CARE HOMES FOR OLDER PEOPLE
Laywell House Ltd Laywell House Summer Lane Brixham Devon TQ5 0DL Lead Inspector
James Rose Unannounced Inspection 6th June 2007 9:00 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.V338434.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. Laywell House Ltd DS0000018384.V338434.R01.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.V338434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th November 2006 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. 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.V338434.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 over 10.5 hours in June 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 a returned questionnaire and healthcare professionals who provide a service to the home. The way care was delivered to residents was also observed. This inspection was undertaken with the assistance of the deputy manager, the chairperson and a member of the home’s committee. What the service does well: What has improved since the last inspection?
The healthcare professionals that were consulted as part of the inspection process advised that the service had improved since the time of the last inspection. The home has a maintenance programme in place and this continues.
Laywell House Ltd DS0000018384.V338434.R01.S.doc Version 5.2 Page 6 What they could do better:
At the time of the last inspection the care plans and the assessments examined did not contain all the needs of residents and it was therefore difficult for the home to provided an appropriate service. At that time the issues were discussed in detail with the registered manager and a timescale was agreed for all the work to be completed for the home to have a comprehensive written foundation of the care required for each resident. This work has not been achieved and the registered manager has made no contact to the Commission with an explanation. These matters have been raised with the Chairperson of the home’s committee at this inspection who was surprised by the current position as he was under the impression that the work had been completed. The requirement calling for comprehensive care plans for each resident has been repeated in this report and a requirement has been raised concerning assessments of residents’ needs. The home must also ensure that the residents’ care planning arrangements contain detailed risk assessments. This issue was also made at the last inspection and risk assessments are still missing. This is a very serious matter and it must receive urgent attention as residents remain at risk. The recordings undertaken by the home of the administration of medication for residents had some gaps apparent, however they were in general improved from the recording available at the last inspection. A requirement has been repeated in this report for the administration to be improved further. 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 requirement has been raised here for this purpose. At the time of the inspection little recording was available of the formal supervision that must be undertaken of all care personnel. A requirement has been repeated in this report to ensure this is rectified. No record was available at the time of the inspection of the quality assurance system being used. A requirement has been raised to ensure this is undertaken. 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. This matter was
Laywell House Ltd DS0000018384.V338434.R01.S.doc Version 5.2 Page 7 raised at the time of the last inspection and the recommendation has been repeated 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.V338434.R01.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.V338434.R01.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 adequate. Some of the assessments undertaken of residents needs did not contain all the information needed for the care planning process. Standard 6 refers to a service not provided at Laywell House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five residents care records were examined at this inspection. Some assessments did not contain any social needs and some assessments were missing. New residents should only be admitted on the basis of a full assessments being undertaken and relevant professionals consulted where necessary. A requirement has been raised in this report to ensure this is achieved. If a person is admitted on an emergency basis a detailed assessment should be completed at the earliest opportunity.
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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. The care planning undertaken by the home did not cover all the residents’ needs and some risk assessments were missing. Some care plans had not been reviewed. Residents are able to self medicate. The administration of medication in the home has improved but there are still some difficulties. Residents felt they were treated with respect and their privacy was maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The issues found at the last inspection with reference to the care planning process undertaken by the home remain. Five care plans were examined and all had substantial gaps in the information available and no record was available of the monthly reviews that should have been undertaken. Some risk assessments were also missing on residents. This position is very serious and must be rectified without delay as residents are at risk. At the time of the last inspection a timescale was agreed with the registered manager for the above work to be completed but little progress has been
Laywell House Ltd DS0000018384.V338434.R01.S.doc Version 5.2 Page 12 achieved. The requirement raised in the last report calling for the care planning process for all residents to be completed by 01/01/07 has been repeated and the timescale has been set at 07/09/07. Requirements have also been raised to ensure risk assessments are completed and monthly reviews are undertaken as required. The healthcare professionals that provide a service to the home continue to have concerns about the service provided although they acknowledge that the quality of the care has improved since the employment of the deputy. The recordings undertaken by the home of the administration of medication were examined at this inspection and these were found to be much improved. Some gaps were apparent, however, in the issue record and the requirement concerning the correct administration of medication has been repeated in this report. Six residents were consulted individually as part of the inspection process, they were all complimentary about life at Laywell House and advised that they felt they were always treated with respect and care was taken to ensure their privacy was maintained. Laywell House Ltd DS0000018384.V338434.R01.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 adequate. The care team in the home meet residents’ needs where these are known. Residents that were consulted said they enjoyed life at the home and felt they were in control of their lives and they could maintain contact with family and friends. All the residents advised that they were very happy with the food provided at the home and the facilities of the dining room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six residents were consulted individually during the inspection and they all advised that they liked the life at the home and praised the care team and the food. Many observations were made during the inspection and from these 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. Laywell House Ltd DS0000018384.V338434.R01.S.doc Version 5.2 Page 14 Residents also confirmed when asked that they could change mealtimes and cleaning times of their rooms if they wished. Residents felt that they had control over decisions that affected them 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. 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.V338434.R01.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. Six residents and three visitors were consulted during the inspection and all were confident that if they raised an issue it would be taken seriously and a resolution 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.V338434.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 and 26. Quality in this outcome area is good. Laywell House provides a safe, comfortable and well-maintained environment for the residents who live there. The home is clean and pleasant throughout with high standards of hygiene apparent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A comprehensive tour of the home and grounds was undertaken as part of the inspection process. All the bedrooms were seen and no malodour was found. 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.
