Inspection on 02/06/06 for St Lawrence

This inspection was carried out on 2nd June 2006.

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

St Lawrence 18/09/08

St Lawrence 20/03/08

St Lawrence 23/07/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Lawrence Churchill Drive Crediton Devon EX17 2EF Lead Inspector Dee McEvoy Announced Inspection 2nd & 5th June 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 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.V289045.R01.S.doc Version 5.1 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 Devon County Council Ms Karen Louise Fereday-Jaskowski Care Home 29 Category(ies) of Dementia (29), Old age, not falling within any registration, with number other category (29), Physical disability over 65 of places years of age (29) St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager must obtain the Registered Manager’s Award by December 2005 1st November 2005 Date of last inspection Brief Description of the Service: St Lawrence is a purpose-built care home, owned and managed by the local authority, Devon County Council. 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. A designated dementia wing 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, 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.V289045.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took 12 hours to complete, with the inspector visiting the home on the 2nd and 5th June. During the inspection the inspector case tracked 4 residents, including a resident no longer living at the home. Case tracking helps us to understand the experiences of people using the service. Nine other residents were met and spoke with during the course of the inspection. The home provides care for people with a dementia related illness and some residents do not have the capacity to communicate fully or understand the inspection process. The inspector spent a considerable time observing the care and attention given to these residents by staff. Thirteen staff were spoken with during the inspection, including care and ancillary staff and the three assistant managers. Prior to the inspection surveys were sent to 9 residents to obtain their views of the service provided; 5 were returned. Comments were in the main positive with the majority of the respondents confirming that they ‘always’ receive the care and support they need. Surveys were sent to 8 staff in order to hear their confidential views; 2 were returned. A number of surveys were also sent to various health and social care professionals to express their views, responses were received from three GPs, two community nurses, and two social care professionals. An occupational therapist was also interviewed. The inspector toured the premises and inspected a number of records including residents’ assessments and care plans and records relating to recruitment and health and safety. The acting manager had completed a pre-inspection questionnaire prior to the inspection. The Commission has received one complaint about the service since the last inspection; which was dealt with by the provider. What the service does well: When residents were asked what the home did well, staff were generally praised for being friendly and kind. One resident said, “Overall it is excellent here”, another said, “I can’t find any fault, food good, staff good!” The majority of professionals feel good quality care is provided at the home. The intermediate care service was described as a “useful service” by one health professional. Residents admitted for short stays are supported to maintain their independence as far as possible. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 6 Residents’ health care needs are generally well met with good multidisciplinary working. All residents spoken with and those responding with surveys said the food was “always” good. The home offers choice and caters for special diets. St Lawrence provides a comfortable home for residents, which is clean throughout and residents said it was always like this. Quality assurance systems ensure that the home listens to residents’ views. What has improved since the last inspection? What they could do better: Residents’ care records, including assessments, care plans and risk assessments must be comprehensive in order to reflect resident needs accurately and ensure needs are met. Medication is well managed with the exception of one area of practice, which could put residents at risk. Social activities within the home need to be developed further to ensure that residents’ preferences, expectations and abilities are taken into consideration. Some residents could be better encouraged and supported to exercise control and choice. Staffing levels need to be monitored and increased when necessary to aid individual care and meet needs and preferences. The home has been without a registered manager for a considerable period and must now consider the appointment of a permanent manager. Provision for hand-washing facilities in the laundry room must be made to ensure adequate infection control. This is an outstanding requirement. Compulsory training needs, such as first aid, must be addressed. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 7 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. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 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 St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A statement of purpose has been developed but residents do not always have sufficient information to help them exercise choice about where they live, this is partly due to contractual arrangements. Prospective residents’ needs are not always fully assessed prior to admission. Residents receiving rehabilitation or respite care are well supported and encouraged to regain independence. EVIDENCE: The statement of purpose has been revised since the last inspection and now contains the necessary information. It is freely available in the foyer of the home. Due to the admission process of some residents, for example unplanned admissions and intermediate care users; information available does not always inform choice but gives residents an idea of what the home offers. The quality of the four assessments examined was inconsistent and did not reflect residents’ needs. Staff and managers said that it was particularly difficult to get all the necessary information from care managers due to the St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 10 admissions process; this results in staff being unaware of individual needs and having unrealistic expectation of residents’ abilities. Several areas of the home’s assessment were