Inspection on 18/09/08 for St Lawrence

This inspection was carried out on 18th September 2008.

CSCI found this care home to be providing an Adequate service.

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

St Lawrence 20/03/08

St Lawrence 23/07/07

St Lawrence 02/06/06

St Lawrence 01/11/05

St Lawrence 12/05/05

St Lawrence 25/01/05

St Lawrence 28/07/04

St Lawrence 25/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOMES FOR OLDER PEOPLE St Lawrence Churchill Drive Crediton Devon EX17 2EF Lead Inspector Dee McEvoy Unannounced Inspection 18th September 2008 09:20 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 St Lawrence DS0000033100.V371951.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. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Lawrence Address Churchill Drive Crediton Devon EX17 2EF 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) 01363 773173 01363 774121 http/www.devon.gov.uk Devon County Council Manager post vacant Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29), of places Physical disability over 65 years of age (29) St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2008 Brief Description of the Service: St Lawrence is a purpose-built care home, owned and managed by the local authority, Devon County Council (DCC). It is situated on the edge of the small, busy town of Crediton. St Lawrence provides a range of services for older people but cannot admit anyone with nursing needs unless the district nursing service can meet the needs. The home has 29 rooms spread over three floors. An intermediate care and short stay unit is located on the ground floor. The aim of the intermediate care unit is to help people to regain their independence so that they can return to their own homes. Rosella is a designated dementia wing and is situated on the top floor. Each floor has its own lounge and dining room, bathroom and toilets. Access from outside is level, and there is a connecting lift to all floors. The home has limited garden space and parking. A provision for residents to smoke has been made under the porch by the front entrance. This home also provides a fifteen place day service for local older people on weekdays. This facility is not regulated by CSCI, and is run as a separate service. On certain mornings residents from the home are welcome to join a card group at the day centre. The average cost of care is £556.57 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, some continence products, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective residents. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit to St Lawrence we sent a number of confidential surveys to 10 people living there, to staff and outside professionals to hear their views. Senior staff had helped 8 people living at the home to complete surveys. We also received completed surveys from 6 staff and 2 health professionals. The comments and responses we received have helped us to form the judgements we have reached in this report. We (The Commission) spent 15 hours at the service, over a period of two days. At the time of our visit there were 14 people living at the home. Admissions remain suspended until 1st October 2008. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to four people. Most people living at the home were seen or spoken with during the course of our visit and 7 people were spoken with in depth to hear about their experience of living at the home. We also spoke with 2 relatives, 3 visiting health professionals and 19 members of staff, including the manager, care and agency staff and domestic staff to hear what they think about this service. The home provides care for people with a dementia related illness and some people do not have the capacity to communicate fully or understand the inspection process. We spent considerable time observing the care and attention given to these people by staff. We looked around the home and checked records such as care files, staff recruitment and training records, quality assurance records, and some safety records. A random inspection was carried out on 2nd July 2008 in order to look at how the improvements required at the last key inspection were being met (See what has improved since the last inspection). A copy of this report can be obtained from the Commission for Social Care Inspection. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 6 What the service does well: We asked people what this service does well. People told us that the staff were “very good”, that routines were flexible and suited them, and that they liked the food. People said the laundry service was good and that their clothes were always returned to them in good condition. Their comments included, “It’s house and home to me. You couldn’t get much better”, “The staff are very good to me, they understand me and are very respectful people”, “I am free to please my self here”, “We are all treated well”, “St Lawrence suits me” and “I feel safe here. I am glad to have someone to look after me”. Relatives were happy with the overall standard of care at the home. One relative told us, “Mum seems happy here, she always looks nice and well cared for”. Another told us, “The atmosphere is good, calm and caring”. Relatives said they always received a warm welcome at the home and we saw that staff provide refreshments for visitors. Relatives told us the home keeps them informed of important events affecting their loved one and they told us they were confident that most staff had the skills to care for people living at the home. People have access to a full range of health care professionals and specialist advice is sought where necessary to ensure people’s health needs are appropriately met. People’s personal care needs were well attended to. People told us that staff were respectful and that their privacy and dignity was maintained. People told us the routines within the home were flexible and suited their needs. The majority of people told us that staff listen to them and act on what they say, ensuring that people’s choices and decisions are respected. The food served at the home is generally good. Balanced and varied meals being provided and most people confirmed that they enjoyed the meals; comments included, “the food is lovely”, “There is nothing wrong with the meals” and “Excellent – very good”. The home is keen to improve menus and is consulting