Inspection on 01/11/06 for Lawns Nursing Home The

This inspection was carried out on 1st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Lawns Nursing Home The 10/01/06

Lawns Nursing Home The 20/06/05

Lawns Nursing Home The 22/04/04

Lawns Nursing Home The 11/03/04

Lawns Nursing Home The 16/10/03

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

CARE HOMES FOR OLDER PEOPLE Lawns Nursing Home The 31 Oatlands Drive Harrogate North Yorkshire HG2 8JT Lead Inspector Kate Shackleton Key Unannounced Inspection 1st November 2006 09:00 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 Lawns Nursing Home The DS0000028032.V315622.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. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawns Nursing Home The Address 31 Oatlands Drive Harrogate North Yorkshire HG2 8JT 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) 01423 889353 01423 887055 None Amocura Limited Miss Kathryn Appleton Care Home 32 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (32), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (32) Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category (DE) refers to a named service user only. Date of last inspection 10th January 2006 Brief Description of the Service: The Lawns is a large three storey converted and extended detached house situated in its own grounds in quiet residential area of Harrogate. It offers nursing care for up to 32 elderly service users who have dementia care needs or a mental health disorder. At the time of this visit the weekly charge ranges from £489-30 to £590. Item’s not included in the charge are hairdressing, private chiropody and toiletries. The Commission for Social Care Inspection report is available in reception for anyone to read. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the homes file since its last inspection. • Information submitted by the registered provider in the Pre Inspection Questionnaire • Surveys received from eight relatives/representatives •An unannounced visit to the home lasting seven hours. The visit included a tour of the premises, talking to catering staff, care staff, nurses and management. Examining some records and observing staff working with service users What the service does well: The home is managed in a manner that is service user focussed. It concentrates on the needs, wishes and views of the people who use the service. The home is mostly clean and comfortable Staff are kind and helpful. Comments returned in surveys included “I am very impressed by the care and attention provided by all the staff. They are all very courteous” and “the staff are a credit to a well run care home” Routines are flexible and emphasis is placed on treating people who use the service with respect and enabling them every opportunity to exercise choice in key areas of their lives. Examples given included rising and retiring times, clothes, food and activities. This ensures that service users maintain some control. Service users are able to access the primary health care team and other health professionals ensuring that their health care needs are met. Particular attention is paid to ensuring that service users get enough to eat. Visitors are encouraged and made welcome. This helps service users maintain contact with family and friends. Regular relatives meetings take place. This is seen as a way of involving families in the running of the home. There are a variety of activities designed to interest service users and encourage participation to overcome boredom and isolation. People who use the service are supported to follow their religious beliefs. There is a clear and user-friendly complaints procedure and complaints are taken seriously. This promotes openness and transparency, which helps Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 6 relatives and others on behalf of service users to say if they are not happy with any aspect of the service. The staff are provided with comprehensive training to improve their knowledge and skills. This makes sure that service users receive care from a wellinformed staff team whose practice is up to date. The safety of service users is an important aspect of the service delivered. It is demonstrated through proper risk assessments, staff training and the servicing of equipment and maintenance of the premises. 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. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Proper assessments are completed prior to admission to make sure that the service can deliver the care needed. EVIDENCE: Files examined confirmed that proper assessments are completed prior to admission. A member of staff from the home always visits the prospective service user to discuss their care needs. This makes sure that people are only admitted when the staff of the home are confident that they can deliver the service needed. Relatives and service users are offered the opportunity to visit the home. It is more often the case that relatives/representatives visit and make the decision on behalf of the person requiring care. At this visit there is the opportunity to have a look around and discuss any aspect of the care service Five of the eight surveys returned confirmed that enough information was provided about the home before an admission date was confirmed. The Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 9 remaining three did not provide information relating to The Lawns but confined their comments to the poor choice of care homes providing dementia care services in the Harrogate area. Seven of the eight surveys confirmed contracts received. Files examine confirmed this. Checked the situation regarding the one survey where there are difficulties with the Social services contract. The relative does not want to sign up to the homes contract until the social services contract is sorted out Staff spoken to confirmed that they are given enough information about the needs of new service users before they arrive in the home. Proper discussions take place so that everyone involved in the delivery of care knows what they have to do to deliver the service that is needed. Staff demonstrated an awareness of the distress that service users may experience as a result of having to move into a care home. