stored separately. At the time of this visit a service user requested money from the office to go to the shops. The manager agreed with her that her requested would be met when she was ready to go out with the support worker. The support worker described the process of how the monies were recorded and receipts kept that demonstrated client’s monies are safeguarded. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service are provided with a clean, homely and welcoming environment to live in. EVIDENCE: All areas of the home were visited, with the permission of the service users. The service users are provided with comfortable surroundings and have homely rooms furnished with suitable furniture and decorated to a good standard. The bedrooms were very individual and reflected the personalities and preferences of each person. The service users told us that they had chosen the colour schemes for their rooms and were very proud to ‘show off’ their private space. Service user surveys returned to the CSCI indicated that service users were happy with their home and those spoken with at the time of this visit were very satisfied with their environment. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 23 The house is generally well maintained. The manager said the organisation had introduced an annual redecoration programme to ensure each room is decorated to an acceptable standard, and she is involved with monitoring and making recommendations to the decoration plan for the year. The AQAA stated that the home planned to redecorate the activities room. This had subsequently been done following requests by service users at one of their meetings. A requirement was made at the previous inspection to refurbish the front of the house. This has now been completed. The AQAA identified the improvements made to the environment over the last year and said that one improvement could be to convert the en-suite bathrooms on the first floor into shower rooms. The organisation is now in the process of obtaining quotes for the work to be undertaken. The previous report identified that some adaptations had been made to the environment to accommodate a service user who uses a wheelchair. A requirement was made for the physical environment to be adapted, by widening the doorway, to enable the service user to manoeuvre into his room without obstruction. At the time of this visit the area manager spoke to the contractor who said that the work would commence the following week and be completed by the end of March. The home has a maintenance man employed who was present on the day of this visit and who was observed to be mending fences and adjusting the water pressures. A maintenance log is kept and audited monthly by the manager. The home is clean and service users said they are involved, some choosing to clean their own rooms and organise their own laundry. Arrangements were flexible. Safeguards are in place to maintain infection control. This was discussed with a member of staff who had received relevant training. Staff, who had undertaken training in infection control was evidenced on the training matrix. Staff were observed to be using protective clothing such as disposable gloves, aprons and hair coverings (in the kitchen). Signs were posted in various places about the benefits of regular hand washing. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a dedicated and competent staff group in sufficient numbers to meet their support needs. Service users are protected by the recruitment policies and practices of the home. Service users are supported by key-workers who are well supported and supervised. EVIDENCE: The service users are supported by a dedicated staff group, some of who have been employed at the home for some years and are very familiar with the service user’s wishes and needs. From observation at the time of this visit and talking to service users there is evidence that good relationships exist between staff and the people who use the service. Since the last inspection the home has negotiated to obtain more funding to care for one service user with complex needs and who needs one to one care Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 25 and support. As a consequence the home has employed extra staff to be on duty each day and night and this has resulted in there being four carers and the manager on duty all day and at night a waking staff and one sleeping staff. This was discussed with the manager who said that this allows more continuity of care for this service user who is more settled with familiar staff. On the day of this visit the home had delegated a number of staff to go off site for training later in the morning for two hours over the lunch period. This had resulted in the manager being included in the staffing rota, but from observation and speaking to staff it was evident that this did not have a detrimental effect of the support for service users. Training files evidenced that staff have received training in relevant subjects such as, managing challenging behaviours, makaton skills for communication, learning disabilities, dementia, epilepsy etc. 50 of the workforce have achieved their NVQ level 2 and one care spoken with said that she had her NVQ level 3 and although the organisation does not fully support the NVQ 3 training programme, they fully support carers undertaking the level 2. The manager said that the carers undertake the relevant components of the NVQ level 2 appertaining to learning disabilities. Sample of three staff recruitment files was viewed and were found to be in place with most relevant checks completed such as an application form, POVA first, CRB and references received before the recruitment of staff. It was observed that in one file there were no references but the manager told us that this person had been recruited by an overseas agency that had taken up references and informed the organisation. The area manager said that this was the normal procedure when recruiting through an overseas agency and that this was the agency