Inspection on 01/06/05 for Malmesbury Lawn

This inspection was carried out on 1st June 2005.

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

Malmesbury Lawn 01/07/08

Malmesbury Lawn 27/07/07

Malmesbury Lawn 05/02/07

Malmesbury Lawn 25/10/05

Malmesbury Lawn 23/02/05

Malmesbury Lawn 05/08/04

Malmesbury Lawn 02/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Malmesbury Lawn Woolston Road Leigh Park Havant Hampshire Lead Inspector Roy Bega Unnannounced 1/6/2005 10:00am 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 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. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Malmesbury Lawn Address Woolston Road, Leigh Road, Havant, Hampshire, PO9 4JY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02392 244900 Hampshire County Council William Tollins Dyet CRH 37 Category(ies) of DE(E)- Dementia over the age of 65 years: registration, with number OP- Old Age: of places Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23/2/2005 Brief Description of the Service: Marlmesbury Lawn is managed by Hampshire County Council Social Services. It is a purpose built residential care home for 37 older persons including those who have dementia. The home is situated within a residential area of Leigh Park, a short distance from the town of Havant. Residents are accommodated on two floors in single bedrooms. A passesnger lift provides easy access to both floors. The home has recently been refurbished. Currently 25 residents are being accommodated due to ongoing discussions with regards to dining room/lounge spatial requirements. Residents have the benefit of two enclosed landscaped gardens. There is a separate 6 beded Intermediate Care Unit located on the ground floor designated to deliver short term intensive rehabilitation for residents discharged from hospital to return home. This unit has not been commisioned due to ongoing discussions with regards to clarity of its intended purpose. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Malmesbury lawn is managed by Hampshire County Council. This inspection took place over one day, a total of six and a quarter hours between 9-45 a.m. and 4 p.m. Opportunity was taken to look around the home, view records and talk with, residents, staff and relatives. This report reflects the situation with regards to standards inspected at the time of the visit. Standards not inspected on this occasion will be assessed during future visits. Three requirements were made resulting from this inspection. It is understood that there are ongoing discussions within senior management of Hampshire County Council regarding the home not operating to full capacity due to the following concerns Dining room spatial requirements. Clarity with regards to the operational use of the 6 bedded unit located on the ground floor. What the service does well: The home is well managed. The staff team are highly motivated and have good relationships with residents. Residents care plans are well documented in meeting their needs and wishes. Staff were observed to respect residents and explain aspects of care before carrying it out. Residents have a stimulating and varied life. There is a full informal activities programme provided by external specialist entertainers and care staff. Residents are also encouraged to maintain their independence and be part of the community. Residents spoken with felt that they are treated very well and respected by staff. Comments made included - “They really care”, “They don’t rush you” and “Staff like a laugh”. Visitors spoken with had nothing but positive remarks with regards to the manner in which the home is run. Comments made included – “They are so helpful here”, “Folk are so friendly” and “Nothing is too much trouble”. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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 standard(s) 3, 4, 5 and 6. The admission process is well managed with residents and their representatives being provided with clear information regarding the home and ability to make pre admission visits. The intermediate care unit has not been commisioned due to ongoing discussions with regards to clarity of its intended purpose. EVIDENCE: Care managers and management staff from the home are involved with prospective residents pre admission assessments. Further information is obtained when the potential resident visits the home. This includes, for example, communication, mobility, dietary requirements and medication. A sample of 2 comprehensive pre admission assessments were seen. There was evidence to confirm that residents and/or relatives are involved in the assessment process. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 9 Residents spoken with stated staff were so kind and helpful before and after they had moved in. They and their family had opportunities to visit the home before making a decision. This was echoed by relatives spoken with. There is a separate 6 beded Intermediate Care Unit located on the ground floor designated to deliver short term intensive rehabilitation for residents discharged from hospital to return home. Mr Dyet informed the inspector that this unit has not been commisioned due to ongoing discussions with senior management within Hampshire County Council with regards to clarity of its intended use. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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 standard(s) 7, 8, and 10. The health and personal care needs of residents is provided in a manner which ensures respect, dignity and rights. EVIDENCE: A sample of 2 care plans which covered all aspects of residents assessed needs and wishes were seen. They included detailed information with regards to personal health needs, daily, evening and bathing routines and wishes. For example – What time they liked to get up, what they like to do during the day, news papers read, the preferred temperature of bathing water and brand of toiletries. Observations, discussions and available training records indicated that staff have the skills and experience to deliver care effectively. Staff were observed to inform residents what they were going to do with regards to care before carrying it out. Staff were also observed to be courteous, respectful, ensuring residents dignity and privacy at all times. Residents and visitors echoed this in discussions. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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 standard(s) 12, 13, 14 and 15. Social activities are well organised and creative providing stimulation and interest for people living in the home. Visitors are made welcome at all times. Meals are nutritious and balanced offering a healthy and varied diet. EVIDENCE: The activities programme for June was clearly displayed which covered day time and evening events. A sample taken from the programme includes – Craft work, sing –a- longs, word quizzes, cooking, painting, crafts, organ recitals, skittles and board games. During the afternoon of this inspection, with the assistance of care staff, several residents were busily engaged in baking cakes. Discussions with several residents indicated that they have been consulted about the activities that occur in the home and are satisfied with the programme. Discussions with management and staff indicated a keenness for personnel to attend activity co-ordinator courses. Relatives spoken with readily informed the inspector of the “open house” attitude with regards to visiting arrangements commenting they are always made welcome. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 12 Available menus indicated a varied and balanced diet is provided. A record of food provided that varies from the main menu was seen. Residents readily expressed their satisfaction with regards to the quality, quantity, and choice of food provided. The meal was taken at residents pace. It was noted special dietary needs and choice other than the main menu were provided. The kitchen was well maintained. It was noted that there is not natural ventilation in the kitchen. The inspector was informed that this matter has been raised with the appropriate department within Hampshire County Council. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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 standard(s) 16 and 18. Residents and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. Policies and procedures are in place to ensure residents are protected from abuse. EVIDENCE: The home’s complaints procedure is included in the residents’ handbook. Residents spoken with and their relatives are aware of how to report any concerns and are confident any complaint will be taken seriously. The record log for complaints was seen but was void of any reports. Discussions with residents and visitors indicated that they have not had any cause to make a complaint but felt reassured that any concerns would be dealt appropriately. The Commission for Social care Inspectorate have not received any complaints with regards to the home subsequent to the previous inspection. The home has Hampshire County Council’s a policy and procedure document with regards to the protection of vulnerable adults in place. Records seen and discussions indicated that the protection of vulnerable adults forms part of staff training. Discussions with staff indicated a good awareness in respect of the protection of vulnerable adults. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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 standard(s) 19, 20, 22 and 24. The home has recently undergone a complete refurbishment to provide safe and comfortable bedrooms and indoor and outdoor communal facilities. There are however, ongoing discussions with regards to dining room/lounge spatial requirements. Residents have the specialist equipment they require to maximise their independence EVIDENCE: The home has recently been refurbished and registered to accommodate 37 residents. Mr Dyet informed the inspector that due to concerns with regards to insufficient dining/lounge space only 25 residents are currently being accommodated. For example there is insufficient space to manouver wheelchairs and walking aids and provide a comfortable environment. The inspector observed this to be the case during the visit. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 15 Mr Dyet also informed the inspector that there are ongoing discussions with senior management within Hampshire County Council to overcome this problem by means of providing an all season conservatory and possibly converting a first floor bedroom into another lounge. The home provides a variety of adaptations and equipment to enable residents to maximise their independence. Residents were observed to walk freely around the home independently or with the assistance of various walking aids. A sample of three residents bedrooms were seen. They were well decorated and equipped. It was noted residents had personalised rooms with their own possessions. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Residents’ needs are met by the number and skill mix of staff. The home has a good recruitment policy and practices in place. EVIDENCE: On the day of the inspection, the unit manager, an assistant unit manager, 6 care staff, kitchen staff and house keeping staff were on duty. This level of staffing was reflected in the available rota. Discussion and available rota also indicated that night levels comprise of 1 assistant manager sleeping and 3 awake care staff. Available records and discussion indicated that 17 of the total care staff compliment have completed the National Vocational Qualification in care level 2 or 3. Discussions with staff indicated that training needs and wishes are discussed as part of their personal supervision. There was a positive attitude by staff towards training. Hampshire County Council have a recruitment policy based on equal opportunities. A sample of 2 staff files were seen, both of which contained the required information. At the time of this visit there were not any staff vacancies. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 17 Staff spoken with confirmed that they had to complete an application form, CRB check, obtain two written references and attend a formal interview before being appointed. Post appointment they were “shadowed” by experienced staff and completed an induction programme before being assessed competent. The deputy manager is responsible for co-ordinating the home’s staff training programme which was made available to the inspector. Courses arranged included- Manual handling; Caring for people who have dementia, First aid. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 and 37. Residents live in a home which is well managed with an ethos of being open and honest. EVIDENCE: The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Mr Dyet has several years experience at a senior level and has completed the National Vocational Qualification level 4 in care and management. Discussions and observations indicated there are clear lines of accountability within the home. Observation and discussions indicated that the management approach of the home creates an open, positive and inclusive atmosphere. Minutes of staff meetings were available. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 19 Good relationships between staff on duty and staff and residents’ was evident. Staff portrayed a strong loyalty towards their work and management. Residents’ spoken with had nothing but positive comments to say about staff which included – “They really care”, “They don’t rush you” and “Staff like a laugh”. Visitors spoken with had nothing but positive remarks with regards to the manner in which the home is run. Comments made included – “They are so helpful here”, “Folk are so friendly” and “Nothing is too much trouble”. Records seen were well managed, up to dated and kept secure. Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 2 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 2 x 3 x 3 x x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 x x x x 3 x Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 21 no Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard 6 20 38 Regulation 23 (1 a ) 23 (2 e ) 23 (5) Requirement To clarify the proposed use of the 6 beded unit located on the ground floor. To clarify the proposals in meeting the communal dinning space. Proposals to improve the ventilation in the kitchen.The Environmental Health office for the area may need to be consulted. Timescale for action 25/07/05 25/07/05 25/07/05 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 Good Practice Recommendations Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire 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. Extracts may not be used or reproduced without the express permission of CSCI Malmesbury Lawn H54 S38646 Malmesbury Lawn V230426 010605.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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