Inspection on 25/04/06 for The Lawns, Tavistock

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lawns, Tavistock 22/11/05

The Lawns, Tavistock 14/04/05

The Lawns, Tavistock 17/01/05

The Lawns, Tavistock 03/08/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Lawns 52 Plymouth Road Tavistock Devon PL19 8BU Lead Inspector Helen Tworkowski Key Unannounced Inspection 25th April 2006 8:00 The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 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 DS0000003830.V291495.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 Adults 18-65. 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 DS0000003830.V291495.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Lawns Address 52 Plymouth Road Tavistock Devon PL19 8BU 01822 610233 01822 610265 stewart@thelawns.wanadoo.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) Mrs Joan Morwenna Lily Stewart Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 4 The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 5 SERVICE INFORMATION Conditions of registration: 1. 2. Main client group Learning disability some of whom may have additional physical disability One named Service User over 65 years of Age Date of last inspection 22/11/05 Brief Description of the Service: The Lawns is a 4-storey town house near the centre of Tavistock, and all the amenities that the town has to offer. The home is registered for 12 Residents that have a learning disability. There are 12 single rooms, and two have en suite facilities. Two of the rooms in the annexe of the house and the two residents who live there, can be semi-independent, with their own private lounge and kitchen. The home has a minibus that provides transport to the Residents at no extra cost. The home organises activities and holidays. The home has pleasant communal areas and well-maintained gardens and patio areas that are easily accessible. The home is staffed 24 hours per day - and at night there are 1 waking and 1 sleeping staff. The home employs a domestic, though care staff are involved in cooking all meals. Mrs Stewart, the Registered Provider, lives close by and takes a active role not only in the management of the home but in the providing care. The fees range from £300 upwards depending on assessed needs. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Inspection covered all “Key” standards. The site visit took place between 8am and 6pm on 25th April 06, and included interviews with Mrs Stewart and four of the care staff on duty. Four staff survey forms were also returned. Time was spent talking with service users, including during the three main meals that day. One of the Service Users was happy to show the Inspector around the building. Ten completed Service User survey forms were returned. The Inspector also spoke with staff from the local day centre and one of the families of a service user who had used the service. Feedback was also received from the local Social Services department and from a psychologist who has regular contact with people at the Lawns. What the service does well: What has improved since the last inspection? What they could do better: The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 7 Service User Plans, documents that should help ensure that individuals get the care they need, need to be in place for service users as soon as they move to the Lawns. They must also be regularly reviewed with the service user and if appropriate their representative. It is also recommended that there are discussions with the Environmental Health Department, so that Service Users can be more involved in cooking meals, both for enjoyment and to develop their independence. 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 DS0000003830.V291495.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can be assured that staff will know their needs, prior to a move. Prospective Service Users are provided with the opportunity to get to know everyone at the Lawns, prior to a decision being made as to whether the Lawns is the right place for them to live. EVIDENCE: One new person has stayed at the Lawns since the last inspection. Information had been provided by Social Services about the individuals needs. Mrs Stewart (Registered Provider) explained that the individual had visited the Lawns on a number of occasions prior to the stay. Relatives of the individual confirmed that there had been a gradual process of introduction, and that staff and Service Users had met the individual before their stay. Mrs Stewart was able to show the inspector the a folder containing information about the Lawns, including the Service User Guide, that is given to prospective Service Users or their representatives. Relatives of a prospective Service User confirmed that the Lawns had provided not only provided the services they said they would, but had exceeded expectations. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are well supported and able to make decisions about their lives. EVIDENCE: The files of a number of individuals were looked at and discussed with care staff. Each person had a brief plan that explains how an individuals needs are to be met. This information was brief. There was also specific information about goals, and how these would be achieved- for example in relation to loosing weight. Files also contained a copy of “My Life, my Plan”, which had been completed for the individual with someone from Social Services, whilst the individual was attending a day centre. It was unclear how this document related to the care and support at the Lawns. One person, who had stayed at the Lawns for a period of weeks, had no Service User plan of any sort. Discussions with staff and mangers indicated that they knew the individual and their needs, and had agreed consistent approaches. However these were not recorded. It is important that each person has a written plan of how his or her needs will be met. This ensures The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 