CARE HOMES FOR OLDER PEOPLE
Lawns Residential and Nursing Home (The) Lawn Lane Springfield Chelmsford Essex CM1 7JB Lead Inspector
Jane Greaves Key Unannounced Inspection 23 February 2007 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 Residential and Nursing Home (The) DS0000015351.V316790.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 Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lawns Residential and Nursing Home (The) Address Lawn Lane Springfield Chelmsford Essex CM1 7JB 01245 450101 01245 464123 savillejupa.com www.bupa.com BUPA Care Homes (BNH) 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) Mrs Jacqueline Eunice Saville Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (14), Physical disability (14), Physical disability of places over 65 years of age (52), Terminally ill (8) Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 18 years and over, who require general nursing care by reason of a physical illness/disability -14 Persons of either sex, aged 65 years and over, who require general nursing care by reason of a physical illness/disability - 52 Persons of either sex, aged 18 years and over, who require general palliative care - 8 Old age, not falling within any other category - 14 Total number of persons accommodated not to exceed 52. Date of last inspection 3rd August 2006 Brief Description of the Service: The Lawns provides accommodation in a modern and well maintained, purpose built two storey brick building. The home has nineteen single bedrooms and two double bedrooms on the ground floor and twenty-nine single bedrooms situated on the first floor. both floors are accessible via a passenger shaft lift. The home is situated in the grounds of Springfield hospital, within three miles of Chelmsford town centre and mainline train station. There is a bus stop outside of the home. The Lawns caters for a variety of people including Older People, Younger Adults with Physical Disabilities and people who have a diagnosed Terminal Illness and the fees paid range from £527.31 to £1009.87 per week. A copy of the Commission for Social Care Inspection report is available at the home on request. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection site visit that took place on the 23/02/07, lasting 6 hours. The registered manager was not present on the day of this inspection. The inspection process included: discussions with the person in charge, eight care and nursing staff, nine residents and seven visitors; a tour of the premises including residents’ bedrooms, bathrooms, the laundry, the sluice, Kitchen and food store and communal areas. Documents and records were sampled including any records of notifications or complaints sent to the CSCI since the last inspection. Twenty-one key standards were assessed using information gathered at this site visit and presented to the commission since the past inspection visit. Action had been taken promptly to address previous requirements and recommendations. The person in charge and all staff were welcoming and helpful throughout this inspection site visit. What the service does well: What has improved since the last inspection?
The registered person had further developed the home’s record keeping procedures to ensure that complaints received and dealt with by the home were appropriately recorded to reflect all actions taken and correspondence entered into. The staff duty rota provided a true reflection of the staff on duty and their designation.
Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 6 Staff members were observed interacting with residents, visitors to the home and colleagues in a respectful and sensitive manner. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 7 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 Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 8 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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Lawns operated a thorough and responsible pre-admission assessment process: care and attention was given to ensuring that the home can meet the individual’s needs, resulting in appropriate admissions. This home does not provide intermediate care. EVIDENCE: A new system of care documentation had been introduced. Four residents’ care files were inspected, two related to residents recently admitted to the home. All files included an assessment of need. The new system included an assessment of all elements of need as detailed under this standard. Copies of care management assessments were held on file as relevant. Evidence was available to confirm that residents’ representatives were involved with the initial assessments and on going development of the care plans. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 9 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a clear and consistent care planning system in place that provided staff with comprehensive information and ensured residents’ health, personal and social care needs were appropriately met. EVIDENCE: Four care files were inspected, two for recent admissions to the home and two for established residents. The recently introduced care documentation covered all physical and social needs and provided good detail of the action required from staff to meet residents’ needs. Staff reported that training had been delivered to ensure that a consistent approach had been used when transferring existing care plan information onto the new format of recording and when admitting new residents. The trainer was to attend the home in the near future to assist with any teething problems encountered with the new system. Agreement of the care plans was confirmed by signature of the resident or relative. Risk assessments for moving and handling, pressure areas, and general risk assessments were recorded in all sampled files.
Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 10 It was reported that a qualified staff member reviewed one resident’s care plan daily ensuring that each individual’s plan was subject to a thorough monthly review and ad hoc changes would be made to an individual’s care plan as health needs dictated. Daily records were detailed and in the main evidenced good monitoring of care needs with appropriate action taken, however, there the statement “all care given” appeared in some recording. The home had policy and procedures for administration of medication. All medication was stored in the clinical/medication room and room and drug refrigerator temperature monitoring was undertaken daily. Medication administration records (MAR) were generally well recorded. Some residents reported that call bells were not answered promptly. The call bell system at the home was electronically monitored and a print out produced daily providing evidence of when bells had been rung and the time taken for staff members to answer. Evidence showed that the local policy stating that call bells must be answered within three minutes was being adhered to. Residents who could express their views and visiting family members spoken with as part of this inspection process said that staff were kind and caring and treated them with respect and dignity at all times. Staff members were observed delivering care and support with sensitivity and kindness. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 11 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were supported to exercise choice and control over their daily lives wherever possible. EVIDENCE: The home employed two full time activity facilitators. It was reported that some days there was a lot of interest in participating in the afternoon activity sessions however residents were able to exercise their choices and some elected not to take part. A staff member responsible for co-ordinating the activity programme reported that some residents received 1:1 visits in their own room and enjoyed a chat or a manicure from time to time. Group activities reported to be popular at this time were Bingo, whist, cards and making Easter Cards. A regular exercise class took place; some residents took part whilst others took pleasure in watching. Photo collages dotted around the walls of the home provided evidence that residents enjoyed outings to local places of interest such as Audley End, Tropical Wings Butterfly Farm, Marsh Farm and garden centres etc. A weekly shopping trip was offered to one or two residents at a time to ensure that each was able to have quality time as opposed to a mass outing.
Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 12 Some family members spoken to as part of this inspection process and via postal survey indicated their concern that some residents spent a lot of time in isolation in their rooms and that this was not their choice. There were communal lounge areas available in all parts of the home however it was noted at the inspection visit that most of these were unoccupied and residents were in their rooms with their televisions on. These residents were not able to express an opinion. There were a number of visitors to the home on the day of this inspection visit and all those spoken with confirmed they were encouraged to visit their loved ones at any time of the day or night and as frequently as they wished. Most of those consulted visited the home daily and reported that they were always offered a cup of tea and the home was always clean, fresh and tidy. Residents were supported to exercise choice and control in their daily lives as much as possible. It was reported that routines of daily living such as times for going to bed and rising were discussed during the admission process however if an individual had a change of heart on any particular day and decided they fancied a ‘lie in’ this was respected. Some visitors reported that staff put some residents to bed immediately after tea at 5.30pm. It was reported that these residents did not have the verbal ability to express when they wished to go to bed. The staff reported that the residents were asleep in their chairs and would be more comfortable in their bed. The menu offered to the residents at The Lawns was wide and varied and rotated seasonally on a four weekly cycle. The hostesses visited with each residents daily to establish their menu selection. Not all residents reported enjoying the varied menu on offer however the person in charge on the day of this visited reported that in the circumstance that an individual did not wish to eat any of the options offered the chef would provide an alternative. The traditional option of fish on a Friday was provided however the options for the day were between Battered Cod or Poached Cod, Poached Cod or Scampi, and Poached Haddock or Fried Haddock. The daily alternative did not cater for residents who didn’t like fish. Family members reported they were pleased that their relatives had gained weight since moving to the lawns. The dining room was pleasantly appointed and residents were able to take medals in the privacy of their own room if they so wished. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 13 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families/representatives could be confident that any written complaints would be listened to and taken seriously. Appropriate policies, procedures and practices were in place to promote the protection of residents from abuse. EVIDENCE: The registered person had further developed the home’s complaints procedures in line with organisational policy since the previous inspection visit. Records were available to provide detail in respect of the outcome, actions taken to prevent re-occurrence and the response made to the to the complainant. The previous inspection report identified that there were some concerns regarding the nature of some complaints received as they referred to inappropriate behaviour and attitude of some staff when dealing with vulnerable people. ‘Personal Best’ training has since been provided for the staff team in the last year and all residents and visitors spoken with as part of this inspection had positive things to say about the staff team. Some family members spoken with gave instances where verbal complaints had been made to staff members relating to the care provided for the residents. The complaints records did not contain any reference to these complaints and the complainants reported that they had not been responded
Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 14 to. A discussion was held with the person in charge about recognising complaints. There were many letters of compliment available praising and thanking the management and staff team for the kindness and care shown to residents. The home had a robust abuse and whistle blowing policy and procedure in place. All staff had received relevant training by the organisation and been provided with guidance published by the EVAPC (Essex Vulnerable Adults Protection Committee) for their information. There had been no allegations of abuse made. Records inspected showed that appropriate pre-recruitment checks on new staff were undertaken prior to appointment. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 15 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Lawns was safe, well maintained and appeared clean and hygienic. EVIDENCE: A partial inspection of the premises was made that included communal areas, a number of residents’ rooms, bathrooms, the kitchen and the laundry. Communal rooms were bright, clean and well decorated and furnished to a good standard. There was no evidence that infection control training or refresher training had been provided for the staff team. Residents spoken with said their rooms were always kept clean. The surrounding gardens were attractive and well-maintained, some residents spoke of how they had bird feeders sited in the trees in the grounds so they could be seen from their rooms.
Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 16 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were generally satisfied that the care they received met their varied needs. EVIDENCE: There were Fifty-two residents living at the home. Staffing levels were confirmed as 3 qualified nurses and 10 care assistants for the early shift, 2 qualified nurses and 7 care assistants for the afternoon shift and 2 qualified nurses and 3 care assistants on the night shift. Pre inspection information supplied to the commission stated 41 residents required two or more staff to deliver care both day and night. Nursing and care staff members spoken with at this site visit reported that they felt there were sufficient staff on duty to meet the assessed needs of the residents, however the inspectors concern was around the reduced numbers available to deliver care over the night time period taking into account the layout of the building and the dependency levels of the residents. Some residents’ families reported concern that there were not enough staff on duty to meet the varied needs of the residents living there. This was especially a concern for the night shift. Visitors reported that some residents were ‘put to bed’ as early as 5.30pm and that they had been given the reason that the resident was sleeping in the chair and they would be more comfortable in bed, however the resident was not able to voice their own views. One family
Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 17 member reported, “We visit often and feel that there seem to be very few carers about”. Relatives comment cards returned to the commission as part of this inspection process included comments such as “the staff are overworked” and “Not always sufficient staff on duty”. Other comments included “I am very pleased with the care and attention my loved one is receiving” and “I feel my loved one is being looked after by supportive and considerate staff” Copies of staff rotas provided evidence of the numbers of staff on duty each day, some days as many as 5 staff members were working long day shifts from 7am until 9pm. The staff records confirmed that no one under the age of eighteen was employed to provide personal care. Staff training records were made available for scrutiny. There were a number of ‘gaps’ in mandatory training provision, for example records showed 47 of the 97 staff (this number includes ancillary staff) had attended infection control training and 11 had attended 1st Aid. Some gaps were seen in the records for fire safety training, PoVA and manual handling training. Pre inspection information provided for the commission by the home reported that 50 of the care staff had achieved NVQ level 2 or above in care and that the home employed 13 first level registered nurses. Staff files were sampled for two established members of staff and two staff members recruited since the previous inspection visit. The sampled files contained evidence that all the required checks had been obtained (two satisfactory references, CRB/POVA checks). Copies of birth certificates, passports, photographs were present on file. All staff had received a statement of terms and conditions of employment. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 18 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for service user consultation are good with substantial evidence that indicates their views are both sought and acted upon. The financial interests of residents are well protected by the robust systems in place. EVIDENCE: There were clear lines of accountability throughout the home. It was reported that the manager’s office door was always open and staff, residents and visitors felt comfortable approaching the manager on any subject. The organisation operated a quality assurance assessment involving residents, their families and representatives and the staff team. A discussion was held with the registered manager regarding involving other stakeholders with the
Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 19 annual quality assurance process. Results of this survey were analysed and formed the basis of the development plan for the home. The previous inspection report contained three requirements and these had been actioned within agreed timescales. The home operated a robust system of maintaining individual residents’ monies. There was a computer system to record all transactions; statements could be printed at any time for residents/representatives. Any interest accrued was reported to be shared by the residents pro rata. The home employed dedicated maintenance staff who ensured that the premises and equipment was maintained in good working order. As a matter of practice the estates manager from the organisation carried out an annual physical inspection of the building involving a comprehensive survey, any works identified would be subject to risk assessment to determine the urgency. The lawns operated under BUPA policies and procedures for health and safety and maintaining safe working practices. Staff members received regular training updates in respect of how to deal with an outbreak of fire at the home. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 4 Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 13(3) Timescale for action The registered person shall make 31/08/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This specifically refers to the provision of annual infection control training for the whole staff team. Requirement 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 OP7 Good Practice Recommendations It is a recommendation of good practice that detailed daily records must be kept to help the manager to audit the care being provided to service users, and ensure that staff are following the guidelines in the care plans. It is in the home’s interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. The recording of All Care Given does not achieve this. It is a recommendation of good practice that residents be
DS0000015351.V316790.R01.S.doc Version 5.2 Page 22 2. OP10 Lawns Residential and Nursing Home (The) 3. OP16 4. OP27 encouraged to make use of the communal lounge areas and avoid the isolation of being alone in their private rooms for long periods of time. It is a recommendation of good practice that the registered person develops a working practice that recognises residents/relatives verbal complaints and uses them to drive forward the quality of the service provision. It is a recommendation of good practice that the registered person assess the skill mix and numbers of staff members working on the night shift having regard to the size and layout of the care home, the statement of purpose and the number and needs and dependency levels of service users. Lawns Residential and Nursing Home (The) DS0000015351.V316790.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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
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