Inspection on 26/02/08 for Lawrence House

This inspection was carried out on 26th February 2008.

CSCI found this care home to be providing an Excellent 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

Lawrence House 09/01/07

Lawrence House 06/12/05

Lawrence House 21/07/05

Lawrence House 04/10/04

Lawrence House 13/05/04

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

CARE HOMES FOR OLDER PEOPLE Lawrence House 15 St Marks Close Shorncliffe Folkestone Kent CT20 3LY Lead Inspector Mrs Sue Gaskell Unannounced Inspection 26th February 2008 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 Lawrence House DS0000037880.V357965.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. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawrence House Address 15 St Marks Close Shorncliffe Folkestone Kent CT20 3LY 01303 248177 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) susan.harrison@kent.gov.uk Kent County Council Mrs Susan Rita Harrison Care Home 30 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Lawrence House DS0000037880.V357965.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: Dementia (DE) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 30. Date of last inspection 9th January 2007 Brief Description of the Service: Lawrence House is a Kent County Council run Home providing care, rehabilitation and step down care for up to thirty people. The Home was purpose built in the 1980s and is a single story building set in pleasant and safe gardens. The accommodation is divided into three homely living units, comprising intermediate/step down accommodation for six people, residential care beds for 6 people plus 2 additional step down/intermediate care beds, and a unit for 16 service users with failing mental capacity. Service users within the intermediate unit are enabled and supported to maintain independence and develop skills that will allow them to return home, and are supported to retain community activities and social contacts. The recuperative unit has access to occupational therapy and Physiotherapy services. Lawrence House is situated in the residential area of Shorncliffe. Cheriton High Street is close by and provides amenities such as post office and shops. Previous Inspection reports are available to view upon request. The fee for this service is currently £364.79 per week and is reviewed annually; service users contribution towards this is based on individual financial assessment. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th February between 10.00am and 2.30pm. There were 30 residents in the home and no vacancies. I spoke with 4 residents in private and with two residents’ relatives. I spoke with the registered manager, deputy manager, a team leader, and three care staff. I also spoke with a visiting District Nurse. I toured the building and looked at bedrooms and all communal areas. The inspection process also consisted of information collected before and during the visit to the home. The home also submitted the annual quality assurance assessment required by the CSCI. Other information seen included general assessments, risk assessments and care plans, medication records and the duty rota. There were no outstanding requirements from the previous inspection and no requirements made following this inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. What the service does well: What has improved since the last inspection? Care plans have been reviewed and include more detail. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 6 Medication procedures have been reviewed and checklists introduced. More infection control measures have been introduced. Some areas have been decorated with new furniture, carpet and curtains. Further training has been provided for staff. Quality assurance has been improved. 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. Lawrence House DS0000037880.V357965.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 Lawrence House DS0000037880.V357965.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): 1, 3 & 6 People who use the service experience excellent outcomes in this area. The statement of purpose and service user guide says what service will be offered. Prospective residents can be confident that their needs can be met This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide are reviewed and amended regularly and provide residents, prospective residents and their relatives with all necessary information about the home. If necessary, this information can be provided in other languages or Braille. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 9 The home accepts people whose care needs require varying levels of support. The current focus of the home to provide intermediate care is likely to change in the near future to providing care solely for dementia. One resident and two residents’ relatives confirmed that they had either been visited in their own home’s prior to admission or that staff from the home had visited them in hospital. The manager and deputy manager said that they spend a lot of time and attention on ensuring that a proper pre-admission assessment is carried out. People referred for intermediate care are assessed prior to admission at the hospital and their assessment is forwarded onto the home for decision as to whether the home could meet their needs. The staff I spoke to showed a clear understanding of the categories of care the home is registered for and the level of needs that can be safely met at the home. I examined four care plan files, including two referring to residents who were admitted recently. All files inspected include comprehensive pre-admission assessments carried out by the home with supporting information from care managers. Lawrence House DS0000037880.V357965.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 & 10 People who use the service experience excellent outcomes in this area. Residents’ care plans are reviewed and their health care needs are met. Residents are protected by the home’s policies and procedures for dealing with their medication. Residents are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All files inspected included reference to all various aspects of daily living including mobility, nutrition, skin condition, and personal needs. The care plans were seen to be reviewed recently and include risk assessments. The care Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 11 plans, wherever possible, are prepared with the residents, and/or their families, and signed by them. The intermediate care provided at the home involves a multidisciplinary team comprising of care staff and visiting physiotherapists, occupational therapists and social workers working together to provide a programme of support to enable residents to return home. Any nursing support or