Inspection on 27/07/07 for Malmesbury Lawn

This inspection was carried out on 27th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Malmesbury Lawn 01/07/08

Malmesbury Lawn 05/02/07

Malmesbury Lawn 25/10/05

Malmesbury Lawn 01/06/05

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 PO9 4JY Lead Inspector Christine Walsh Unannounced Inspection 30th July 2007 10:00 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 Malmesbury Lawn DS0000038646.V341190.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. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Malmesbury Lawn Address Woolston Road Leigh Park Havant Hampshire PO9 4JY 023 92 244900 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) Bill.Dyet@hants.gov.uk Hampshire County Council William Tollins Dyet Care Home 37 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (35) of places Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Malmesbury Lawn is managed by Hampshire County Council Social Services. It is a purpose built residential care home for 35 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 passenger lift provides easy access to both floors. The home has recently been refurbished and the residents have the benefit of two enclosed landscaped gardens. The fees for the home are £446 per week. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh, regulatory inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. In addition “Have Your Say” resident and relatives comment cards were sent of which a small number have been received. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, where possible speaking with the residents and staff and observing care and support practices. A tour of the home took place and documents pertaining to health and safety were viewed. What the service does well: Malmsebury Lawn does well in ensuring that the care it provides to people with dementia is based on their individual needs and wishes and those of family and friends. The home makes sure it can meet perspective residents’ needs by carrying out an assessment before they move in. Following an assessment the home develops a personal plan providing vital information on how the residents wish to be supported. This helps staff to support the residents in the way they are used to. The manager and staff make sure residents health care needs are fully met and where possible will support the residents to maintain contact with their own doctor as well as making sure their mental health care needs are carefully monitored and reviewed. Malmesbury Lawn provides a variety of in house and social activities that are stimulating and rewarding such as music sessions, reminiscence therapy and themed social events such as a summer ball which family and friends are also invited to. The home provides healthy nutritious meals in pleasant and relaxing surroundings. The people who live at Malmsebury Lawn have their nutritional needs assessed and if they need help with their meals this is provided by staff who are aware of the importance of ensuring elderly people receive a healthy well balanced diet. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 6 If the people who use the service are unhappy with the care they receive the home has a clear complaints procedure and an open door approach to listening to concerns raised by residents or their family and friends. People who live at Malmesbury Lawn live in a comfortable spacious, clean and safe environment that is furnished and decorated to a high standard; residents have a room of their own and have access to communal areas throughout the home including an enclosed garden. The people who live at Malmesbury Lawn are supported by skilled and competent staff who receive regular training and support to do their job. They are recruited using robust recruitment procedures and who are employed in sufficient numbers, which assists in providing a continuity and individualised approach to the residents care. The home is managed by a competent manager who is enthusiastic and keen to continually improve the quality of care and the environment for the people living in the home. The home regularly seeks the views of the residents, relatives and others regarding the quality of care it provides and is open to suggestions on how this can be improved. The home has systems in place to support the people who use the service with their finances and will make arrangements to safe keep monies and valuables if the resident wishes. A comment recieved about the home from a relative: “The whole establishment is always bright and cheerful, as is the staff. They communicate well with the residents in a very caring way. My mother has settled very well and is very happy. I consider myself very lucky to have found Malmesbury Lawn”. What has improved since the last inspection? Following the last visit to the home in February 2007 the home was issued with four requirements these were made at the time as pre admission assessments, care plans, medication and staff training in adult protection was poor. Three of the four requirements have been met. The home has made significant improvement in undertaking pre admission assessments, which have assisted in improving the quality of information, and detail provided in the care plans. Care plans were viewed as providing information on how the residents wish to be supported with their health and welfare needs and staff said they found the care plans informative and helpful in providing a continuity of care. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 7 All staff have received training in adult protection and the staff member spoken with at the time of the visit was very clear about what she would do if she observed an act of abuse taking place. 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. The summary of this inspection report can be made available in other formats on request. Malmesbury Lawn DS0000038646.V341190.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 Malmesbury Lawn DS0000038646.V341190.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 good. This judgement has been made using available evidence including a visit to this service. Malmsebury Lawn does well in ensuring it can meet the needs of the people who wish to use the service by carrying out a full assessment of their needs prior to them moving in. The home does not provide intermediate care. EVIDENCE: The annual quality assurance assessment (AQAA) tool informed us that the home does well to admit all new residents by referral from care managers whether funded or self funding, receiving a copy of the pre admission assessment before the resident moves in. