Inspection on 13/02/08 for The Lawns Nursing Home

This inspection was carried out on 13th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Lawns Nursing Home 12/08/08

The Lawns Nursing Home 17/04/07

The Lawns Nursing Home 07/11/06

The Lawns Nursing Home 12/10/05

The Lawns Nursing Home 27/06/05

The Lawns Nursing Home 20/12/04

The Lawns Nursing Home 07/07/04

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

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

CARE HOMES FOR OLDER PEOPLE Lawns Nursing Home, The Main Road Kempsey Worcester Worcestershire WR5 3NF Lead Inspector Sandra J Bromige Key Unannounced Inspection 13th February 2008 08:05 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 Nursing Home, The DS0000004121.V347783.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 Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawns Nursing Home, The Address Main Road Kempsey Worcester Worcestershire WR5 3NF 01905 821388 01905 828171 lynette@frontsouth.co.uk Heritagemanor.co.uk Heritage Manor Limited 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) Vacant post Care Home 40 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user under 65 years Date of last inspection 28th September 2007 Brief Description of the Service: The Lawns Nursing Home is registered to provide 24 - hour nursing care for 40 elderly residents. Accommodation is provided on the ground and first floor in both single and shared bedrooms. A passenger lift enables residents to access all areas of the home. The home, which was originally a regency manor house, is set in 3 acres of well-maintained gardens providing a pleasant outlook from the home. In 1984, it was registered as a nursing home and in 1987 a purpose built unit was opened. The home is situated in the village of Kempsey, which is located within easy commuting distance of Worcester. The registered manager’s post is currently vacant. The fee range charged by the home is listed in the statement of purpose and service user guide. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection started on a Wednesday morning at 08.05 hrs. We, the commission spent nine hours in the home. This was a key inspection – this is an inspection where we look at a wide range of areas. To help us plan the inspection we looked the Annual Quality Assurance Assessment completed by the service, survey forms received from residents (two), relatives (three) and staff (eight). During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents. Following the last key inspection in April 2007 we have carried out four random unannounced visits to this service. These reports are not available on our website (www.csci.org.uk) but are available upon request from our regional office. We issued a statutory requirement notice in July 2007 relating to care records. A compliance visit carried out in August 2007 found that the home had not complied with the notice. We formally interviewed the provider and a representative of the organisation in relation to this breach of regulation. The provider was issued with and accepted what is know as a simple caution. It was agreed following this interview as they had arranged for an external consultant to implement new format of care records and provide training that the home would be given until 31st March 2008 to rectify the shortfalls in the care records. Any further breaches of this regulation following this date may lead to prosecution of the provider. The home continues to be monitored by the multi-agencies as part of the local strategy for safeguarding adults. Since the key inspection we received a complaint about the day-to-day management of the service. We asked the owner to investigate this and elements of the complaint were upheld. The owner has been very open and co-operative in order to try and improve the service. What the service does well: The staff speak to the residents in a polite and respectful manner and they ensure that the residents privacy and dignity is maintained whilst assisting Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 6 residents with personal care. Residents are assisted to present themselves nicely and their clothes are clean and well laundered. Visitors are made welcome in the home and are able to have a meal if required. Residents are able to see their visitors in private. Staff recognise that food and mealtimes are an important part of everyone’s lives and do their best to make sure people enjoy their meals and eat well. A choice of a nutritionally balanced menu is offered and cater for individual like and dislikes. The home has procedures in place for dealing with concerns & complaints and they ensure that residents and visitors to the home know who to speak to if they have any concerns. Staff work hard to keep the home clean and free from any unpleasant smells. The home is situated in very large gardens which are well maintained and accessible to residents in wheelchairs. Good systems are in place for managing residents’ monies when the home act as appointee. What has improved since the last inspection? The home’s statement of purpose and service user guide is currently being reviewed. The terms and conditions of residence has been reviewed and are issued to residents upon admission to the home. Residents who need to use bedrails have a risk assessment done prior to use to ensure that they are safe and they are checked each month for safety. More hours have been provided for social care provision in the home and the frequency of entertainment in the home has increased. A new telephone system has been installed to make it easier for staff to communicate with each other, as it is a large home. More training has taken place for staff about safeguarding the residents. The environment has been improved. A new lounge area has been created, new beds have been purchased, the corridors and some bedrooms have been re-carpeted, handrails have been fitted in the corridors, parts of the home have been re-decorated, a new television has been purchased for the lounge, window restrictors are in place and checked regularly, hot pipe work has been boxed in, work is continuing to provide thermostatic valves on wash hand basins and rooms are being refurbished in the old part of the building to provide four additional en-suite bathrooms. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 7 A senior trained nurse has been recruited. Eleven of the 16 care staff have achieved NVQ level 2 or above. Staffing levels have improved. Questionnaires have been sent to residents, staff, relatives and healthcare professionals to seek their views of the standard of the service. What they could do better: The home need to complete the review of the statement of purpose and service user guide and ensure that a copy of given to all the people living in the home and is available to prospective residents. A comprehensive pre-admission assessment needs to be undertaken prior to admission of residents to ensure that there is sufficient information to formulate a care plan prior to or upon the day of admission. Care records need to be more detailed, reviewed and updated when changes take place and available to care staff so that residents receive the care that they need in a safe and consistent manner. Medication administration records need to be improved. If medication is given it needs to be signed as being given and if it is not given an appropriate code needs to be written on the medication administration record. A system should be introduced which demonstrates that medication is stored at a safe temperature in order to ensure that people who use the service are protected from harm. Care plans should be written when ‘as required’ medication is prescribed by the general practitioner, particularly in respect of the management of pain, to make sure the resident’s pain is managed consistently. The privacy curtains in the shared rooms should be reviewed to ensure they enclose both beds so that the resident’s privacy and dignity are maintained when receiving personal care. The home should review the activities provided to ensure that suitable activities are available in the home and residents can access activities within the community. All staff need to have training on safeguarding adults, fire, moving and handling, infection control, and health and safety. Staff need to have induction training and this needs to be recorded. Records of interviews of prospective staff need to be kept and show that they have explored any gaps in their employment history to ensure that people are protected from harm. Copies of certificate/qualifications that staff have undertaken and are relevant to their role should be held on their individual files. Information collected through the home’s quality monitoring systems need to be collated and any action plan put into place. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 8 Staff need to have regular supervision to ensure that they have the right skills and competencies to carry out their role and a record of this needs to be maintained. 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. Lawns Nursing Home, The DS0000004121.V347783.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 Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, & 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents with sensory disabilities would benefit from the home’s statement of purpose and service user guide being produced in a format suitable to their needs. Residents benefit from having comprehensive terms and conditions of stay given to them when they move into the home. Preadmission assessments do not provided sufficient information to enable a plan of care to be written prior to or upon the day of admission. Intermediate care is not offered by the home. EVIDENCE: The home’s Statement of Purpose and Service User Guide is being reviewed and is almost complete. The document is currently only available in a standard format. As the review is almost complete the requirement has been removed. A copy needs to be sent to us upon completion and made available to the residents and prospective residents. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 11 The home’s contract outlining their terms and conditions has been reviewed and provides comprehensive information about fees and residents’ rights. With the exception of one resident case tracked, they had been provided with a contract upon admission. The reason for the identified resident not having been issued with terms and conditions was because they were awaiting a Power of Attorney to be established. The pre-admission assessment for a resident admitted to the home 19 days ago was poor. It did not provide sufficient information to enable the staff to formulate a care plan prior to or on the day of admission. The resident was not fully assessed until three days after admission. This has the potential to place the resident at risk of harm. See information under the health and personal care section of this report. The home does not provide intermediate care facilities. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans do not identify all of the care needed and do not give sufficient information to ensure that the residents’ care is consistently met by the staff in the home. This has the potential to place residents at risk. Improvement is needed to the way the home manages medication records and procedures, and staff require further training in respect of these areas to ensure that medication is managed safely in the home and residents are not placed at risk of harm. Residents in shared rooms would benefit from the privacy curtains being altered to ensure that their privacy and dignity is maintained at all times. EVIDENCE: The care records for a resident admitted to the home on the 25th January 2008 were seen. The pre-admission assessment was of a poor quality and did not provide sufficient information to enable the staff to formulate a care plan. A full assessment was not undertaken for this resident until three days after admission. At the time of the inspection (19 days after admission) there was no moving & handling risk assessment in place and this resident is unable to mobilise independently. This places the resident at risk of harm. The resident Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 13 was observed being assisted to mobilise by two staff using no walking aids and the staff were supporting the resident’s arms and walking either side of the resident, they were not using a handling belt. This is poor practice. The only care plan in place was for “long/short term memory loss”. An entry in the “daily progress record” by the night staff states “care given as planned”. This statement is flawed, as there is only one care plan in place as stated above. A second entry dated 11th February 2008 states “behaviour charts commenced – aggression during personal hygiene interventions”. There is no care plan to show how this is to be managed. A third entry dated 6th February 2008 states “bruise noticed to left buttock, cause not identified yet see care plan” which refers to 1b. Section 1b is not a care plan it is a section of the “nursing assessment” form. A “wound record” was seen dated 5th February 2008 with an entry written on it about the bruise dated 6th February 2008, which again refers to “care plan no. 1b”. There is no evidence to show that this wound has been reviewed since. An accident form was located dated 3rd February 2008 which states “found X on the floor –lying down. No bruise at time of assessment”. This accident had not been entered into the care records and as staff stated “cause not identified yet” on the 6th February 2008, it is evident that the communication amongst the nursing staff is poor and that along with poor care records places residents at risk of harm. The care records of a second resident were also of a poor quality. The “skin” care plan stated action, “monitor ankle daily”, but there was no evidence to show that this had been actioned. The action plan for the breathing care plan stated “good fluid intake”, but does not state how much fluid the staff should aim to give the resident each day to ensure they have a good fluid intake. The resident should have a shower and hair wash weekly, but the last entry for this was dated the 29th January 2008. The mobility care plan did not state the type of hoist, and size of sling and slide sheet to be used for this resident. The resident has their own teeth and at 10.00am the resident was up and dressed and sitting in an armchair in their room and was nicely groomed. A relative told us they were “very happy with the care”. Written comments from a relative stated, ‘requests for toilet – if unreasonably frequent are dismissed before checking for infection’. We issued a statutory requirement notice in July 2007 relating to care records. A compliance visit carried out in August 2007 found that the home had not complied with the notice. We formally interviewed the provider and a representative of the organisation in relation to this breach of regulation. The provider was issued with and accepted what is know as a simple caution. It was agreed following this interview as they had arranged for an external consultant to implement new format of care records and provide training that the home would be given until 31st March 2008 to rectify the shortfalls in the care records. Any further breaches of this regulation following this date may lead to prosecution of the provider. Refer to requirement. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 14 The medication administration records for the residents’ case tracked were seen. The front sheet for two residents was not fully completed as the name and telephone number of the general practitioner was missing and a residents room number. There were no records of the medication received by the home for one resident and there were gaps on the medication administration record for three types of prescribed medication, making it unclear if they had been given as prescribed. Another resident had a handwritten entry on the medication administration record for co-codamol to be given ‘when required’. A second nurse had not checked the hand written entry for accuracy and the route of administration of this medication was not completed. There was not a pain management care plan in place for this resident. Two controlled medicines were seen for two residents that were deceased and a box of paracetamol 500mg tablets dated 5th September 2006 were seen. All this medication needs to be destroyed. The medication storage was too hot for the safe storage of medication. At 16:50hrs on the day of the inspection the temperature in the treatment room was 25.5°C, the window was open and the fan was on. We saw the daily records for the temperature of the room, which showed that the temperature of the room had exceeded 25°C on a number of occasions recently including a temperature of 27.3°C on 10th January 2008, which is above the safe storage limit for medication. This means that people who use the service are at risk of being given medication that has been stored incorrectly and they are therefore at an increased risk of harm. The privacy curtains in a shared room do not fully enclose both beds and this may compromise the privacy and dignity for these residents’. Staff were observed transferring female residents in the lounge using a hoist and their privacy and dignity was respected at all times. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their lifestyle and would benefit if more resources were provided to support existing facilities and provide more opportunity for residents to engage in social and recreational activities in and outside of the home. Residents are provided with a choice of wholesome and balanced meals in a pleasant environment. EVIDENCE: The home employs a social carer for 25 hrs per week. The social carer stated that they do not have a programme of activities, they decide on that morning and she tells them verbally what is planned. She stated that she visits all of the residents twice each day and spends some one to one time with more dependent residents in their rooms. This information is written in a diary and not in the individual residents social care plan. The social care plans for residents need to be further developed to ensure that residents are consulted and are given the opportunity to develop and maintain their recreational interests in the home and in the community. The social carer is not aware of any allocated budget for leisure and entertainment. A written comment received from a relative stated, ‘I believe that the “residents” need very much Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 16 more mental stimulation and be encouraged to walk, with nurse support, rather than automatically seated in a wheelchair’. The Annual Quality Assurance Assessment completed by the service prior to the inspection identifies a need to increase the social care provision support to cover seven days per week and to investigate the possibility of changing or adapting the home’s transport, which would open up the opportunity for more dependent residents to get out and about in the community. A four-week rotating menu is provided offering choice of meals. It is evident from the information seen on the board in the kitchen that specialist diets are provided. There is a choice of a cooked breakfast is available at weekends. The chef confirmed that there are no limitations on the food budget. Fresh meat and vegetables are delivered to the home and a there was plenty of food in stock. Homemade cakes had been made for afternoon tea. The table at lunchtime were nicely laid linen cloths. The meals are portioned by the catering staff and served to the residents in the dining room or in their own room. Staff were assisting and encouraging residents to eat their meals where required in a discreet and sensitive way. A resident was enjoying a bottle of lager with lunch, which had been provided by their family. A written comment from a resident stated that the meal ‘portions too small’, but they did ‘always’ like the meals. Discussion with a relative confirmed that ‘good’ food is provided by the home. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have access to an effective complaints procedure. All staff have not received formal training on safeguarding adults to ensure that they know what to do and residents are fully protected from abuse. EVIDENCE: The home has a complaints procedure that is on display in the home. The home’s complaints records show that the only concern/complaint they have received since the last key inspection in April 2007 was one received by us, where the provider was asked to investigate. The complaint related to the day-to-day management of the service. Areas of the complaint were upheld. Written comments from residents (two) show that one knows how to complain and relatives (three); two do not know how to complain. It is recommended that upon completion of the review of the home’s Service User Guide a copy is given to all residents and their relatives as this document will contain this information. We were let into the home by a carer without confirming our identity. The Annual Quality Assurance Assessment completed by the service prior to the inspection states that 95 of the staff had received training about ‘safeguarding people’ and further training took place on the 18th September 2007. The training audit submitted to us by the service on the 1st February 2008 shows there are 10 staff from all grades (trained, care and domestic) Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 18 who have not received this training. The staff spoken with had received training for ‘safeguarding adults’ and had a good understanding of the importance of ‘whistle blowing’ if they suspected any safeguarding concerns. As we were able to establish that staff had awareness of the importance of safeguarding people and the home’s procedures, this requirement has been removed. However, the remaining staff highlighted in the training audit need to receive this training as a matter of priority. Written comments from staff (eight) and staff records (two) show that Criminal Record Bureau checks are being done prior to appointment of staff. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been and continue to be made to the environment to make it a more pleasant and safer environment for the people that live there. Residents’ benefit from living in a clean environment with practices and procedures in place to reduce the risk of cross infection. EVIDENCE: At the time of the inspection the upper floor of the old building was closed to residents for refurbishment as they are installing four en-suite bathrooms. The Annual Quality Assurance Assessment submitted by the service prior to the inspection states that have undertaken the following improvement work since the last key inspection: - created another lounge area, new beds purchased, re-carpeted passage areas and some bedrooms, handrails fitted in corridors, repainted passage areas and improved the appearance, ensured window restrictors are in place, boxed in the pipework, and continued work on Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 20 thermostatic valves on basins. It was evident from observation on the day of the inspection that this work has enhanced the décor, safety and facilites for the people living and working in the home. The home was light and much brighter, the new carpets have provided a more warm and homely appearance and the handrails provide support for residents with balance problems whilst walking around the home. When the refurbishment of the bedrooms in the old part of the building is complete it will complement the work already carried out to other parts of the home. Please see the health and personal care section about the provision of privacy curtains in shared rooms as the adequacy of the current curtains need to be reviewed. Parts of the home seen were clean and tidy and free of offensive odours. Written comments from residents (two) indicate that the home is ‘usually’ fresh and clean. We noted in one bathroom soiled linen that had been left on the floor by the linen skip. This is poor practice and staff need to be reminded about the risk of cross infection. The training audit submitted to us on the 1st February 2008 shows that 23 staff have not received training in infection control. This needs to be addressed to ensure staff have the knowledge base to support good practice about the management of infection control. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers but further training is needed to support the smooth running of the service and to ensure residents are not placed at risk of harm. Recruitment processed need to be more robust to ensure that residents are protected. EVIDENCE: At the time of the inspection there were 26 people living in the home with two trained nurses, five care staff, administration support and five ancillary and catering staff on duty. The Annual Quality Assurance Assessment shows that the home currently employs male and female staff from a multi-cultural background. Staff when asked about staffing levels stated “no problems at present due to numbers of residents”. The Annual Quality Assurance Assessment completed by the service prior to the inspection states that 11 of the 16 care staff employed have ‘NVQ level 2 or above’ and one carer is working towards this qualification. Training on the new format of care plans that have been introduced is ongoing and is being provided by an external consultant. The health and personal care section of this report identifies that there are still considerable shortfalls in the quality of the care plans. The training audit submitted by the provider on the 1st February 2008 shows that there are shortfalls in the training for identified Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 22 staff for fire safety, food hygiene, safeguarding, moving and handling, infection control and health and safety. These shortfalls in training have the potential to place residents and staff at risk of harm. Two recruitment files were seen. One file had gaps in the employment history for this person and there was no evidence to indicate that this had been explored at interview. Certificates were not on file to confirm their qualifications relevant to their role, although the staff member confirmed that they had been asked to provide these certificates. The second file did not have any evidence to show that they had been interviewed or received any induction training. The service support manager confirmed that this employee had been interviewed and received induction, although this had not been recorded. Both staff had undertaken a Criminal Records Bureau check prior to appointment. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from having a manager in post to provide direction and leadership for the staff team to ensure residents health, social and welfare needs are met and individual rights and choices are promoted. Residents’ monies are managed in a robust and transparent way to protect them from abuse. Management systems need to be put into place to ensure that staff training and reviews of risk assessments relating to the safety of the premises are undertaken at regular intervals to ensure that the people living, working and visiting the home are not at risk of harm. EVIDENCE: The home has been without a registered manager since March 2006. An application for registration was received in November 2006, but the outcome failed to result in a manager being registered. An interim manager was put Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 24 into place for a period of time but this person is has now returned the their service where they are the registered manager. At the time of the inspection visit there was no manager in post and the provider has advised us that they are continuing to try and recruit a manager for this service. The home has a general manager who oversees the administration of the home. Quality monitoring questionnaires