Inspection on 10/01/06 for Lawns Nursing Home The

This inspection was carried out on 10th January 2006.

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

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

Other inspections for this house

Lawns Nursing Home The 01/11/06

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 Anne Prankitt Unannounced Inspection 10th January 2006 10:00 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.V277023.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 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 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.V277023.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category (DE) refers to a named service user only. Date of last inspection 20 June 2005 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 or a mental disorder. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection lasted for approximately six hours. It was unannounced, and was undertaken by two inspectors. Three hours preparation took place prior to the inspection. The registered manager, Kathryn Appleton, was available throughout the inspection. She and the responsible individual, Mrs Maureen French, were provided with feedback at the close. During the course of the inspection, some service users, staff and visitors were spoken with, and time was spent observing care practices where appropriate. Records were looked at, including some care plans, staff training files and health and safety and maintenance records. The medication systems were also inspected. All communal areas and a number of private bedroom areas were also inspected. What the service does well: The registered manager is enthusiastic, and wants to continue with the improvements already made at the home for the benefit of the residents who live there. The residents have a warm and comfortable environment to live in, which is spotlessly clean. Staff receive training to help them in providing good care for residents, and residents have a care plan which tells staff what their needs are, and how they can best be met. Staff are provided in sufficient numbers so that the care provided is not rushed. The registered manager is not included in the staff numbers, so that she is given time to manage the home properly and oversee the care that is provided. The home is kept maintained, so that the health and safety of residents is well protected. The responsible individual visits the home on a regular basis, and writes a report which provides the commission with an update about the running of the home. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 6 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. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 EVIDENCE: This standard is not applicable. The Lawns does not provide Intermediate Care. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Staff are provided with information so that the holistic needs of service users can be understood and acted upon. EVIDENCE: Care plans were of very good quality. Relatives are invited to become involved in their development. The plans explain to staff the current holistic needs of service users, and the action that should be taken to assist in them being met. They also provided information about the intervention of outside professionals, such as the General Practitioner. They were reviewed on a regular basis. They include an activities care plan, and information provided by relatives about the social needs of individual service users is collected where possible. This information was differing in quality and quantity. It was recommended that staff look at ways of collecting additional information about past and current social needs where necessary in order to complement the information already gathered. Staff were clear about their roles as key workers for individual service users. Service users’ appearance suggested that staff had taken care when providing Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 10 assistance to individuals. One visitor stated that the care was ‘very good’, and the atmosphere very relaxed. Some trained staff who are responsible for the administration of medication have completed additional training to update their skills. Medication kept on behalf of service users was stored and managed appropriately, and the records kept were signed and up to date. The registered manager audits the medication systems on a monthly basis. Whilst a daily count of Temazepam is recorded on the Medication Administration Record, it is recommended that the receipt, administration and disposal be recorded in the Controlled Drugs register. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Service users benefit from a routine which offers some flexibility and a relaxed atmosphere which may assist in enhancing their quality of life. EVIDENCE: Staff at the home endeavour to collect information from relatives about the social and recreational preferences of individual service users. There is a programme of activities available. In addition to the input provided by the activities organiser, staff are specifically allotted time each afternoon in order to spend time with service users during which social and recreational activities are offered. On the day of the inspection, some residents were watching a film, whilst others were enjoying activities, including singing. A number of visitors are welcomed into the home on a regular basis, including a hairdresser and a representative from the local convent. 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. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 12 The menu offers a choice at tea time. The registered manager stated that the likes and dislikes of individuals are known and understood, and that alternatives to the main meal of the day are offered where required or requested. Meals are fortified, and record is kept of service users whose nutritional status is assessed as ‘at risk’ in order that this can be monitored. The kitchen currently caters for special diets, including pureed and diabetic meals. Service users appeared to enjoy their meal at lunchtime, and there were sufficient staff to assist them in a dignified way. One service user commented that the food was ‘lovely’. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the standards were assessed at this inspection. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The informal arrangements in place for the observation of service users who do not have access to their nurse call alarm needs to be formalised to ensure that they are not subject to unnecessary risk. EVIDENCE: The layout of some of the bedrooms resulted in some service users no longer having access to the call bell system once they were in bed. However, the registered manager stated that staff check on all service users during the night on a regular basis, as many do not have the ability to use the call bell in order to alert staff. The care plan should include an assessment to ensure that service users are not at risk where they do not have immediate access to the call bell facility. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 15 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 28 Service users are cared for by sufficient staff, who receive appropriate training to assist them in providing good care. EVIDENCE: Observations concluded that staffing levels on the day of the inspection allowed service users to be provided with assistance in a timely and unrushed manner. There are currently no staff vacancies, and the manager was pleased that it was not necessary to employ the use of agency staff. The manager’s hours are now supernumerary, which allows her to complete additional tasks commensurate to her post. An extra staff member had been provided in order to meet the needs of one service user who requires one to one supervision, and the duty rota now incorporates an extra member of staff to assist during the busy period between 4pm and 9pm. New staff undergo a period of induction, and foundation training is also undertaken. The deputy manager mentors adaptation students at the home. Staff now receive an extensive programme of training to assist them in their work, as well as formal supervision sessions. This includes statutory training, as well as training which will assist staff in understanding and meeting the needs of the people who live at the home. Two staff have completed NVQ Level 2 training, and a further three staff await their certificates. Staff stated that they receive lots of support from the trained staff when undertaking training. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 16 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): 31,33,35 and 38 The overall management and supervisory systems at the home have been improved upon. EVIDENCE: Staff stated that they have confidence in the registered manager, and the input that they provide to the home. They remarked that the service had improved since her appointment. One comment concluded ‘The manager is very open’. Carer and trained staff meetings are held on a regular basis. One visitor stated that the manager was ‘very good and relaxed – a lot better’. The registered manager is developing quality assurance systems at the home. She carries out regular audits of the medication systems, care plans, accidents to service users, kitchen profile, health and safety matters and personnel files. Questionnaires have been circulated, and the results are published in a ‘Commitment Plan’ which is made public. In addition to this, the responsible Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 17 individual makes regular visits to the home under regulation 26, and provides a written report of her visit to the Commission for Social Care Inspection. A visitors book is available for professionals, which invites them to complete a questionnaire about the service. The home can safe keep personal monies on behalf of service users. Those records checked could be reconciled with monies held, which are stored separately and securely. Receipts are kept where transactions are made on behalf of the service user. Head office collects monies on behalf of some service users. Assurance was given that these are kept in named bank accounts, and details of up to date balances were faxed through to the home at the time of the inspection. It is strongly recommended that an up to date copy of the current balance is kept in house with the financial records of the service user concerned. The maintenance certificates seen were up to date, and evidenced that suitably qualified contractors regularly maintain the building. The registered manager confirmed that outstanding works to replace bulbs to the nurse call and emergency lighting systems were imminent. Detailed records are kept of weekly, monthly and quarterly in house checks, which are carried out at the home. This includes a visual check of the bed rails. It was agreed at the time of the inspection that one bed rail required adjustment. This was carried out during the inspection, and the registered manager assured that all other bed rails were also checked as a precaution. Hot water temperatures were recorded as being variable. However, random checks on the day concluded that the temperatures were within satisfactory limits, and confirmed the registered manager’s assurance that the maintenance man addresses any problems straight away. The kitchen and storeroom were clean. Temperature records were kept appropriately of fridges, freezers, and the service temperatures of hot food. However, opened and prepared foodstuffs which were being stored in the fridges was not labelled, and distributors’ labels did in some cases cover up the ‘use by’ date on the original packaging. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 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 X 17 X 18 X X X X 2 X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 1 Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13 Requirement Stored and refrigerated foodstuffs must be appropriately labelled and dated. Timescale for action 10/01/06 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 Refer to Standard OP7 Good Practice Recommendations It is recommended that staff look at ways of collecting additional information about past and current social needs and interests of service users where the information currently available is limited. The receipt, administration and disposal of Temazepam should be recorded in the controlled drugs register. The care plan should include an assessment to ensure that service users are not at risk where they do not have immediate access to the call bell facility. It is recommended that the home continue to offer training to NVQ Level 2 in care to care staff as part of their DS0000028032.V277023.R01.S.doc Version 5.1 Page 20 2 3 4 OP9 OP22 OP28 Lawns Nursing Home The 5 6 OP35 OP38 development programme. It is strongly recommended that an up to date copy of the current account balance is kept in house with the financial records of the service user concerned. The recommendations within the most recent lift maintenance record should be looked into and acted upon. Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Lawns Nursing Home The DS0000028032.V277023.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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