Inspection on 27/03/07 for The Lawns Neighbourhood Care Centre

This inspection was carried out on 27th March 2007.

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 Neighbourhood Care... 28/03/09

The Lawns Neighbourhood Care... 02/03/06

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Poldhu

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE The Lawns Neighbourhood Care Centre Bristol Road Quedgeley Gloucester Glos GL2 4QW Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 09:30 27th March 2007 X10029.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 The Lawns Neighbourhood Care Centre DS0000065043.V318821.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 and Care Homes for Adults 18 – 65*. 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. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lawns Neighbourhood Care Centre Address Bristol Road Quedgeley Gloucester Glos GL2 4QW 01452 721345 01452 723628 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) The Lawns NCC LLP Miss Anna Marie Carrier RGN, BSc (Hons) Care Home 31 Category(ies) of Learning disability (2), Old age, not falling registration, with number within any other category (31), Physical of places disability (15) The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 Brief Description of the Service: The Lawns is a care home providing nursing care, for adults over the age of 18 years. A qualified nurse is on duty 24 hours a day. The home is currently caring for some service users who have very specialist needs. The main accommodation is provided in a converted older style house, with a contemporary extension, and is provided on two floors. Staircases, a shaft lift and stair lift provide access to the upper floor. Various equipment and adaptations have been provided for assisting service users and staff, which includes assisted bathing facilities and hoists. Service users’ private accommodation is provided in single rooms on both floors, though there is one shared room on the upper floor. Many of the rooms have an en-suite facility. There are several lounge areas and a dining room. An adjoining day centre provides an additional spacious room. A pleasant and accessible garden also includes a ‘sensory patio’ area. There are many opportunities for social activities available inside and outside the home. Two specially adapted wheelchair buses are available to transport service users. The Statement of Purpose and Service User Guide are available in the office. Fees for the home range from £350 to £1500 per week. Items not covered by this fee include Chiropody, Hairdressing and Transport. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This Key unannounced inspection took place in March 2007 and included a site visit to the home on 27th March by two inspectors. Twenty-three Care Standards for Older People and Younger Adults were assessed on this occasion. Of these, seven exceeded the standard, twelve met the standard and four almost met the standard. Time during the inspection was spent speaking with the Manager, staff, residents and visitors. A range of records were examined including care plans, medication records, staff files and training information as well as health and safety systems and the environment A pre-inspection record was provided prior to the visit. Fourteen people living at the home returned comment cards and fourteen surveys were returned from staff. Two comment cards were received from visitors. Time was spent observing the care being provided to people and talking to them about the service they receive. Two visitors also shared their views. What the service does well: A stable staff group with a wealth of knowledge and experience ensure there is continuity of care for the people living at the home. Morale within the home is good with staff commenting that ‘family is the essence of this home which contributes to its success’ and ‘we are kept well informed’. The health needs of people living at the home are well met with evidence of good multi disciplinary working taking place. The home is able to care for people with complex needs and disabilities from the age of 18 years upwards. People have access to a full and varied activity programme in the home at the day centre on site. Comments from people at the home indicate that they enjoy the activities and outings on offer and feel that they are consulted about them. Comments from relatives indicate that “a high level of care and attention is provided from a very professional team,” and that “ the Lawns are a very welcoming home”. Ongoing investment and maintenance provides a home which people say is ‘homely and comfortable’ and provides a safe environment that is pleasantly decorated and furnished. Specialist equipment is provided to those who need it. Thought and care is taken to meet the diverse needs of people under 65 and those over 65, providing activities and meals that recognise the differing needs The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 6 of each group. Rooms are also decorated to reflect each person’s tastes. A room for a person under 65 has been developed into a sensory environment with good use of colour and stimulating fixtures and fittings. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Older People) and 2 (Adults 18-65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that each prospective resident is fully assessed prior to admission and on admission, to ensure that all their specific and complex (in some cases) care needs can be met by the Home. EVIDENCE: There have been five new admissions to the home since the last inspection only one of these people was able to have a conversation with the inspector. So much of the evidence here was gained from observation and discussion with those caring for the people. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 9 The home specialises in care for a group of people who have general nursing needs as well as younger adults who have complex nursing needs. Therefore each admission is well planned with training and specialist equipment provided prior to the admission of the individual either for short, long term or respite care requirements. Individuals are assessed prior to and on admission and documentation seen confirmed this. Copies of the health and community joint assessment forms were in place for the four people casetracked. These are used as the admission assessments and each persons care file contains specific details of care needs, medical history, next of kin and general information. A daily careplan is then devised from this assessment. Each persons needs are then reassessed on a six monthly basis or more frequently if necessary, to ensure that changing needs are identified and care intervention is changed as necessary. The care and interactions observed during the visit confirmed the care written in the care plans of individuals. The home is ensuring now that the reviews are undertaken with the placing authorities and these are recorded in the care file, it appears that the placing Authority are now undertaking the reviews, evidence was seen in records examined. Other agencies involved in the individuals care are also recorded. Residents spoken with confirmed that they or their relatives visited the home prior to the admission and found the home to be very suitable. Residents had contracts (a sample were seen) but it was the relatives / representative or Social Services who dealt with this and not the resident, due to the fact that many were unable to deal with it themselves. The contract contained all the required details and was compliant with Office of Fair Trading Standards. One person recently admitted confirmed that they were happy with the home and they had no concerns. Others spoken with felt they were kept well informed, were very happy at the home, found the carers good and felt that there was appropriate stimulation in the home. People were seen given choice during the inspection. All the comments made by residents, relatives/representatives in conversation and via questionnaires were very positive about the home, staff, care and the food. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 (Older People) and 6,9,16,18,19 and 20 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system ensures that all members of staff have a clear understanding of the care each person requires and how assistance is to be given. People are assessed and reassessed when their personal needs change. The health needs of people are well met with evidence of good multi disciplinary working taking place. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 11 People are protected by the home’s policies and procedures for dealing with medicines. Medicines are managed and given to people in a safe way. People are treated with respect and dignity and facilitated to live as independent a life as possible within their own limitations. People’s records are accurate, secure and confidential. EVIDENCE: Comprehensive information is maintained for people living at the home. This is being regularly monitored, reviewed and updated. Four care records were examined for four people, all observed during the inspection and spoken with albeit they could give limited or no response. The care records contained all the required documentation and were clear in how the individuals were to be managed regarding their care. Care plans are discussed with the each individual person and their next of kin (where necessary) and signatory evidence on care plan and reviews is now being sought to demonstrate individuals’/next of kin involvement in the preparation of these plans. People living at the home were observed being spoken to with respect and addressed properly and all interactions were appropriate. It was evident from their daily records and observation that staff adhere to care plans and risk assessments. The care plans seen indicated specific care needs and enabled care staff to know how to assist the resident. Risk assessments, monthly weight and personal background information is recorded for each resident. A photograph of the resident is kept with the care file to aid identification. Daily recording was observed to be appropriate and informative. The care plans are reviewed at least once a month or more frequently if residents care needs change. The inspector read care records for four new residents who were spoken with / observed during the inspection. The records confirmed the assistance and care that the residents required. It also confirmed other information that had been shared with the inspector during the discussions. There is the requirement for some minor amendments to care plans: • Where wound care charts are in place that there is wound mapping, aims of treatment and the frequency of the change of the dressing. • Where there is a change in weight this must be updated on the moving and handling assessment. • Where a pressure assessment system (Waterlow) is in place it is essential that when the aids in use are changed there is an amendment to the assessment information and care plan. • Where additions or alterations are made to care plans at any time these are dated and signed to ensure an audit trail for changes to care. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 12 • The Manager must regularly audit care files and care plans to ensure that the correct information is recorded, dated, signed and that there is consistency of recording in the home. All care documentation is kept securely in the home and is readily accessible to all the staff responsible for providing care. Any restrictions to choice or freedom are recorded on people’s files. Through discussion with the Manager and observations at the home it was evident that personal autonomy and choice are promoted as fully as possible. Risk assessments are in place for a variety of activities and several of these were examined. These are signed, dated and are regularly reviewed. Risk assessments are documented for anything specific to the individual person. Issues relating to life and death wishes are discussed in full and documented and signed by the person and their next of kin and these