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 10 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,and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are met. EVIDENCE: Files examined showed comprehensive care plans detailing the type of service that staff have to deliver to meet the personal, health and social needs of the service user. Plans are regularly reviewed in order to ensure up to date information is available. Plans are changed as and when changes to care needs dictate. The recommendation made at the last inspection to improve the information relating to the type of activities that service users might enjoy has been completed. The manger confirmed that all plans have up to date information regarding activities. Plans include a range of risk assessments, which guides staffs practice. The assessments highlight areas of high risk e.g. nutrition, moving and handling, aggressive behaviour and skin care. Information provided enables staff to mange risky areas of people’s lives in a safe and competent manner. Staff Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 11 complete a daily record for each service user and inform management of any changes to service users needs. Feedback from eight surveys completed by relatives/representatives on behalf of service users show that five always receive the care and support that they need. Two usually do and one sometimes does. Comments received included “I am very impressed by the care and attention provided by all the staff. They are all very courteous” and “the staff are a credit to a well run care home” All of the surveys confirmed that peoples health care needs are met. Service users looked clean and well cared for. Staff were observed providing support in a kind and helpful manner. They were able to give many examples of best practice relating to the promotion of respect for the privacy and dignity of service users. Service users are registered with a General Practitioner and are able to access the primary health care team and other health care professionals. Medications managed and administered by staff are undertaken in a safe manner. Medicines are stored securely and appropriate records kept. The recommendation made at the last inspection in relation to the administration of one particular drug has been implemented. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A flexible routine promotes the type of lifestyle that meets the differing needs of service users. EVIDENCE: From observations made on the day, routines appear very flexible. It was not possible to get the views of service users. Service users were observed moving freely around the home, some were listening to music others watching a video and some spending time quietly in their rooms. Staff spoken to were able to give numerous examples of how they support service users to make their own decisions in key aspects of their lives. Examples given included: rising and retiring times, clothes to wear and food. Staff were observed delivering the service in a manner that offered choices to service users and respected their right to remain in control. There is a comprehensive activities programme and the rota designates named staff to spend time with services users for a few hours every afternoon engaging in activities that they want to do. Staff were observed doing this. Surveys confirmed that activities are arranged. Monthly religious services take Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 13 place in the home. Some Christian festivals e.g. Christmas and Harvest Festival are celebrated. Visitors are made welcome and are offered a drink. At the time of this visit there were a number of visitors to the home. Service users can see their visitors in private. The visitors’ book confirmed that there are no restrictions placed on visiting times. Details of how to access advocacy services are advertised on the main notice board. Menus examined show a choice of food at every mealtime. Staff were observed offering people choice and providing appropriate support to service users who needed help with feeding. Service users were brought into the dining room for breakfast as and when they were ready to eat. There are two sittings at lunchtime. The first sitting is for people who eat more slowly. This provides a calmer “unhurried” environment with good staff support. Service users don’t have to eat in the dining room, they can stay in their bedrooms or use other parts of the house. Some service users were seen taking advantage of these arrangements. Discussions with the cook showed that every effort is made to provide high calorific food for people who have difficulty maintaining a healthy weight. Service users food preferences are known and special diets are catered for. Surveys returned were limited in the information provided, two suggested that service users always liked the meals and five suggested that they usually did. One commented that” The food seems to be fresh cooked from what I have seen. Some residents could do with more help eating”. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An informed staff team promotes an atmosphere that safeguards service users from the risk of harm. EVIDENCE: Discussions with staff confirmed that they understand the complaints procedure and that if they suspected or witnessed any abuse of service users they would report it to the nurse in charge or the manager. The policies and procedures that guides staffs practice in the safeguarding of adults are robust and in line with best practice. Staff receive training in this aspect of their work. Surveys received confirm that relatives /representatives know who to complain to. The complaints record examined shows that no complaints have been received since the home was last inspected. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a mostly clean, safe and comfortable home. EVIDENCE: A tour of the premises showed the majority of areas to be fresh and clean. The exception to this was the entrance hall and one of the lounges, which smelt of urine. Decorations and furnishings are adequate. The arms of the chairs in one lounge are grubby and would look better if they were cleaned. There are two communal lounges and other smaller sitting areas around the home. This provides service users with a choice of place to sit quietly, meet with family and friends or be actively engaged with other service users. At the time of this visit the hallway was decorated in a “Halloween “ theme in preparation for a forth-coming Halloween/Bonfire party. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 16 The majority of bedrooms are single rooms of which seven have ensuite facilities. Service users are encouraged to have some of their personal possessions in their bedrooms, this allows people to have familiar things around them and helps promote a sense of individuality and feelings of ownership. The two shared bedrooms have screening to ensure privacy and all bedroom doors have locks fitted. There are three assisted bathing facilities and one shower. Toilets are placed strategically around the home. Commode facilities are available in bedrooms if needed. Call bells are within reach of service users who are able to use them. For those people who are unable to use the call bell system especially throughout the night, staff confirmed that regular checks are made by the night staff. Three of the surveys received say that the home is always fresh and clean, four say it usually is with an additional comment that the ventilation to the day rooms would be improved by some form of air conditioning. One response says it is never clean and fresh with an additional comment that it always smells of urine. Aids and adaptations are provided and regularly serviced. The home employs a handyman who is responsible for routine maintenance and the monitoring of some health and safety aspects of the premises. The garden areas are well maintained and the courtyards are made attractive with planting and other garden features. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient, well trained competent staff to meet service users needs. EVIDENCE: Staff were observed responding quickly and appropriately to service users and spent time talking to them. Staff were friendly with a measure of good humoured banter being overheard. Feedback from surveys confirmed that staff are available and provide the care and support needed. Comments received include “There seems to be adequate staff available during the day time” and “Kind and pleasant staff” The rota shows that there are enough staff employed on each shift and especially at times of peak activity. Staff spoken to say that other than in unforeseen circumstances there are always enough staff on each shift to ensure good service delivery. There is enough time to spend with service users to allow proper respect for privacy and dignity. The home employs its own bank staff to cover shifts. Staff files examined showed in some cases an unsatisfactory recruitment process. Not all of the necessary references had been received prior to the Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 18 person starting work. This has the potential to recruit unsuitable people and subsequently place service users at risk. There is an induction programme that ensures new staff members are given the right information to be able to do their jobs well. Staff spoken to said that the on going training programme is good providing them with the skills and knowledge to meet service users needs. The training programme includes all the mandatory training needed to meet service users basic needs such as lifting and handling, first aid, food hygiene, and health and safety. Specialist training provided includes dementia care, infection control, nutrition, epilepsy and diabetes. Staff said that they are able to identify their training needs in supervision sessions with their manager. 58 of staff have achieved National Vocational Qualifications level 2 or above. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 19 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): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of service users. EVIDENCE: The registered manager is a qualified mental health nurse and has completed the Registered managers Award. She has experience in delivering a care service to people with dementia care needs and other mental health issues. Regular relatives/friends meetings where ideas for improvements can be put forward, staff meetings, staff supervision and appraisal encourages an open and transparent management style that concentrates on the needs of service users and the proper support of staff. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 20 Staff spoken to said that they are well supported by the management team to do their work. Comments received in surveys included “Well run home coping with difficult people, kind and pleasant staff” There is a quality assurance scheme and regular quality monitoring systems in place some of which attempt to canvass the views of others. However because service users are unable to complete the “Resident Questionnaire” it is given to their family or friends to fill in. The problem with this approach is that relatives cannot answer most of the questions with any degree of accuracy because the questions posed are designed to be answered by people who live in the home. Surveys for other people to complete e.g. GP’s, Community Nurses and visitors are available in reception but no-one shows any interest in completing them. The management team need to improve the quality of the information gathered if it is serious about involving service users representatives and others as part of checking the quality of the service provided. A senior manager of the organisation does monthly audits of the service. Proper financial arrangements are in place when the service holds personal monies on behalf of service users. Head office collects some monies on behalf of service users, which is deposited in individual named bank accounts. Staff provide support for service users who require help in managing their finances and there is a robust procedure in place to direct staff in their practice and protect service users from financial abuse The home works to a clear health and safety policy and regular safety checks are carried out. Some randomly selected records and safety certificates were looked at and were up to date. Requirements made following the last fire and environmental health officers visits have been actioned. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 22 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 OP29 Regulation 19 Requirement A minimum of two references plus CRB clearance must be received before care staff are allowed to work in the home. Timescale for action 02/11/06 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 2 Refer to Standard OP26 OP33 Good Practice Recommendations Better cleaning schedules need to be arranged to eliminate the smell of urine in some areas of the house and to make sure armchairs are kept clean. More appropriate questionnaires need to be produced to capture accurate and useful information to help develop and improve the service. More pro-active measures are also needed to get other people who have an interest in the service to share their views. Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Lawns Nursing Home The DS0000028032.V315622.R01.S.doc Version 5.2 Page 24 - 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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