Inspection on 17/04/07 for The Lawns Nursing Home

This inspection was carried out on 17th April 2007.

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

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

Other inspections for this house

The Lawns Nursing Home 12/08/08

The Lawns Nursing Home 13/02/08

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 Unannounced Inspection 17 April 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lawns Nursing Home, The DS0000004121.V334769.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.V334769.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 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) Heritage Manor Ltd 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.V334769.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 1st March 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 is surrounded by large well maintained gardens providing a pleasant outlook from the home. 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 homes fees range between £507.00 and £640.00 per week; hairdressing, chiropody and newspapers are not included within the fees. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started on a Tuesday morning at 09.00 hrs. Two Inspectors spent 8.5 hours in the home and a specialist Pharmacist Inspector joined them in the afternoon. 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 at pre-inspection information requested from the home some weeks earlier, survey forms received from residents (4), relatives (5) and health and social care professionals (4). 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, including the Service Support Manager. 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 previous key inspection in November 2006 there was an unannounced random inspection in January 2007 due to an incident that happened at the home. A second unannounced random inspection took place at the beginning of March 2007 as a follow up to the one in January 2007. The reports of the January and March inspections are not available on our website but copies may be requested from the local office. The Commission has received no complaints since the last key inspection. Following a recent incident at the home and general concerns raised through visits to the service by healthcare professionals from the Commission and Primary Care Trust, the home is being monitored by the multi-agencies as part of the local strategy for safeguarding adults. What the service does well: A representative of the home does an assessment before offering a place to someone to ensure that they are able to meet the person’s needs. The staff speak to the residents in a polite and respectful manner and they ensure that the residents privacy is maintained whilst assisting residents with personal care. 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. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 6 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. What has improved since the last inspection? What they could do better: The homes Statement of Purpose & Service User guide needs to be reviewed as it does not contain enough information for prospective residents. All residents need to be given a contract providing them with information about their individual terms & conditions of residence. The care plans need to provide more detailed information to show accurately all of the care needs of each resident. They need to be reviewed each time a change in care needs takes place and at least every month. Care staff need to read the care plans each day to make sure that they know what care is needed for that person. The care plans need to show the care that the resident is being given each day. Residents need to be showed their care plan and asked if they agree with the information. If the resident is not able to do this, the home need to ask the resident’s representative to look at the information and seek their agreement. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 7 Before bedrails are used the trained staff need to ensure that there is a detailed written assessment done to ensure that they are needed, are the correct type, are fitted correctly and that the residents cannot harm themselves if they are used. The resident or their representative needs to give written consent to their use. Medication administration records need to be completed correctly by the trained nurses and immediately following giving the medication to the resident. More work needs to be done to ensure that people living at the home have things to do to pass the time enjoyably. This information needs to be written down in the residents records so that staff know what support the person needs to achieve this. The home should review the current system used for holding cash belonging to individual residents, so that the remaining balance is held individually and not collectively. Valuables belonging to residents who are no longer at the home should be returned to their next of kin. Systems need to be put into place to ensure that this is done routinely when people leave the home. Staff need to be provided with more training to ensure that they can safeguard the residents and have the skills and knowledge to meet their care needs and to ensure in doing so they do not put themselves at risk. The home needs to discuss with staff their skills, knowledge and aims for future training. The owner & staff need to ensure that they identify anything that may be of risk to the residents health & safety and do something to eliminate or reduce the risk of harm such as window openings, loose carpet tiles, provision of handrails in corridors. The home should review the quality of the carpets in the corridors of the home. The home need to ensure that they provide enough staff throughout the day & night and when calculating these numbers they need to take into account the size of the home and the needs and dependency of the people living there. Staffing levels do not enable staff to spend time talking to residents, they do not have time to read the care plans. Trained staff need the time to write & review the care plans so that they provide full and accurate information about the residents care needs and an account of the care given to each resident. The home needs to ensure that they have done thorough checks on all staff that work in the home. They need to ensure that the trained staff working in the home have a current Personal Identification Number from the Nursing & Midwifery Council which allows them to work as a trained nurse. The owner needs to ensure that residents are being consulted regularly about the service they are receiving and if/how it can be improved. Other people who visit or provide a service to the home also need to be consulted for the same reasons. The information needs to be collated and the findings used to contribute to a review of the quality of the service. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 8 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.V334769.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.V334769.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 adequate. This judgement has been made using available evidence including a visit to this service. The service provides prospective residents with written information about the home to help them make an informed choice about moving into the home. This information needs to be reviewed to ensure that prospective residents receive all of the information that the home is required to provide to prospective residents. Contracts have not been issued to all residents prior to or upon admission to the home to ensure that they are aware of the homes terms and conditions of residence. A representative from the home does an assessment before offering a place to prospective residents to make sure the home can meet the person’s needs. EVIDENCE: The pre-inspection information provided on the day of the inspection states that the home has a Statement of Purpose which has been reviewed since the last inspection. The Service Support Manager showed the inspector a Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 11 document that had recently been revised, which was information for prospective residents. A copy of the homes Statement of Purpose & Service User guide was provided the next day. The current Statement of Purpose & Service User guide in use needs reviewing as it does not contain all of the information that is required such as the arrangements for consulting residents about the operation of the home, the size of the rooms, reference to the last inspection report and any information about fees, nursing care contributions including a sample contract. All the survey forms from residents confirmed that they had received enough information about the home before they moved in. One residents survey form confirmed that they had not received a contract. Three residents files were seen and a contract was only available for one of these residents. Information was seen in all 3 care records of a pre-admission assessment being carried out by a representative of the home. Lawns Nursing Home, The DS0000004121.V334769.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. People who use services are being placed at risk by unsafe management of medication. Medication systems do not follow good practice or safe practice guidelines. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care records are provided for all the residents living in the home. The records are held in one file for each resident with the exception of some personal hygiene records. The care plans do not identify all of the residents care needs and do not provide a clear plan of care for staff to follow to ensure the resident receives consistent care at the required frequency. Daily reports are not written by the trained or care staff giving a picture of how that person has been that day or of the care given. Care plans are not being reviewed at the Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 13 frequency stated in the homes Statement of Purpose & Service User guide. Concerns have also recently been received by the Commission from a visiting healthcare professional to the home about the quality of the care plans. Overall the quality of the written information to support the care given to each resident is poor. Further improvement is needed as the action plans are not detailed enough for staff to follow. A hygiene care plan stated as its total action plan “To totally care for X & maintain privacy & dignity”. There are no specific instructions on the care that is needed to help the resident wash & bathe, look after their teeth, hair & nails and how much of this the resident can do for themselves or be encouraged to do for themselves. All equipment identified as being required at the time of the pre-admission assessment to prevent the development of pressure ulcers was not provided. There was a high risk pressure relieving mattress in use, although this was not recorded in the care plan or the risk assessment. Nutritional screening tool documentation was in the care records, but it had not been used. This would have been particularly useful with an identified resident, as they had not been weighed since they had been admitted to the home due to their physical disability. Alternative nutritional risk assessments were being used. A resident had been assessed in February 2007 as being “high risk” and the guidance in this assessment says, “give extra nutrition”. The nutrition care plan for this resident did not include this in the action plan and the care plan had not been reviewed since February 2007. Some of the care plans are generic and are not specific to the individual residents needs. The written information to support the management of wounds and pressure ulcers is poor. For one resident seen it was not possible from the documentation to identify the degree of severity of the pressure ulcer. The pressure ulcer had not been graded using a recognised tool, there were no photographs, grid outlines or measurements of the pressure ulcer as a baseline for staff to measure the progress or decline of the wound. A specialist nurse had seen the pressure ulcer in January 2007 and the staff were using the prescribed treatment. The wound care plan in use up until the beginning of April 2007 did not specify how often the wound was to be redressed. Documentary evidence did not support whether the staff were following this prescribed regime, as there had not been any entries since the 11th April 2007. Bedrail risk assessments were not in use for all residents with bedrails in situ and there was no information to show that the residents or their representatives’ consent had been obtained prior to use. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 14 There was no information to show that the care plan had been discussed with the resident or their representative and that they agreed with the content. All residents seen were clean, appropriately dressed and appeared well cared for. Surveys from relatives and 4 General Practitioners confirm that “overall they are satisfied with the care provided”. The residents spoken to about their care expressed no concerns. Medication was secure and locked within a dedicated medication room, which contained locked cupboards and two locked medicine trolleys. There was a dedicated and locked refrigerator for the safe storage of medication requiring cold storage. Controlled drugs were securely locked within a controlled drug cupboard. A separate locked storeroom was used to store dressings, creams, and ointments. The keys were held by the person in charge to ensure safety. Medication was stored neatly, which made it easy to locate service users medication. One medicine was seen which was not labelled with the name of the resident. A comprehensive medication policy was available in the office, which staff could easily access. It was last updated in January 2006. It contained details for obtaining medication, receipt, administration, records, storage, controlled drugs, disposal, and medication errors. Four medication audits were undertaken at the inspection. Two of the medication audits showed accurate balances of medication, which means the medication records show medicine had been correctly administered to the residents. Two of the medication audits were not accurate. The administration of medication to residents was not witnessed, however a nurse was observed signing all the medicine record charts together after she had completed the lunchtime medication round. On asking if this was normal practice she responded ‘No, but the lift is broken at the moment.’ There was no further explanation provided. This was poor practice and did not follow the medicine administration policy. All of the medicine record charts were seen, which were hand-written, signed and checked for accuracy by two members of the nursing staff team. The majority of the medicine charts seen were documented accurately, however some errors were seen. Five residents care plans were seen. There was very little up to date information regarding residents medication requirements recorded in the five care plans, for example: Two residents were prescribed medication to help with behaviour management such as agitation or distress. The medication was only to be given to the resident when necessary. The medicine records had been signed for Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 15 administration on several occasions for both residents. There was little or no documentation available, which detailed under what circumstances the medication should be given to the resident. The care plans did not record why the medication had been administered on several occasions. This means that the health and welfare of the residents were not adequately safeguarded. Surveys from relatives and visiting General Practitioner’s all stated that they could see the resident in private. Staff were observed addressing residents in a polite and respectful manner. Doors were closed whilst personal care was being given. Some of the bedrooms have a small glass panel in the door. Curtains have been provided to maintain the privacy of the resident and these were seen being used. Curtains were seen in shared rooms to maintain the privacy of each resident and were observed being used by staff. The home has a written policy on privacy & dignity that states, “All room doors are lockable to ensure that service users can maintain the right to security”. Many of the bedroom doors seen during the inspection did not have the facility to lock the door. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 16 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. The residents are able to make choices about their lifestyle and improvements have been made by the home in the provision of a Social Carer to help support and develop the interests of the individual residents. Residents are provided with a choice of wholesome and balanced meals in a pleasant environment. EVIDENCE: The home has appointed a Social Carer since the last inspection to work 25 hrs each week. Group and individual sessions are held with residents. The Social Carers diary contains information of sessions on Easter decorations, ball exercises, sing-a-long, reading to individual residents, games, puzzles and helping to feed residents. From observation it seemed that care staff had limited time to spend talking to residents except interaction whilst giving personal care to individuals or when serving lunch. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 17 The pre-inspection information states that recreational facilities on the premises include mobile library, videos, CD & DVD players, TV & singers & musicians at regular intervals. Recreational activities outside the home include visits to a day centre, local shops, pubs, church, outings to country parks and ‘runs’ out in the car with relatives & staff. Resident surveys say there are ‘always’ (1), ‘sometimes’ (2) or ‘usually’ (1) activities arranged by the home that they can take part in. A relative spoken with said “activities are sparse”. Social care plans need improving. One action plan stated, “Encourage to do some social activities”. The type of activities that the resident liked was not included in the action plan and how the home were going to enable the resident to engage in these activities. There were no entries in the care plans by the Social Carer to show how the home were meeting the social and psychological needs of the residents. This is not in line with the homes Statement of Purpose & Service User guide. No residents meetings have taken place. The visitors book shows that the home has many visitors throughout the day and evening. One relative spends each day with their spouse and the home provides them with lunch at no extra charge. Relative surveys confirm that they are able to visit the resident in private and residents were seen receiving visitors in their bedrooms. Residents bedrooms seen contained some small personal items. The homes Statement of Purpose & Service User guide refers to facilitating the access to advocacy services where required or requested by the resident. A four-week rotational menu is offered by the home. This is changed every 6 months. A continental breakfast is offered Monday to Friday with an additional choice of a cooked breakfast at weekends. The menus offer a choice of 2 main courses at lunchtime and the dessert of the day or ice cream and soup, a light snack or sandwiches for supper with the dessert of the day or cheese & biscuits. Supper is served at 5.00 pm leaving a long gap between breakfast at 08.00 am the next day. There was no information within the menus or preinspection information to indicate that any snacks are available in between if required. The residents were seen eating in the dining room, one of the lounge areas or in the privacy of their room. The dining room was pleasant and the tables were nicely laid with clean tablecloths. Residents were sitting 3-4 to a table. The meals are plated and served by the care staff and drinks including bottles of beer were available for residents to enjoy with their lunch. Residents were assisted by the care staff according to their individual needs. Residents with a poor appetite were given encouragement by staff to eat and provided with an alternative choice as they turned away the choice they had Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 18 made prior to lunch. Residents were observed being assisted to eat in a discreet and sensitive manner. All residents spoken with were complimentary about the meals and choice of food. Written feedback from 3 residents all stated that they “usually” liked the meals at the home. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 19 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. 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 maintain records of any complaints and upon inspection showed that no further complaints have been received since the one noted at the last key inspection in November 2006. The Commission has received no complaints since the last key inspection. A letter has been received by the Commission complimenting the home on the care received by a resident on respite care. Written feedback from 4 residents indicated that 3 knew how to make a complaint. Written feedback from 4 relatives said that they were aware of the homes complaint procedure. The Inspector was invited into the home without confirming their identity. This Inspector had never visited the home before. Safeguarding adult training has still not taken place in the home, although staff spoken with were aware that they need to do this training and were clear that they would report any poor Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 20 practice. This requirement remains unmet from the last two inspections and must be addressed as a matter of priority. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 21 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, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the environment are needed to ensure that they are safe and suitable for all residents living in the home. Systems are in place for the management and control of infection. EVIDENCE: The inspectors looked at parts of the premises including a selection of resident bedrooms, toilets, bathrooms and public areas. The service offers accommodation in single and double rooms some with en-suite facilities. The home has made some improvements since the last inspection as they have redecorated some of the bedrooms and thermostatic valves to control the temperature of the hot water are in the process of being fitted. Pipe work and radiators have been boxed in to prevent residents burning themselves. This Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 22 work has been done to a good standard to enable it to blend in with the décor of the home. Parts of the home are in need of repair/refurbishment such as corridor carpets, residents are not able to lock their bedroom doors (the homes Statement of Purpose states that all room doors are lockable), a lock on a bathroom door was broken & the wall tiles were cracked, there are no hand rails in the corridors, a carpet tile was loose on the stairs, the nurse call system can be turned off without going to the residents room, and a number of windows could be opened more than 100 mm. An immediate requirement notice was issued in respect of the window openings. A representative from the home confirmed that they have sourced a new call system that is to be put into operation starting with the ‘older wing’ of the home. The new system can only be cancelled in the residents’ room. The pre-inspection information provided by the home provides no information about any visits from the Fire Officer to the premises. The gardens are mostly laid to lawn, are accessible to the residents and are well maintained. The premises were very clean and free from any bad odours. The laundry is well equipped, very clean and organised. Good practice is in place for the management of foul washing. Hand washing facilities are available throughout the home. Mechanical sluice facilities are provided for the disposal of body waste and disinfection of commode pots and urinals. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty should be reviewed to ensure the needs of the residents can be met and this is supported through written evidence in the care records. Residents are not fully protected from abuse by the current recruitment procedures. Staff training should be reviewed for all staff to ensure the residents assessed needs can be fully met. EVIDENCE: On the day of the inspection there were 32 residents in the home. Staff on duty during the morning included the Service Support Manager, a registered nurse, 5 care staff, a carer on induction and a social carer. In the afternoon there was a registered nurse and 5 care staff. These numbers are below the recommended minimum staffing levels. The staffing levels in respect of residents needs have not been completed by the Provider on the preinspection information. Rotas show that registered nurses are working 1-2 shifts each week that are 14.25 hours in length, including permitted rest periods. On a Sunday there are 5 care staff all working a 14.25 hour shift including their permitted rest periods. Some care staff are working 6 days each week. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 24 Written feedback from 2 of the 5 relatives are of the opinion that there are not always sufficient numbers of staff on duty. From observation it seemed that care staff had limited time to spend talking to residents except interaction whilst giving personal care to individuals or when serving lunch. From discussion with care staff it is evident that they do not routinely refer to the care plans to ensure that they are aware of the care needs of the residents. There is no evidence that the care staff are contributing to any daily written reports of the personal care given, other than ‘ticking’ the bath rota. Care plans are of a poor quality and do not reflect the care required, suggesting that staff have little available time to complete these records, which are legal requirements. Taking into consideration the above information and the size and dependency of the residents being cared for, there remains an urgent need to review the staffing levels provided by the home. The pre-inspection information provided by the home states that 10 of the 21 care staff employed have achieved NVQ level 2 or equivalent. This equates to 47.6 of the care staff, which falls marginally below the required percentage. Two staff files were seen. They contained all of the relevant pre-employment checks with the exception of one file which only contained one previous employment reference. The pre-inspection information confirms that with the exception of two staff the home have received Criminal Records Bureau disclosures. One of these staff were on duty at the time of the inspection. The Personal Identification Numbers (PIN) for registered nurses are all current with the exception of one nurse where there is no date of the expiry of the PIN. The home must ensure that this information is obtained and recorded. The Service Support Manager reported that there was a carer on induction on the day of the inspection. Seven staff training files were seen, none of these contained any evidence that these staff have received induction training. Only 2 files showed any evidence of dementia care training and this took place in 2005, so is not current. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 25 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. There is no registered manager in post in order to provide leadership and direction for the staff. The home has no effective quality assurance system in place and residents are not being regularly consulted about the service provided. All staff are not being appropriately trained & supervised, records are not being fully maintained and systems are not fully in place for the maintenance of health & safety in the home. This has the potential to place residents at risk. EVIDENCE: The application for registered manager submitted to the Commission has been considered and the applicant has been refused registration. The Provider has Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 26 been asked to submit in writing to the Commission how the home is to be managed on a day to day basis in the absence of a registered manager. At a random inspection on the 01/03/07 it was noted that a commercially produced quality assurance document has been purchased. This has not been implemented. A questionnaire has been sent out to residents with the April invoices. No residents meetings have taken place. The pre-inspection information states that the Provider acts as an appointee for one of the residents. Monies for incidental expenditure are held by the home for a number of residents. This money is held collectively and not separately and therefore it was not possible to check the accuracy of the balance of the individual accounts. An identified resident had run out of funds, although money belonging to other residents was used for this resident. This is poor practice. Records of expenditure maintained by the home for individual residents are being seen by people charging for services to the residents, as they are signing these records. This is not good practice as these records are confidential and should only be seen by designated employees of the home. The home has some personal possessions in safe keeping belonging to residents who are no longer living. These items must be returned to the deceased resident’s next of kin. It was reported that the supervision of staff has been started, although none of the night staff have received any formal supervision. A number of records required to be held in the home in respect of each individual resident are not being fully maintained, such as care plans, medication records, a detailed record of the incidence and treatment of pressure sores, an identified bedrail risk assessment, two references for each employee, records of induction training. A number of staff files seen show that some staff have received moving and handling training in June 2006. None of the four ancillary staff spoken with have received moving and handling training in the last twelve months, 3 of these staff have never received any moving and handling training since being employed at the home. It is evident from staff files and discussion with staff that not all staff have received fire training. Staff working in the kitchen on the day of the inspection