Inspection on 23/06/06 for The Lawns Residential Care Home

This inspection was carried out on 23rd June 2006.

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 22/08/07

The Lawns Residential Care Home 01/11/06

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 11:00 23rd and 30th June 2006 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.V289786.R01.S.doc Version 5.1 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.V289786.R01.S.doc Version 5.1 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 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 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.V289786.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 2005 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 threestorey 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 assisted 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 £361 to £365. Additional charges are made for hairdressing, aromatherapy and chiropody. A copy of the Commission’s most recent inspection report was available for visitors to read. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, took place over 10 hours and involved one Inspector. A range of evidence has been used to support the judgements reached in this report, including interviews conducted with the Home’s Manager, members of her staff team and residents. The premises were also inspected, as were a sample of care records, policies, and procedures. Four relatives returned survey questionnaires, which confirmed that they were satisfied with the quality of care provided at the Home. A sample of comments is given below: “The Lawns is a wonderful residential home. The staff are excellent. They are very kind and patient and if there is something on your mind, you are encouraged to discuss whatever the problem is. They are the best! My mother is very content.” “My Aunt seems very settled and content. surroundings is very good.” The level of care and comfort of Ten residents returned survey questionnaires, which confirmed that they felt well cared for. What the service does well: The staff on duty at the time of the inspection were polite, courteous and appeared to have developed caring relationships with the people in their care. The Manager had informed families where they could get hold of a copy of the Home’s policies and procedures. Over 75 of the staff team had completed qualifying training. The Home was clean, hygienic and odour free. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? The Manager had redesigned the Home’s Service User Guide. It was attractively presented, had been written in plain English and was easy to understand. A new care plan system had been introduced. A new rota system and a fire roll call had been implemented. The Company had registered with the Criminal Records Bureau to allow it to undertake its own checks. Recent investment had improved the overall appearance of the building and the quality of its furnishings, fittings and decoration. All bedrooms and landing areas had been redecorated. A range of new equipment had been purchased as follows: • • • • • • • • • • • • • • • • • Office furniture such as: a photocopier; a digital camera; a whiteboard for the main reception area; Lampshades, light fittings and dining tablecloths; Toilet mirrors and toilet frames; Bedroom equipment such as: cushions; throws for armchairs; new beds and commode chairs; ‘Walkie Talkies’ for night staff; Hairdressing equipment such as new hairdryers; A set of sit-on weighing scales; Towels, bed linen and air freshener machines; Kitchen equipment such as: a commercial cooker; kitchen ware; new crockery; Medication related equipment such as: a new drugs trolley; a medication fridge; Polo style T-shirts with staff names and job roles on; Laundry equipment such as: ironing boards; an iron; storage equipment; Bathroom equipment such as: curtains; clinical waste bins; cabinets; Personal hygiene equipment such as: denture pots; nail brushes; toothbrushes; New paintings for communal areas; A loop system had been fitted to assist residents with hearing needs; Digital boxes had been fitted to provide residents with access to a wide range of television programmes. The Manager had set up a Daily Register to ensure that key information about residents was easily accessible. A new programme of activities had been introduced. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 7 The Manager had prepared a detailed plan setting out her response to requirements and recommendations arising out of the last inspection. A new quality assurance system had been purchased. A newsletter had been produced. A fundraiser had been appointed. A large amount of money had been raised for the Residents’ Amenity Fund. More domestic and catering staff had been appointed. New planters and hanging baskets had been purchased to improve the garden areas. New pharmacy arrangements had been put in place. A staff photo board had been placed in the main reception area. New quality questionnaires had been devised and sent to residents, families and professionals visiting the Home. What they could do better: Ensure that: The Service User Guide includes the information required by residents to make an informed choice about whether to accept a placement at the Home. Consideration should be given to making the Service User Guide available in other formats. The local Safeguarding Team is provided with an opportunity to read and comment on the Home’s Adult Protection Policy. This will ensure that it contains the required information and fits with the Local Authority’s procedures for protecting vulnerable adults. All staff have undertaken training in the protection of vulnerable adults. This will ensure that residents are properly protected at all times. Residents are only assisted to mobilise in line with the guidance contained in their manual handling risk assessments and care plans. Prospective staff only commence work at the Home following completion of the required pre-employment checks. Staff regularly update their training in key areas. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 8 The Manager obtains a National Vocational Qualification in Care Management. (Level 4) Additional work place risk assessments are completed. Further improvements to the Home’s care plans and medication arrangements are made. 