Inspection on 06/06/06 for The Lawns

This inspection was carried out on 6th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Lawns 26/01/06

The Lawns 20/07/05

The Lawns 25/10/04

The Lawns 29/06/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Lawns (The) Fernhill Avenue Weymouth Dorset DT4 7QU Lead Inspector Mike Dixon Key Unannounced Inspection 02:30 6th June 2006 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 Lawns (The) DS0000032130.V299516.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. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawns (The) Address Fernhill Avenue Weymouth Dorset DT4 7QU 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) 01305 760881 a.vallins@dorsetcc.gov.uk Dorset County Council Ann Christine Maria Vallins Care Home 42 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (30) of places Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. 26th January 2006 Date of last inspection Brief Description of the Service: The Lawns is a purpose built home providing care and accommodation for elderly people, situated approximately ½ mile from the town centre. The home is owned and managed by Dorset County Council Social Services Directorate; Mrs Ann Vallins is the manager and Mr Harry Capron the registered person. The manager has overall responsibility for the home which provides care for up to 42 residents, with 30 places for persons in the category of old age (OP) and 12 places for persons in the category of dementia over 65 years of age (DE (E)). Currently, a maximum of five places at the home are for people needing respite care for short periods; this number will eventually reduce to three in September. Residents are accommodated in 34 single and 4 double bedrooms on the ground and first floor. All double rooms are ordinarily occupied as singles, unless two people wishing to share are admitted to the home (e.g. a couple). All bedrooms contain a wash hand basin and close to all bedrooms are toilets and bathrooms suitable for residents with mobility difficulties. One of the bedrooms has an en-suite toilet. A shower which is suited to the needs of people with a disability has been installed in a former bathroom. The home is divided into three units, each providing a lounge, dining room and kitchenette facilities for the preparation of drinks and light snacks. There is an 8 person passenger lift to the first floor, a stair lift and a wheelchair lift on first floor corridors to enable service users with mobility problems to negotiate the short flights of steps connecting different levels of the first floor. There are level gardens with wide footpaths. There is a car park and a nearby bus stop, for buses to and from the centre of Weymouth. The home’s Service User Guide is part of the information pack that is provided to service users and/or their representative prior to admission. The weekly fees range from £67.50 to £417; the amount payable is determined by a financial assessment. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection visit was carried out as part of the Commission’s regulatory duty to inspect all care homes. The purpose was to assess the home’s compliance with key National Minimum Standards for older persons and also to review the home’s progress in implementing the requirements from the previous inspection report. Prior to the inspection, a pre-inspection questionnaire was completed in detail by the home and returned to the Commission. Questionnaires were distributed to service users by the home on behalf of the Commission and comment cards were given or sent to service users’ relatives and to health and social care professionals. Eighteen completed service user questionnaires, five comment cards from relatives and four cards from health and social care professionals were returned to the Commission. The inspection was conducted over two days and included a visit from the pharmacy inspector. In total the inspection lasted for eleven hours, during which time the inspectors looked around the premises, talked with ten service users, the manager and seven staff members, reviewed the medication arrangements and looked at a range of records that related to the running of the home. The inspector also talked by telephone with the relative of a service user. What the service does well: The home ensures that it only admits service users whose care needs it can meet by carrying out a thorough pre-admission assessment. Care plans are comprehensive and are in a format that is readily accessible to the staff. Care staff monitor service users’ well-being and there is close liaison with general practitioners (GPs) and community nurses. Comment cards received from healthcare professionals confirmed the good working relationship between themselves and the home, thus benefiting the service users. The staff assist service users with personal care tasks where this is necessary and encourage service users to retain their independence, wherever feasible. The inspector was able to observe a number of examples of staff assisting and interacting with service users over the two days. Tasks were carried out sensitively and with due respect. A few of the service users suffer from a significant degree of short-term memory loss; they were approached and responded to in an understanding manner by the staff. Service users are able to retain control over their own lives, with guidance and support where needed, and to “personalise” their bedroom by bringing in additional items. The home offers a varied weekly programme of activities, Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 6 providing a stimulating environment for service users, with imaginative use of resources. Religious services are arranged for service users who wish to participate. Visitors are always made welcome at the home. Service users enjoy nutritious meals and have plenty to eat and drink. The complaints procedure is clearly set out so that service users or their representatives can raise any concerns. There are policies and procedures in place to help protect service users from coming to harm. The premises include some large bedrooms and, overall, the accommodation is spacious, light