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 10 To test this three residents assessment documents were viewed and discussion took place with the manager in respect of the process the home uses to support prospective residents to move in. On the day of the visit the home was making arrangements to welcome a new resident to the home. The residents room was prepared and ready, staff were aware of the new comer and all documentation required to support the resident were in place including details of next of kin and GP. The three assessments viewed demonstrated that the home is now undertaking an assessment of their own which assesses the strengths and needs of the residents and identifies where the residents needs support. The assessment also looks at the health and welfare of the residents including their social and emotional and cultural needs. This is an improvement from the previous visit to the home where it was only relying on the information provided by placing care managers assessments. Malmesbury Lawn DS0000038646.V341190.R01.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 . This judgement has been made using available evidence including a visit to this service. Malmesbury Lawn does well in ensuring the people who use the service have their personal and health care needs met in the way that they wish and prefer. The development of personal plans and risk assessments has improved however the home must ensure all areas of individual risk are recorded to provide guidance for staff. The people who use the service are not receiving their medications using safe and required practices. This places the residents at potential risk. EVIDENCE: The annual quality assurance assessment (AQAA) tool informed us that the home does well in actively promoting individual choice in its care planning and risk assessment process which is supported by each resident having an assigned keyworker and involving other relevant agencies in the process. The Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 12 AQAA also informed us that the home ensures people are supported with their medication and they are treated with respect, which is maintained by a high profile management team and staff undergoing Core Values training. This was tested by viewing four residents personals plans, viewing comment cards received from residents and relatives, speaking with staff, observing interactions between residents and staff and observing a medication round. Following the last visit to the home it was required to ensure care plans provide clear guidance for staff in order to provide a consistency of care. The four personal plans viewed provided evidence that improvements had been made to the care plans, providing information on how the residents need support with their care and how they wish this to be carried out. The plans provide evidence of the residents preferred morning and day routine providing the staff with guidance on what time a residents wishes to get up and go to bed, however it doesn’t cover how the resident wishes to spend their time during the day. The home is advised to consider this as it plays an important part of the resident’s social life including mealtimes, preferred activites, hobbies and interests and visits to and from relatives and community events. Three of the four plans provided a past history of the resident including where they were born, their occupation, important dates in their life, spouses and their children. This information provides an important in sight into the residents’ lives and why they may act in certain ways to certain activities and times of the day. However the home must ensure that they as far as feasibly possible obtain histories for all residents. A resident said: “Care staff support and care for me in all my needs”. Another said: “The staff are very good”. A staff member said: “I am a keyworker and part of my role is to keep an up to date record of the residents needs and make changes where required” Another staff member said: “The care plans are clear and provide good information on how to support the residents”. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 13 A relative said: “My mother is very well looked after”. The four residents personal plans viewed also included risk assessments that identified areas of risk for the resident, how the risks can be minimised and what action staff need to take. This included moving and handling risk assessments. However through viewing a residents risk assessments and observation of the resident the home is advised to ensure there are clear risk assessments in place to prevent the risk of choking, it is advised that is done with the appropriate health care professional. The plans detail individual medical histories and health care plans provide information for staff on how to support the residents to maintain a healthy lifestyle. Personal plans also provide evidence that residents receive medical attention when required including primary health care professionals such as GP’s and dentists and specialist health care professionals such community psychiatric nurses (CPN’S) and speech and language therapies (SALT). Following the last visit to the home there were concerns raised and a requirement issued in respect of as required medications, these are medications given only when a residents requires them such as a painkillers and medications to assist with anxiety and challenging behaviour. The home was required to produce guidelines for staff for when these types of medications must be given. Through observation of a medication round by a senior member of staff further poor practices were observed despite this member of staff confirming she had received comprehensive medication training over a six month period by an outside trainer and attended training provided by the service. It was observed that: 1. Liquid medications were not shaken before pouring. 2. Medications were disposed of down the sink. 3. Medications were signed for before the resident had taken the medication. 4. A resident was left unsupervised to take his medication and his medication was left in reach of other residents. 5. Tablets were handled. 6. Eye drops were administered at the dining room table with out consultation and the option to go somewhere else and in front of others. 7. Eye drops were administered without hands being washed first, placing the resident at risk of cross contamination and infection. These observations were discussed and fed back in full with the manager and the member of staff concerned. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 14 In the main the home demonstrates that it respects the dignity, privacy and rights of the residents. Care plans describe the resident’s wishes and preferred choices such as cooked meals rather then cold and times to get up and go to bed. Staff were observed to interact positively and respectfully with the residents calling them by their preferred name: A staff member said: “Its important to respect the individuality of the residents and support them to maintain their independence as far as possible”. A relative said: “They recognise and respond to individual needs”. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. The home does well in ensuring the people who use the service are provided with a range of activities, social and individual to meet their preferences and needs The home does well to ensure friends and relatives of the people who use the service are made welcome and kept informed of their wellbeing. In the main the home does well in ensuring the people who use the service are supported to exercise choice and control over their lives, however this must be a consistent practice throughout all areas of the residents health and wellbeing. The home does well to ensure the people who use the service are provided with nutritious and well-balanced meals, considering their dietary and cultural requirements. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 16 EVIDENCE: The annual quality assurance assessment (AQAA) tool informed us that they consider the resident’s individual hobbies and interests and incorporate these into the resident’s personal plans. Relatives are encouraged to visit and when residents choose not to meet with relatives this is supported. Residents are encouraged to bring in special pieces of furniture with them and supported to manage their own financial affairs in respect of exercising choice over their lives and are provided with three meals a day, regular snacks and a choice of menu. This was tested by viewing four residents personal plans, observing activities, speaking with staff and residents and observing interactions with staff and residents and support provided for them at meal times. Three of the personal plans viewed had a pen picture of the resident’s life history noting their occupation and hobbies and interests, this was also noted on the assessment documentation. The home is fully aware of the value of the life histories and how this helps them to understand the needs of the residents, therefore they are advised to ensure as far as possible all residents have a pen picture. Through the course of the visit it was established that the home provides a range of activities to stimulate and interest the residents. The home has a designated activity coordinator who has developed an activity plan which involves group and individual activity such as reminiscence, arts and crafts, music therapy, pampering days for the ladies and watching sports and enjoying a can of beer for the men. The home holds large events every year such as summer balls and BBQ’s which relatives and friends are welcome to attend. A music session observed taking place with an outside entertainer was stimulating and enjoyable for all the residents, each resident was observed to be engaged and encouraged to play an instrument as well as sing along. A member of staff said she regularly gets involved in activities with the residents and enjoys playing snakes and ladders and other types of board games with them. The manager spoke of how the home has been taking steps to involve friends and relatives in the home and support residents to maintain contact with them. The manager said he sends out newsletters to next of kin and has held relatives meetings, although he admits this area needs working on. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 17 The home has a pay phone and residents are supported to write letters and send birthday cards to loved ones and there is a separate visitors room where residents can meet with their relatives in private. Visitors were observed to be made welcome with the offer of tea and coffee and biscuits. A relative said: “I am always made to feel welcome and they keep me informed of how my husband is”. Through observation and viewing personal plans there is evidence that residents are provided with choices on how to spend their day, what they would like to wear, eat and do, allowing the residents to exercise their rights. A member of staff was clear of the importance of treating residents with respect and providing them with opportunities to choose how they wish to spend their day. However this must be followed through in every aspect of the residents’ life including when receiving their medication. The home has and continues to undertake a special interest in the importance of meal times, including dietary and nutritional requirements, the best times to eat and the environment. The home undertakes a comprehensive nutritional assessment on each resident, which includes the resident’s likes and dislikes, and weight and height, special dietary requirements including supplements or assistance to eat. The home has moved the main hot meal of the day from lunchtime to the evening meal as they have established that this assists residents to have a restful night, however if a resident requests a hot meal at lunchtime this would be accommodated. Residents are provided with a daily menu and offered a choice at the time of the meal being served, using plated meals as prompts. The environment and atmosphere at mealtimes was noted to be relaxed and unrushed and residents were being supported when required. The mealtime appeared to be a pleasant experience and social event of the day. The AQAA informed us that the home is looking to further develop its response to mealtimes by being more pro active in ensuring residents requests for certain foods are made available on a more regular basis such as a “Today’s Special” which then can be in addition to the planned menu. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. Malmesbury Lawn does well in ensuring the people who use the service feel that their views and concerns are listened to and acted upon. The homes adult protection policies and procedures and training of staff protect the people who use the service from potential risk of abuse. EVIDENCE: The annual quality assurance assessment (AQAA) tool informed us that they ensure all new residents, family and friends are provided with written information on how to make a complaint, that the service has a dedicated performance department to monitor its performance and they offer discharge questionnaires to assist the homes development. They informed us that the home has robust adult protection procedures and all staff have received adult protection training. This was tested by viewing the homes Statement of Purpose, and polices on complaints and adult protection prior to visiting the home, viewing comment cards received from residents and relatives, speaking with staff and viewing staff training records. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 19 Both the Statement of Purpose and complaints procedures provide residents and relatives with clear information on how they can make a complaint, who to and how this will be managed. Comments received from residents and relatives all indicated that they new how to make a complaint. A resident said: “I will speak to my keyworker if I am unhappy or need to make a complaint” A member of staff said she would inform a senior member of staff or the manager if a resident made a complaint and document it. A relative said: “There is no need to make a complaint the staff are very caring and loving” The home has a complaints logbook where the nature of the complaint is recorded, what action has been taken and by who and the outcome. The AQAA informed us that the home has not received any complaints in the last twelve months. Following the last visit to the home is was required to ensure all staff are trained in adult protection, this requirement has been met and the manager provided evidence of staff having received training. A member of staff spoken with confirmed that she had completed the training and demonstrated that she is aware of what constitutes abuse and how this must be reported. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. Malmesbury Lawn does well in ensuring the people who use the service are provided with a homely, clean and comfortable environment to live in. The people who use the service each have a room of their own which promotes their individuality and suits their needs. Malmesbury Lawn is a large home, but despite this it does well in ensuring a very good standard of hygiene. EVIDENCE: The annual quality assurance assessment (AQAA) tool informed us that the home has been refurbished in the last three years and provides individual accommodation to all residents and that the home has a dedicated laundry Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 21 facility with trained staff and that they can provide evidence that staff have received infection control training. This was tested by taking a tour of the building, observing hygiene practices, viewing comment cards and speaking with staff. The manager demonstrated that he has a good awareness of the needs of people with dementia and the importance of having an environment that is planned and decorated to assist the residents to maintain their independence and move around their home as freely as possible, specific colours, textures and notices supports this. Each area of the home has been utilised to provide either a relaxing or stimulating environment such has a quiet area for music with a tropical fish tank and an area with reminiscence artefacts to stimulate residents such as an old type writer and ration books. The home is spacious, bright, airy, and decorated and furnished using quality furniture and furnishings. The home has taken into account the continence needs of the residents and the home is free of odours. The home is lacking in communal space, which the manager has plans in place to address and is hopeful that plans to add a conservatory will take place soon, he also plans to develop a currently unused garden area to meet the sensory and cognitive needs of the residents. The home has ample bathing and toileting facilities and the manager plans to introduce a shower room. The manager explained the purpose of this is to support residents efficiently and effectively with continence mishaps, thus preserving their dignity. Each resident has a room of his or her own that is personalised and reflects their individuality. These have been decorated and furnished with good quality furniture and furnishings. The home was noted to be spotlessly clean throughout and a dedicated team of domestic staff were observed to be hard at work, a domestic member of staff said she takes pride in keeping the home clean. Notices, hand gels and automatic dispensing hand towel machines support the staff to undertake good hygiene practices. The staff spoken with confirmed that they had received infection control training, however the practice of touching tablets and administering eye drops with unwashed hands places residents at risk of cross contamination and infection. A resident said: “I get my room cleaned every day” Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 22 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Malmesbury Lawn supports the people who use the service with skilled and competent and suffient numbers of staff to meet their needs. The home has robust recruitment procedures and systems in place to safeguard the people who use the service from potential risk of harm. EVIDENCE: The annual quality assurance assessment (AQAA) tool informed us that the home uses assessment tools to inform them of the numbers and hours of staff required to meet the needs of the residents. They have experienced staff leading the shifts including nights and they have over 50 of their staff team trained to national vocational qualification (NVQ) standard and staff undergo regular training and have annual performance reviews to identify further training needs. This was tested by observing staff practice and interactions with residents, viewing staff training and recruitment files and speaking with staff and the manager. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 23 Throughout the course of the visit the staff were observed going about their daily duties in an unhurried and relaxed manner, residents were responded to promptly and when required encouraged to maintain their independence. This is seen as good practice as it is easy to do for than to encourage people to do things for themselves. The home is split into three areas with a dedicated staff team in each, however it was observed that each team helps one another out and are familiar with all residents living in the home. The home is carrying a small number of vacancies, which in the main are ancillary workers, however the manager stated if they are short of staff they will call upon the organisations domiciliary care service to cover shifts rather than go out to agency. This provides familiarity and consistency and supports regular staff rather than them supporting an unfamiliar agency member of staff. Information provided in the AQAA confirmed that over 50 of the staff team have a NVQ, some having gone onto NVQ3 and senior staff to level 4, this demonstrates that the home is proactive in encouraging staff to expand their knowledge. A member of staff confirmed she had just completed a NVQ and had found it very beneficial for work she carries out daily in the home. She went onto say: “ I like my job it’s rewarding and challenging and its nice to see the residents smiling”. Four staff recruitment files were viewed and evidenced that staff had undergone a robust recruitment procedure including completing an application, attending an interview and a criminal record bureau (CRB) and protection of vulnerable adult (POVA) check had taken place prior to the member of staff commencing in the home. There was evidence that some staff had started on a POVA check only, however there was evidence that the staff had started an induction and were shadowed before providing personal care or working in isolation. A member of staff spoken with confirmed that she had undergone a robust recruitment procedure. The home is proactive in ensuing staff receive the correct and appropriate training to meet the needs of the residents, a lot of this taking place before the staff member starts working hands on with the residents. Staff supervisions and annual performance reviews assist in identifying areas of individual strength and training need. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 24 A member of staff confirmed that in the year that she had worked in the home she had been provided with numerous training to assist her to meet the needs and understand the residents, such as moving and handling, first aid, adult protection, infection control, dementia care, nutrition and communication. Relatives said: “I know the staff have ongoing training and they recognise and respond to the residents individual needs” “The staff are trained in “Care” and they are able to deal with all situations that may arise”. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 25 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. This judgement has been made using available evidence including a visit to this service. The people who use the service live in a home that is managed by someone who is fit to do so, who considers their views and expectations when developing the home. However due to poor medication practices id does not safeguard them from potential risk of harm to their health and welfare. EVIDENCE: The annual quality assurance assessment (AQAA) tool informed us that the manager is registered, that he regularly meets with his peers and line manager, receives regular supervision and completes an individual performance plan as well as reviewing performance plans of his senior staff. He ensures quality-monitoring systems are in place to measure the homes performance and quality of care, ensures residents monies are held safely and Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 26 accounted for and he ensures the home is maintained to a high and safe standard. This was tested by spending time with the manager, observing his practice and interactions with residents and staff, viewing quality monitoring systems, the homes service certificates, comment cards and speaking with staff. Although the manager demonstrated through the course of the visit that he is dedicated to ensuring the needs of the residents are appropriately and efficiently met with the emphasis of the residents being at the centre of care and deciding how their home should be managed, medication practices fail to safeguard the people who use the service. The manager was observed to have a good rapport with residents and staff and was familiar with the individual needs of the residents. Staff were observed to be comfortable and relaxed in his presence. A relative said; “I think the home is very well run and could not be bettered” A staff member said: “I feel well supported by the managers they are approachable and good to work with”. The manager said he takes improving the quality of the service seriously and is taking steps to improve the involvement of the residents and their relatives in decision making and seeking their views of the quality of care. The manager has undertaken a quality audit and collated the information into an action plan, which he said he refers to frequently. The home encourages residents to maintain their independence in managing their money but provides a safe place where monies can be kept and managed on their behalf they wish. The manager, administrator and/or deputy manager hold the keys to this safe place. Each resident has lockable storage in their room where they can keep valuables and money if they wish. The manager regularly audits monies held on behalf of the residents and is also subject to outside audits. A tour of the building and viewing service certificates demonstrated that the home is well maintained and as far as reasonably practical provides a safe place for the residents to live. All visitors to the home are asked to sign in and out of the building and all doors are alarmed and will alert staff to a resident leaving the building unescorted. Warning signs are in place to notify people that cleaning is in Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 27 progress and corrosive substances hazardous to health (COSHH) are safely locked away. Staff records provided evidence that they have received training in health and safety, first aid, food hygiene, moving and handling and fire safety. Fire safety records and service certificates demonstrated that the home is regularly monitored to eliminate risks to residents and staff. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 28 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 3 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 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 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13(2) Requirement The administration of ‘as required’ medication must be is recorded in line with Royal Pharmaceutical Guidelines, with reasons given and outcome for the individual. This requirement has been from the inspection undertaken on 05/02/07 2. OP9 13(2) The people who use the service must have their medication administered to them using safe and recognised practices. 1. Tablets must not be signed for before taken. 2. Tablets must not be left unsupervised and left in reach of other residents. 3. Liquid medications must be shaken before poured or as according to the pharmacy instructions. 4. Medications must not be disposed of down the sink. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 30 Timescale for action 30/09/07 30/09/07 3. OP10 13(2) 12(3) & (4) The people who use the service must have their rights to privacy and dignity respected at all times. Residents must be consulted where they would like to have invasive treatments such as eye drops administered. 30/09/07 4. OP26 13(2) The people who use the service must be safeguarded from the risk of cross contamination and infection. 1. Staff must not handle medications. 2. Staff must not administer eyed drops without washing their hands first. 30/09/07 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 OP7 Good Practice Recommendations The home is advised to as far as possible obtain a life history/pen picture for each resident. Malmesbury Lawn DS0000038646.V341190.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 © 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 DS0000038646.V341190.R01.S.doc Version 5.2 Page 32 - 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. 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