Inspection on 22/08/07 for The Lawns Residential Care Home

This inspection was carried out on 22nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Residential Care Home 01/11/06

The Lawns Residential Care Home 23/06/06

The Lawns Residential Care Home 08/12/05

The Lawns Residential Care Home 19/05/05

The Lawns Residential Care Home 11/10/04

The Lawns Residential Care Home 11/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE The Lawns Residential Care Home 1-2 Kensington Gardens Monkseaton Whitley Bay Tyne & Wear NE25 8AR Lead Inspector Glynis Gaffney Key Unannounced Inspection 22 August & 03 September 2007 14:30 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 The Lawns Residential Care Home DS0000000308.V349472.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. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lawns Residential Care Home Address 1-2 Kensington Gardens Monkseaton Whitley Bay Tyne & Wear NE25 8AR 0191 2530291 0191 253 7248 thelawns@ascotcare.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) Mr Trevor Nesbit Mrs Sylvia Tidmas Care Home 28 Category(ies) of Dementia - over 65 years of age (8), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (19) The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2006 Brief Description of the Service: The Lawns is situated on Monkseatons high street. The home provides residential care for 28 older people, of whom up to eight may have dementia care needs. Nursing care is not provided. It is a large, older style, detached building and has been adapted to meet the needs of older people. It is a three-storey building and a lift provides access to all floors. There are 26 single bedrooms, one of which has an en-suite facility. There is one double bedroom. There is a kitchen, a large lounge, a smaller lounge, a dining room and a laundry. There are toilets and bathing facilities on each floor. At the front and side of the home, there are pleasant and attractively landscaped gardens. There is a secluded patio garden to the rear. Bus routes, pubs and local shops are all within easy walking distance. The current scale of charges for a place at the Lawns ranges from £365 to £400. Additional charges are made for hairdressing, aromatherapy and chiropody. Copies of the Commission’s most recent inspection report, and the home’s statement of purpose and service user guide, had been placed in the main reception area. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last visit on 1st November 2006; How the service dealt with any complaints & concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people; The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on the 22 August 2007. During the visit we: • • • • • • Talked with people who used the service and the manager; Looked at information about the people who use the service & how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills & training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe & comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: Relatives who returned surveys said: “I find staff at the Lawns are very helpful and caring. They inform me at all times of even the slightest mishap my mother may have.” The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 6 “I find that the staff manage incredibly well in an old building that wasn’t purpose built as a care home. Impressed with my mum’s room and the standards of cleanliness throughout.” People are provided with “not only professional care, but with loving care.” “The staff are tremendous – if they lack particular skills they more than make up for it in patience, empathy, humour and good people skills.” The staff on duty at the time of the inspection were polite, courteous and appeared to have developed caring relationships with the people they looked after. The deputy manager had informed families how they could access the home’s policies and procedures. Over 75 of the staff team had completed qualifying training. The remaining staff were undertaking relevant qualification in care. The home’s furnishings and fittings were of a good standard. A number of bedrooms, the staircases and landings had been re-decorated. The Lawns was well maintained and had a homely domestic appearance. The home had attractively landscaped gardens. The Lawns had its own gardener and maintenance man. The home’s activities co-ordinator had devised an activities programme built around peoples’ needs and wishes. Information about activities and events was displayed around the home. Individual evacuation plans had been put in place for each person living at the home. Vacant bedrooms had been refurbished before they were re-occupied. All senior staff had received accredited medication training. What has improved since the last inspection? The home’s service user guide had been updated to include: • • Information about the services offered to older people with dementia and those with different ethnic and cultural backgrounds; The comments of people living at the home. The provider’s representative had carried out regular monitoring visits to ensure that people living at the home received a good quality of care. A new ‘quality questionnaire’ had been devised for use with relatives. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 7 A new development plan had been prepared setting out the improvements to be made to the home over the next two years. A quality audit of the services provided at the home using a recognised quality assurance system had been completed. The deputy manager was in the process of devising an action plan to meet any shortfalls identified. All bedrooms had been fitted with lace curtains to protect privacy. One of the downstairs toilets had been refurbished. The lift had been repaired. The dining room had been re-decorated and arrangements had been made to refurbish the ground floor toilet, the lounge areas and bathrooms. Peoples’ care plans had been reviewed on a monthly basis. The deputy manager had begun the process of streamlining the home’s care records to reduce duplication and make them easier to use. What they could do better: Relatives who returned surveys said: “ Extra toilets would be good. Also time each day when the TV is switched off as this can be quite distressing and distracting for residents who like peace and quiet to talk and read” “Probably more staff. A ‘tuck’ in service – checking that elderly person is actually safely in bed rather than asleep in their chair in their room.” “ Laundry service needs to be more vigilant and ensure correct clothing reaches correct room.” “Possibly more baths.” Ensure that the home’s service user guide contains a summary of the staff group’s experience. This will help to enable people and their families to make an informed choice about whether to accept a placement at the Lawns. Ensure that peoples’ care plans clearly identify their current level of need and what the home hopes to achieve for the individual by providing the required care. This will help people to receive more individualised support and a better quality of life and experience. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 8 Ensure that all staff have completed training in the protection of vulnerable adults. This will help ensure that people living at the home are protected from the potential threat of harm or abuse. Ensure that the staff records contain the required information including documentary evidence of qualifications. Robust pre-employment checks must be carried out before staff are employed at the home. This will help protect people from people who are considered unsuitable to work with vulnerable adults. Ensure that all care staff receive training in caring for older people with dementia. Bank staff must complete in-house induction training on commencing work at the home. This will help ensure that staff have the skills and knowledge they need to provide people with safe care. Ensure that an application is made to the Commission to register another manager for the home. This will help ensure that the home is managed and run by a person with an appropriate qualification and relevant experience. Staff should receive regular formal supervision. There should be a personal development plan for each member of staff. This will help ensure that staff are well supported, appropriately supervised and aware of their responsibilities in protecting the welfare of people living at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Lawns Residential Care Home DS0000000308.V349472.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 The Lawns Residential Care Home DS0000000308.V349472.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 & 3. Standard 6 was not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and wishes of each person had been satisfactorily assessed before they moved into the home and this meant that staff knew about the needs of each person and what care and support they required. EVIDENCE: The home’s service user guide had been updated to include the required information, with the exception of the staff group’s experience. It was easy to understand, attractively presented and written in plain English. All people living at the home had been given a copy. The guide was not available in alternative formats. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 11 People had not been admitted into the home until a full assessment of their needs had been undertaken. A copy of each person’s social services assessment and care plan was available in their care record. The home had also carried out its own pre-admission assessment. A qualified and experienced member of staff had carried out these assessments. The home’s pre-admission assessment proforma covered the required areas with the exception of the needs of people from different cultural and ethnic backgrounds. The Lawns Residential Care Home DS0000000308.V349472.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of information recorded about peoples’ needs, and how those needs should be met, was not comprehensive. Staff may not be clear about how they should meet peoples’ needs. EVIDENCE: Care plans had been devised to meet peoples’ assessed needs. For example, care plans covering the following areas had been put in place for one person: assistance required with personal hygiene and daily routines, mobility, night time care needs and eating and drinking. But, in one person’s care records, a care plan had not been put in place to meet their diabetic care needs. At the time of the inspection, the deputy manager was in the process of streamlining the home’s care records to reduce duplication and make them easier to use. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 13 In some of the care plans that were checked, there was no clear identification of need or statements of desired outcomes. Also, in some of the care records, the plans of intervention drawn up to meet peoples’ needs were too general and did not provide staff with clear enough guidance. The deputy manager said that she hoped these issues would be resolved through the introduction of the new care plan documentation. Peoples’ care plans had been reviewed on a monthly basis. Of the four people who returned surveys, two said that the home helped their relative to live the life they chose. Two others said that this usually happened. In response to a previous requirement, review meetings had been used to ensure that people were clear about the information contained in the home’s care plans. Care staff are expected to re-read peoples’ care plans if concerns about their health and welfare are referred to in the shift handover. Although none of the people interviewed could recall being involved in the preparation of their