CARE HOMES FOR OLDER PEOPLE
Lawton Manor Church Lane Church Lawton Stoke-on-trent Staffordshire ST7 3DD Lead Inspector
Helena Dennett Unannounced Inspection 16th March 2006 09:30 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 Lawton Manor DS0000018727.V273629.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 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. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lawton Manor Address Church Lane Church Lawton Stoke-on-trent Staffordshire ST7 3DD 01270 844200 01270 882725 lawtonmanor@majesticare.co.uk 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) Lawton Healthcare Limited Mrs Sharon Smith Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home is registered for a maximum of 50 service users to include: * Up to 25 service users requiring nursing care The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 19th July 2005 Date of last inspection Brief Description of the Service: Lawton Manor is a care home with nursing accommodating up to 50 older persons. It is located just off the A50 between Kidsgrove and Alsager, close to the village of Church Lawton. Lawton Manor is a two storey Georgian detached property, which has been converted and extended into a fifty-bedded care home. The home is situated in its own grounds, which consist of landscaped gardens, walkways and patio areas. Bedroom accommodation is on three floors and comprises of 44 single rooms and three double rooms. Twenty eight of the rooms have en-suite facilities. There are two passenger lifts and staircases. Wheelchair access is good within the building and grounds. There is a very spacious lounge and dining room, and in addition there are smaller quiet areas and a conservatory. There are a variety of assisted bathing/showering facilities and assisted toilets. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3.5 hours. The inspector toured part of the building, spoke with 4 residents, one relative and members of staff. Their comments are included in the body of this report. Feedback on the main findings of the inspection was given to the operations manager and the home manager at the end of the inspection. What the service does well:
The care residents receive at Lawton Manor Care home is of a very high standard. Residents and relatives said they were very happy with the care and facilities on offer. All were complimentary about the staff and their approach and felt that they or their relative’s needs are met. Comments from satisfaction questionnaires obtained as part of the home’s quality assurance system were made as follows: ‘we are delighted with the care mum is receiving’ ‘my relative enjoys a better quality of life and going to outings and day trips’ and …… is doing things now that she hasn’t done for quite a while’ A member of staff visits prospective residents before they move into the home so that they can be sure they can meet their needs. A summary of the proposed care plan is provided to the prospective resident before they arrange to move into the home. Individual care plans were in place for each resident. These were comprehensive, up to date and contained information on the health and well being of the resident so that staff are well informed and provide the best care to residents. There was plenty of evidence that advice from other professionals is sought as necessary and in the care plans looked at, staff had acted promptly on the advice given. The provision of activities is strength of this home and is an integral part of daily living for the residents. Residents said they could choose whether to take part in activities. One resident said ‘you will certainly be kept stimulated here’. Several residents were seen reading magazines, books newspapers etc on the morning of the inspection. A wide range of activities and outings is offered on a regular basis. Details of activities being planned have been circulated to the residents. The home has a competent and experienced manager; staff are very well supported in their training and development so they can provide better quality
Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 6 care for residents. The company provides good support to the registered manager so that the home is run for the benefit of the residents. 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. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 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 Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 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 Assessments of people’s care needs are carried out before they move into the home and they are provided with a copy of their care plan so residents know what to expect when they move in. EVIDENCE: A member of staff visits prospective residents before they move into the home. This gives them the opportunity to meet with the resident and discuss their needs so the resident is confident that staff at the home will be able to care for them effectively. A copy of prospective care plans is sent to the prospective resident before they move in. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 &10 Individual care plans were in place which reflected the health and social care needs of residents so residents are confident that their needs will be met at all times. Residents’ health care needs are monitored closely so that any deterioration in condition is recognised and addressed quickly. Residents are treated with respect and their privacy is upheld at all times. EVIDENCE: Four residents spoke with the inspector. All appeared to be relaxed, and well cared for. Residents said that their needs are being met by staff at the home. Samples of care files were examined as part of this inspection. All contained individual care plans. These were very comprehensive and contained good information on the health and social care needs of the residents. Risk assessments were in place. There was evidence that when a resident’s needs changed, the care plans were updated to reflect the changes. Wound care records were excellent and provided good evidence of the healing process. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 10 Equipment such as hoists and pressure relieving mattresses were available in the home. There was evidence that residents are referred to specialist professionals such as the dietician, when needed. Relative comment cards returned to the home as part of the internal quality assurance process were very positive about the care provided. A sample of the comments made: ‘I think staff at Lawton Manor provide a very high level of care’ ‘ Excellent care and attention to detail’ ‘ we are delighted with the care mum is receiving’. Staff were seen to work well with residents. They knocked on bedroom doors before entering and closed doors before any care was carried out thus promoting residents’ dignity and privacy. All residents were addressed in a friendly but respectful manner. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 & 14 The activity organiser is well qualified and provides plenty of varied activities to keep residents stimulated and active. Visiting can take place at any reasonable time so that residents can keep in touch with their relatives and friends. . EVIDENCE: There is an activity co-ordinator employed at the home. She is qualified to Level 3 City and Guilds in therapeutic care for the elderly. There are plenty of activities going on in the home to keep the residents active and stimulated. Staff at the home have identified activities around the canal area where the home is situated. Outings such as canal boat trips, visit to the Anderton Boat Lift and pub lunches are being organised. Plans are in place to hold a masquerade ball and residents who wish will wear formal dress. Staff at the home are providing long black skirts for some residents. Thank you letters to staff are displayed in the foyer. One letter expressed gratitude that their relative enjoyed the poetry sessions and chatting to the ‘craft’ ladies.
Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 12 There were plenty of photographs on display on the notice board of the outings that residents go on. Copies of newsletters of the local parish were available at reception. One resident who spoke with the inspector said ‘ activities are excellent, you will certainly be kept stimulated here’. Visitors who were spoken with said they were happy with the care and facilities. They are made feel welcome into the home and can visit at any reasonable time. A small room is available near to the reception area where visitors can make themselves a drink of tea or coffee. Residents said that they can ‘suit themselves’ in the home. They are offered a choice of what they want to do. They said the staff attitudes were very good and caring. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Information about the complaints process for the home is readily available so residents and relatives know how to make a complaint. EVIDENCE: There is a clear complaints procedure on display in the entrance hall, which identifies the action to be taken in the event of a complaint. Residents knew who to go to if they wished to make a complaint. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 &26 The home is clean and tidy and well maintained. There are plans in place to refurbish several areas of the interior to improve the facilities for residents. The nurses’ station does not provide an ideal environment for staff to conduct confidential conversations or telephone calls. EVIDENCE: There are signs of wear and tear in some parts of the home, however the operations manager recognises this and said that several areas are going to be refurbished. This will include the hairdressing salon. New carpets for the dining room have been purchased and the operations manager confirmed that plans are in place to redecorate this area in the near future. The lounge looked comfortable. The dining tables were nicely laid with contrasting tablecloths, cutlery and glasses in preparation for lunch. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 15 The nurses’ stations, which are situated in the corridors around the home, are open and not conducive to the management of confidential telephone calls, or discussions with residents, relatives, staff and other professionals. The manager of the home confirmed that all baths have had new thermostatic valves fitted to ensure that the temperature of the bath remains on or around 43°C. The door to the cellar was locked and the key had been removed so residents are not placed at risk. The home was clean and tidy. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 16 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 There were plenty of staff on duty to meet residents needs. Staff are supported in their training and development. EVIDENCE: All of the residents said that staff attend to them in a caring manner. Relatives were also complimentary about staff. There were adequate numbers of both qualified and care staff on duty to meet the needs of residents. Staff were seen interacting with each other and other professionals to ensure that residents were receiving the care they needed. 50 of care staff have achieved NVQ Level 2 or equivalent qualification. An additional 8 staff have started NVQ Level 2 in care course and two staff have started the NVQ Level 3 in care course. The deputy manager has started a Registered Manager’s award as part of her own development plan. All staff said they felt supported in their training and personal development. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 17 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 & 37. The manager of the home is experienced and qualified so the home is run for the benefit of the residents. There is an excellent quality assurance system in place, which provides evidence of the quality of care and services offered to residents. Regular audits are carried out. There is a system in place to ensure that residents’ monies are safeguarded. EVIDENCE: The registered manager is a first level Registered General Nurse and has completed the Registered Managers Award. Recent publications regarding care practice had been downloaded from CSCI Internet site and were available in the office for staff to use. The registered manager confirmed that she intended to implement some of the suggestions in the document covering nutritional needs.
Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 18 Staff spoken with said they felt very supported by the management of the home. They confirmed that they have supervision sessions regularly as well as an annual appraisal. All saw this as a positive experience. The home has held the Investors in People Award since 2001. Staff were currently working towards their second re-assessment. Subsequent to the inspection the CSCI were informed that the home successfully achieved this on the 11th April 2006. The company have developed the quality assurance system. A new document has been issued to the manager, which requires her to complete a selfassessment. Once completed a report will be compiled with outcomes recorded. The manager does regular audits to monitor the quality of care and facilities in the home. Staff meetings are held monthly, and residents meetings are held two monthly. Questionnaires, which can be anonymous, are sent to relatives and residents as part of the quality assurance system and action is taken if any issues are raised. The most recent sample that were returned were very positive about the home. The comments have been incorporated into the body of this report. Only small amounts of money are kept for residents. These are kept in individual folders and receipts are kept for any transactions. Staff also obtain signatures wherever possible before any transactions take place. One resident manages his own money. The activity co-ordinator assists him to get to his bank regularly. All records seen on this inspection were up to date and current. Care plans are now locked up so that only authorised persons can access them. Lawton Manor DS0000018727.V273629.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 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 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 3 3 X Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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. 1. Refer to Standard OP19 Good Practice Recommendations The position of the nurse’s stations in the home should be reviewed to ensure that staff office areas provide the opportunity for telephone calls and conversations to be conducted confidentially and in private. Lawton Manor DS0000018727.V273629.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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