with people about their likes and dislikes. The home respects people’s religious beliefs and a local church provides a regular service. The environment is generally a clean and safe place for people to live and work. Specialist equipment is provided where it is needed to aid people with their independence. The home is accessible, with a passenger lift, handrails and other adaptations. People feel confident that their complaints or concerns will be addressed. Staff have a good knowledge about how to safeguard adults from abuse and there are systems in place to ensure that people’s money and valuables are protected. There are quality assurance systems in place, which help to ensure that the home listens to people’s views. Resident’s and relative’s meetings are St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 7 beginning to happen on a more regular basis to allow people to take part in the development of the service. The home is currently being managed well and several areas of improvement have been noted at this inspection. What has improved since the last inspection? What they could do better: No requirements have been made as a result of this inspection. Nine recommendations for good practice have been made. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 8 We have asked the home to ensure that information in care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of people’s health care needs, including continence care are met. Care plans should include details of peoples’ interests and hobbies, and social needs to ensure that needs and expectations can be planned for and met. In order to ensure people get their medication when prescribed the home should review how the medicines are delivered and administered in the morning. To ensure accuracy and accountability, the home should ensure that two people sign handwritten entries on Medication Administration Records. The home has been asked to ensure that staff competency with regards to the management of people’s medication is checked and any further training requirements are identified and provided. In order to maintain people’s privacy and dignity, we have recommended that staff do not discuss people’s personal care needs in communal areas where others can hear their conversations. The home should ensure people’s preference and expectation regarding activities are met, and we have recommended that the home continue to develop meaningful and stimulating activities and outings for people. The home has been asked to make sure that people living there, and their family and friends are aware of the complaints procedure. Where restrictive equipment is used the home should get consent for this and ensure there are clear guidelines for using things like lap belts. We have recommended that consistent staffing levels be maintained particularly on Rosella unit to ensure people’s needs are met safely and in a timely way. The staff rota should record which staff are on duty at any time including the hours worked by the manager. To ensure that improvements continue and people receive the care they need, it is recommended that arrangements be made to ensure that the home has a permanent manager who is registered with the Commission. In order to protect people’s finances, we have recommended that people’s cash be kept separately and not polled together. 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. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 9 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 St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 10 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): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new admissions procedure will ensure that people are given information about the home to help them decide if it will suit their needs. The new assessment process, if carried out fully, will ensure that the home assesses people’s needs thoroughly and that people will only be admitted if their individual needs can be met. EVIDENCE: Four of the eight people returning surveys told us they had received enough information about this home before deciding to move in. Two people told us they had not received enough information; two people did not answer this question. The home has a Statement of Purpose and Service Users Guide, which tells people about the services offered at St Lawrence. New and robust admissions procedures will ensure that all prospective residents of the home get the information they need to make a decision about whether the home will St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 11 suit their needs and preferences. A copy of the most recent inspection report can be found in the entrance hallway. There have been no new admissions to the home since January 2008 therefore we were unable to check to ensure the home has improved the way they assess people before they move in. Admissions are due to start again on 1st October 2008. In preparation for this the manager has developed a new admissions procedure, which will ensure that detailed information is gathered before an admission will be considered. The manager or senior staff plan to visit prospective residents to get to know them, to provide information about the home, to answer any questions, and to carry out a detailed assessment. In addition comprehensive information will also be gathered from any relevant professionals, involved in the persons care. Where possible people will be invited to visit the home before making a decision about moving in. The home is not currently providing intermediate care. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning systems and the delivery of care are improving and generally ensure that people are getting the care they need in a way that suits them. Peoples’ privacy and dignity is generally maintained and health care needs are well met by good monitoring, and close working with other professionals. The way the home manages medicines has improved in recent months, although there are still some areas that need to be addressed. EVIDENCE: We received 8 completed surveys from people living at the home; 5 people told us they “always” get the care they need, 2 said “usually” and one said this was “sometimes” the case. One person wrote, “Staff are ever so good to me” and another wrote, “Very happy here. Plenty to eat and drink. Looked after well”. One person told us via their survey, “Staff are busy and I don’t like to use the call bell, I wait till I see a carer”. During our visit we spoke with 7 people about the care and support they receive. All were generally happy. One person told us, “Although some staff St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 13 are better than others, they help us all they can”, “We get good care here…” and “Staff are taking care of me wonderfully”. We also spoke with two relatives during our visit; both were happy with the overall care. One told us, “Mum seems happy and well cared for. She is always clean and nicely dressed”, another relative said, “They are good to Mum, thinking about her needs. They (staff) are on the ball and more person focused now”. We looked at four care plans and could see that care planning continues to improve to ensure that people’s needs, preferences and wishes are accurately recorded, which will ensure that care is delivered in a more ‘person centred way’. Most care plans gave staff clear and up-to-date instructions on how each person should be assisted with their daily care needs, including assistance required to maintain personal care and help needed with mobilising. Care plans gave information about people’s preferred daily routine, for example their preferred times for getting up and going to bed. People we spoke with told us they could decide when to go to bed and get up. Staff now have instructions about how to support people with confusion, anxiety, aggression or memory loss. A comprehensive dementia care course is also supporting staff practice and several staff, who had completed the course, told us they felt better equipped to deliver care to people with a dementia type illness. Where people are at risk of developing skin problems such as pressure sores, the care to be delivered is written in the care plans. Individual cream charts show that the necessary care has been delivered. Since our last visit staff are beginning to evaluate skin care to determine whether the current treatment is effective. We saw that as a result of evaluating one person’s treatment the home was consulting with the GP to look at other forms of treatment, which may be more effective. The Community nurse told us that they were preparing to deliver training to staff to support them to care for people’s skin. A community nurse recently visited the home to complete health needs assessments for everyone living there. The outcome of the assessments are to be included in care plans in order to ensure that people’s health needs are clearly identified and planned for. During our visit a district nurse was visiting to assess people’s continence needs, the outcome of these assessments is to be integrated into individual care plans as well. At present the help people need to maintain their continence is not clearly recorded, in particular care plans need to direct night staff about the support people need with their continence needs. One area of care not fully addressed in care plans was people’s social care preferences and how to meet them. One person had been allocated significant one to one time to support them with activities. There were no clear St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 14 instructions in the care plan about when this time was to be allocated or how this one to one time should be used. During our visit this person requested to go to town to do some shopping. The officer in charge told them that staff were not available to take them, although an extra member of staff was on duty to facilitate trips to town for this person. There was general confusion among staff about how this time was to be used. There were no clear records to show that this considerable resource had been used in the way it was intended. Daily notes showed that this person had just half an hour of one to one support during our visit. Another entry in daily notes showed the person had become upset and aggressive towards staff when told, without notice, that staff were available to help them cook, something they really enjoyed doing. However they were unprepared and did not have ingredients needed. This situation could be avoided with good consultation and planning with the individual. We found ‘activities action plans’ to be blank in all the care plans we looked at. The manager told us this was an area of care planning to be completed with key workers taking the lead (refer to standard 12). We saw that care plans have been developed and reviewed by senior staff, with input from people living at the home, their relative (where appropriate), care staff and some outside professionals. Risk assessments and moving and handling assessments have been undertaken for all of the people we case tracked, although one did not mention the use of a wheelchair or lap belt. One permanent member of staff told us when the lap belt should be used but unless this is recorded in the care plan not all staff, including agency staff, will be able to provide the necessary care. The daily notes staff now keep are generally very informative. They show the care delivered, the diet taken by the individual and the choices people make about their daily life. One visiting professional was particularly impressed with the detail kept about one person’s diet, which helped the professional with her assessment and treatment plan. Overall staff told us they “always” have up to date information about people’s needs and that care plans had improved. One staff member told us, “Care plans are much better”, another said, “We are getting there, getting used to the paper work now”, and a third said, “The new care pans are much better. All the information is in one place”. One staff member wrote in their survey to us, “Care plans and passing information now has become excellent for all on my opinion”. We also spoke with several agency staff currently working at the home. Most said they were given good verbal information about people’s needs and also time to read people’s care plans. One agency staff working on Rosella Unit had not seen the care plans for people living there. They were unsure of the St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 15 approach to take with one person in particularly, whose behaviour could be a challenge for the home to deal with. All staff working on the unit should be aware of this important information to avoid difficult