care plans, the deputy manager said that each person, where this had been possible, had been consulted about how their care needs would be met. Since the last inspection, people living at the Lawns, and their relatives, had been given a copy of the home’s service user guide and encouraged to read its statement of purpose. There was evidence that six monthly placement reviews had taken place for each person. Assessments of peoples’ levels of dependency had been completed. The operation of the home’s key worker system was under review at the time of the inspection to ensure that it worked in the best interests of the people living at the Lawns. Peoples’ records were securely stored. There was evidence that the deputy manager had undertaken checks of the quality of information held in peoples’ care records. Other than locking the front reception door and other exit doors, no limitations had been placed on peoples’ right to make decisions and choices about how they lived their lives. A range of preventative risk assessments had been completed for each person covering such areas as: the management of skin care needs; nutrition; falls prevention and continence care. Some of the assessments checked had not been signed or dated. An initial pressure area care assessment had been completed for two people. The scores obtained indicated that a more detailed assessment needed to be carried out. This had not happened. The deputy manager said that new documentation to assess peoples’ susceptibility to developing pressure sores was being introduced. People interviewed said that their health care needs were met by the home. There was evidence in peoples’ care records that the home ensured that they received regular chiropody and optical care. People had been supported to access local health services such GP surgeries and community nursing staff. Of the four relatives who returned surveys, two said: The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 14 “Sometimes feel that parents’ clothes are not changed regularly enough. Clothes go missing from the laundry or other people turn up in parents clothes.” “May be slow in getting medical attention for my mum, but otherwise yes very good.” “When I ask for specific information the staff are super at getting my mum’s notes, giving me information and noting my concerns.” All medication was stored in a locked trolley to which only senior staff had access. The medicines trolley was clean, tidy and had been secured to the wall. Only limited stocks of medication were kept at the home. Photos to identify each person had been placed in their medication records. Lockable facilities for the safe storage of medication were available in all bedrooms. There were records covering the administration and disposal of medication within the home. All staff administering medication had received accredited training. No incidents concerning the mis-administration of medication had been reported to the Commission. Staff administering medication from the trolley in the main lounge were able to access anti-bacterial hand wash. Staff were observed providing personal care to people in a kind, considerate and helpful manner. People interviewed said that staff respected their privacy and treated them in a dignified manner. Relatives who returned surveys said: “(Staff) treat my mum with respect, love and care.” “All the staff display care and respect to all parents and other residents to make their stay pleasant.” The Lawns Residential Care Home DS0000000308.V349472.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for providing people with opportunities to participate in a range of stimulating social activities and events, and maintain contact with their families and friends, were good. EVIDENCE: Information about activities and events taking place at the Lawns was displayed on the home’s notice board and at the front entrance for visitors. A full time activities organiser had been employed to deliver the home’s programme of social activities. The activities programme for the week of the inspection included – a bingo session, a musical and arts and craft session, and cards and dominoes. People had been consulted about the range of activities provided at the home. A hairdresser visited the home on a weekly basis and an aromatherapist every fortnight. Opportunities to participate in chair-based exercises were provided. The home had a selection of books and access to a mobile library facility could be provided on request. Information about The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 16 peoples’ previous and current interests and hobbies was available in their care records. Care plans addressing peoples’ social care needs were in place. But, they did not contain clear statements about peoples’ needs. Two of the people interviewed said that they were happy with the social activities provided. Recently, trips to the Amble coastline and Alnwick gardens had taken place. The home had built up good quality information about resources available within the local community and surrounding area. A photographic diary had been kept of events held within the home. At the time of the inspection, some people were enjoying an aromatherapy session and a bingo session was underway. Relatives that returned surveys said: “We would like to see staff take (residents) around the block up to the shops to get some fresh air. It was implied that this was normal practice when we chose the home – no evidence that this happens for them.” “The home has a lovely atmosphere and that is down to the staff. Also they do their best to provide events and entertainments to the residents.” Two people said that the home did not help their relative to keep in contact. One person said that they were not kept up to date with issues affecting their relative. People spoken with confirmed that the manager and her staff