and comfortable, offering a variety of communal rooms and sitting areas. There is easy access to a secure and well-designed garden. A programme of maintenance and refurbishment is in place. The equipment for assisting service users who are highly dependent or who have mobility problems are to a good standard. The home is kept in a clean condition and free from unpleasant odours. The laundry arrangements work well and attention is paid to the care of service users’ clothing. There are enough staff on duty to ensure that service users’ basic care needs and safety requirements are met. Staff are caring and competent; for the most part service users and their relatives have a high regard for the quality of the care that is provided. The following examples reflect the positive views expressed to the inspector either in person or in comment cards. • • • • • ‘The staff are wonderful’ ‘They’re very good girls’ ‘They’re kind people’ ‘Care is top class’ ‘We cannot speak highly enough of the way she is cared for’ In most respects the staff recruitment procedure is to a good standard. The home encourages staff to receive training and the training courses that are arranged help staff to develop and to carry out their tasks with confidence. The manager and senior officers support the staff well and for the most part regular supervision takes place. The manager is experienced, qualified and a good leader. There is good communication between staff, e.g. hand-over meetings between shifts and staff meetings where there is the opportunity to discuss matters that affect the running of the home. The management team reviews the quality of the care and services that are provided and takes steps to address issues that are raised. The home has suitable arrangements in place to safeguard service users’ finances and to assist those who may need help with looking after their money. The home promotes the health and safety of all who live and work on the premises by the regular servicing of equipment, carrying out of risk assessments and by the training of staff. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There are two requirements, six recommendations and two suggestions arising from this inspection visit. The manager must continue to monitor the administration of medicines to ensure that they are given as prescribed and accurately recorded. The home should follow guidance from the Royal Pharmaceutical Society with respect to monitoring the temperature of the fridge which contains medicines and with regard to advice about “as directed” medication prescribed by doctors. It is suggested that a record is made of who supplies the information that is gathered for the compiling of the pre-admission assessment. This will help to demonstrate the extent to which the service user was involved in the information-giving exercise. The home should set out a clear rationale to determine the frequency of weighing of service users which respects their wishes and takes into account their particular needs and circumstances. Continence aids should be stored out of sight in bedrooms in order to safeguard service users’ dignity. It is suggested that consideration be given to inviting relatives and friends of service users to residents’ meetings. Arrangements should be put in place to ensure that service users who wish to make use of the facility are given the keypad code of the front door to enable them to come and go as they please. A police check via the Criminal Records Bureau (CRB) must be completed on all prospective staff members prior to their appointment in order to fully protect service users. The home should obtain details of the training/qualifications of regular agency care staff to assist in determining the capacity of the staff Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 8 group to meet the care needs of service users. Supervision for care staff should take place every two months so that the home is better able to demonstrate the monitoring of the progress of staff. Looking ahead, the continuing upgrading programme of the premises will provide two bigger bedrooms for the benefit of service users. Planned improvements to staffing levels should give care staff the time to meet service users’ care needs in a more flexible way. 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. Lawns (The) DS0000032130.V299516.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 Lawns (The) DS0000032130.V299516.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that it only admits service users whose care needs it can meet by carrying out a thorough pre-admission assessment. EVIDENCE: The manager conducts pre-admission assessments on prospective service users in order to determine if the home is able to meet their care needs. In the event of an emergency placement the home receives a care plan from the referring social worker, containing relevant information about the service user in question. The inspector looked at two examples of pre-admission assessments carried out by the manager and both contained the information needed to enable her to make a decision about the suitability of the prospective service user. The inspector suggested that the record also reflect the extent to which the information gathered came from the service user or from other sources. Following the assessment, the home writes to the prospective service user or their representative, informing them of the outcome. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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. Care plans are clear and concise, providing staff with the information they need to deliver care to the service users. The home liaises effectively with the primary health care team and ensures that service users’ health care needs are met. The home’s capacity to effectively monitor service users’ health would be improved by a more systematic approach to the weighing of service users. The home is making progress towards managing medication safely and effectively to promote the health and well being of residents. In most respects the arrangements in place at the home serve to promote the dignity and privacy of service users, encouraging them to feel that they are valued members of the household. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each service user has a care plan which is discussed and agreed with the service user or their representative. The inspector looked at four examples of care plans and all had comprehensive information about the care needs of the service user in question. The manager explained that ordinarily the care plan would be signed by a service user’s representative if the service user in question were not able to do so. In one example looked at by the inspector this exercise had not happened. There are detailed risk assessments for any area of potential concern, such as poor mobility, the risk of falling, aggression or challenging behaviour. Information is also recorded on how the risk in question is to be managed or minimised. In discussion with the inspector care staff confirmed that they had access to all relevant information about service users’ care needs. They also said that there was good communication between senior staff and themselves at “handover” meetings between shifts, ensuring that necessary information is passed on. Several of the service users currently living at the home are frail and dependent. The facilities provided by the home to ensure their comfort are to a good standard and include adjustable beds, special mattresses, hoists and standaids. Advice, equipment and staff training is provided by Occupational Therapists from the local authority with regard to mobility and transferring problems in relation to service users with particular needs. Care staff monitor service users’ well-being and there is close liaison with the primary health care team, including general practitioners and community nurses. Comment cards received from healthcare professionals confirmed the good working relationship between themselves and the home, thus benefiting the service users. The staff assist service users with personal care tasks where this is necessary and encourage service users to retain their independence, wherever feasible. One of the areas of care that the home takes into consideration following service users’ admission is the question of dietary intake. An assessment of their nutritional needs is conducted and any particular matters of concern are noted and are kept under review. Monitoring of service users’ well-being involves weighing them either monthly or less frequently. From the four examples of care records that the inspector saw there did not appear to be a consistent approach to the question of weighing service users or a rationale to determine the desired frequency of undertaking such an exercise. Although it was evident that the home was taking action when concerns about service users’ health were noted, a more systematic approach to this area would provide a better safeguard for service users. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 13 The inspector was able to observe a number of examples of staff assisting and interacting with service users over the two days. Tasks were carried out sensitively and with due respect. A few of the service users suffer from a significant degree of short-term memory loss; they were approached and responded to in an understanding manner by the staff. On the other hand, during the late afternoon the inspector noted one example of a service user who had been admitted to the home for respite care the previous day and who was experiencing some difficulty orientating herself on the first floor. There did not appear to be an arrangement in place to assist her to settle in at this early stage. The manager has reviewed systems of administration of medicines and plans to increase the number of staff in the morning when most medicines are given. In-house monitoring of staff has been introduced and any problems found have been followed up in staff supervision. The inspector observed the evening medication round which was carried out in a safe manner. There was an assessment of relevant risks on file for one resident who selfmedicates and she said that she kept her room locked. Another resident was not self-medicating although her social services assessment recommended that she be encouraged to with monitoring. She told the inspector that she was not well enough when she first came in but it would be good practice to plan ahead for her return home. The security of one of the medicines cupboards had been improved. The trolley was well organised despite being very full. The actual temperature of the fridge was monitored but not the maximum and minimum, as previously recommended. The inspector showed staff how to do this. Actual temperatures recorded were in the correct range but the maximum reading at the time was too high. All staff who give medicines have had additional training and are working hard to improve the administration and recording of residents’ medicines. The inspector checked a sample of five residents Medicine Administration Record (MAR) charts with the medicines in stock to see if they were given as prescribed and recorded. Except for two medicines checked the number of tablets remaining agreed with the records, indicating that they were given as prescribed. One antidepressant, prescribed once a day, was signed as given twice on two days, although from the audit trail it was only given once. There were one and two more tablets than expected of two different strengths of a medicine to thin the blood, indicating that some doses were not given as prescribed and recorded. Medicines received were recorded and the balance of Controlled drugs checked was correct and administration witnessed. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 14 Two eye drops were labelled ‘as directed’ and the GP should be asked to include full directions on the next prescription. Another eye drop needed replacing as it was dispensed 4 weeks ago. A new prescription was requested immediately. Service users said that staff respected their privacy by knocking on their bedroom door before entering; they have a key to their door should they want to lock it. A payphone is situated in one of the hallways and is therefore not in a private location. The manager informed the inspector that service users could use a mobile handset from the office if they wished to make or receive a call in private. A few service users have their own telephone installed in their room or have a mobile phone. In some bedrooms continence aids were stored in a prominent place, either on top of a wardrobe or on the floor. This occurs because service users ordinarily receive a month’s supply of pads and there is insufficient storage space in their bedroom. In discussion with the inspector the manager said that she would endeavour to find a way to address the issue. ` Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 good. This judgement has been made using available evidence including a visit to this service. The home offers a varied programme of activities, thus providing a stimulating environment for residents. The home makes arrangements which enable residents to have their spiritual needs met. The home makes visitors welcome and thereby helps service users maintain contact with the local community. Service users are assisted to make choices about their daily routine and retain control over their lives where this is feasible. The home provides a nutritious and varied diet which meet the expectations and dietary needs of service users. EVIDENCE: Service users who spoke to the inspector said they were able to make choices about their daily routine, such as when they get up and go to bed, how they spend their time and what they have to eat and drink. One very physically frail service user was already in bed early in the evening on the first day of the inspection; he confirmed to the inspector that this was what he wanted. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 16 Service users have some degree of choice with respect to bathing or showering arrangements. Service users with whom the inspector spoke said that they were content with the provision although they could not recall having been given a choice about it other than with regard to the timing of the bath. The general opinion expressed was that the staff were too busy to bath or shower them more than once a week. The manager said that the staff would endeavour to meet the service users’ expectations in this regard and that requests for more frequent bathing would be accommodated. The activities officer works on each weekday and arranges a programme of activities that are geared to the differing needs of the service users. This includes both group work and interaction with service users on a one-to-one basis. The weekly programme is displayed in the front hallway and includes word and card games, “extend” physical exercises, art, the use of “memory box” artefacts, music and bingo. Entertainment sessions form an outside provider take place each month. The officer gathers information about service users’ past history and interests, and seeks to adapt the programme to suit the different tastes and levels of capability of service users. The inspector saw examples of information gathered by the officer from families and sets of photographs which assist her in establishing a link particularly with mentally frail service users. Comments expressed by service users either in person or through surveys generally gave a favourable view of the activities programme. However, half of the respondents from surveys indicated that activities were sometimes or never suitable. From discussion with the manager and activities officer and from looking at the evaluation notes for each service user that the officer keeps with regard to activities, it was clear that a lot of thought was given to the content of the programme. An outing is arranged each month through the loan of a minibus with a tail-lift and it would appear that this facility is particularly popular. The home does not have the resources to provide more frequent outings. At present there are no service users from an ethnic minority or who belong to a faith group outside of mainstream Christianity. Regular Communion and other services are held at the home twice a month, including on a Sunday. Although these are Church of England led sessions the small number of practising Roman Catholic service users are welcomed as part of the congregation. Service users told the inspector that their visitors were always made welcome by the staff. This was confirmed by relatives who returned comment cards to the Commission. The Service User Guide contains the following statement: “We welcome relatives and friends at any reasonable time”. During the course of the inspection the inspector noted a few relatives visiting the home and the visitors’ book is kept up-to-date with names of visitors and times of visits. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 17 Service users are able to personalise their bedroom by bringing in items of furniture or other features of interest. The inspector saw several examples of bedrooms, many of which had pictures, photos and ornaments. The size and shape of smaller bedrooms limit the extent to which the layout of furniture can be varied to suit individual preferences. Service users are given access to their personal records; in recent months the home has made efforts to better inform people about their rights in this regard. Service users have some opportunity to participate in decision-making at the home. This is achieved at the time of their care needs review or, informally, in discussion with their key-worker, or with the manager who operates an “open door” policy. Periodically, residents’ meetings take place and a record is kept of the outcome. The last meeting was held in December 2005 when sixteen service users attended. The inspector suggested that consideration be given to inviting relatives and friends of service users to meetings, particularly in situations where the service user is not able to participate owing either to mental or physical frailty. The home has a five week rotating menu, the content of which is kept under review. Account is taken of the dietary needs of service users which are assessed at admission. Service users are offered a choice of items and dishes at each meal time. Mealtimes are spread evenly throughout the day; service users may have breakfast anytime between 7.30 and 10 am. In addition to the main kitchen there are smaller kitchen areas where service users or their visitors may make a hot drink. The inspector observed the serving of the evening meal which was conducted in an unrushed manner; staff assisted those service users requiring help with feeding. Most of the service users with whom the inspector spoke said that the meals were very either good or very good and all eighteen questionnaires returned to the Commission indicated service users’ satisfaction with the food quality. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be 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 complaints procedure which enables service users and/or their representatives to address any concerns they might have. The policies and practices of the home ensure that service users are safeguarded from abuse or harm. EVIDENCE: The home has a complaints procedure which is part of the Dorset County Council Adults Services formal complaints procedure. Details are contained in the information pack that is supplied to service users on admission. Leaflets containing the complaints procedure are also available in the front hall. Two complaints have been logged since the previous inspection, one concerning the care of a service user and one concerning a lost item of clothing. The matters were investigated by the manager and were partially upheld. A concern was also raised with the management earlier in the year about the heating levels in a service user’s bedroom. This issue was subsequently addressed. From talking with service users during the visit and from reading surveys sent to the Commission the inspector gained the view that service users or their representatives would feel free to raise issues with the management if the need arose. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 19 The home has adult protection and “whistleblowing” policies/procedures and a copy of the Dorset County Council “No Secrets” guidance. The topic is covered either in the induction/foundation programme for newly appointed staff or in a subsequent training session for other staff. The manager reported that four night staff members had yet to receive training. During discussions with the inspector staff demonstrated knowledge of the topic and knew what action to take in the event of their having a concern about the welfare of service users. The management has responded appropriately to allegations about poor practice on the part of staff. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The accommodation provides a pleasant, clean, odour free and safe environment and meets the needs of the service users who currently live there. Laundry facilities and arrangements are suitable and meet service users’ expectations. EVIDENCE: The home is situated in a residential part of Weymouth close to the seafront and near to a range of amenities including shops, post office, churches and pubs. It is approximately half a mile from the town centre. The premises and facilities have been assessed as suitable for their stated purpose of providing care and accommodation for older people in a report from an Occupational Therapist. The majority of the bedrooms are small and this imposes some Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 21 limitations on the home’s capacity to provide care for physically frail service users who require assistance with hoists. Upgrading work is underway at the Lawns. This has involved the fitting of a new shower room which meets the needs of physically disabled people and the creation of a ground floor sluice room. The refurbishment of two rooms at first floor level will result in two larger bedrooms, replacing two of the small bedrooms elsewhere in the building. This alteration will give the home a “treatment” room on the ground floor where service users can be seen in private and a designated room for the storage of medication. The premises are protected by a keypad entry system at the front door and by the fitting of alarms at other exit doors. The purpose is to ensure the security of the service users. Service users who are able to make use of the facility are given the keypad code so that they may come and go as they wish. In one questionnaire completed by a service user the person commented that he/she had to always ask a staff member to be let out. Another service user told the inspector that service users and relatives were not given the keypad code; she thought this was a good thing to help maintain security. There appears to be some lack of clarity about the arrangements. Service users have access to a secure, level rear garden which provides a pleasant area for sitting and walking. In addition to lawns and flower beds a sensory garden is being created for the benefit of the service users. Maintenance of the premises, grounds and facilities is conducted on a regular basis. There is servicing of the equipment such as hoists, bath aids and lifts and checking/testing of the electrical installations and portable electrical appliances. Fire precautions are maintained in accordance with guidance from Dorset Fire and Rescue Service. The fire risk assessment has been updated and reviewed. On the day of the inspection a fire training session for staff took place and examination of the records indicated that fire training was taking place at the required frequency. The kitchen and food storage areas are checked by the Environmental Health officer in accordance with the risk assessment procedures of that department. The home has a suitably equipped laundry room. Laundry duties are currently undertaken by care staff; the home will shortly have a laundry assistant to take care of this side of the running of the home. Service users or their relatives are asked to label their clothes prior to admission to assist staff with laundry duties. The inspector randomly selected a sample of bedrooms and found that items of clothes were correctly labelled. No adverse comments were received by the inspector about the laundry provision during the course of the inspection. Service users were suitably dressed in clean and welllaundered clothing. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 22 There are sluice facilities to enable the hygienic cleaning and sterilising of commode pots to take place. The home was found to be in a clean and odourfree condition at the time of the inspection. The carpet in one of the communal rooms was significantly stained; the manager explained that arrangements were already in place for the carpet to be cleaned the same evening. Service users confirmed to the inspector that their rooms were cleaned and their linen was changed regularly. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to ensure that service users are kept safe and that their basic care needs are met; planned improvements to staffing arrangements should ensure that service users’ care needs are more comprehensively met. Staff are competent at their work and enjoy the confidence of service users, relatives and external professionals alike. They receive the necessary training to meet service users’ care needs Staff recruitment procedures for the most part provide the necessary safeguards to service users but one matter concerning the carrying out of Criminal Records Bureau checks needs attention. EVIDENCE: The staff team comprises the manager, five senior officers, a clerk, shift leaders, care assistants, an activities coordinator, housekeepers, chefs and kitchen assistants. Most of the vacant care posts have now been filled and the home is actively seeking to fill the remaining post for a morning carer. Staff sickness has been a problem until recently, resulting in a reliance on agency staff. This situation has improved; for example there was just one agency carer on duty during the afternoon/evening and on the following morning at the time of the inspection visit. It is also the case that for the most part Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 24 agency workers are regular attendees at the home and are therefore familiar with the service users. The inspector received confirmation of this point in discussion with the agency staff he met during the visit. Concern about staffing levels and/or the use of agency staff was expressed by service users, a relative and staff during the course of the inspection. Some service users considered that staff were very busy and did not have time to spend with them other than to do the essential things. There was also some comment about the length of time it took for staff to respond to call bells. The manager informed the inspector about the measures that were in place to improve the situation: the addition of a shift leader for each morning period to provide hands-on support and guidance to staff at this busy time of the day; the appointment of a laundry assistant to free care staff to concentrate on caring duties. From observation and looking at staff rosters for both day and night periods it is clear that there are sufficient staff on duty to ensure the safety of the service users. Planned improvements will enable staff to meet service users’ care needs more comprehensively. All care staff are given the opportunity to attain a National Vocational Qualification (NVQ) at level 2. It is an expectation that newly appointed staff will prepare for the award on successfully completing a probationary period. At present over 50 of the care staff have achieved the award, a further four are preparing for it. Plans are in place for the majority of the remaining care staff members to embark on the award in the near future. Comments from the service users and relatives both in person to the inspector and in questionnaires returned to the Commission indicated that for the most part service users considered that they were well looked after. Service users evidently have confidence in the competence and caring disposition of the staff. The following views are representative of such comments: • • • • • ‘The staff are wonderful’ ‘They’re very good girls’ ‘They’re kind people’ ‘Care is top class’ ‘We cannot speak highly enough of the way she is cared for’ The inspector looked at the records of two recently recruited staff members. Most of the necessary measures and checks had been carried out, including the completion of an application form, the taking up of two references, conducting and recording the outcome of an interview and the carrying out of police/POVA checks via the Criminal Records Bureau (CRB). In the case of one staff member a new CRB check should have been conducted; although the person had previously worked in a Dorset County Council home there had been a gap when she had worked elsewhere for a few months. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 25 New staff attend an induction programme and care staff go on to complete a foundation training course within six months of commencing employment. This enables staff to attain the necessary basic knowledge and skills to equip them to carry out their work. The manager reported that “refresher” training was being organised for experienced care staff to help them to keep up-to-date with current practice. Outside of health and safety topics the main areas that the staff group are focusing attention on are caring for people with dementia, and nutrition. The activities officer already has attended a course in dementia awareness. Training for ancillary staff is arranged in accordance with their particular needs and circumstances. The care staff who spoke to the inspector confirmed that the training provision was to a high standard and that it assisted them to carry out their duties with confidence. Agency staff are trained by their employer. The agencies give the home a written assurance that all staff sent to work at the home are suitably qualified. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 26 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): 31,32,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and qualified and manages the home efficiently in the best interests of the service users. Staff are assisted in carrying out their duties through the leadership and support of the management team. The home has the necessary arrangements in place to safeguard service users’ financial interests. The health and safety measures that the home takes ensure that service users are protected from harm. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager, Anne Vallins, has recently completed the Registered Manager’s Award, National Vocational Qualification (NVQ) at level 4 and is awaiting the certificate. She has a number of other relevant qualifications, including the Diploma in Social Care Management and NVQ level 4 in Social Care. She keeps up-to-date by attending training courses that relate to the care of older people; for example, she will shortly be participating in a two-day dementia awareness course. She is employed as the full-time manager of the Lawns and does not have responsibility for other establishments. She has a job description which reflects the nature of her responsibilities. The other senior officers also keep abreast of current practice that relate to their care and supervisory duties. There are regular staff meetings for senior staff and the staff group as a whole. Additionally, the manager holds quarterly meetings for the night staff. There is an expectation that staff will attend at least three meetings each year. Most staff members with whom the inspector spoke considered that they were well supported by the management team in general and by the manager in particular. They feel that they can approach the manager informally for advice and guidance and that information is communicated effectively between the staff and management. Care staff receive one-to-one supervision from a senior officer and a record is kept of the outcome. Ordinarily, sessions take place at two monthly intervals. This is an opportunity for staff to discuss care issues and for the supervisor to review the carers’ progress. Four of the five care staff with whom the inspector spoke said that they received regular supervision; one said that she had had to “chase up” her supervisor to arrange a supervision session. From looking at a sample of staff records the inspector noted that one staff member had not had supervision for several months. The home conducted a detailed survey of service users’ views last year which concluded that there was a generally high level of satisfaction about the quality of the provision. The results of the survey have been produced and are included in the Service User Guide. The manager has taken action to address the few areas of shortcoming identified in the survey. The intention is to conduct a further survey and to widen its scope by seeking the views of other interested parties, including relatives and external professionals. The manager and her team also conduct exercises to monitor the quality of the home’s performance in a number of areas, e.g. ensuring that service users’ care plans and reviews are kept up-to-date and auditing the medication administration and recording arrangements. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 28 The home has a procedure for assisting service users to manage their finances. The home does not act formally on behalf of any service users. Dorset County Council has put in place Court of Protection arrangements for three service users. Service users either look after their own finances or have a relative or other representative to assist them. Lockable facilities are provided in bedrooms so that service users may keep money or valuables safe. In most cases the home holds small amounts of money in a secure place on behalf of service users. Records and receipts are held for transactions made. The inspector randomly checked three sets of records and all were correct. Over the course of the two day visit the inspector spent time looking around the building. No hazards or matters of concern were noted. Equipment and cleaning materials/liquids were safely stored. The management has conducted a detailed health and safety audit and checks are carried out to ensure that policies and procedures are implemented. Staff receive training in such health and safety topics as first aid, manual handling and food hygiene. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 2 x 3 Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement The Registered Person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: Continuing to monitor the administration of medicines to ensure that they are given as prescribed and accurately recorded. A police/POVA check via the CRB must be completed on all prospective staff members prior to their appointment. Timescale for action 1 OP9 13(2) 31/07/06 2 OP29 19(1)(5) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP8 Good Practice Recommendations The home should set out a clear rationale to determine the frequency of weighing of service users which respects their wishes and takes into account their particular needs and circumstances. DS0000032130.V299516.R01.S.doc Version 5.2 Page 31 1 Lawns (The) 2 OP9 3 OP10 4 OP19 5 6 OP30 OP36 The home should follow guidance from the Royal Pharmaceutical Society including: a) Monitoring and recording the maximum and minimum temperature (normal range 2-8°C) of the refrigerator used to store medicines daily when in use. b) The GP should be asked to include full directions on all prescriptions rather than “as directed”. The home should keep a copy of new prescriptions, or written confirmation of the doctor, or other prescriber, changing medication. Continence aids should be stored out of sight in bedrooms in order to safeguard service users’ dignity. Arrangements should be put in place to ensure that service users who wish to make use of the facility are given the keypad code of the front door to enable them to come and go as they please. Such an arrangement should be made within a risk assessment framework, taking into account the safety of the service user concerned. The home should obtain details of the training/qualifications of regular agency care staff to assist in determining the capacity of the staff group to meet the care needs of service users. Supervision for care staff should take place every two months. Lawns (The) DS0000032130.V299516.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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