CARE HOMES FOR OLDER PEOPLE
Laywell House Ltd Laywell House Summer Lane Brixham Devon TQ5 0DL Lead Inspector
James Rose Unannounced Inspection 15th November 2006 09:00 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 Laywell House Ltd DS0000018384.V315215.R02.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. Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Laywell House Ltd Address Laywell House Summer Lane Brixham Devon TQ5 0DL 01803 853572 01803 853572 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) Laywell House Limited Mrs Jennifer Victoire Dewaele Murray Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age of places (30) Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Laywell House is a large extended detached residence that has two stories and stands in its own grounds. The home offers 24-hour residential care for up to 30 persons in the category of Old Age and Physical Disability over the age of 65 years. The home has available four separate communal lounge areas and a dining room. Smoking is possible in one of the smaller lounges. There are 28 single rooms and 1 double, 12 of the single rooms have on suite facilities. Two vertical lifts are provided and bathing and toileting aids are available for persons with mobility issues. At the front of the building there is a hard standing car park, which has the capacity to take several vehicles. At the rear of the home there is a large well-tended garden, which has views of the surrounding area. There are also productive vegetable and fruit plots that supply the home. Access into the building is by a single step; a folding ramp is available for use when required, all other entrances into the building are level. The weekly fees payable are: lowest £300.00 and the highest is £365.00. Laywell House Ltd DS0000018384.V315215.R02.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 over 6.25 hours on 15th November 2006. A complete tour of the building was undertaken and samples of care records maintained by the home were examined. Six residents were consulted who gave their views of the service provided and three of the care team were interviewed. Evidence was also obtained from returned questionnaires and healthcare professionals who provide a service to the home. The way care was delivered to residents was also observed. The registered manager assisted throughout the inspection. What the service does well: What has improved since the last inspection? Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 6 A substantial investment has been made in the windows of the main lounge, the glass is in the process of being replaced by double glazed units, which will help to insulate the room and make it more comfortable for residents. What they could do better:
The care plans that were examined as part of the inspection process had some problems. Some of the information needed to provide a comprehensive service to the resident concerned was missing and some of the sheets were not dated making it difficult to orientate the data in time. A requirement has been raised in this report calling for a complete care plan to be available for all residents and a timescale for completion agreed with the registered manager. The recordings undertaken by the home of the administration of medication for residents had several errors apparent and a requirement has been raised to ensure that this position is rectified. The basic training offered to new carers was taking too long to achieve and this position should be reviewed as a matter of urgency. A recommendation has been raised for this purpose. At the time of the inspection no record was available of the formal supervision that must be undertaken of all care personnel. A requirement has been raised in this report to ensure this is rectified. Several bedrooms in the wing of the home had a malodour that was unacceptable and this position should be resolved without delay. An urgent review should be undertaken to find a solution to this issue and a recommendation has been raised for this purpose. No record was available at the time of the inspection of the quality assurance system being used. A recommendation has been raised to ensure this is undertaken. The home does have a record of the fire precautions undertaken by the home; this is carried out by the home’s handyperson. However, no arrangements were in place to ensure this work is completed when the handyperson is on holiday and a recommendation has been made that appropriate arrangements are made to ensure continuity of the precautions to ensure residents are safe. Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 7 It was apparent during the inspection that several of the residents in the home appear to have a substantial degree of confusion, as the home is not registered for dementia a review should be undertaken to ensure this is appropriate and the registration modified to reflect the service provided. A recommendation has been raised for this purpose. 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. Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 8 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 Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 9 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): 3 and 6. Quality in this outcome area is good. Comprehensive assessments were undertaken for all residents in the home that covered their needs in the areas of health, personal and social. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comprehensive assessments were undertaken by the home to ensure that all the needs of the person could be met at Laywell House. If a resident is admitted on an emergency basis an assessment is undertaken by Social Services and a further assessment is undertaken by the home on arrival. Three assessments were examined during the inspection and six residents were asked for their views and they confirmed that this process was undertaken and that their needs were well met at the home. Standard 6 refers to a service not provided at Laywell House. Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 10 Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is adequate. Care plans examined at the inspection were incomplete. Residents are able to self medicate subject to a risk assessed approach. The administration procedures of medication in the home were not complete and have the potential to put residents at risk. Residents did feel that they were always treated with respect and their privacy was maintained at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were picked at random from the homes files and examined. There were gaps in the information available and the plan did not provide a comprehensive foundation for the service to be provided to the individual concerned. These files were used as the key document to inform carers who were asked by the registered manager “to read the care plan”. It is acknowledged that some of the information was held in different places in the office; however, the registered manager was unable to locate some of the information needed at the time of the inspection. Under these circumstances it
Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 12 is difficult to see how carers would provide an appropriate service to residents. A requirement has been raised in this report with a timescale agreed with the registered manager for complete care planning files to be made available for each resident at the home to ensure residents get the service they require. Health issues appeared to be covered appropriately, however, with the integrity of the care planning files in question it is not possible to make an informed judgement. Healthcare professionals were consulted and the district nursing team expressed a wish to work closer with the care team at the home. The home has a policy of residents being able to self medicate subject to a risk assessment process to ensure that they have the capacity. At the time of the inspection a resident was self-medicating but no risk assessment could be located by the registered manager to ensure this process was safe. One resident had been without her prescribed medication for three days because, it was understood, it had not been delivered by the pharmacist. Clearly this position should have been resolved by the home. The administration record of medication undertaken by the home was examined and several gaps were apparent in the issue record, these are being investigated by the registered manager. A confused issue record was also apparent for some residents and the code system was not used appropriately. A requirement has been raised to ensure that all carers adhere to the policy and procedures for the correct administration of medication in the home to ensure residents are safe. Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 13 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 and 15. Quality in this outcome area is good. Residents advised that they liked the lifestyle at the home and generally felt that they had sufficient recreational interests available. The home has an unrestricted visiting policy. Residents were encouraged to exercise choice and to make their own decisions. A wholesome balanced diet is provided that is served in a pleasant spacious dining room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six residents were consulted individually and in private about their life at Laywell House; they were well able to express their views and advised that they enjoyed the lifestyle at the home and joined in the activities when they wanted to. One of the residents said she would like to have more activities available. From observations made during the inspection it was clear that care was delivered in a sensitive way to residents and they were encouraged to make their own decisions. When asked questions by staff residents were given time to consider and make their replies to carers. Residents also confirmed when asked that they could change mealtimes and cleaning times of their rooms if
Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 14 they wished. Residents felt that they had control over decisions that affected them and the management of the home and the staff had their confidence Three visitors were also asked for their views of the service on the day of the inspection and they were all very complimentary and felt that their relatives were well cared for, one visitor added that she came into the home regularly and was always made welcome. The home has an unrestricted visiting policy in place. Residents praised the quality of the food provided at the home. A varied menu was available that offers choice and meals are taken in a spacious dining room that is easily able to accommodate wheelchairs and walking aids. Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 15 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 and 18. Quality in this outcome area is good. Residents and their visitors were confident that any complaints made would be dealt with appropriately. Service users are protected from all types of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Laywell House has a comprehensive complaints procedure in place that includes an appropriate timescale for response. Six residents and two visitors were consulted during the inspection and all were confident that if they raised an issue with the manager it would be taken seriously and a resolution would be found without delay. The home has available a policy and procedure concerning adult protection that is based on the Department of Health Guidelines ‘No Secrets’, this includes an element on whistle blowing. This issue is taken seriously by the home and they have had printed their own booklets which forms part of the home’s training to the care staff team to ensure residents are safe. Three carers were interviewed individually in private and they all clearly understood the range of abuse and the home’s procedure to be adopted if required. Laywell House Ltd DS0000018384.V315215.R02.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 and 26. Quality in this outcome area is good. Laywell House is a safe well maintained home that provides a comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complete tour of the home was undertaken as part of the inspection process, and all rooms were seen. A substantial investment has been made by the home in having the glass replaced in the large arched windows in one of the main lounges for double glazed units. The work is not quite finished but will be, it was understood, in the next two weeks, this will improve the environment for residents and make the room more comfortable. All the bedrooms were seen at this inspection, some of the bedrooms in the wing of the home had a malodour, which was very strong and is unacceptable. It was understood that the particular issues of the occupants in these rooms
Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 17 caused this. This situation is not appropriate and a recommendation has been raised in this report that an urgent review should be undertaken to find a solution. It is acknowledged that in general the standards of hygiene throughout the home are good. Some internal work has been undertaken in the main building to provide a new large bedroom with on suite facilities and this will become available in the near future. The home has an active maintenance programme running and bedrooms are redecorated if needed when they become available. Six residents were consulted as part of the inspection process and it was clear that all these residents were very happy with their rooms and the communal facilities available in the home. Laywell House Ltd DS0000018384.V315215.R02.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 and 30. Quality in this outcome area is adequate. There are always sufficient numbers of carers available to meet the needs of the residents appropriately. The home ensures that residents are protected by having appropriate recruitment practices undertaken. The home does have a training programme running but it takes too long for new carers to receive basic training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a stable core of experienced carers available and they are encouraged to undertake further training and this is rewarded financially by the home, this approach provides a well-informed, up to date care team for residents. However, at this inspection it was apparent that new carers were taking too long to complete the basic training. A recommendation has been raised in this report to ensure that an urgent review is undertaken to rectify this position. No record was available at the time of the inspection of formal supervisions sessions that must be undertaken with all carers. A requirement has been raised to ensure this is undertaken. Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 19 The home has an appropriate policy and procedure for the recruitment of new staff, four files were examined and all clearances and references were in place to ensure the safety of residents. Three carers were interviewed individually and in private during the inspection, they were all clear on the types of abuse that can be found and what action should be undertaken if abuse was discovered. All the residents consulted were very complimentary about the staff at the home and one said “Nothing is too much trouble for them” and another remarked “The staff are helpful and considerate and don’t rush you”. Laywell House Ltd DS0000018384.V315215.R02.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 and 38. Quality in this outcome area is adequate. The home is run by a person who is experienced and fit to be in charge. Regular consultation with service users takes place to inform the service provided. Residents’ financial interests are appropriately safeguarded. Health and safety issues are given priority and are promoted to ensure residents and staff are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager at Laywell House is very experienced and of good character and is fit to be in charge. It was clear from conversations undertaken at the time of the inspection that the needs of the residents are given appropriate priority and that health and safety issues are seen as important.
Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 21 The home does not get involved with the finances of residents beyond giving some assistance with the administration of pocket money. Four sets of records were examined of the pocket money accounts of residents these were chosen at random and demonstrated that all transactions were appropriately recorded and signed for and any purchase made on behalf of a resident the receipt was always retained. The actual cash available was checked with the records and was found to be correct. Health and safety issues are given appropriate priority by the management of the home, all equipment is regularly serviced including the home’s two lifts and the water supply is checked for unwanted bacteria. Gas and electrical items are checked and the home has a current electrical installation certificate available. All harmful chemicals had appropriate secure storage and the management were aware of the procedure for the reporting of any dangerous occurrences in the home. The records of the fire precautions undertaken by the home were examined and were found to be up to date. However, it disclosed that no checks are made when the handyman is on holiday. The home does have a quality assurance system available but no record was available at the time of the inspection of its use. A recommendation has been raised to ensure this is undertaken. It was clear at the inspection that several residents appear to have a substantial degree of confusion; this situation should be reviewed to ensure that the homes registration categories are appropriate for the service provided. Laywell House Ltd DS0000018384.V315215.R02.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Laywell House Ltd DS0000018384.V315215.R02.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. 1. Standard OP7 Regulation 15 Requirement The registered manager must ensure that each resident in the home has a care plan that has the residents health, personal and social care needs set out in an individual plan of care. The registered manager must ensure that all staff adheres to the homes policy and procedures for the correct administration of medication. The registered manager must ensure that all care staff receive formal supervisions a minimum of six times per year and the areas covered are: (a) all aspects of practice; (b) philosophy of care in the home. (c) career development needs. Timescale for action 01/01/07 2. OP9 13 17/11/06 3. OP36 18 01/01/07 Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 24 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 OP38 Good Practice Recommendations The registered manager should ensure that all new carers receive training in: (a) moving and handling; (b) fire safety; (c) first aid; (d) food hygiene; (e) infection control: The registered manager should ensure that the premises are free from offensive odours throughout. The registered manager must ensure that effective quality assurance is undertaken and recorded. The registered manager should ensure that the fire precautions are always undertaken to ensure the home is safe. The registered manager should review the needs of residents in the home to ensure the registration of categories accurately reflects the service provided. 2. 3. 4. OP26 OP33 OP38 5. OP33 Laywell House Ltd DS0000018384.V315215.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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