were sent out by the home to residents, relatives, staff and healthcare professionals in December 2007. The responses from these questionnaires have not been collated and any action plan developed. No responses were received from any healthcare professionals. This information needs to be collated in order to assess the quality of the service and to inform any action plan needed to improve the quality of the service. The results of this audit need to be published in the home’s Service User Guide. An Annual Quality Assurance Assessment was completed by the service before the inspection visit. This is a new requirement through regulation and it was well completed and informative. The home act as appointee for one resident. These accounts were seen. They are well managed and are clear and transparent, thus protecting this resident. It is evident from discussion with staff and the training audit that regular supervision is not in place. This needs to be addressed. There are a number of records required through regulation that need improvement, these include; pre-admission assessments, care records and care plans, medication administration records, the statement of purpose and service user guide, and staff recruitment records. The training audit undertaken by the home dated 1st February 2007 shows that identified staff need training for fire safety, food hygiene, protection of adults, dementia, moving and handling, health and safety and infection control. Staff have not received appropriate health and safety training as referred to under the Staffing section of this report. Monthly checks of bedrails were recorded. Window restrictor records showed that the last recorded check was 25th January 2008. Weekly and monthly fire system checks were recorded. The last external fire training took place in May 2007. The home’s fire risk assessment had not been reviewed since 17th June 2006. This has now been booked to take place on the 25th February 2008. Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 25 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 2 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 2 2 Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement A pre-admission assessment must be carried out prior to admission and sufficiently detailed to enable staff to formulate a care plan necessary to ensure residents needs can be met. Care plans must be in place and sufficiently detailed to enable staff to understand and meet the health and care needs of residents. (The wording of this requirement has been changed to meet current CSCI guidance) Timescale of 01/03/07 not met. Timescale of 31/05/07 not met. (A statutory requirement notice was issued on the 06/07/07 with a timescale for compliance by the 06/08/07. This was not met) A simple caution was accepted by the provider in November 2007 and it was agreed that the timescale for compliance would be extended to 31/03/08. Medicine records for the administration of medication must document what has been DS0000004121.V347783.R01.S.doc Timescale for action 31/05/08 2. OP7 15(1)(2) 31/03/08 3. OP9 13(2) 31/05/08 Lawns Nursing Home, The Version 5.2 Page 27 4. OP30 18(1) 5. OP33 24 6. OP36 18(1)(a) (c) & (2) administered or record a reason why it was not administered in order to ensure that the people who use the service are safeguarded. New staff must receive induction training and training appropriate to their role upon employment and updates at regular intervals for example fire safety, safeguarding adults, moving and handling, infection control and health and safety so that residents can be confident their needs will be met by appropriately trained staff. The home must make arrangements to seek the views of residents, their relatives and other stakeholders and where necessary use this information to improve service delivery. The results should then be included in the homes Statement of Purpose. (The wording of this requirement has been changed to meet current CSCI guidance) (The previous timescale of 30/06/07 not met. The date given is the date of this inspection) Staff must be regularly supervised so that their performance is monitored and training needs identified and addressed so that residents’ benefit from having their needs met by trained and competent staff. (The wording of this requirement has been changed to meet current CSCI guidance) Timescale of 31/12/06 not met. (The previous timescale of 31/05/07 remains. The date given is the date of this inspection) 31/05/08 13/02/08 13/02/08 Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations A system should be introduced which demonstrates that medication is stored at a safe temperature in order to ensure that people who use the service are protected from harm. It is recommended that there is a care plan for the management of pain which describes the care to be given to the identified resident. This should include details for the administration of medication prescribed ‘when required’ for pain management. The adequacy of the privacy curtains in shared rooms should be reviewed to ensure that residents’ privacy and dignity is maintained at all times. The home should review the activities provided to ensure that suitable activities are available in the home and within the community for all of the people who use the service. Gaps in employment history should be explored at interview and records held in the file to ensure that residents are protected from harm. 2. OP9 3. 4. 5. OP10 OP12 OP29 Lawns Nursing Home, The DS0000004121.V347783.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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