situations. People have access to a range of healthcare services to help meet their health care needs including chiropody, opticians, dentists and specialist services such as, mental health professionals and speech and language therapist. The majority of people told us their health care needs were “always” met; 3 people told us this was “usually” the case. One person wrote, “ I am diabetic and the nurse looks after me”, another told us, “My GP is requested whenever needed”. A visiting GP told us they had “no concerns about the standard of care” provided at the home, we were told, “Staff seem to know the residents well and people look well cared for”. A visiting Speech and Language therapist (SALT) told us that staff had alerted her to people’s needs appropriately and that staff “always” followed her instructions. We were told that staff had received training from the SALT and she felt that staff “know people very well”. The SALT was particularly impressed with the detailed information kept about people’s dietary intake and weights, which helped her to assess people’s needs and decide on the right course of action. Other health professionals also commented on the improvements at the home, one told us, “Communication is improving” and another said, “They are trying to do things properly, they are extra careful now”. We received two completed surveys from health professionals, who told us that people’s heath care needs were “always” or “usually” met by the home. One GP wrote, “Generally caring and respectful… The staff try very hard to meet the needs of the clients/patients and generally do a good job. We have no specific concerns as a practice”. Relatives and visiting health professionals commented that people appeared to be “well cared for”. We noted that people’s personal care needs were well attended to, people were well groomed, their clothes were clean and coordinated and several women had their fingernails painted, which they said they enjoyed. Since the last key inspection one staff member has assumed responsibility for a regular medication audit, ensuring that stock and records are accurate. The storage of medicines is generally good; the storage and management of controlled drugs is satisfactory and medicines needing refrigeration are kept at the appropriate temperatures. The assistant manager on duty currently administers all medicines and all have been trained to make sure their practice is safe. The medicines round is currently taking about an hour and a half to complete, one staff member told us, “Some people get their medication late, it takes a long time to ensure everyone has taken their medication, you can’t rush people”. The morning St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 16 medicine round does take a long time with just one person administering to people on two floors. In order to ensure people get their medication when prescribed the home should review how the medicines are delivered in the morning. We looked at the Medication Administration Records (MAR). We saw that three handwritten entries had not been signed by two members of staff to ensure accuracy. The MAR charts showed that people were getting their medication as prescribed, there were no gaps on the MAR and codes were used to indication why a medicine had not been given. Records are kept of variable dose medicines with the actual dose given. We saw that there were clear instructions on cream charts about when and where to apply prescribed creams and records showed creams were applied as prescribed. There has been one medication error since our last visit. We discussed with the manager how staff competency is monitored to ensure practice remains safe. At present there is no formal way to assessing the competency of staff. A recommendation has been made. Most people told us staff were “always” respectful, one person told us staff were “usually” respectful, adding “Some are very good and some are average”. People described staff as “friendly, respectful, understanding and very kind”. People told us that staff always knocked on their door before entering and we saw that this was the case several times. Overall we observed positive interactions between the people living at the home and staff. Staff were friendly and polite when responding to people’s needs or requests. Staff took care to promote one person’s dignity who needed a lot of help and reassurance when transferring from her wheelchair. One staff member on Rosella Unit was particularly skilled at engaging people at a level they were comfortable with. She engaged people in conversation and patiently encouraged them with their meal. When one person became restless and anxious but could not express why, one agency staff member told her to “sit down”. However another permanent staff member offered this person a meaningful and familiar activity to help distract the person from their anxiety. Although the person declined the activity staff intervening in a positive way appeared to relax this person. There were two incidents where staff showed no awareness that their conversation was having an adverse affect on people. One carer spoke to another about how tired they were. This resulted in one person on Rosella Unit being concerned about the staff member and asking if they were “alright”. We also heard staff discuss another person’s needs in front of people in a communal sitting room. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible and people are supported to exercise control over their daily lives, and the opportunity for people to enjoy social activities is improving. People benefit from contact with their family and friends, which is supported by the home. People enjoy a balanced diet, which takes into account the needs and likes and dislikes of most individuals. EVIDENCE: We spoke with people living in the home about daily life. They told us routines within the home were flexible, one person said, “Routines suit me. I am not told what to do or when”, another person told us, “Staff never tell me what to do. I can get up and go to bed when I want to”. People’s preferred daily routine is recorded to ensure staff are aware of favoured times for getting up and going to bed. We asked people, via surveys, if there were activities they could take part in at the home. 5 people told us there were “always” activities they could do, 2 said this was “sometimes” the