are reviewed yearly. The homes medication system was checked. The Manager explained the procedure for administration of medication and the inspector accompanied her for part of the medication round. A number of MAR sheets were examined; all had been signed and checked. The home undertakes regular audits of their medication and excellent stock control procedures are in place. The records for controlled medication were examined and no issues were identified. All bottles of liquid medication were seen to be dated on opening. There is a contract for medication disposal in place All the Nurses who dispense medication receive medication updating yearly. The Manager supervises all the Nurses with medication, undertaking medication rounds with them. This is not formally recorded. The Manager needs to find a method of recording this supervision. Policies and procedures relating to medication were all in place including some that cover the extended roles the Nurses have been trained to undertake. These were all reviewed in May 2006. Oxygen is stored appropriately and signage is in place. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 (Older People) and 12,13,15 and 17 (Adults 18-65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People participate in age, peer and culturally appropriate activities through engagement in social activities of their choice and liking. People living at the home are offered a range of freshly produced meals giving them choice about their diet. EVIDENCE: The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 14 There is a family model of care within the home where people choose their activities and people act like a community and ‘look out for each other.’ People are seen by the day centre staff on admission to discuss their hobbies and interests. There is access to a full and varied activity programme in the home or at the day centre on site. People living at the home influence the activities through residents meetings and through opting for the activities that they enjoy. Each person is allocated sessions at the day centre weekly when the activity they enjoy takes place. Some people choose to spend doing their own thing. The activities tend to be group activities for mental and physical stimulation and these are provided over four days during the week. On the fifth day two extra staff are employed and they take 2 to 3 people out to a variety of venues depending on the choice of the individuals. The programme of activities gives a valuable insight into the diversity of activities that the residents’ engage in and demonstrates that not everyone is doing the same thing. It also demonstrates that they are part of the wider Community. Two staff have been trained in the ‘active ageing’ programme. The Home arranges with the people living at the home to go on holiday each year with staff from the home and they always have a wonderful time. Samples of menus were supplied prior to the inspection providing evidence that a range of freshly produced meals are offered. People said they really enjoy the food. The cook described how a rolling menu is devised taking into consideration the diversity of people’s needs and catering for a wide age range of people. All the required checks are in place and a recent visit from the Environmental Health Officer gave the home a Level 4 ‘Score on the doors’ rating, this is the Environmental Health accreditation for food hygiene and handling. On the day of the visit people were observed enjoying a meal of lasagne or lamb hotpot with fresh vegetables. One person was observed saying that they did not want the pudding of semolina and were offered banana with fresh cream. Some people require a soft diet and the cook explained how each ingredient is liquidised separately. Some people choose to eat their meals in their rooms, others in the dining room or in the lounge. Those people who attend the day centre have meals there. Weight monitoring for loss and gain is undertaken monthly and recorded. Where this is being done routinely to monitor weight then this is included in the care plan actions. Appropriate action is taken to address any issues raised that may impact on the health of the individual The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (Older People) and 22 and 23 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident in the knowledge that any concerns they may express will be listened to and acted upon. Systems are in place that safeguard people from possible harm or abuse. EVIDENCE: People spoken to say that if they have any concerns they would speak to the registered manager or co-owner. Relatives said they are aware of the complaints procedure and would speak directly to the manager if they have concerns. The complaints policy and procedure is displayed on notice boards around the home. The manager should consider how she could produce this complaints procedure in a format appropriate to the needs of people who are unable to read for instance using symbol or photograph. Neither the home nor the Commission have received any complaints. There are quarterly ‘House’ meetings that provide another forum for people to express their concerns. At a meeting in September 2006 one person requested air conditioning. Air conditioning units are provided in some The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 16 bedrooms. Another meeting was held in February 2007. Minutes of these meetings are displayed on a notice board in the lounge. Four of the comment cards indicated that staff are unaware of adult protection procedures. The registered manager said that staff attended training in the protection of vulnerable adults two years ago. The training database confirmed that staff attended training in 2005. The registered manager said that further training would be arranged when the new safeguarding adults policy and procedure is introduced in Gloucestershire. Staff who have completed their NVQ Awards will also have completed a unit on abuse. A copy of the ‘alerter’s guide’ produced by the local adult protection team is displayed on