Inspection on 11/11/05 for Lawrence House

This inspection was carried out on 11th November 2005.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lawrence House 15/01/07

Lawrence House 25/01/06

Lawrence House 17/12/04

Lawrence House 23/09/04

Lawrence House 10/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Lawrence House Lawrence House Landkey Road Barnstaple Devon EX32 9BX Lead Inspector Susan Taylor Unannounced Inspection 11th November 2005 11:50 Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 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 Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lawrence House Address Lawrence House Landkey Road Barnstaple Devon EX32 9BX 01271 377189 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) Linda Harvey Linda Harvey Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users will be aged between 25 and 55 years Three named service users over the age of 55 may continue to reside at the home On the termination of their residency the home will revert to its registered categories and the Registered Persons must notify the Commission of the fact. The Registered Person/Manager Linda Harvey maintains her Nurse registration or undertakes NVQ level 4 in care and undertakes an NVQ 4 Registered Managers Award by 2005 17th December 2004 3. Date of last inspection Brief Description of the Service: Lawrence House provides 24-hour residential care for 10 people who have learning disabilities. At night time there are two staff sleeping in. Lawrence House is a large detached Victorian house standing in its own grounds and is a short walk away from the centre of Newport. There is a ramp leading up into the rear entrance of the Home. Wheelchair users cannot easily be accommodated. Service user’s rooms are on the ground and first floors. All vary in size and have an outlook over the garden. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took five and a half hours over one day. The purpose was to follow up requirements made at the last inspection, and key standards covering lifestyle, personal and health care, complaints and protection, staffing and management issues. The inspector looked at records, policies and procedures. A tour of the building took place. Six residents gave their views of the home to the inspector. Two staff and the manager were interviewed. Prior to the inspection, the Commission received a pre-inspection questionnaire and comment cards from five residents and one relative and this data is also incorporated into the report. The people living at Lawrence House told the inspector at the last inspection that they preferred to be referred to as ‘residents’. Therefore, this term is used throughout the report. What the service does well: Lawrence House is a well run home. Resident’s live full and varied lives, and are involved in interesting activities and work. There are few restrictions at the home. Residents are encouraged to have close links with their families and friends. Meals are varied, appetising and provide residents with plenty of choice. Residents say that the staff treat them well and that their views are respected. When people are ill, they are well cared for by the staff and other healthcare professionals. The home’s policies and procedures for handling medication ensures that residents receive the correct medicines as prescribed. Abusive care is not tolerated at the home, and staff are properly trained to recognise and report the signs of it should it occur. The team of staff are well qualified and experienced to care for people with learning disabilities. This means that residents are properly cared for. The manager has done well to set up a team that has a diverse cultural background, gender mix and age range, which matches that of the resident group. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 6 Lawrence House has systems that enable residents to improve their lives at the home. Health and Safety is taken seriously and therefore protects everyone who lives, works and visits the home. 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. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 7 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 Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14,15,16,17 Resident’s are enabled to live their lives to the full with varied and interesting activities. There are few restrictions at Lawrence House. Residents are enabled to maintain close links with their families and friends. Meals are varied, appetising and provide residents with plenty of choice. EVIDENCE: Six residents were at home during the inspection and each person made comments to the inspector about their lives at Lawrence House. The inspector was told “we had a really lovely holiday this year” and was a shown photographs, which illustrated this. Another resident told the inspector that they attended Silver Hill Lodge, a local day centre, several days every week. Every resident had an activity program that was in ‘Total Communication’ format. The inspector observed a resident initiating a discussion about doing Christmas boxes for a local charity, which was well received and encouraged by staff on duty. Other service users were out at college, or working in a local supermarket. Planned events and outings for the Christmas period were documented in the minutes of staff meetings. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 11 Five residents sent comment cards to the Commission prior to this inspection. Their comments verified that they were satisfied with the food and number of activities provided. A visitor verified in a comment card that they were made welcome in the home and able to visit their relative in private. Another visitor told the inspector that Lawrence House “is a much better home” for their relative, and that they were “very satisfied with everything”. Lunch was observed and consisted of a choice of sandwiches, yoghurt and fruit made according to the individual preferences of residents. The record of meals provided demonstrated that menus were varied and that alternatives had been available to residents. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Residents are treated with privacy and dignity. Their healthcare needs are well met by appropriate referrals to other health and social care professionals. The home’s policies and procedures for handling medication ensure that residents receive the correct medicines as prescribed. EVIDENCE: Five comment cards were received from residents prior to the inspection. All of the residents verified that their privacy and dignity had been maintained. Two residents who had healthcare needs gave their views about how these were met. One person told the inspector “I have regular checks at the doctor’s and the staff keep a close eye on me”. The inspector observed the staff were attentive and concerned about the welfare of a resident who was unwell in bed. The resident told the inspector “I’m being pampered” and “I’ve already been seen by the doctor, but [the registered manager] has suggested that he should come out to see me again”. Medication Administration Record charts are in use and no gaps in the records were seen. Medicines had been administered as prescribed. All medicines were seen to be stored in a new locked cupboard, which was securely affixed to the wall. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Residents are able to voice concerns about their care safe in the knowledge that their views will be respected and properly investigated. Policies, procedures and training to keep residents safe and protect them from abuse are evident at Lawrence House. EVIDENCE: The inspector saw that the complaints procedure was displayed, and is in a ‘total communication’ format. A resident verified that they were confident that if they did have a complaint, the manager would investigate it appropriately. A member of staff said “They’re [residents] very happy souls here. If they’re unhappy about something the will definitely let you know”. The complaints record demonstrated that no complaints had been made over the previous twelve-months. Residents who were spoken to during the inspection made positive comments about the manager, staff team and their lives at Lawrence House. The home had a written policy and procedure for dealing with suspected allegations of abuse. The inspector spent sometime observing interactions between staff and residents. These were respectful and valued residents. Training records demonstrated that all of the staff had attended a course covering the protection of vulnerable adults. Additionally, staff told the inspector that they had seen the ‘No Secrets’ video and had undertaken further work on the subject of abuse and whistle blowing as part of the NVQ level 2 & 3 in Care. Staff spoken to had a clear understanding of the concepts of whistle blowing and adult protection issues. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35 Residents’ needs are met by suitably qualified care staff that are on duty in sufficient numbers. The team of staff is diverse in their age, cultural background and gender mix, which reflect the needs of the resident group. Recruitment procedures are not robust and therefore do not protect residents. There is a training culture at Lawrence House that ensures that staff are appropriately qualified and experienced to care for residents living there. EVIDENCE: The Commission received a comment card from a visitor prior to the inspection, which verified that in their opinion there were sufficient numbers of staff on duty. Five residents verified in comment cards that they felt well cared for. The inspector observed that care staff were attentive and respectful toward residents. The home’s recruitment procedure was not up to date with guidance on taking up POVA checks for new staff prior to commencing employment. The manager demonstrated that equal opportunities are practiced at Lawrence House by appointing two disabled volunteers. Records demonstrated that the team of staff was diverse in their age, cultural background and gender mix, which reflected the needs of the resident group. Three staff files were inspected, of which two did not contain the information required under regulation 19. The Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 16 inspector met one of the individuals concerned who verified that a CRB and POVA check had been undertaken. However, written references had not been obtained for that person. This was discussed with the registered manager, who was advised to follow robust recruitment procedures for volunteers as well as paid employees. An immediate requirement was issued in respect of this. The registered manager told the inspector that written references and CRB checks would be obtained by 15th December 2005. Pre-inspection information provided by the manager verified that two staff, including a volunteer, had completed an induction course and had started the NVQ level 2 or 3 in Care. 50 of the staff held an NVQ level 2 in Care. Staff told the inspector that the manager encouraged their professional development by offering support for them to attend training courses and to attain qualifications. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Lawrence House continues to be well run. The manager of the home is in the process of doing the Registered Manager’s Award in Care, and should achieve this during 2006. The quality assurance systems in the home have improved since the last inspection. These ensure that residents participate fully in the process and that their views are respected. The health, safety and welfare of residents are promoted and protected by Lawrence House’s policies and procedures. EVIDENCE: The manager told the inspector that they were part way through the Registered Manager’s Award and NVQ level 4 in Care and Management. The inspector saw letters and course information that further verified this. The inspector was shown quality assurance comments received from residents and staff during a recent audit of the service. The manager told the inspector that the results from the recent audit would be collated into an annual Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 18 development plan, which would be sent to the Commission on completion. Minutes of meetings demonstrated that these are held monthly with residents. Supervision records were seen on three staff files and demonstrated that one to one meetings were held regularly with staff to discuss practice issues and personal/professional development. Accident records were seen in individual care files. These had been audited and demonstrated that appropriate action had been taken following each incident. The health and safety file was inspected. Policies and procedures on health and safety issues had been summarised into a ‘total communication’ format making them accessible to all the residents. Risk assessments for the environment, fire safety systems and food hygiene had been completed and regularly reviewed. Certificates for the fire, gas and electrical installations demonstrated that specialist contractors carry out regular maintenance. A resident commented, “The fire extinguishers are check regularly and the fire alarm goes off to be checked”. The inspector observed staff using alcohol gel as an infection control measure after every episode of giving care. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x x x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lawrence House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 3 x DS0000043932.V253073.R01.S.doc Version 5.0 Page 20 YES 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 YA34 Regulation 19(1)(b) Requirement The registered person shall not employ a person to work at the care home unless— subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 This requirement is repeated having not been met at the last two inspections on 23/9/04 and 4/12/04 respectively. An immediate requirement was issued at the inspection. (b) Timescale for action 15/12/05 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 Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 21 1 YA34 The recruitment of volunteers should be thorough and included CRB and PoVA checks. The recruitment procedure should be updated to cover this, and provide guidance on taking up POVA checks for new staff prior to commencing employment. Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Lawrence House DS0000043932.V253073.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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