have received Food Hygiene training. None of the domestic staff spoken with have received any Control of Substances Hazardous to Health training (COSHH). No safety data sheets were available in the laundry for the cleaning products in use. It is evident from the staff files and discussion with staff that infection control training has not been provided. The pre-inspection information provided by the home states that the fire equipment was last checked on the 29/09/06, although a number of fire extinguishers seen in the home state they were last serviced on the 28/04/06 and a representative of the home stated that they were aware that the fire Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 27 extinguishers needed servicing soon. A number of smoke detectors were being checked by an external contractor on the day of the inspection. Fire records have weekly and monthly checks recorded. The pre-inspection information confirms that the gas and central heating was last serviced in February 2006 and the requirements/recommendations were implemented. The servicing of these areas is now overdue. Water temperature checks for compliance for Legionella are recorded. A Trixie hoist seen was last serviced in January 2007. The pre-inspection information lists no date for the servicing of the emergency call system in the home. A number of windows in the home on the first floor had inadequate devices in place to prevent them from being opened more than 100mm. An immediate requirement was made for this to be addressed by the end of the day. Accidents records were being maintained. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 28 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 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 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 1 2 X X X X 2 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 1 1 1 Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4, 5 Timescale for action The homes Statement of Purpose 17/06/07 & Service User guide must be reviewed to include all of the information required by these regulations. All residents must be provided 25/05/07 with a contract containing all of the information required within this Regulation. The registered person must 31/05/07 ensure that care plans set out in detail the actions to be taken by all staff in all aspects of health, personal and social care needs. Timescale of 01/03/07 not met. All residents must have a bedrail 18/04/07 risk assessment & signed consent prior to use. An immediate requirement notice was issued. Medication Administration Record 31/05/07 (MAR) sheets must be completed correctly and following the administration of medication. Timescale of 01/03/07 not met. The registered person must 31/05/07 ensure that when medication is DS0000004121.V334769.R01.S.doc Version 5.2 Page 30 Requirement 2 OP2 5A 3 OP7 15 4 OP8 13 5 OP9 13(2) 6 OP9 13(2) Lawns Nursing Home, The 7 OP12 15 (1) 8 OP18 12, 13 administered to a resident the medicine record is documented according to the medicine policy to ensure the safety of residents. The home must review the 30/06/07 activities provided. More suitable activities must be available for the more highly dependent residents. Brought forward partly met. The home must provide some 17/06/07 formal training for staff to ensure that they are fully aware of the procedures to follow if they suspect any form of abuse or neglect. The previous timescales of the 31/01/07 & 31/03/07 have not been met. 9 OP19 13 (4) (c) 10 OP25 13 11 12 OP19 OP38 OP25 13 13 (4) (c) 13 OP38 13 (4) (c) The registered person must ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. Timescale of 08/01/07 not met. The registered person must review all windows to ensure that they cannot be opened more than 100mm. An immediate requirement notice was issued. The carpet tile must be secured. An immediate requirement notice was issued. The registered person must ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. Timescale of 08/01/07 not met. The registered person must ensure that unnecessary risks to the health and safety of residents are identified and as DS0000004121.V334769.R01.S.doc 17/04/07 18/04/07 18/04/07 17/04/07 17/04/07 Lawns Nursing Home, The Version 5.2 Page 31 14 OP27 18 (1) (a) far as possible eliminated. Timescale of 08/01/07 not met. The home must ensure that the 30/04/07 staffing levels are meeting the required minimal guidelines throughout the 24-hour day. This must take into account the size of the home and the number and dependency of the residents. Timescales of 30/11/06 & 08/01/07 are not met. The home must ensure that the appropriate checks are completed for all new staff prior to them commencing work. 15 OP29 19(1)(b) 30/04/07 16 OP30 18(1)(a) & (c) 17 OP33 24 Timescale of 30/11/06 is not met. The home must ensure that all 31/05/07 staff are appropriately trained to ensure the assessed needs of the residents are met. Timescale of 30/03/07 not met. 30/06/07 The home must review their quality assurance system based on seeking the views of residents, relatives and other professionals. The results should then be included in the homes Statement of Purpose. (This requirement was assessed as part of this inspection. The timescale of 30/06/07 remains as it has not expired) The home must recommence a 31/05/07 formal staff supervision program, and a record of this maintained on their personnel records. Timescale of 31/12/06 not met. 18 OP36 8(1)(a)(c) & (2) Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 32 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 Refer to Standard OP19 OP35 OP35 Good Practice Recommendations It is recommended that the home review the carpets along the corridors, they appeared quite worn in areas. It is strongly recommended that the balance of cash held in the home for individuals are held separately and not collectively. Valuables belonging to deceased resident’s should be returned to their next of kin. Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Lawns Nursing Home, The DS0000004121.V334769.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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