they used for all their homes if they recruit from abroad. All new staff undertake a structured induction training programme based on the Skills for Care Induction programme. A member of staff completed induction programme records were evidenced in their training file and was observed to be thorough and comprehensively completed. The home has a staff training programme in place. The new manager has compiled a large training matrix to enable her to monitor the training and when updates for mandatory training are needed. The organisation is in the process of storing all training information electronically and this will automatically alert the home’s manager to when training is due. The new manager has worked hard to ensure that staff are up to date or have planned updates of the relevant training and showed us a training programme to support this. Staff spoken with said they now get plenty of training opportunities and that the organisation will fully fund all training, a number of staff having attended the equality and diversity training that day. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 26 The manager has developed the supervision and appraisal programme. Two senior carers are trained to supervise and appraise more junior staff and the manager supervises and appraises the senior staff. Supervision and appraisal notes were evidenced in personnel files that identify training needs. The staff spoken with said they now get regular supervision with their senior. This has improved since the staff surveys that were returned to CSCI in December, many of which indicated that they were feeling unsupported, as they did not have a manager in post at that time. This has now changed and the new manager said that she is endeavouring to ensure that all staff are supervised on a regular basis. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 &42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users now benefit from a well run home. Quality assurance systems are in place to review and monitor the development of the home. The health and safety of people who use the service and staff are generally promoted and protected. EVIDENCE: The home has gone through a period of instability and has recently undergone another change in management, and this was reflected in the staff surveys returned to the CSCI in December. The current manager has been in post since December and is in the process of registration with CSCI. Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 28 The manager has worked at the home some years previously and therefore is familiar with some staff and service users. She has many years experience working with this client group and management of a home and is working hard to implement systems to ensure the smooth running of the home. The manager has achieved her registered manager award (RMA) and her training file evidenced that she has a comprehensive portfolio of training appertaining to the client group and management. Staff spoken to were very complimentary about her being at the home and managing and called her ‘wonderful’, ‘kind’, and said they were glad she was now back at the home and their manager. She was observed interacting with people who use the service when dealing with their anxieties and problems in a calm and respectful manner. An area manager and a network of other managers in the organisation support the manager in her role. The organisation has introduced a quality assurance system and this is monitored by the area manager who was visiting the home that day to undertake a Regulation 26 visit and report. The manager is expected to audit systems monthly and report back to the organisation. The AQAA states that the organisation sends auditors in twice yearly to audit systems and the aim of the home is to improve the audit scores. Questionnaires are distributed to service users and relatives approximately twice a year and there is a general consensus that people are satisfied with the support and care provided by the home. The home has staff and service user’s meetings and these are recorded. The training matrix and files evidence that staff do attend the health and safety training and that the manager is in the process to organising when the updates are due. Staff spoken with confirmed that they receive the fire, moving and handling, food hygiene and first aid training. There were no obvious health and safety hazards noted and substances were being stored in a secure environment. The carer responsible for the maintaining the fir log and checking the fire system showed us the records. There was no record that the fire alarms and emergency lighting has been tested for the previous month. This was discussed with him and he conceded that they had not been done. This that that also was discussed with the manager and area manager and they assured us this would be done at the appropriate and recommended intervals and the people responsible for this would be spoken to. The area manager identified that this should have been picked up during the manager’s DS0000037558.V360814.R01.S.doc Version 5.2 Page 29 Lawn House Care Home monthly audit of systems. The manager assured us this would be done in the future and therefore a requirement will not be made in this instance. A sample of servicing certificates was viewed for systems and equipment and were found to be in date and current. A risk assessment of the environment was seen. Lawn House Care Home DS0000037558.V360814.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 Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 2 Lawn House Care Home DS0000037558.V360814.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. Standard Regulation Requirement Timescale for action 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 Standard Good Practice Recommendations Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Lawn House Care Home DS0000037558.V360814.R01.S.doc Version 5.2 Page 33 - 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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