always made families and friends feel welcome. People living at the home said that visitors could be seen in private or meet with their relatives in the lounges or dining room. Nobody spoken with could recall the home placing any restrictions upon their visitors. A relative who returned a survey said that “I’m very impressed that as relatives we can visit any time and are offered tea and encouraged to have some private time with mum in her room.” People interviewed said that they were able to make decisions about how they wanted to live their lives. One person said that she had chosen how to ‘do up’ her bedroom and had been allowed to bring in some of her own furniture. Another person said that she had been consulted about whether she wanted to hold her bedroom key and take responsibility for her own medication. The home operated a rotating four-week menu cycle. Details of the menu for the day had been placed on a whiteboard in the main reception area. Choices were offered at all main meal times and a cooked meal was provided at the teatime meal. The lunchtime meal appeared to be enjoyed by the people who participated in the meal. Staff were on hand to provide people with support throughout the mealtime. The food served at the lunchtime meal was of a good quality, well presented and met peoples’ dietary needs. Regular drinks and snacks were available throughout the day. The dining area was pleasant and had been nicely decorated. The tables were attractively set. People said that they received enough to eat and drink and alternatives were available to the main menu meals. The kitchen was clean and tidy. The Lawns Residential Care Home DS0000000308.V349472.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The written procedures for handling complaints were satisfactory. The relatives of people using the service were confident that their complaints or concerns would be listened to, taken seriously and acted upon. EVIDENCE: There was a complaints procedure that included details of how to make a complaint, who the complaint would be handled by and the home’s timescales for completing investigations. People spoken with said that they had been made aware of the homes complaints procedure and would be happy to raise matters of concern with any member of staff. The Commission had received one complaint since the last inspection. The provider carried out an internal investigation. The complaint was resolved to the satisfaction of the complainants. A relative who returned a survey said “we liaise frequently with the care home who usually take our concerns on board.” Three people said that the home always responded appropriately when they raised concerns. Another person said that this usually happened. There was an adult protection policy that provided guidance on what action should be taken to protect people from potential harm. Neither the home nor The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 18 the Commission had received a referral that needed investigating under these procedures. The majority of staff had received training in the protection of vulnerable adults. Arrangements had been made to provide the remaining staff with the required training. The Lawns Residential Care Home DS0000000308.V349472.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, 20, 22, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were in place to maintain, replace and improve the home’s decoration, furnishings and fittings. People living at the home had comfortable accommodation that was well maintained and met their needs. EVIDENCE: On the day of the inspection, the Lawns was clean, safe and well maintained. People living at the Lawns said that they were encouraged to see the home as their own. People had access to a large lounge area, a smaller adjoining lounge and a dining room. A relative commented that it would be nice if a private quiet lounge could be provided for visitors. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 20 Although the home’s physical environment met the individual requirements of the people who lived there, arrangements had been made to further improve the facilities provided at the Lawns. For example, the provider is intending to create extra assisted bathing facilities. A range of aids and adaptations such as toilet frames, grab rails and a mobile hoist were available. The deputy manager said that extra aids would be provided according to need. A thermometer was available in each bathroom to enable staff to test hot water temperatures. The home was fully accessible to people with physical disabilities with the exception of one of the first floor bathrooms. There was a lift to the first and second floors. The entrance to the home offered level access. The home had an infection control policy. The deputy manager had completed the Department of Health’s guide ‘Essential Steps’ to assess the effectiveness of the home’s infection control practices. She was in the process of drawing up an action plan to address identified shortfalls. 