case. Two people told us they didn’t want to take part in activities, and two people felt that their disability limited their involvement in activities, for example one person wrote, “My deafness causes St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 18 me problems sometimes”. When the “activities action plans’ are completed for each person living at the home, a programme will be developed for individual’s which will reflect their interests and capabilities. We spoke with several people about the activities they enjoy or would like to be involved in. One person told us they did not enjoy the group activities and described them as “childish”. One staff member told us they thought some activities did not suit people’s needs or capabilities. The home had bought colouring books and pens and musical instruments, one person asked staff “Are we the school band now!” Other people told us they enjoyed the exercise and pampering sessions and the games and quizzes organised. During our visit staff on the first floor organised a quiz. This brought several people together and they appeared to enjoy seeing each other and catching up on each other’s news. The quiz generated lots of discussion between people and staff were mindful to ensure that everyone had a chance to speak and take part. Staff on Rosella unit also provided some group activity for people; staff had time to chat with people on a one to one basis, and a general reminiscence session encouraged people to talk about their memories and the “old days”. Two or three people appeared to really enjoy this. On the second day of our visit two people were escorted to town to shop for personal items. Both told us how much they enjoyed going out, seeing other people and “being part of the world”. The home has a regular visit from Pets as Therapy (PAT) – during our visit we saw that several people really enjoyed the opportunity to give the dog ‘treats’ and stroke and chat to him. Two people also told us they enjoyed the regular service in the home provided by a local church. Since the last inspection the home has tried to improve opportunities for people to enjoy meaningful activity. The AQAA shows that all staff are now involved in activities where possible, it also shows that the home wants to continue improving opportunities for people by planning activities in advance as well as offering more spontaneous activities. Two staff members were allocated specific time to organise group and individual activities, including trips to town to enable people to shop or have tea and coffee. However, we were told that one staff member had decided to withdraw from this role and the other was “too busy” as a senior carer to continue. One staff member has been allocated 6 hours a week to organise outings for individuals and small groups, and this is beginning to happen more regularly. Although there is an activities programme staff told us this was just for generally guidance and that activities are provided when staffing levels and time allowed. The manager has been in contact with a local community group St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 19 offering activities for older people such as Tai Chi. This will also enable people to get out of the home and meet other local people. We spoke with two visiting relatives during our visit; both said the home keeps them up to date with important information about their relative. One person told us, “They always ring me if there is a problem with Mum” and “The assistant managers are very informative”. Another relative told us that staff had acted on their request for their Mother to see a specialist, and said that communication was usually good. We saw that visitors got a warm welcome from staff; trays of tea or coffee were offered and people could see their visitors in their rooms if they wanted to. Since the last inspection a comment/communication book has been put in place to encourage relatives and other visitors to ‘have their say’. We could see that where requests had been made, (for example, two people requested a clock in the reception area), this had been done. We also saw several very positive comments from relatives and visitors. One person wrote, “Pleased by staff’s friendly and welcoming attitude on arrival”, another wrote, “Love the activities going on now” and another commented, “Wonderful to see Mum so happy every time we come to visit”. The majority of people returning surveys told us that staff listen to them and act on what they say; one person said this was “usually” the case. During conversation with people they told us that they could choose how and where to spend their time at the home and that they were not forced or expected to join in with activities if they didn’t want to. People were given simple choices by staff, such as what they wanted to eat and drink. People said that they were able to choose when they got up or went to bed. People told us they “always” or “usually” like the food served at the home; one person said they “sometimes” like the food. Their comments included, “There is nothing wrong with the meals”, “Not old fashioned cooking but its alright”, “The food is excellent – very good”, “Very good – rarely dislike the food” and “We are given a choice”. One relative told us their Mother had been prescribed supplement drinks and that staff always ensured these were taken and they knew which flavours were preferred. The daily menu is displayed in each dining room and people’s dietary needs and preferences are recorded to ensure they are served meals they like and need. Records are kept of the meals provided to each person. The AQAA shows that the home has recently started a ‘quality group’ involving people living at the home and staff from all disciplines – this group is currently looking at meals provided by the kitchen and how they can offer more choice. The home plans to hold ‘taster’ sessions for people to try new foods then add these preferences to the menu. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 20 We observed breakfast and lunchtime. Mealtimes were not rushed, there was a relaxed atmosphere, with staff on hand to help and encourage people where needed. On Rosella unit additional staff were available during breakfast time to provide one to one support for one person who needed extra help at mealtimes. It was noted that fluids, such as juice/squash were now freely available to people on Bluebell, which may encourage people to help themselves. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 21 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People feel their concerns or complaints will be listen to and acted on. People are protected from the risk of abuse by well-trained staff and good policies and procedures. EVIDENCE: Although only half of the people returning our surveys said they knew how to make a complaint, 7 of the 8 said they knew who to speak with should have any concerns. We spoke with several people about this during our visit; all said they did not have any complaints or concerns at present and that if they did they would speak with staff or a relative. One person told us, “You only have to tell one of the staff and they will report it to the manager”. The AQAA shows that the home would like to improve people’s awareness of the complaints procedure in future. People felt that staff would listen to their concerns and act where possible to improve things. All staff returning surveys knew what to do should a complaint or concern be raised with them. The AQAA shows that no complaints have been received by the home since our last key inspection and the manager confirmed this during our visit. The Commission has received two anonymous concerns in recent months, and these concerns were looked at during this inspection. We could find no evidence to substantiate the concerns raised with us. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 22 The majority of people we spoke with told us they liked living at St Lawrence, and that they felt well cared for and that staff treated them well. We asked several people if they felt safe at the home; all said they did. One person told us, “…There is no one hurting us or telling us what to do”. All staff working at the home, including domestic staff, have received training to help them recognised abusive practice and how to report any concerns. We spoke with staff about safeguarding adults; all staff spoken with had a good understanding of what abuse is and what to do if they witness or suspect abusive or poor practice. All were aware of the outside agencies to be contacted in the event of any concerns; this helps to ensure people are protected from poor practice. Lap belts continue to be used for some people using wheel chairs but we could find no reference to how and when these should be used in people’s care plans. As a lap belt is viewed as a form of restraint and the decision to use it should be clearly documented. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 23 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, 20, 21, 22, 23, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally comfortable, clean, free from odour and safe. EVIDENCE: St Lawrence is a purpose built care home over three floors, which are accessed by passenger lift or stairs. The communal accommodation includes a dining room and sitting room on each floor. There are sufficient toilets and bathroom to meet people’s needs. The general environment is homely and comfortable although some areas, such as the dinning rooms would benefit from re-decoration. There are peeling wallpaper boarders on Rosella unit as noticed at the last key inspection. The intermediate care and short stay unit located on the ground floor was not in use at the time of our visit. There are plans to move the dementia unit to this area of the home to reduce isolation and enable people to access other St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 24 areas of the home more readily including the garden. The AQAA tells us that the home has contracted a company to complete remedial works to move the dementia unit to the ground floor unit. This environment would benefit from being assessed in line with dementia care environmental good practices. Several individual bedrooms were visited, with people’s permission, during our visit. All rooms are single occupancy. We found bedrooms were clean and fresh and had been personalised with various items, such as furniture, pictures, photos etc. People were very happy with private accommodation. New furniture and a sun canopy have been purchased for the garden. We saw a number of people enjoying the front garden. There are also plans to develop an enclosed part of the garden for people to enjoy. The home has the necessary equipment to assist people and meet their needs. Aids, hoists, and assisted toilets and baths are installed which are capable of meeting people’s individual needs. Staff told us they had the equipment they needed to ensure that care was provided safely. The AQAA showed that equipment such as hoists had been serviced and maintained. All people returning our surveys told us the home was “always” clean and fresh, one person commented, “They keep it lovely and clean, you can’t fault it”, another person told us, “Never had any complaints about the cleanliness of the building”. We found the home was clean and fresh throughout. This is to be commended as currently domestic hours have been reduced through staff sickness. Two dedicated domestic staff try to cover the extra hours between them, including the weekends to ensure the cleanliness of the home is maintained. There are good hand washing facilities, in bedrooms and bathrooms, and liquid soap and paper towels are freely available to promote good infection control practice. Several improvements have been made since the key inspection to ensure the home is clean throughout and that staff maintain good infection control. We found the sluice areas to be clean and odour free. Since the last key inspection the home has a new system for disposing of waste, such as pads. This means that overflowing bins are no longer an issue. Equipment has also been repaired, such as the macerator, which staff said had made a big difference, one told us during our random inspection in July, “It is brilliant and works a treat now, it means the sluice is not so smelly”. All staff spoken with had attended infection control training since the last inspection, records show that the majority of staff have now attended this training to ensure that good standards can be maintained. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 25 The laundry is well equipped and people told us they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. One person said, “Nothing is ever lost or ruined”. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 26 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. The current staff arrangements are satisfactory and will be improved by the recruitment of new permanent staff. The way the home recruits new staff ensures that people are protected from unsuitable workers. Staff receive the training they need to meet people’s diverse and complex needs. EVIDENCE: Several staff at St Lawrence told us how much they enjoyed their job and that they were proud of the home. One wrote, “I love my job and it’s my foremost priority to my clients to be a good carer and provide a good standard of care to them”, another comments, “I’ve been in the job for many years I feel very passionate about my job. I love going to work to provide excellent care for them”. The home is using a high level of agency staff at present due to the long-term sickness or absence of several permanent staff. They currently have four vacant posts. On the first day of our visit most staff on duty were agency staff; there were two permanent members of staff working on each floor, supported by five agency staff, which included a senior carer who “floated” between both floors offering addition support. The home tries to ensure they book agency staff that are familiar with the home and the people living there. This helps to provide some continuity for the people. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 27 Several staff commented about the use of agency staff in their surveys. When asked what the home could improve, one wrote, “More regular staff so that clients can recognise faces instead of thinking “Oh, who is it today”. Another staff member wrote, “We can work on a shift with all agency staff who obviously wouldn’t know our service users. This can make it difficult. Some service users can become quite upset when staff are not familiar to them”. We asked people living at home what effect the high use of agency staff might be having on the delivery of their care. Most people told us it made very little difference to them, one said, “They are just staff, they are usually pretty good”, another person told us, “The agency staff are alright as a rule. I have no trouble with them”. One person said, “The agency staff are very nice but I would sooner have our own”. We looked at the duty rota, which showed that there was always an assistant manager on duty to support staff. There are usually between 7 or 8 care staff on during the morning shift, from 08.00 to 14.00. This reduces on some days to 4 or 5 staff between 14.00 and 15.00. The rota shows there can be between 5 and 8 staff on duty from 15.00 to 21.00 with this reducing to 4 after 21.00. At night there is one assistant manager and two care staff awake. We noted that the staff rota did not record the hours that the manager worked at the home; a recommendation has been made to ensure that the staff rota accurately reflects the staff on duty at any time. Five people told us via surveys that staff were “always” available when needed, one person said this was “usually” the case and two told us this was “sometimes” the case. One person wrote, “Staff respond quickly to alarm when activated”. During conversation with people they told us staff were usually at hand when needed. One person said, “There are not always enough around to help me with my interests, like cooking”, another told us, “They usually come when you call them, sometimes they say ‘just hang on a minute’ but they do come back”. Most people felt that staff responded “fairly quickly” when needed. Staff returning surveys and those spoken with told us there were “usually” enough staff on duty to meet people’s needs. No new staff have been recruited since the last inspection although the home is in the process of recruiting. We looked at the files for two prospective new staff. All the necessary checks, such as Criminal Records Bureau checks (CRB & POVA) and two references, had been obtained in readiness for the staff to start working at the home. All staff are completing a new induction programme introduced at the home. The induction programme follows national guidelines and includes training on the principles of care and safe working practices. This will ensure that new and long serving staff can fulfil the aims of the home and meet the changing needs of people living at there. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 28 The home is now committed to providing training for staff to support them in their role. All staff returning surveys told us they “always” receive training relevant to their role, which is an improvement since the last key inspection. Their comments included, “Extensive Dementia training, NVQ and all courses undertaken over the last few months have been excellent training for us all. …It brings us up to scratch with any new changes & developments and our approach to this”. Other comments included, “Continuing training in all aspects of good care are now available yearly or when needed which gives us all the knowledge etc. to give a high standard of care overall”. All staff are completing a comprehensive dementia course provided by an experienced outside trainer. We spoke with several staff that had completed or were completing the course and they showed genuine enthusiasm and wanted to improve their practice in this area. One told us, “It is very detailed training and helped me to recognise things and put things into practice”. Other comments included, “We are learning but it is also fun. It has been very enjoyable”, “It makes you think about your approach and the person as an individual”, and “The training was brilliant. I can only sing the praises of the trainer. It’s the best course I’ve been on”. The manager is also arranging other specialist training including skin care and prevention of pressure sores, and catheter and stoma care. The home is forging good links with health professionals and is hoping to use their expertise with further training. Team building days have been organised to ensure that all staff are working towards the home’s aims and objectives. Currently just over 40 of staff have or are working towards a nationally recognised qualification in care, (NVQ). The home is working towards achieving 50 of care staff holding NVQ, which will help to improve the overall quality of care delivered to people. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 29 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is currently well managed, with good systems in place to ensure that people’s views are sought and acted upon. Health and safety at the home is generally managed well. EVIDENCE: As reported at previous inspections this year, the home has been without a permanent manager since May 2007. The providers have advertised and appointed on previous occasions but these appointments were not successful. The day-to-day management of the home is overseen by a temporary manager, who is to be commended for the progress made to ensure that this home made the necessary improvements. However, the provider must consider the registration of a permanent manager to ensure the home is consistently well managed. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 30 Several staff commented positively on the improvements achieved at the home under the temporary manager. One told us, “I think our home has come along in leaps and bounds over the last few months”; Another wrote, “We are going through change at this time, but with a strong manager and willing staff, I feel more positive that we can offer a individual service based on clients needs”. Other comments include, “The day to day running is smooth”, and “I have a lot of respect for the manager. She is focused and level. She is a good manager”. Overall staff felt that the atmosphere and staff morale had improved, although two staff members were not so positive and felt that the high use of agency and the future plans for the home had a negative impact on staff morale. The home has a range of ways of checking the quality of the service. Annual questionnaires are used to get people’s opinions and experiences as part of Devon Council Council’s quality assurance. Resident’s and relative’s meetings are beginning to happen and give people an opportunity to talk about issues and raise any concerns. The quality assurance reports completed by Devon County Council’s representative (regulation 26 reports) have improved. These are now happening on a regular basis, and help to identify any problems and actions needed to ensure the home is meeting people’s needs and operating safely. The home assists some people with personal finances and we looked at how people are supported to manage their finances. Records clearly account for any purchases made on behalf of a people living at the home and receipts are kept. Transactions are signed by two people to ensure accuracy. The home will also hold people’s bank/cheque books in the safe. We found that people’s cash is held in one ‘pool of money’, rather than separately, which would be good practice. Health and safety at the home is generally well managed. During our tour of the building no immediate hazards were identified. Staff told us and records showed that they have received recent training on a range of health and safety topics including moving and handling, infection control, fire safety, food hygiene, and health and safety. This ensures that staff are working safely. The AQAA showed that maintenance of equipment and systems, such as fire, water, gas and electrical systems, and equipment such as the passenger lift, and hoists were up-to-date. The home notifies the Commission of deaths and serious incidents. Accident reports have been completed satisfactorily and an audit of accidents and incidents is kept to help the manager identify any trends and allow her to put measures in place to reduce risks. St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 31 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that information in care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of people’s health care needs, including continence care are met. Care plans should include details of peoples’ interests and hobbies, and social needs to ensure that needs and expectations can be planned for and meet. In order to ensure people get their medication when prescribed the home should review how the medicines are delivered and administered in the morning. To ensure accuracy and accountability, you should ensure that two people sign handwritten entries on MAR charts. You should ensure that staff competency with regards to the management of people’s medication is checked and any further training requirements are identified and provided. In order to maintain people’s privacy and dignity, it is recommended that staff do not discuss people’s personal DS0000033100.V371951.R01.S.doc Version 5.2 Page 33 2. OP9 3. OP10 St Lawrence 4. OP12 5. OP16 6. OP18 7. OP27 8. OP31 9. OP35 care needs in communal areas where others can hear their conversations. To ensure people’s preference and expectation regarding activities are met, it is recommended that you continue to develop meaningful and stimulating activities and outings for people. Staff should ensure that all people have access to activities, whether on a one to one basis or in a group. Their choices should be recorded. People living in the home should be supported to use the garden and to access the local community. (Carried over from previous inspection) To fully protect people’s rights, it is recommended that everyone living at the home and/or their relatives are aware of the complaints procedure. (Carried over from previous inspection) In order to protect people from restrictive practices, it is recommended that where restrictive equipment such as lap belts are used, consent is obtained and a risk assessment is completed. (Carried over from previous inspection) It is recommended that consistent staffing levels be maintained particularly on Rosella unit to ensure people’s needs are met safely and in a timely way. The staff rota should record which staff are on duty at any time including the hours worked by the manager. (Carried over from previous inspection) To ensure that improvements continue and people receive the care they need, it is recommended that arrangements be made to ensure that the home has a permanent manager who is registered with the Commission. (Carried over from previous inspection) In order to protect people’s finances, it is recommended that people’s cash be kept separately and not poloed together. (Carried over from previous inspection) St Lawrence DS0000033100.V371951.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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