advice needed for interim/respite residents is obtained from local district nurses. Various arrangements are in place for residents to access GP’s or other healthcare consultants. This includes residents own GPs if they live locally or registering temporarily with a local GP. One resident said that when she recently asked to see a GP this was arranged the same day. The daily records are clear and both the day and night records contain enough detail to monitor residents’ health and well being. There is also evidence in the care plan of the monitoring of residents’ health care needs and general well being, eg food and fluid intake charts. Residents are weighed regularly and referred for specialist care when necessary.. The home’s medication policy is clear and accessible to staff. Staff confirmed that they do not administer medication unless they have received training, been judged as being competent, and feel confident. There are appropriate records for the receipt, administration and disposal of medication. Medication systems have been reviewed recently and checklists are maintained to ensure consistency and avoid errors. Medication administration records were in order and important details and administration times are highlighted to make them clearer. Medication is currently stored in locked trolleys in a locked room. The manager said that the home is planning to review the storage of medication in order to provide a less institutional feel when it is being administered to residents. Any changes are likely to take place when the home has undergone the planned refurbishment of the building. Support with personal issues is provided in a sensitive manner that respects residents’ choice and dignity. The staff I spoke to referred to the importance of treating residents with respect and to consider dignity when delivering personal care. The four residents and two relatives I spoke to said that the staff are helpful and friendly and that they are kind and sensitive when giving assistance. They said that the home is a nice place to live in and that the care they receive is very good. One local District Nurse who visits the home on a regular basis said that the residents appear to be very happy and that the home responds well to any requests or particular issues. Lawrence House DS0000037880.V357965.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, & 15 People who use the service experience excellent outcomes in this area. Residents’ lifestyle preferences and expectations are generally met. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans contain a list of residents’ needs, likes and dislikes and preferences. One resident and another resident’s relative said that there are various activities in the home. These activities include armchair and light exercises, arts and crafts, films and musical activities. During the inspection a member of staff accompanied one resident who likes to go to the local shop. The home keeps an individual record for each resident of the activities they have undertaken. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 13 There was evidence in the residents’ daily records to show that families, and other visitors are encouraged and welcomed. I also spoke with one visitor who visits on a very regular basis and one whose relative has recently moved into the home. They all said that they are always made to feel welcome and offered refreshments and meals. The residents I spoke with said that they generally get up and go to bed at the time they choose. One resident said that she likes to stay up late and that this is not a problem. Residents said that they are often asked whether they need anything and that they are encouraged to make choices wherever possible. Breakfast is served between about 7.00am and 8.30am. The main meal of the day is generally served at about 1.00pm, with the evening meal at about 5.00pm. One resident said that there are always snacks available in the evening and that staff will bring them a cup of tea during the night if they ask for it. The food served on the day of the inspection appeared appetising and wholesome and the residents and relatives said that the food served in the home is very good. Residents confirmed that there is always a choice of 2 dishes for the midday meal and a wider choice for breakfast and the evening meal. The store cupboard contained a wide range of food including fresh fruit and vegetables. Nutritional assessments are carried out and residents are weighed monthly. The home is keeps records of any involvement in residents’ finances, with appropriate receipts and records kept. Staff said that although there are no residents at present with different ethnic or cultural needs they have attended training in equalities awareness and found it very useful and interesting. The manager said that residents would be supported with personal relationships when necessary whatever their gender or choice of lifestyle. Lawrence House DS0000037880.V357965.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 & 18 People who use the service experience excellent outcomes in this area. Residents and/or their representatives can be confident complaints will be listened to and dealt with appropriately and that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide includes the home’s complaints procedure. Four residents and two residents’ relatives confirmed that they would feel comfortable in mentioning any complaints to the management or staff and confident that any concerns would be resolved. The manager referred to a concern expressed recently by a relative following a misunderstanding. This was resolved immediately through a personal visit by the manager to the relative to explain the circumstances and reassure her. Staff are provided with training on adult protection and they confirmed that they are issued with a copy of the council’s “whistle blowing” procedures during their induction period. The staff interviewed all showed an awareness of the complaints procedure and safeguarding adults. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 15 Staff said that there regular training sessions on the protection of vulnerable adults and on awareness of practices that might restrict resident’s choice or liberty. The District Nurse said that when problems have occasionally been identified, the home has reacted promptly and appropriately to ensure that the issue does not become cause for concern Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 16 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 & 26 People who use the service experience good outcomes in this area. Residents live in a comfortable, safe, clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The accommodation for residents is on one level and set out in three wings. There is a small lounge and kitchenette in each area, and a large communal lounge. In addition there is a quiet room, and good office and training facilities. There are well-maintained gardens all around the building, which have been cleared recently and provided with attractive seating. Gardening is carried out by a regular contractor, with additional visits as required. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 17 Whilst all areas are furnished and decorated to a reasonable standard, with some new carpets and furnishings, the home is due for a major refurbishment in the foreseeable future. At present there is no special storage area for wheelchairs, but they are placed where they will not be in anyone’s way or present a hazard. The bedrooms are small but adequate, and comfortably furnished. There are no en-suite facilities but there are toilet and bathing facilities in nearby corridors. There is a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, adjustable height beds, walking aids, hoists, ramps and grab rails. There are alarm call facilities throughout the home, and residents said that they never have to wait long for staff to come. All areas of the home are clean and hygienic and well maintained. There is separate laundry room with commercial washers and driers. There are disposable hand drying towels and pump soap dispensers in communal WC’s and bath or shower rooms. There are appropriate foot operated bins for particular waste products and staff said that personal items are “double bagged” and disposed of appropriately. Light pull cords have recently been covered in plastic to help with infection control. Staff showed a good knowledge of health and safety, including infection control procedures. Maintenance certificates are current and there are no outstanding health and safety requirements. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 18 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 & 30 People who use the service experience excellent outcomes in this area. Staffing numbers are adequate to meet the daily needs of the residents. Residents are protected and supported by the home’s recruitment and induction training procedures. Residents benefit from a well trained and supported staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing level is generally four to five care staff on duty in each area in addition to the manager, deputy manager and team leaders. There are adequate kitchen and domestic staff, administrators, and a part time maintenance man. Night staffing is adequate to cover all areas and there is an emergency on call system covered by the manager and area managers. In the manager’s absence there is always a person in charge who is appropriately qualified and/or experienced. All of the residents and visitors praised the staff, saying that “they are all helpful and friendly” and “you only have to ask for something and it’s done”. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 19 All of the staff spoken I spoke to showed an excellent awareness of the needs of individual residents, and of good care practice. Four staff files were examined and all contained evidence of sound employment, recruitment and supervision practices. The staff interviewed confirmed that they had to complete application forms, and that the home applied for their references, CRB checks and evidence of identity. Staff said that there is on-going or refresher training in areas such as medication, infection control, COSHH, moving and handling, first aid, fire safety, protection of vulnerable adults and health and safety. The home is also committed to providing NVQ training. The majority of staff have completed NVQ2 training and one member of staff said that she is hoping to do NVQ3. Staff said that there is regular supervision and they also commented on the good working atmosphere and teamwork, and the high level of support provided by the manager and senior staff. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 20 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, 36 & 38 People who use the service experience excellent outcomes in this area. The current management arrangements ensure that the home is being run in a way that benefits residents and staff. The record keeping, and health and safety systems are sufficient to safeguard residents’ welfare, rights and best interests. This judgement has been made using available evidence including a visit to this service. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager and deputy manager have extensive experience and have completed care and management courses. The team leaders are delegated to take responsibility for key management tasks, eg the correct receipt and disposal of medication and they also demonstrated a high level of competence. The management of the home and completion of records are generally of a good standard with care and daily records regularly checked by the registered manager. There are further checks by the area manager as part of the monthly regulation 26 reports. The annual quality assurance assessment required by the CSCI has been received and is completed to a high standard. Staff said that the home is run for the residents and that residents are regularly asked for their views and feelings about activities, meals and how things are done. This is either through clients’ meetings or through questionnaires for residents, and/or their families. The questionnaires include questions on satisfaction with personal support, staff attitudes, complaints and the comfort and cleanliness of the environment. A report of the feedback from the questionnaires has been produced in an easily understandable graph format and is displayed on the home’s main notice board. Residents confirmed that any suggestions or feedback are acted upon. Other quality assurance methods include an annual business plan. Staff said that the manager and senior staff are supportive and that staff morale is good. The manager was very ready to praise the staff team. There were no obvious hazards around the home and there was evidence to show that health and safety issues are taken seriously e.g. staff ensuring that personal items were appropriately disposed of and warning signs in place for wet floors. The maintenance file contains current certificates to show that regular checks e.g. gas and electricity, are carried out. Risk assessments on the environment, and for activities involving residents, have also been prepared. Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 4 X 4 Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 23 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 Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 24 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 Lawrence House DS0000037880.V357965.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!