incomplete, for example issues relating to mental health needs and some health care needs such as mobility and personal care needs. Assessments were not reviewed following incidents or accidents. This may result in residents’ needs not being met. 75 of staff, including the cook and some ancillary staff, have commenced a training course, which will provide an understanding of the different stages of dementia type illnesses and provide insight for care staff into the experience of this client group. Although “stretched” at times to provide individualised care, staff working with residents with dementia demonstrated a general understanding and had a caring attitude. Intermediate care and short stay residents were very positive about their stay at the home, comments included, “I have really enjoyed my stay”, “They’re all smashing here” and “It’s a homely place”. All said the staff were caring and friendly, a visiting health professional echoed this. A small team of staff are allocated to care for these residents, one professional described the good communication with the home and said, “The steady, allocated group of staff has really improved things”. Staff spoken with on the unit were aware of individual needs despite the lack of comprehensive assessments and care plans. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Whilst some care records were of an adequate standard, there was insufficient detail in others to ensure staff had all the information to meet residents’ needs. Residents’ health needs are generally well met, with evidence of good multidisciplinary working taking place. Attention is needed to ensure that medication records are accurately maintained to lessen any risk to the residents. Caring staff maintain the residents’ privacy and dignity. EVIDENCE: The care planning system is in the process of being reviewed but information contained in care plans was basic. Some accurate and relevant information was available, with pertinent personal information such as preferences and life history’s recorded but generally care plans did not reflect all the resident’s needs or specify how needs were to be met; for example, mobility, mental health and dietary needs and social interests and hobbies. One care plan said, “Unsteady” but no clear action for staff to follow was recorded. Another had not been reviewed following a fall to highlight action needed to reduce this St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 12 risk. One care plan had not been reviewed since May 2005. Whist three manual handling plans were comprehensive; a fourth was poorly completed even though the resident was identified as being at risk of falling and wandering. One visiting health professional felt that care plans did not reflect the level of care provided at times. The resident or their representative had signed care plans seen. Risk assessments are documented in a pre printed format and there is limited information for more individual problems to be described and action determined. One risk assessment did not accurately identify the action to manage shortness of breath when the resident was mobilising and conflicting information was recorded in the assessment and care plan. Two staff spoken with were aware of this problem. Another resident did not have a risk assessment at all although daily notes raised concerns about wandering behaviour and a risk of falls. One visiting professional felt that staff provided good emotional and psychological support to residents. Three GPs and two district nurses were happy with the overall care provided at the home and felt the home communicated effectively and staff demonstrated an understanding of the residents needs. The majority of residents replying with a survey said they “always” received the medical support they needed. The storage and administration of medicines was generally good. Controlled drug stock levels tallied with records where checked for one medication. Assistant managers administer medicines and have received training in the safe handling of medication. One hand written entry was noted on the Medicine Administration Records (MAR) charts, which had not been signed or dated, another had been signed and dated correctly. The medicines fridge needs to be de-frosted and cleaned regularly. Where assessed as appropriate the selfadministration of medicines is encouraged and supported, particularly for intermediate care residents. Health professionals were satisfied with the management of medication within the home. During the inspection staff were observed to be sensitive and attentive towards residents, on one occasion eliciting a smile and positive response from a resident with dementia. Friendly banter and laughter was enjoyed between staff and residents, particularly at mealtimes. Residents said that staff were kind and friendly and would ‘do anything for you’. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities are provided and offer some stimulation and interest, however further consideration should be given to extending and developing the activities for residents who lack capacity. Able residents are enabled to take control of their daily lives where possible but there is limited opportunity for residents who lack capacity to choose what they wish to do. The meals in the home are enjoyed; with choice and variety offered. EVIDENCE: Several residents described the routine as flexible, one said, “You can more or less do what you like.” The home has started to collate personal histories for some residents, which will inform preference and expectations when planning activities and meaningful occupation. At present limited preferences are recorded and two care plans contain no reference to social interests or hobbies. Care staff are allocated 12 hours a week for activities, but there seems to be a lack of direction and management of meaningful activities. During the first day of the inspection little social contact was observed between staff and residents living on the top floor unit. Three residents with a dementia type illness were observed to sleep for periods of the morning with no stimulation or activity provided. Residents appeared bored and unoccupied. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 14 One personal plan stated that the resident would like to join in with activities but only one entry in the notes confirmed that this had happened over a period of four weeks. The resident was full of praise for the care provided at the home and said, “There is nothing wrong with this place at all”. A resident on the second floor said, “It would be nice to have other things to do, the TV is always on.” Two residents responding with surveys said that they could only “sometimes” take part in activities; two others said they could “usually” join in. A regular church service is held at the home, the inspector was told that the services were enjoyed and well attended. Outside entertainers visit the home on occasion and outings are organised, although infrequently. A “Pat the dog” scheme does visit regularly and is enjoyed by many residents. Bingo and quizzes are held but not all residents can participate with this kind of activity. Visitors are welcome and residents confirm that staff will always offer refreshments; this was seen during the inspection. One resident said it was important for them that the family were treated well and offered tea and coffee, “Just as I would at home”. The more capable residents confirmed that they were able to exercise choice and express wishes and views, for example when they get up and go to bed and how they spent their day generally. The challenge for the staff is to ensure that less able residents and those with diverse needs are given choices and encouraged to communicate their wishes and views, particularly in relation to meaningful activities. Although dietary preferences are not routinely recorded, all residents spoken with or those responding with surveys said the food was “always” good. Comments received included, “ The food is lovely”, “There is always a good choice” and “The food is very good”. Meal times were pleasant and relaxed. Residents were offered a choice of meal and those requiring assistance were helped in a sensitive and discreet way. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. 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. The home has a satisfactory complaints system, with evidence that residents feel that their concerns or complaints are listened to and acted on. Staff are aware of the procedure to follow to protect residents from abuse. EVIDENCE: Residents responding with surveys and those spoken with knew who to speak with if they were unhappy about anything. The majority also said that staff usually listened and acted on what they said. A record of complaints is kept with details of any investigation and outcome. The Commission has received one complaint since the last inspection relating to management issues at the home. This was dealt with by the provider Devon County Council. All care staff spoken with had undertaken adult protection training and demonstrated a good understanding poor practice and their personal responsibility to report any concerns. All residents, with the exception of one, said that they were well looked after. One resident felt that staff could be rough an “odd time”, but could not be more specific or identify any individual. Where bedrails are in use, residents or their representatives have been consulted and consent has been obtained. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in clean, comfortable and well-maintained surroundings, which are generally suited to their needs. Poor hand washing facilities place staff and residents at risk of infection. EVIDENCE: The home is extremely clean and well maintained both internally and externally. The communal areas, such as sitting rooms and dining areas, are bright and comfortable. Resident’s bedrooms are personalised with sentimental items, photographs and items of small furniture. Bathrooms and toilets have been adapted to assist residents. As noted in previous reports, residents with a dementia type illness are mainly cared for on the top floor, but there is a risk of isolation for this client group because of its location, which may limit opportunities for residents to spend time in other environments. The lack of enclosed garden may prevent a safe and enabling environment for all of the residents. A security keypad has been St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 17 fitted to the top floor to prevent access to the stairs and reduce risks for people with a cognitive impairment. In spite of a shortage of domestic staff at the time of the inspection, the home was clean throughout and free from any offensive odours, residents responding to surveys and those spoken with said it was “always” like this. This is to be commended. The laundry is well equipped and well organised. The staff member responsible for the laundry in the home was knowledgeable about her job and had received infection control training to ensure the correct procedures were followed. The home has a good system for dealing with any soiled laundry to reduce the risk of infection. One resident told the inspector that laundry service was good, “Things come back respectable and nothing has been lost!” Since the last inspection hand-washing facilities have been installed in the top floor sluice. Hand washing facilities are needed in the laundry area and these have been outlined in previous requirements. The provider does have plans to review the laundry facilities but a timescale for action is unclear. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff is not always sufficient to meet individual residents’ needs and preferences. Robust recruitment procedures protect residents. Access to appropriate training means that staff are competent to do their job and meet residents needs. EVIDENCE: There are currently four vacancies for care staff at the home, a considerable number of care hours, up to 80 per week, are covered by agency or bank staff. Existing staff are also covering additional hours. Two visiting professionals felt that staffing levels at times did not meet residents needs, one described staff as being “extremely stretched and under pressure”, another felt that for intensive rehabilitation more staff were required to assist with therapeutic tasks such as helping residents to prepare meals or snacks and more one to one time providing a safe environment for residents to explore their independence. Most staff spoken with felt that there were enough staff to “do the basics” but many said they would like more “quality” time with residents to chat and engage them with interests on an individual basis. Residents were described as having medium to high needs and some required the assistance of two staff, which would have an impact on staffing levels. There was little evidence that staff had sufficient time to meet residents social care needs (refer to standard 12). One resident at the home said they could “wait” for the assistance needed. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 19 Three staff files were looked at and all staff had been recruited using robust procedures to ensure the protection of residents. This includes obtaining Criminal Record Bureau (CRB) checks, two written references and completed application forms. Good recruitment procedures are in place for carers employed through an agency. The opportunity for staff training at the home is good, with the exception of first aid (refer to standard 38) and ensures that staff have the necessary skills to meet the residents’ needs. 50 of care staff have obtained NVQ level 2 or above. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and some staff benefit from the experience and positive approach of the acting manager but the home must have a registered manager. The system for resident consultation is good and residents benefit from influencing the way the home is run. Residents’ finances are safeguarded Health and safety of the building is good, but there is inadequate training and follow up of accidents, which puts residents at risk. EVIDENCE: The acting manger of the home has many years experience and has achieved the registered managers award, NVQ 3 and 4 and is a qualified assessor. Staff spoken with were generally very positive about the inclusive and approachable style of the manger, but some staff were less positive about the management at the home. When asked what the home could improve, one staff member St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 21 said, “A permanent manager “. The home has been without a registered manager for several months. The home has a good quality assurance system in place, including satisfaction surveys and regular residents’ and staff meetings. An audit report of the last survey, which is freely available in reception, showed high satisfaction levels within the service. The home does assist some residents with personal allowances. Monies are held in a ‘residents bank account’ but interest is allocated quarterly. Records clearly account for any purchases made on behalf of a resident and receipts are kept. Transactions are signed by two people to ensure accuracy. A range of servicing and maintenance records were seen at this inspection, which were satisfactory. A recent Devon Fire & Rescue reported noted satisfactory standards of fire safety. A recent environmental health report highlights areas required for action. Mandatory training records were difficult to audit in the current format but deficits were noted in first aid training. The assistant managers said that often training places were restricted and they were unable to access certain courses, such as first aid and food hygiene. Accidents are recorded; nine falls were recorded in May 2006. Two deputy managers told the inspector that monthly statistics are sent centrally but there is no clear evidence of how accidents are reviewed and action taken to reduce harm. Care plans and risk assessments for those residents case tracked had not been reviewed and up-dated following a fall. The manager has completed environmental risk assessments and the inspector was told that these could be found in most areas of work. A member of staff working in the kitchen was unaware of any risk assessments for their working environment. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 1 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X X X 1 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 3 X X 1 St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Timescale for action 03/07/06 2. OP7 15 (1) (2) The registered provider must ensure that new residents are admitted only after the completion of a full assessment of their needs. (Previous timescale of 30/11/05 not met) The registered person shall, after 03/07/06 consultation with the service user, or a representative, prepare a written plan (service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met (Residents interests and hobbies are also to be recorded) and keep the service users plan under review The registered person shall ensure that necessary risks to the health or safety of service users are identified and so far as possible eliminated. This relates to the need to assess situational, behavioural and environmental risks. The registered person must DS0000033100.V289045.R01.S.doc 3. OP7 13 (4)(1) 03/07/06 4. OP26 13(3) 31/07/06 Version 5.1 Page 24 St Lawrence 5. OP31 8 (1) (2) make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (The laundry room only has one sink, which doubles for staff washing their hands, washing clothes and washing commodes, which must be addressed.) (Previous timescale of 31/8/05 & 31/01/06 not met) The registered provider shall appoint an individual to manage the care home where - (a) there is no registered manager in respect of the care home. Where the registered provider appoints a person to manage the care home he shall forthwith give notice to the Commission of (a) the name of the person so appointed; and (b) the date on which the appointment is to take effect. 04/09/06 An application to register a manager at the home must be received by the Commission within three months. 6. OP38 13 (4) The registered person shall make 07/08/06 suitable arrangements for the training of staff in first aid. St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 25 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 OP9 Good Practice Recommendations It is recommended that for all hand written entries on the Medication Administration Record chart that the person signs and dates the entry, and this is then checked and signed by a second person and that the medicines fridge is de-frosted and cleaned regularly. It is recommended that all residents be given an opportunity for stimulation through leisure and recreational activities inside and outside the home. It is recommended that residents are helped to excercise choice and control over their lives with particular consideration given to those with a dementia type illness. Consideration should be given to relocating the rooms for people with a dementia type illness to a more central position within the home. The home should have an enclosed garden, which is safe and accessible to all residents. Staffing levels should continue to be monitored and records kept if the levels impact on residents and there are instances of unmet need. For example, if staffing levels impact on activities and allocation of a key worker. It is recommended that accidents, particularly falls, are analysed and a pro-active approach to preventing accidents is taken. It is recommended that all staff be aware of environmental risk assessments for their particular working area to ensure safe working practices continue. 2. 3. 4. 5. 6. OP12 OP14 OP19 OP20 OP27 7. OP38 St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Lawrence DS0000033100.V289045.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!