the notice board. Staff commented that increasingly they are having to deal with challenging behaviour and some feel they do not have the skills to support people when they are angry. The registered manager said that she is liaising with a psychologist with the Head Injury Team and he will be providing support and training to staff. The registered manager is aware of the implications of the Mental Capacity Act and will arrange training for staff in due course. Information about how to access IMCA’S will be made available to people. During 2006 people were potentially put at risk by unsafe recruitment practices where staff were being appointed before their Criminal Records Bureau check had been received. The registered manager confirmed that this practice has ceased. (See standard 29) The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 (Older People) and 24, 29 and 30 (Adults 18-65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 18 A walk around the environment was conducted and some bedrooms were inspected. Carpets throughout the home have been replaced and some communal areas redecorated. The handyman deals with day-to-day maintenance issues. The home has a lived in feel with evidence of lots of personalised touches – photographs, jigsaws, knitting and videos in communal areas. People said that they have brought in their own furniture and possessions and been involved in any redecoration of their rooms. Rooms for people under 65 have been developed into sensory environments by creating a stimulating environment that uses bright colours, lights and mobiles. Likewise thought has been given to people with special needs ensuring that any equipment they need is provided. People living at the home have access to a day centre on site and many were using this facility during the site visit. Others chose to spend time in their rooms, in the lounge, dining room or small lounge. A relative was observed spending time in the quiet lounge and said that the gardens which have an area for children are ‘great when my son is visiting’. An array of hoists and slings are available around the home, which are being regularly serviced. An assisted bath is available on the ground floor that also has a Jacuzzi facility. At the time of the inspection the home was clean and tidy. There was evidence that staff are provided with personal protective equipment that is accessible throughout the home. Washing machines have sluicing facilities. A person has responsibility for overseeing the laundry and good practice was observed to be in place. She confirmed attending an infection control course. Hazardous products are locked away and data sheets/risk assessments are displayed in the laundry and cleaning cupboards. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 (Older People) and 32,34 and 35 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a mainly satisfactory training programme that needs to ensure staff have knowledge about the diverse needs of people living at the home. People have been put at risk by unsafe recruitment processes although recent improvements if sustained will protect people from possible harm. EVIDENCE: Staff confirmed that they complete an induction course that involves working through a booklet. Copies of this were not available at the time of the visit but have been inspected previously. The registered manager stated that new staff work supernumerary to the staff team for the first month. One person was observed shadowing a member of staff. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 20 Rotas confirm that there are two registered nurses working at the home throughout the day assisted by care staff who have access to a NVQ programme. Half of the care staff have a level 2 or 3 award in Care and two care staff are completing their awards. This exceeds the standard. Pre-inspection information confirms that kitchen assistants support the cook, a person has responsibility for the laundry and cleaners are employed. Staff from the day centre are also involved in the care of people. Pre-inspection information indicated that six staff appointed during 2006 were appointed before their Criminal Records Bureau check had arrived. The registered manager stated that this was the case but that she is now appointing staff upon receipt of the Criminal Records Bureau check or in exceptional circumstances after a povafirst check. The last member of staff to be appointed had started work with a povafirst check, three references had been obtained and the registered manager had consulted with us prior to doing this. The registered manager is advised to complete a risk assessment to describe the processes she has in place when employing staff with a povafirst check. These practices comply with the Care Home’s Regulations. Recruitment and selection processes are on the whole satisfactory with evidence that at least two written references are being obtained as well as proof of identity, an occupational health check and a full employment history. Where there are gaps in the employment history there was evidence that the registered manager is questioning this during the interview process. The registered manager confirmed that people living at the home are involved in the interviewing of staff. A training matrix is in place that gives information about each member of staff’s training for the year. Each person has the opportunity to attend three days paid training per year that includes in house training and training from external providers. Staff confirmed that their mandatory training is kept up to date. The registered manager stated that open learning is also available in the form of videos and short courses. Copies of certificates of attendance are kept on staff files. Training specific to the needs of some people living at the home is provided such as epilepsy, diabetes and active ageing. Staff do not appear to have access to training or courses that relate to the needs of people with a learning disability. All Registered Nurses are trained and updated regularly by the Critical Care outreach Advanced Nurse Practitioner in a variety of practices to ensure they have the skills and knowledge to care for the people who reside at the home who have complex care needs. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 (Older People) and 37,39 and 42 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home which is run in their best interests offering them choice, respecting their wishes and keeping them safe. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager is a Registered Nurse and has a degree in management. She actively pursues her continuing professional development by participation in local associations, working with the local Community and Adult Care Directorate of Gloucestershire County Council and attending training courses. Staff comment cards indicate that the manager is accessible and a good role model working alongside them in the home. People were observed having positive interactions with the manager. Where there have been identified shortfalls in the Care Homes Regulations and in meeting the National Minimum Standards the manager has worked to address these issues. A major issue of concern had been addressed prior to the site visit and that was about staff being appointed without a Criminal Records Bureau check in place. The registered manager described the systems she has in place to assess the standards of care being provided. People take part in an annual quality assurance survey from which a report is produced indicating what measures will be taken to address any issues identified. This is displayed on the notice board in the lounge. Additional quality audits are completed for health and safety and medication. The registered manager has been involved in a dependency audit of people using services in Gloucestershire. As part of this she completed a seven-day assessment of people living at the home. There has been a significant improvement in the quality of recording for people’s personal monies. Staff described the processed that are in place. Records for three people were examined. Receipts can be cross-referenced with transactions and auditing is much easier. Staff confirmed that they regularly check the balances although there was no evidence on the financial record. Staff confirmed that they have an annual appraisal, copies of which were observed on their files. The manager states that she observes staff practice regularly although there is no evidence of this apart from an annual appraisal assessment. Records confirm that staff receive six supervision sessions each year but not the content of these supervisions. The record indicates the dates, which appear to be over a two-month period and comments such as “a dependable experienced care assistant who enjoys outings”. Health and safety systems are in place that are monitored and reviewed. Water temperatures are regularly taken for outlets around the home. The cook maintains comprehensive records in line with ‘Safer Food Safer Business’ guidelines. First aid and COSHH risk assessments are displayed around the The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 23 home. The pre-inspection questionnaire and service inspection documents confirm that equipment is regularly serviced. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 24 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 X 2 X 3 4 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 4 20 X 21 X 22 3 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 3 37 X 38 3 The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14(2) Requirement The Registered Person must ensure that the following care plan amendments are addressed: • Where wound care charts are in place that there is wound mapping, aims of treatment and the frequency of the change of the dressing. • Where there is a change in weight this must be updated on the moving and handling assessment. • Where a pressure assessment system (Waterlow) is in place it is essential that when the aids in use are changed there is an amendment to the assessment information and care plan. • Where additions or alterations are made to care plans at any time these are dated and signed to ensure an audit trail for changes to care. Timescale for action 01/09/07 The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 26 2. OP7 24(1) 3. OP18 13(6) 4. OP29 19 Sch 2 The Registered Person must ensure that service users care plans are regularly audited to ensure all the correct and relevant information is recorded. The Registered Person must ensure that all staff receive training in the safeguarding of vulnerable adults so that they can recognise abuse and understand the processes to be followed. The Registered Person must ensure all new staff have a current Criminal Records Bureau check in place before they start work to protect people from possible harm. 01/09/07 01/09/07 01/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP16 OP18 OP29 OP30 OP35 OP36 Good Practice Recommendations The complaints procedure should be made available in a format appropriate to the needs of people unable to read text. All staff should attend refresher training in the safeguarding of adults. Risk assessments should be used for staff starting work on a povafirst check describing how people are protected from possible harm. Increasing the knowledge and awareness of people with a learning disability will help staff to understand their needs. When financial records are checked staff should initial the record to provide evidence that balances are correct. The Registered Person should provide staff with written evidence of the content of their supervision meetings to give them guidance about their practice and developmental needs. The Registered Person must find a method of recording the observation of medication supervision. DS0000065043.V318821.R01.S.doc Version 5.2 Page 27 7. OP36 The Lawns Neighbourhood Care Centre Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. The Lawns Neighbourhood Care Centre DS0000065043.V318821.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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