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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. The home ensures that residents are protected by having appropriate recruitment practices undertaken. The staff team does receive training but it has taken too long for basic training to be achieved for all carers, which has lead to competence issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a core of experienced carers available and they can undertake further training and this is rewarded financially by the home, this approach provides a well-informed care team for residents. Healthcare professionals that provide a service to the home have advised that some of the moving and handling undertaken by staff in the home is inappropriate. A recommendation was raised in the last report concerning the basic training of carers and this has been upgraded to a requirement in this report. Little recording was available at the time of the inspection of formal supervision sessions that must be undertaken with all carers. A requirement has been repeated in this report to ensure this is undertaken.
Laywell House Ltd DS0000018384.V338434.R01.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, “They will always help you, nothing is too much trouble” and another remarked “The girls, (carers) always give you time when they are helping you about in the home”. Laywell House Ltd DS0000018384.V338434.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 and 38. Quality in this outcome area is poor. The home is run by a person who is experienced and fit to be in charge, although performance has been poor recently. Consultation takes place with residents. Residents’ financial interests are appropriately safeguarded. Health and safety issues are given priority and are promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current registered manager of the home is very experienced and of good character. At the time of the last inspection the requirements of the report were discussed in detail and the manager gave an undertaking that they would be satisfied by the agreed timescales, unfortunately this has not been achieved and the requirements have been repeated here.
Laywell House Ltd DS0000018384.V338434.R01.S.doc Version 5.2 Page 21 The residents in the home are consulted about the service provided but the new quality assurance system that was being introduced is not yet in place. All the residents consulted at this inspection were very happy at the home and felt that they were consulted about matters that affected them. The home does not get involved with the finances of residents beyond giving some assistance with the administration of pocket money and the procedures in place are appropriate. Health and safety issues are given priority, 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. The fire precautions are in place. All harmful chemicals had appropriate secure storage and the procedure for the reporting of any dangerous occurrences in the home is in place. At the time of the last inspection a recommendation was made that confused residents should be reviewed to ensure that their needs are appropriately met and that the home is acting within its registration. This has not been undertaken and the recommendation is repeated here. If necessary the home could amend its registration to provide a service to residents with dementia as long as they could meet all the needs presented and with additional staff training undertaken. At the time of the last inspection the Commission forwarded to the registered manager an improvement plan to be returned within one month to date this has not been received. Laywell House Ltd DS0000018384.V338434.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 N/A 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 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Laywell House Ltd DS0000018384.V338434.R01.S.doc Version 5.2 Page 23 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. 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. (Completion date agreed in the last report 01/01/07 not met) The registered manager must ensure that all staff adheres to the homes policy and procedures for the correct administration of medication. (Completion date of 17/11/06 not met) 3. OP36 18 The registered manager must ensure that all care staff receive formal supervisions a minimum of six times per year and the areas covered are: all aspects of practice; philosophy of care in the home. career development needs. (Completion date agreed at the last inspection 01/01/01 not met)
Laywell House Ltd DS0000018384.V338434.R01.S.doc Version 5.2 Page 24 Timescale for action 07/09/07 2. OP9 13 11/06/07 31/07/07 4. OP3 14 5 OP7 15 6 7 OP7 OP38 15 18 8 OP33 12 The registered manager must ensure that comprehensive assessments are undertaken of proposed residents needs in the areas of health, personal and social. The registered manager must ensure that comprehensive risk assessments are undertaken for each resident in the home and these are added to the care plan. The registered manager must ensure that monthly reviews are undertaken of all care plans. The registered manager must 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 must ensure that there is effective quality assurance and quality monitoring systems in place in the home. 29/06/07 29/06/07 29/06/07 29/09/07 31/07/07 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 OP33 Good Practice Recommendations The registered manager should review the needs of residents in the home to ensure the registration of categories accurately reflects the service provided. Laywell House Ltd DS0000018384.V338434.R01.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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