24 staff had completed infection control training. Anti-bacterial gel hand wash dispensers had been fitted in all toilets and bathrooms. The home had established links with the Health Protection Unit and a senior member of staff had completed more advanced training in infection control. The laundry was clean and tidy. The deputy manger said that the laundry was shortly due to be re-decorated. In a recent internal quality survey, one person expressed concern that items of her clothing had gone missing and that staff were too busy to find them. This matter had been addressed by the home. The acting manager said that the provider sought her opinion about any decoration needed and furnishings that might be required. She also said that each bedroom was completely redecorated before a new occupant took up residency. The bedrooms visited were generally clean, tidy, nicely decorated and attractively furnished. One of the bedrooms contained a strong unpleasant odour. Although the bedroom carpet was shampooed daily and specialist continence cleaning products used, the acting manager said that this had made little difference to the odour. Each room had been personalised in line with the occupant’s preferences. Some of the bedrooms visited contained furniture that people had brought in with them. Call points were available in each bedroom and within the communal areas. The kitchen was clean, tidy and well organised. Following the last inspection, the Commission had expressed concerns about kitchen practices and standards of hygiene. During an inspection of the kitchen it was evident that the necessary improvements had been made and maintained. The grounds were tidy and attractively landscaped. People had access to the The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 21 front and side gardens by way of a ramp leading from the main lounge area. Radiators had been guarded and fitted with thermostatic controls. There was no unguarded pipe work. Suitable locks had been fitted to bedroom doors enabling people to protect their privacy and staff to gain access in an emergency. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for carrying out pre-employment checks on new staff were not fully satisfactory and could allow people who might be unsuitable to work at the Lawns. EVIDENCE: The staff rotas contained the required information with the exception of the hours worked by the deputy manager. There were no care staff aged under 18, or senior staff aged less than 21. There had been a small increase in the home’s staffing levels since the last inspection. The deputy manager said that the numbers of staff on each shift were sufficient to meet peoples’ needs. No concerns about staffing levels were identified. A relative who returned a survey said: “We feel that senior staff at the home have qualities in caring for people we feel comfortable with. However, since changes in staff more young people are now employed and we feel that they do not have the experience or skills needed. We do appreciate that on the job training is necessary but that there The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 23 should be a mix of senior/junior ratio. This does not appear the case especially at weekends.” Of the four relatives who returned surveys, two said that staff had the right skills and experience to look after their relative. One person said that this usually happened. Staff personnel records contained the required information with the following exceptions: • • Full employment histories had not been obtained for each member of staff; A declaration of mental health had not been obtained from any of the applicants. All staff had completed induction training. However, a recently employed bank worker did not receive induction training until she returned to the home approximately three months after working a small number of shifts. Two staff whose files were checked had completed recent training in first aid, handling medicines safely, food hygiene, infection control, fire prevention and health and safety. But, there was no documentary evidence that another member of staff had completed training in the above areas. Since the last inspection, an individual development plan had been completed for most staff. Some of those examined needed updating. The deputy manager took immediate action to resolve this matter during the course of the inspection. Some staff had not completed training in caring for people with dementia. Approximately 75 of the care staff team had obtained a nationally recognised qualification in care. Four other staff were working towards obtaining a similar qualification. The turnover of staff within the home over the last 12 months was high. During the previous 12 months, eight full time and seven part time staff had ceased their employment. The deputy manager said that the high turnover of staff was due to the decision made by the provider to recruit more part time staff to provide a more flexible staff rota. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 24 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, 34, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff did not receive appropriate support and guidance in meeting the needs of the older people in their care. EVIDENCE: The registered manager had recently transferred to another of the provider’s homes. The provider had already commenced the process of trying to appoint another manager and hoped to submit an application shortly. The deputy manager, Ms Allan, was in the process of completing the Registered Manager’s Award and had arranged to commence the required qualification in care. She The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 25 had worked in the residential care field for many years as both a carer and a senior carer. Ms Allan had worked at the home for approximately two years in a senior position and felt well supported by the provider. In 2006, the registered manager completed a detailed quality assurance audit of the care and services provided at the home. At the time of the inspection, the deputy manager was in the process of preparing an action plan to address issues that had arisen during the audit. The provider and deputy manager had prepared a detailed annual development plan setting out what improvements they hoped to make at the home over the next 12 months. Quality surveys had been issued to staff, service users and their families. Professionals involved with the home had not been surveyed. The provider had carried out regular monitoring visits to the home and produced reports following his visits. The home had taken on day-to-day responsibility for overseeing some peoples’ money. Each person had their own wallet in which