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 Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 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.V289786.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this Service. Prospective residents had not been provided with all of the information they needed to make an informed choice about whether to live at the Home. Satisfactory arrangements had been put in place ensuring that prospective residents’ assessed needs could be met within the Home. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 11 EVIDENCE: A Service User Guide was available. It contained valuable information about the Home and how it is managed. The Guide had recently been re-designed to improve the content and presentation. It was written in plain English and was easy to understand. However, not all of the required information was included within the Guide. Of the ten survey questionnaires returned: • • Seven residents said that they had received enough information about the Home before moving in; Two residents said that they had not. The records for three residents were examined. These included an assessment of each resident’s needs as carried out by the Home. Care Management assessment and care plan information had been obtained for each resident. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this Service. Care plans did not adequately cover all aspects of residents’ health, personal and social care needs. This could result in staff not being clear about how to meet residents’ needs. Residents’ health care needs were well met ensuring that they were able to lead healthy and pain free lives. Although systems had been put in place to support the safe administration, storage and disposal of medication, additional improvements were needed to ensure that residents were properly protected from potential harm. Staff were seen to provide personal support in such a way as to promote and protect residents’ rights to privacy, dignity and independence. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 13 EVIDENCE: Since the Manager commenced working at the Lawns, a new system of care planning had been introduced. Individual plans of care were in place for each resident and covered most aspects of their health, personal and social care needs. Risk assessments had been completed in the following areas: pressure area care; moving and handling; nutrition; continence and dental health care. It was the intention of the Manager to ensure that care plans are reviewed on a monthly basis. Annual reviews had recently been completed for each resident. Residents had signed some of the records held about them by the Home such as their risk assessment information and annual review records. A Key Worker system was in operation and residents interviewed were satisfied with their Key Workers. Residents’ records were securely stored. Assessments of residents’ levels of dependency had been completed. However, a detailed audit of two residents care records revealed that: • • • • • • • • • • • There were no plans of care covering their needs for assistance with medication and finances; Some care plans had not been reviewed on a monthly basis; Six monthly placement reviews had not been undertaken on a regular basis; Residents’ need for support was not always clearly defined in their care plans; Some of the interventions recorded on residents’ care plans did not provide a clear description of what actions were to be undertaken by staff to meet assessed needs; Interventions recorded on residents’ care plans had not always been updated to reflect changing needs. However, professional advice received by staff had been detailed in their care records; Completed risk assessments had not always been signed and dated; Manual Handling Risk Assessments had not been fully completed; The Nutritional Risk Assessment for one person had not been fully completed; None of the care plans had been signed by the resident, or their representative, confirming their agreement with the contents; There was no written evidence that regular checks of the quality of information held in residents’ care records had been undertaken. Residents confirmed that their health care needs were well met. Of the ten survey questionnaires returned, all residents said that they could access medical support when they needed it. Weight checks had been carried out on a monthly basis. Staff interviewed told the Inspector that they had access to the equipment needed to meet residents’ continence and pressure area care needs. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 14 Hand wash facilities were not available in the area within which medication was stored and administered. However, staff had been provided with antibacterial hand wash. Advice had also been obtained from the Home’s Infection Control Nurse with regards to this matter. Identification photos had been placed on residents’ Medication Administration Records (MARs). A senior member of staff with responsibility for overseeing the Home’s medication arrangements had undertaken accredited training. Refresher training for this member of staff had been arranged. The medication trolley and other storage areas were checked and found to be clean and maintained in an orderly manner. The dressings and creams cupboard appeared disorganised but arrangements were in place to rectify this matter. Eye drops stored in the medicines fridge did not have a date of opening. An in-house record of controlled drugs used within the Home was available. However, a Controlled Drugs Register was not in use at the time of the inspection. Medication stored in the fridge had not been date stamped. The medication records examined were generally well completed. However, it was noted that: • • On one occasion, a resident had not received an item of their medication due to it being out of stock; The Home had failed to identify that an item of medication received on behalf of a resident was of a greater strength than that indicated on their hospital discharge sheet. As a consequence, for almost a week, the resident concerned received in excess of the prescribed dosage before senior staff identified the error. The drug concerned could have had a detrimental affect on the well-being of the resident concerned; On two occasions, a controlled drug had been administered, but not signed for. This problem had been identified by senior staff and corrective action had been taken; Discontinued medications had not always been initialled and dated; The record of medication received into the Home had not always been signed and dated. • • • Staff were observed providing personal care to residents in a kind, considerate and helpful manner. Residents interviewed confirmed that staff respected their privacy and treated them in a dignified manner. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this Service. The provision of social activities was good and opportunities for stimulation through leisure and recreational activities were available. Residents were supported to maintain contact with their families and friends and visitors were made to feel welcome. The meals in this Home were good offering residents both choice and variety. Meals were served in pleasant surroundings by staff that were willing to provide whatever assistance was required. EVIDENCE: Since taking up her appointment at the Home, the Manager had: • Employed an Activities Organiser for 16 hours per week. This person had already arranged fundraising events at the Home to boost the Residents’ Amenity Fund; DS0000000308.V289786.R01.S.doc Version 5.1 Page 16 The Lawns Residential Care Home • • • • • Introduced a range of social activities ranging from talking about the past to board games and sing-a-longs. Residents told the Inspector that there was always something going which you could watch or join in. Records had been kept of the activities that residents had participated in; Arranged for a hairdresser to visit the Home once weekly. It was confirmed that an Aroma therapist visits fortnightly and offers relaxation sessions. An exercise and dance motivator also visits the Home on a regular basis. Monthly yoga sessions are also offered; Arranged for a visiting library to attend the Home so that residents can access new reading material. The Home also had a selection of its own books; Provided residents with opportunities to attend outings and trips out. Forthcoming events had been publicised in the reception lobby; Introduced a social needs assessment proforma, which had been used to obtain information about residents’ previous and current interests and hobbies. Care plans addressing residents’ social care needs were in place. However, one resident’s social care plan had not clearly identified their need for support. The plan was not dated and there had only been one monthly review. Also, the social needs information section had only been partially completed. Of the ten survey questionnaires returned: • • Seven residents said that enough activities were provided; Two residents said that enough activities were usually provided. Residents interviewed said that they were happy with the level and range of activities provided. Residents spoken with confirmed that the Manager and her staff team always made families and friends feel welcome. A relative told the Inspector that visitors could be seen in private or join residents in the lounge and dining areas. A policy outlining the Home’s approach to enabling residents to maintain contact with family and residents was available. None of the residents spoken with could recall the Manager placing any restrictions upon their visitors. Wherever possible, it is the Home’s policy to support residents to maintain control of their own financial affairs. The Manager confirmed that safekeeping facilities, and day-to-day support with managing personal monies and valuables, would be provided if a need to do so was identified. Residents had been supported to bring their own personal possessions with them when they moved in. A written menu was available and included a four-week menu cycle. The menus contained the required information with the exception of the timing of meals. Details of the meals available for each day had been placed on a The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 17 whiteboard in the main reception area. Choices are offered at all main meal times and a hot meal is provided at the teatime meal. The quality of the lunchtime meal was good and appeared to be enjoyed by all residents who participated in the meal. The dining room was a pleasant area and the tables were attractively dressed. Staff were on hand to provide residents with support throughout the mealtime. Of the ten survey questionnaires returned: • • Nine residents said that they were satisfied with the meals provided; One resident said that they were usually satisfied. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 18 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this Service. A satisfactory complaints procedure was available. that their views and opinions were listened to. Generally residents felt Newly appointed staff had not been subject to rigorous pre-employment checks. Not all staff had received suitable training in safeguarding residents. These shortfalls have the potential to place residents at risk of serious harm. EVIDENCE: A Complaints Procedure was available and included details of how to make a complaint, who the complaint would be handled by and the Home’s timescales for completing investigations. Residents 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. An anonymous complaint received by the Commission was investigated as part of the inspection. Four allegations were made. The Commission found three allegations unproven. One allegation was substantiated. (Refer to comments made under Outcome area 31 to 38.) The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 19 An Adult Protection Policy was in place and provided guidance on what action should be taken to protect residents from potential harm. Neither the Home, nor the Commission, had received any allegations that residents had been subject to abuse since the last inspection. However, it was identified that thirteen staff employed by the Company had started work at the Home prior to satisfactory Criminal Record Bureau Disclosure Certificates having been obtained. Neither had POVAFirst checks been applied for. The Registered Persons were required to take immediate action to rectify this concern. Not all staff had received training in the protection of vulnerable adults. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this Service. The standard of the environment was good and provided residents with an attractive and homely place to live. Recent investment had improved the appearance of the Home creating a comfortable and safe place for residents to reside in. The Home was clean and hygienic. Residents’ bedrooms were well maintained and suited their needs. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 21 EVIDENCE: On the day of the inspection the grounds were tidy, safe and attractively landscaped. Residents had access to the front and side gardens by way of a ramp leading from the main lounge area. Residents spoken to commented that the Home was safe and well maintained. The dining room was pleasantly decorated and nicely furnished. The lounge areas were clean, tidy and attractively decorated. A sideboard/dresser situated in the small lounge had a worn appearance. The toilets and bathrooms were clean, tidy and hygienic. Toilets were situated near residents’ bedrooms and the lounge and dining areas. Residents had level access to all parts of the building, with the exception of a step leading down into one of the bathrooms. A lift enabled residents to access bedrooms and other facilities on the first and second floors. There was a ramp at the front of the building, and a selection of aids and adaptations, such as grab rails and hoisting equipment, were located throughout the Home. Call points were available in each bedroom and within the communal areas. Residents’ bedrooms were individually and naturally ventilated. They were warm and comfortable and had sufficient light. Radiators were guarded and fitted with thermostatic controls. There was no unguarded pipework. The flooring in residents’ bedrooms was clean, hygienic and of a satisfactory standard. Although suitable locks had been fitted to bedroom doors enabling residents to protect their privacy, staff were still able to gain access in the event of an emergency. Lockable storage was available in all bedrooms. The Home was clean, hygienic and free from unpleasant odours. The laundry was tidy and well organised. Soiled laundry was not carried through areas in which food was stored, prepared or cooked. A hand wash facility and a sluice were available in the laundry, and the walls and floor covering were easy to keep clean. The washing machines and dryer were seen to be in good working order. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this Service. There were sufficient numbers of staff on duty to ensure that residents’ needs were satisfactorily met. Staff had been supported to undertake qualifying training, which had provided them with the knowledge and skills they required caring for residents. However, the arrangements for ensuring that staff received regular updates to their training in key areas were inadequate. The information held in staff personnel records was inadequate and arrangements for vetting staff were unsatisfactory and placed residents at risk of potential harm. EVIDENCE: The staff rotas contained the required information with the exception of staff designations. There were no care staff aged under 18, or senior staff aged less than 21. Staffing levels had not been reduced since the last inspection of the Home. The Manager confirmed that the numbers of staff on each shift were sufficient to meet the needs of the residents living at the Home. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 23 The following minimum levels of staffing had previously been agreed with the Commission: 8am to 1pm 4 1pm to 6pm 4 6pm to 10pm 3 10pm to 8am 2 An examination of the staff rota for week commencing the 10 July 2006 confirmed that the above levels of staffing had been met with the exception that three staff had not been provided between 9pm and 10pm. However, extra staff were provided to meet residents’ needs during key times of the day. The turnover of staff within the Home was high. A reasonable explanation was provided which accounted for the high level of staff turnover within the Home. Residents commented that staff provided them with a good level of care that met their needs in a considerate and sensitive manner. Residents did not mention any concerns to the Inspector about the quality of staff employed within the Home, or, of the levels of staff provided on each shift. Of the ten survey questionnaires returned: • • • • Eight residents said that staff were available when you needed them; Two residents said that staff were usually available; Nine residents said that they received the care and support they needed from staff; One resident said that she usually did. An examination of the Home’s training records confirmed that over 75 of the care team had obtained a relevant care based qualification. However, a number of staff had not received refresher training in key areas such as: the protection of vulnerable adults; manual handling; first aid, basic food hygiene; infection control. Since her appointment, the new Manager had completed an audit of the key training required by all staff and had booked places on relevant courses for staff to attend. The following information was not available in all of the staff personnel records examined: • • • A completed induction checklist from the current employer; Confirmation that staff had received a copy of the General Social Care Council Code of Conduct for Employees; An application form requiring a full employment history. (This matter was resolved at the time of the inspection.) A Recruitment and Selection Policy was available. Arrangements were in place to ensure that newly recruited staff received relevant induction training. The new Manager intends to ensure that all newly appointed staff undergoes qualifying training. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Because 31, 32, 33 and 38. Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this Service. Adequate arrangements were not in place to review the quality of care and services provided at the Home. The Provider and his Manager had taken steps to protect and promote the health and safety of both residents and staff. But, the arrangements for ensuring required risk assessments were completed were not satisfactory. Also, when the Home’s lift broke down, appropriate action was not taken to have it repaired promptly. This placed residents who were not independently mobile at risk because they had to use the stairs to gain access to their bedrooms. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 25 EVIDENCE: The Registered Manager had relevant and substantial experience in caring for older people within a residential care setting. Mrs Tidmas had obtained the required management qualification and demonstrated managerial competence in the running of the Home. The Home had been through a period of significant change and upheaval and this had had a negative effect upon the staff team. However, the new Manager had a clear view about how she intended to manage the Home and how she hoped to do so in an open and transparent manner that would maximise staff involvement. Mrs Tidmass also displayed a genuine commitment to improving the quality of life experienced by residents at The Lawns. The Manager had recently purchased a professional quality assurance package, which she intended to complete over the next few months. Following completion of the first quality audit, an Annual Development Plan will be prepared. Mrs Tidmass had recently devised new quality questionnaires, which she had issued to residents, their families and professionals visiting the Home. A record of accidents occurring within the Home had been kept. The Home’s Fire Log contained evidence that the required fire prevention checks had been conducted. An up to date fire risk assessment was in place. Service contracts and maintenance reports relating to such matters as gas safety and servicing of the Home’s lift were available for inspection. Certificates of inspection confirmed that the Home’s fire equipment was in good working order. A clinical waste contract was in place and a range of workplace risk assessments had been completed. However, it was also noted that: • • The Home’s water systems had not been checked for the presence of Legionella during the previous 12 months; Following receipt of an anonymous complaint, it was identified that following the breakdown of the Home’s lift, care staff had assisted three residents to gain access to their bedrooms on the first and second floors, by transporting them in wheelchairs up two flights of stairs. This is clearly unacceptable and could have resulted in serious injuries to both staff and residents. A written risk assessment of the risks posed to the residents who were transported in the above manner had not been undertaken; Risk assessments covering the following areas had not been prepared: 1. Prevention of falls from windows and the maintenance of window restrictors; • The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 26 • • 2. Prevention of the spread of the Legionella Bacteria in the Home’s water systems; 3. The risks posed by residents inhaling second hand smoke; A risk assessment completed on behalf of a resident who smoked did not include reference to risks associated with this person smoking in the dining room Some of the generic risk assessments examined did not appear to relate to The Lawns. For example: the risk assessment covering risks associated with radiators indicated that guards would be fitted where a resident’s bed was located beside a radiator or in well used areas. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 27 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 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 X X X X 1 The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 28 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 Ensure that the Home’s Service User Guide is amended to address the following concerns: • Reference to the Home being registered by North Tyneside Council should be removed; Clarification of what is meant by providing services to eight residents with ‘early dementia’ is required; Change the title of the body with responsibilities for inspecting the Home. Requirement Timescale for action 01/11/06 • • Also, service users’ views of the Home must be added. 2. OP7 15 Ensure that: • Each residents care plan sets out in detail the action to be taken by care staff to ensure that all aspects of residents’ health, personal and social care needs are Version 5.1 Page 29 01/11/06 The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc • • • • met, including their need for assistance with medication and managing their finances; Residents, or their representatives, are provided with an opportunity to read and sign their care plans; Six monthly placement reviews take place; Periodic checks of the quality of residents’ care records are undertaken; The Home’s care records contain signed evidence that residents have been given a copy of the Statement of Purpose, Service User Guide, latest inspection report and Complaints Procedure. (Previous timescale of 01/06/06 not met. The Manager was in the process of meeting this requirement) • • • Residents’ care plans are reviewed on a monthly basis; Care plans clearly describe residents’ needs for support and assistance; Care plans clearly describe what actions are to be undertaken to meet residents’ needs; Care plan interventions are updated to reflect changes in residents’ needs; All risk assessments are signed and dated; Care plan interventions take account of needs identified in risk assessments. • • • The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 30 3. OP9 13(2) Ensure that: • • An accurate record is kept of all medications received into the Home; A Controlled Drugs Register is used to record the receipt, administration and disposal of such medications. of 01/10/06 (Previous timescale 01/05/06 not met.) 4. OP9 13(2) Ensure that: • • 01/10/06 A date of opening is placed on medications with a short term life; Information provided