Inspection on 09/01/07 for Lawrence House

This inspection was carried out on 9th January 2007.

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

Lawrence House 26/02/08

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 Michele Etherton Key Unannounced Inspection 09:50 9th January 2007 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.V301842.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.V301842.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 01622 671411 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) caroline.hillen@kent.gov.uk Kent County Council Care Home 30 Category(ies) of Dementia (16), Mental disorder, excluding registration, with number learning disability or dementia (1), Old age, not of places falling within any other category (13) Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents to be 55 years and over Date of last inspection 6th December 2005 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 £353.33 per week and is reviewed annually; service users contribution towards this is based on individual financial assessment. Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection site visit took place on 9th January 2007 between 9.50 am and 5.10 pm. The acting manager, Ms Caroline Barber, service users and staff assisted with the process. The home provides a service for up to thirty people over three units, and eleven of these provided some face-to-face feedback. Three relatives who were visiting also contributed feedback. No service user or other stakeholder comment cards were received before the site visit. A tour of the premises was undertaken that involved all communal areas and some bedrooms (with permission of users). The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, risk assessment information, recruitment and staff training records, duty rota, menus, medication records, accident/incident reports, a sample of safety servicing records. What the service does well: The home has a friendly, calm and homely atmosphere. Service users are encouraged to be involved in individual decision-making processes. Service users can be involved in small ways in contributing to the running the home if they wish. Service users in intermediate care beds make good progress and are enabled to maintain and develop independence skills to support their return home. Staff are supportive of service users maintaining their relationships with families and friends. Personal interests, hobbies etc are encouraged and facilitated where possible. Feedback from service users and relatives’ at the site visit was very positive: they commented that: Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 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. Lawrence House DS0000037880.V301842.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.V301842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service users benefit from receipt of an assessment of need by health and social care professionals, for those admitted for intermediate care the quality of assessment needs further strengthening. Service users referred to and admitted for intermediate care are supported and enabled to regain and maximise their independence allowing them to return home. EVIDENCE: Assessment of prospective service users is undertaken independent of home staff by health and social care professionals, this generally works well with the residential and OPMH units, but needs strengthening for recuperative unit assessments. Staff’ reported that often these assessments either under or overstate the needs and abilities of the service user and it is recommended Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 9 that the home review the current system of assessment for the recuperative unit. The recuperative unit has been successful for many service users in providing an opportunity for them to regain a level of independence prior to return home, staff within the unit felt that liaison between professionals and home staff was very good and that as carers their views were listened to on individual client progress. Service users spoken with during the site visit expressed very positive views of the unit and how it had helped them, comments ranged from: “ I couldn’t walk when I came here, now I’m walking and they’re talking about my going home” “I don’t agree with being made to go home” “When I was in hospital I never ate a meal, since being here I have put on 13LB I eat every bit” “Staff are excellent, kind and warm” “It’s been a wonderful stepping stone, I couldn’t have gone straight home” There was some indication from discussion with one service user and several staff that the timeliness of interventions by Physiotherapy and occupational therapy staff had suffered a little since the decision to move those services from the home to the community, if the unit is to continue within Lawrence House, this is an area that may need monitoring to ensure timescales are not drifting. Discussion with one service user who is returning home and another who is not, highlighted that on occasion, recuperative beds are being used for service users for whom there appears no intention of a return home being pursued. This’ was confirmed in discussion with staff who felt that beds had been utilised in this way recently. Consideration should be given as to whether it is fair or appropriate to mix both groups whose expectations and futures will be quite different. Lawrence House DS0000037880.V301842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service Individual support plans are insufficiently detailed to accurately reflect the needs and support of service users. The health care needs of service users are supported and promoted. Medication arrangements need strengthening around recording of medications. Service users feel cared for, and that their privacy and dignity are upheld by staff who understand their needs. EVIDENCE: Three care plans were viewed one from each unit; these were very basic with insufficient information to adequately inform staff of preferred routines and how care needs are to be supported. The home is required to ensure that care plans are developed to address the identified shortfalls. Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 11 Service users reported that they have access to routine health care checks and to healthcare professionals to ensure their health is maintained. Falls monitoring is not routinely carried out, however, staff highlighted examples of safeguarding referrals to health professionals to seek advice and reassessment where there is cause for concern It is recommended that a system of falls monitoring is implemented linked to accident reporting. Records of service users weights are being maintained. Generally medication arrangements are good. All administering Staff have received medication training. A sample of Medication administration records viewed highlighted a need to discontinue the use of sticky labels on MAR sheets, this practice is not compliant with Royal Pharmaceutical guidelines and may compromise the safety of service users, Changes to MAR sheets are being signed for but dates of changes should also be included. Consents to medications were not clearly evidenced on files viewed either in the care plan or in separate consents. The home is required to address these shortfalls. It is further recommended that the home develop individual service user medication profiles and PRN guidelines to better inform administration of medications. Service users spoke very highly of staff and the support provided to them in their daily routines, they indicated that staff are not intrusive and are there if they are needed. Observations of staff during the site visit supported the view that interventions are discreet and sensitively managed, service users reported that staff had good attitudes towards their job and that they felt cared for. “The staff’ have a feeling for the job”. “My expectations were low but in reality its been marvellous” “I don’t think there are any improvements to be made” Lawrence House DS0000037880.V301842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service Service users lifestyle expectations individual interests and preferences are supported but they would benefit from the development of the existing activities programme. Service users are supported and enabled to maintain contact with their relatives and access the local community where able to. Users are supported to maintain control and exercise choice in their lives. Service users benefit from an appealing and varied menu, meals are presented in a manner that encourages user participation in serving and selection. EVIDENCE: Service users in the recuperative unit were happy with the activities they currently do which mirror what they would expect to do in their own homes; they are supported to retain social activities and community links whilst in the home. Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 13 Service users in the residential unit expressed mixed views in respect of activities some felt that they were adequate; others felt they were inappropriate for them because of poor vision, and another indicated there had been a reduction in activities recently. “I like to keep active, staff let me help” Relatives spoken with indicated concern that in the OPMH unit in particular, activities and general stimulation were inadequate, they felt that the activities board often inaccurately recorded activities that had not taken place. The home should review the activities programme in consultation with users and ensure that activities provided are reflective of their needs and abilities. Family members spoken with were very happy with support offered to their relatives and were made to feel welcome when they visited, they confirmed they are kept informed of events. Service users reported they received visits from relatives and friends, and some accessed the community on a regular basis In conversation with service users in all units many were able to express a view that indicated that they spent their days how they liked, and that their routines were flexible and in keeping with their preferences. They reported that staff support is available where needed. “I’d sooner live here than anywhere else” “Everyone has been nice to us, they listen to you”. Service users were universally complimentary of the meals provided and spoke positively about the opportunity to make choices and that presentation of meals encouraged this. They enjoyed the fact that they could have a cooked breakfast several times per week. One service user indicated that she had made up for a big weight loss in hospital since being in the home. “You can have what you like” “You can asked for something cooked in the evening if you want” Lawrence House DS0000037880.V301842.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel listened to and that their concerns will be acted upon. Policies and practice within the home safeguard and protect service users from exploitation and abuse, but would benefit from improvements to the management of behaviours. EVIDENCE: Service users and their relatives reported that they found staff at all times friendly and approachable, and would not have difficulty in raising any issues of concern with them, relatives indicated that they were kept well informed by the home. One user made an allegation of poor practice against a staff member and was quite open about raising this, they were unsure of the proper forum in which to do this and were awaiting a residents meeting to do this, as a consequence this matter had not been raised with the manager, the home need to ensure that all service users are reminded of the complaints procedure and when this might be used. Some service users indicated that they felt listened to by home staff but not always by other professionals involved in their care e.g. care managers. No formal complaints have been recorded since the last inspection. Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 15 Staff had an awareness of adult protection issues and had undertaken safeguarding referrals in respect of some service users. The case tracking of one service user indicated that there are ongoing behaviour management difficulties; the home has appropriately sought advice and guidance from health professionals. A review of documentation relating to this service user highlighted shortfalls in the accuracy of the care plan, inadequacy of risk assessment and lack of behaviour guidelines to inform staff and ensure consistency of support. Whilst clearly the home has acted in the best interest of the service user by seeking advice and guidance from health professionals, this is an area of weakness that highlights a general lack of planning and consistency around the management of behaviour. It is a recommendation that the home look at developing strategies for managing behaviours that challenge, and systems for recording, monitoring and reviewing how effective interventions are. A staff training programme is in place however, the training matrix is out of date and it was unclear how many staff had undertaken adult protection training, a requirement has been issued in respect of staff training generally (see standard 35). Service users reported in discussion that they had confidence in the ability and knowledge of staff to support them competently and safely. Lawrence House DS0000037880.V301842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24,26 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 safe, warm, comfortable, and clean environment, they are supported and enabled to furnish their bedrooms with their own possessions. In some areas of the home the environment could be improved by redecoration and upgrading, also attention to carpet cleaning is needed to control odour. EVIDENCE: Discussion with service users and their relatives indicated an overall satisfaction with the environment, in which they felt relaxed and comfortable. Permanent residents are encouraged to bring in items of furniture and small possessions to personalise their rooms, which are furnished to a basic standard. Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 17 Whilst priority maintenance is addressed in a timely manner, the building is in need of some upgrading with signs of wear and tear here and there as seen in peeling wall paper borders, and scuffed and damaged paintwork, these works are planned but no date for doing so has been established yet, improvements in this area remain an ongoing recommendation. Previous requirements in respect of a hot-water outlet in the visitor’s toilet and the condition of towel dispensers around the home have been addressed. The home has been pro-active in auditing the current fire safety arrangements making reference to the new fire safety reform order, consideration should be given as to what information needs to be made available to visitors to the building regarding fire safety arrangements and in compliance with the new legislation, this was discussed with the acting manager to address. The emergency lighting system is overdue a service and it is recommended that this is undertaken The home has a comfortable and homely atmosphere in some areas and was generally maintained to a good standard of cleanliness, this was confirmed in discussion with service users and relatives. The breakdown of carpet cleaning equipment has resulted in a build up of unpleasant odours in the OPMH and recuperative areas, the acting manager is aware of this and will be taking action to address it upon the provision of replacement cleaning equipment. Staff within the OPMH unit had an awareness of the need to upgrade that area and an understanding of appropriate types of décor that would best suit the needs of the users. Hoists used to support service users care have been serviced. The nurse call system was demonstrated by a staff member, and is in working order, service users spoken with indicated they have an awareness of the nurse call but have not needed to use it so far. Pre-inspection information provided by the home indicates that annual servicing of the nurse call is overdue this oversight was brought to the acting managers attention to address and is a recommendation. Lawrence House DS0000037880.V301842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service users feel well supported and that there are sufficient numbers of competent staff to meet their current needs. A programme of training is in place for all staff but this needs strengthening to ensure they achieve all mandatory training targets. A thorough staff recruitment procedure is in place to support and protect service users EVIDENCE: Discussion with service users and their relatives indicated general satisfaction with levels of staffing, with users stating they found staff accessible when they needed them but not intrusive. This was supported in observations made of staff during the site visit. Service users thought that staff knew what they were doing, seemed knowledgeable and had confidence in their ability to support them appropriately. Staff reported that staffing levels had improved now that vacancies had been filled by experienced redeployed staff’. On occasion there are difficulties if a service users needs change or have been incorrectly assessed and two staff are needed to support them, in these instances staff are available from other Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 19 areas of the home to help during day shifts, this is not the case with night time shifts and staffing levels at night will need to be reviewed in these cases. Pre-inspection information provided by the home indicated there is a commitment to the NVQ2 training programme and that the level of trained staff is just under the 50 target standard at this time. A review of content of staff files indicated that all relevant documentation is in place, files would benefit from the inclusion of a current photograph for identity purposes and this is a recommendation Over the past year vacant posts have been filled from a pool of redeployed care staff that have not needed the same level of induction as new staff. This was discussed with the acting manager who is aware of the “skills for care” induction programme for new staff and who assured that this would be implemented accordingly in line with the councils own induction programme once new staff care were appointed. Staff confirmed access to a varied training programme, a review of casetracked staff training profiles indicated shortfalls in the completion of some core skills training, the lack of up to date training information on the current staff team meant it was not possible to judge whether similar shortfalls existed throughout the staff team. The home is required to maintain accurate staff training records and to ensure that all staff achieves all basic core skills training, or relevant updates. Lawrence House DS0000037880.V301842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Changes in manager have resulted in slippage in some areas, but have not compromised the structures in place that ensure the safety of service users or the benefits they enjoy from living in a well managed home. Service users are routinely consulted about their individual support but more formal consultation and systems to self assess service quality are needed. Service users financial interests are safeguarded by the policies and practice of the local authority implemented within the home. Staff have access to formal supervision sessions, improvements to the frequency of these are needed. Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 21 Practice and policy within the home promote the health and safety of service users and staff, this would benefit from improvements in recording. EVIDENCE: Whilst there has been a period of instability since the departure of the last registered manager, leadership has continued to be provided from a series of experienced acting managers, staff indicated they had always found these accessible, supportive and easy to work with, however, differing ways of working and expectations were frustrating and unsettling for staff to adjust to. Some service users indicated an awareness of some of the changes happening at present, but, this seems to have had little impact on them or the quality of service they receive, this is largely due to the commitment and professionalism of the staff team who have absorbed much of the effect of the changes. The home benefits from a solid staff structure, staff spoken with had a clear understanding of their roles and responsibilities, they reported good liaison with health professionals with whom they work and felt well supported both individually and within the staff team. Service users confirmed they are routinely consulted about their individual routines, preferences etc, there was, no evidence of wider general consultation in respect of service quality and how service users influence this. Service user meetings have not been held for a while. No formal system for the quality assurance and quality monitoring of the service and its systems is in place. Staff reported that although they had been consulted about some of the changes it has been difficult to feel involved and listened to at times. The home is required to develop an effective quality assurance and quality monitoring system. Policies and procedures are updated centrally, pre-inspection information provided indicated two important policies for the support of service users are not available in the home although clearly staff are supporting service users in these areas, the home are required to ensure that staff practice is appropriately supported by agreed policies and procedures and to evidence clearly that these are being reviewed in line with changes to current legislation and best practice, Service users financial interests are safeguarded by local authority policies and procedures around the management of service user monies and are strictly monitored. Care staff and team leaders are in receipt of supervision but timescales for achieving expected frequencies have slipped, staff reported access to appraisals and some joint practice meetings and these should be considered towards the supervisions total, the acting manager discussed shortfalls in Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 22 supervision frequencies during the site visit and will be discussing with team leaders ways of progressing this. Pre-inspection information recorded that all relevant annual safety checks and servicing had been carried out, there were minor omissions to this and in respect of policies and procedures and these have been addressed elsewhere within the report. Records indicated a low level of accidents and these are appropriately recorded and acted upon. Staff confirmed access to a range of training but training records were insufficiently clear to determine whether shortfalls exist, discussions with service users, staff and relatives indicated that the health and safety of service users is generally promoted within the home through staff practice and support. Service users and their relatives expressed confidence in the support and care provided by care staff, a proportional view has therefore been taken that overall health and safety within the home is good. Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 23 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement The home is to address identified shortfalls in the content and accuracy of care plans Home to discontinue the use of sticky labels on MAR sheets, Changes to MAR sheets are to MAR sheets should be clearly dated as should any changes to medication or administration. Consents to medication are needed. In order to ensure users are supported by competent well trained staff the Home must ensure that all care staff achieve mandatory basic core skills training in addition to specialist training, and that systems are in place to ensure this is updated The home is required to develop an effective quality assurance and quality monitoring system. The home is to evidence clearly that all policies and procedures are in place and are reviewed in Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 25 Timescale for action 31/03/07 2. OP9 13(2) 28/02/07 3 OP30 18(1) & 13(4) 30/06/07 4 OP33 24 31/03/07 keeping with changes to legislation and current best practice 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 3 Refer to Standard OP3 OP8 OP9 Good Practice Recommendations The home to review the current quality and accuracy of assessment of service users to the recuperative unit. A system of falls monitoring is to be implemented linked to accident reporting The home to develop individual service user medication profiles and PRN guidelines to better inform administration of medications. Home to review activities programme in consultation with users and with reference to their needs and abilities The home to look at developing strategies for managing behaviours that challenge, and systems for recording, monitoring and reviewing how effective interventions are. The home should undertake some re-decoration and fit new carpets in areas where the colours have faded (previous recommendation) Emergency lighting to be serviced Nurse call system to be routinely serviced. A current photograph to be included in staff files to aid identity. 4 5 OP12 OP18 6 OP19 7 8 9 OP19 OP22 OP29 Lawrence House DS0000037880.V301842.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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