their money was kept. A check was undertaken of the money held in peoples’ wallets against the balance stated on their financial record. All were found to be correct. A safe was available to ensure that their money could be kept secure. Staff signatures had been obtained for all money spent on behalf of people living at the home and receipts had been obtained. Financial records showed evidence that an audit of peoples’ financial records had taken place recently. Staff had not received formal supervision at the required frequency during the last 12 months. For example, one member of staff had only received three supervision sessions instead of the required six. There was a maintenance contract for the lift and a policy had been prepared providing staff with guidance on what to do in the event of the lift breaking down. Problems with the home’s lift had been addressed since the last inspection. The home’s boiler, electrical and gas installations had been recently checked and found to be safe. Arrangements were in place to prevent the growth of Legionella within the home’s water systems. The home had a current clinical waste contract. A tour of the building was undertaken and no health and safety concerns were identified. An up to date fire risk assessment was in place and an individual fire evacuation plan had been drawn up for each person living at the home. The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 X 3 3 2 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 2 X 2 3 X 2 x 3 The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 27 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 5 Timescale for action Ensure that the home’s service 01/12/07 user guide contains a summary of the staff group’s experience. This will give people wishing to live at the home more information about the staff who might be involved in caring for them. Ensure that: • Peoples’ needs are clearly described in their care plans. 01/01/08 Requirement 2 OP7 15 (Previous timescales of 01/11/06 and 01/04/07 had not been complied with) • Each care plan contains an outcome which describes what the home hopes to achieve for the individual by providing the required care; Each care plan contains a clear and detailed description of how staff are to meet individual’s needs. Version 5.2 Page 28 • The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc By complying with the above requirement, staff will be clearer about what help and support people require and how this is to be done. 3. OP18 13(6) Ensure that all staff have 01/01/08 received training in the protection of vulnerable adults to help protect people living at the home. (The previous timescale of 01/01/07 had not been complied with.) 4. OP26 16 Ensure that action is taken to 01/10/07 eliminate the unpleasant odour identified in one of the bedrooms visited. This will help ensure that people do not have to spend time in bedrooms where they may find the unpleasant odour distressing and stigmatising. Ensure that the hours worked by 01/10/07 the acting manager are detailed on the home’s rotas. This will help the Commission to reach a judgement about whether the manager is spending sufficient time in the home to effectively carry out their duties and responsibilities. Ensure that: • A full employment history is obtained for each applicant. Gaps in employment must be explored and a written record kept to help ensure that only suitable staff are employed. 01/10/07 5. OP27 18 6. OP29 Schedule 2 (Previous timescales of 01/11/06 and 01/04/07 have not been The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 29 complied with) • Staff files contain documentary evidence of qualifications, and a statement that the applicant is mentally fit to do their job, to help ensure that only suitable staff are employed at the home. 7. OP30 18 Ensure that bank staff receive an 01/10/07 in-house induction on commencing work at the home to make sure that they have all the information they need to care for people living at the Lawns. (Previous timescale of 01/11/06 not met.) 8. OP30 18 Ensure that an individual 01/11/07 development plan is completed for each member of staff to help them gain the necessary skills and knowledge. (Previous timescale of 01/04/07 had not been complied with.) 9. OP31 9 Submit an application to register 01/12/07 a manager for the home. Ensure that the registered manager holds, or is in the process of obtaining, a relevant qualification in care and management at Level 4 or equivalent. This will help to ensure that a person who has the right level of experience and competence manages the home. Ensure that professionals visiting 01/12/07 the home are surveyed about their views and opinions of the quality of care and services provided at the Lawns to help DS0000000308.V349472.R01.S.doc Version 5.2 Page 30 10. OP33 24 The Lawns Residential Care Home inform the annual development plan. 11. OP36 18 Ensure that staff receive 01/10/07 supervision at the frequency set out in the National Minimum Standards to help make sure that they are properly supervised and their performance appraised. 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 OP1 OP3 Good Practice Recommendations Ensure that • The home’s pre-admission assessment documentation is updated to include prompts about the needs of people with different ethnic and cultural backgrounds; The home’s service user guide is made available in alternative formats. • 2. OP29 Ensure that there is written evidence that all staff have been issued with a copy of the General Social Care Council’s Code of Practice. Ensure that all staff receive training in caring for people with dementia. 3. OP30 The Lawns Residential Care Home DS0000000308.V349472.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection 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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