by hospital and pharmacy staff regarding residents’ medication at the point of discharge, is verified before any medicines are administered; Controlled medication is administered and signed by two staff; Satisfactory arrangements are in place to prevent residents’ medication being out of stock; All staff administering medication have received accredited training. • • • 5. OP18 13(6) The Registered Manager must 01/08/06 ensure that: • Newly appointed staff do not commence work at the Home until a satisfactory CRB Disclosure has been received; In exceptional Version 5.1 Page 31 • The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc circumstances, where service users may be placed at risk, because difficulties have been experienced recruiting sufficient staff, you may start a member of staff before their CRB Disclosure has been received as long as: i) Rigorous preemployment checks have been carried out; ii) A CRB Disclosure has been applied for; iii) A satisfactory result from a POVAFirst check has been received; iv) Stringent arrangements are in place for induction and supervision of the new employee. 6. OP18 13(6) Ensure that the Home’s Protection of Vulnerable Adults Policy is forwarded to the local Safeguarding Team for comment and advice. Any advice received should be acted upon. 7. OP28 18(2) Ensure that staff regularly update their training in the following key areas: First Aid; Basic Food Hygiene; Manual Handling; Protection of Vulnerable Adults; Infection Control. (The timescale set for this The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 32 01/09/06 01/01/07 requirement had not expired at the time of this inspection. As there has been a change of Manager, a new timescale for compliance has been set.) 8. OP28 18(2) Ensure that: • • The Company has obtained a full employment history for each member of staff; An in-house induction has been completed for all newly appointed staff. Each completed induction checklist should be dated and signed by both the inductor and inductee; An Individual Development Plan is in place for each member of staff. a 01/01/08 01/01/07 A review of the quality of care and services provided at the Home must be undertaken at regular intervals. The views of residents, their families, staff and professional visitors to the Home, must be obtained as part of the review process. A copy of the review must be made available to residents and the Commission. (The timescale set for this requirement had not expired at the time of this inspection. As there had been a change of Manager, a new timescale for compliance has been set.) 11. OP33 24 DS0000000308.V289786.R01.S.doc 01/11/06 • 9. OP31 9 The Manager must obtain relevant care qualification. 10. OP33 24 01/01/07 Version 5.1 Page 33 The Lawns Residential Care Home An Annual Development Plan must be prepared and submitted to the Commission following completion of the Home’s first quality audit cycle. (Previous timescale of 01/06/06 not met. As there had been a change of Manager, a new timescale for compliance has been set.) 12. OP38 13(4) The Registered ensure that: • Persons must 01/09/06 • • • The Home’s lift contract provides the Lawns with a 24 emergency call out facility; All senior staff are aware of the content of the Home’s lift contract and what they can expect of the lift maintenance company; A policy is put in place which clearly sets out what action must be taken by staff to safeguard residents in the event that the lift fails in the future; The risks posed by any future breakdown of the Home’s lift are fully assessed and potential risks minimised. 01/11/06 13. OP38 13(3) Ensure that the Home’s Infection Control Policy covers the latest guidance issued by the Commission and the Department of Health. Ensure that: • All staff have received The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 34 • • recent infection control training; The infection control checklist attached to this report is completed; The risks associated with the failure to provide a hand washbasin in the area in which medicines are kept are fully assessed. Contact the Health Protection Unit and make them aware of the action you have taken to improve infection control measures within the Home. 14. OP38 13(3) Ensure that: • Individual risk assessments are carried out which consider the action that needs to be taken to minimise the likelihood of vulnerable residents harming themselves by falling from, or jumping out of, a window 2 metres above ground level; A programme of maintenance is put in place, which ensures that any window restrictor fitted in the Home is maintained in a safe condition. A record must be kept of any maintenance carried out. 01/11/06 • Information about employers responsibilities in this area can be found on the Health and Safety Executive Website: www.hse.gov.uk The relevant guidance is: SIM The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 35 07/2001/39 Your local Health and Safety Inspector can be contacted for advice. Details are available at the above web address. 15. OP38 13(4) All windows in the Home that: • • • Are accessible to vulnerable residentsAre two metres or more above ground levelCan be opened sufficiently wide enough to enable a resident to fall, or jump out of01/11/06 Must be fitted with restrictors that prevent the window from being opened no wider than 100mm. 16. OP38 13(4) Ensure that: • • The required workplace risk assessments are completed; Completed workplace risk assessments are relevant to The Lawns. 01/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 36 Ensure that residents over 75, on four or more medications, are provided with an opportunity to access an annual medication review. 2. OP15 Ensure that the Home’s menus include the timing of meals. 3. OP27 Ensure that three carers are scheduled on duty between 9pm and 10pm each day as recommended by the Care Staffing Tool for Homes for Older People. The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 37 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Lawns Residential Care Home DS0000000308.V289786.R01.S.doc Version 5.1 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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