11 that everyone can be clear and can be consistent. This is even more critical when someone is new or when he or she potentially has behaviours that challenge. Service Users Plans need to be reviewed so that they cover all aspects of personal, social and healthcare needs, they need to be specific to identify how needs will be met and they must be available in a format that that Service Users can understand. Mrs Stewart, the Registered Provider, said that Care Plans are reviewed informally with Service Users and their representatives; there is no record of any discussions. Plans would be reviewed with the Service User and any relevant people every 6 months, and should be updated to reflect changing needs. A record of this must be kept. Service Users are able to make decisions about their lives. Staff said that Service Users are able to get up when they choose, but that many individuals get up early because they have things they want to do with the day. Service Users make choices about how they spend their time and in the clothes they wear. Staff explained that sometimes this choice was by offering a choice of only two different items of clothing rather an open choice, which could be confusing. Service Users Surveys all confirmed that they were always able to make decisions about what he or she did that day. One of the Service Users explained to the Inspector that she had her own key to her room and that the staff were only allowed into her room for certain agreed reasons. All of the bedrooms, that can, have door locks fitted. It was observed that Service Users respected each other’s privacy, and did not take it for granted that they could walk into each other’s bedroom. There are risk assessments on file, these documents are part of the process of managing risks. Some Service Users are encouraged to learn new skills- such as cooking their own meals, however this cannot be extended to all meals because of concerns regarding food hygiene standards expressed by the Environmental Health. (see next section) The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are supported to live fulfilled lives. EVIDENCE: Each file examined contained a plan of how Service Users usually spent their time. The Lawns employs someone to work with Service Users to improve their numeracy and literacy. Service User may also have educational sessions at the local day centre. Some of the Service Users have jobs in the town, and from discussions with Service Users it was clear that this was an important and valued part of their lives. Service Users use many of the local community facilities in Tavistock including the swimming pool, cinema, local shops and cafes. One parent told the inspector that whilst he had been told that Service Users were part of the local community, but he was surprised and pleased at the extent to which this happened. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 13 Meals are eaten in the lower ground floor dining room. There is a rolling menu that Service Users have been involved in choosing. The menu contains a range of meals, and fresh fruit is on the menu each lunchtime and is available throughout the day. Where individuals need to loose weight there was evidence of discussion with a dietician, weight monitoring and meals that would provide a lower calorie intake. If individuals do not like a particular meal then they are able to have another option, there was a record of this. Service Users who are interested are involved in preparing their own sandwiches at lunch time, however Mrs Stewart, the Registered Provider said that Environmental Health had advised that only people with a Food Hygiene Certificate should be involved in preparing food eaten by other people. This means that service users are not currently involved in preparing the majority of the meals. Mrs Stewart felt that this was something that the service users would not only like to do more of but would be of great benefit in developing their skills and independence. It is recommended that this issue again be discussed with the Environmental Health department so that Service Users can take part in preparing meals, in a safe manner. The inspector spent time with Service Users over three meals during this inspection, and all Service Users seen or spoken with enjoyed the meals. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good system for the management of medication at the Lawns. Service Users receive good support and guidance to help ensure their health and well-being. Support is offered in an appropriate manner reflecting the needs of individuals. EVIDENCE: The Service User Survey forms received indicate that Service User are able to do as they wish and the staff not only listen to what they say but act up on what is said. Discussions with Staff confirmed this view. There are good health records, and where an individual had a particular health issue such as epilepsy, then appropriate advice and guidance had been sought and implemented. There was evidence of considerable improvement in some aspects of health for individuals. One of the staff explained how one of the residents would need to have an operation in the near future. There was evidence of staff working closely with hospital and family to ensure that this person would received the best support and that they were given information in a manner with which they could understand and manage. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 15 A monitored dose medication system is used at the Lawns. This system is pre prepared by the local pharmacist. There are good records to show that medication is administered as specified by the person prescribing it. The Boots pharmacist has checked the system and found it to be in order. There were records of medication returned to the pharmacist and of when “homely remedies” were used. All of the staff had been trained at some level in relation to medication, and there was information on file for each person about the medication they were using. Two of the staff were just completing a management of medication course. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to ensure that Service Users voices are heard and that they are protected from abuse. EVIDENCE: No complaints have been received by CSCI relating to the Lawns, and the Inspector was told that none had been received by Mrs Stewart. When Service Users were asked about what they would do if they had a concern then they were clear that they could go and talk to Mrs Stewart or her deputy. Staff had completed training in relation to Adult Protection and abuse, and had watched training videos and read local guidance. Devon County Council’s Adult Protection team provides training and also trains staff to train others in this field. It is recommended that consideration is given to using this local resource. There was evidence that all staff are being Criminal Records Bureau checked before they provide support to service user. This is part of ensuring service users are kept safe. Mrs Stewart and the deputy said that they would be working with Service Users with an anti bullying pack called “We’ve had enough”, so that individual Service Users could be better protected from this sort of abuse. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Lawns provides a clean, comfortable and homely environment. EVIDENCE: The Inspector was shown around the home by one of the Service Users. The lounge, dining room, bathroom and bedrooms seen were all well maintained and comfortable. Bedrooms were decorated and furnished to reflect Service Users interests and preferences. Feedback surveys from Service Users confirmed that they thought their home was fresh and clean. A cleaner is employed but Service Users are encouraged to be involved in cleaning their own rooms. Adaptations have been made to accommodate disability. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are robust systems in place to recruit new staff. Existing staff feel well supported and are well trained. EVIDENCE: No new Staff were working at the home during this inspection, however two people had been employed for a short period, and their recruitment was looked at during this inspection. There was evidence that appropriate checks had been made to ensure that the individuals had complete application forms, that references had been taken and Criminal records bureau checks had been made. Mrs Stewart confirmed that an induction had been started, but as the individuals had left this had been scrapped. Such documents need to be kept for a minimum of three years. One person who had left the Lawns and later returned commented how this experience had shown her how well run and organised the home is. There are generally three staff on duty between 9am and 9 pm, with two staff working between 9pm and 9am. At night one member of staff stays awake all night and is available to provide support, the other sleeps, and is available in an emergency. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 19 Staff spoken with had completed a range of training- including in relation to managing medication, moving and handling, and epilepsy. Two members of staff were in the process of completing training in relation to the Learning Disability Awards Framework. Others had completed their NVQs. From discussions with staff it was clear that they felt well trained and that the training they received was of a good standard and “made them think”. Staff Survey forms returned by staffing indicated that they felt well supported to do their job. All four of the staff spoken with commented on the support they received from the owner Mrs Stewart and the deputy. They spoke about how if they had a concern or problem, even if related to Mrs Stewart that they would be able to approach her. There were records of supervision and appraisals on staff files, however staff survey forms showed that staff were less clear about whether they received supervision. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Lawns is a safe and well-managed care home. EVIDENCE: Mrs Stewart is the Registered Provider and has run The Lawns for many years, and the home is well run and well managed. Mrs Stewart has not completed an NVQ4 in care or management; the Inspector discussed with Mrs Stewart how this might be resolved. Staff spoken with felt that they were kept up to date with what was happening in the home. When a prospective Service User was considering moving to the home, consideration was given to the views of the existing Service Users. There is a quality assurance system in place that involves consulting with Service Users. Mrs Stewart said that she meets with relatives on a regular and informal basis. The Inspector discussed with Mrs Stewart how she might The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 21 involve relatives and other visitors to the Lawns, so that their views might be part of the quality assurance process. The building is well maintained and there were risk assessments on file. Risk Assessments are part of the process of managing risk. Fire checks and fire training had been completed on a regular basis, and it was clear from time and effort was taken to ensure that Service Users and staff were protected from unnecessary risk. There was a record of checks being made in relation to Legionella, though at this inspection the risk assessment that underpinned the frequency of these checks was not available. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 23 No Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Requirement All Service Users must have a Service User Plan, which is comprehensive and detailed, reflecting changing needs and goals. This must include Service Users who only stay in the home for short periods. These documents must be a format that service users can understand and be regularly reviewed with the Service User. Timescale for action 01/09/06 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 2 3 4. Refer to Standard YA17 YA23 YA32 YA42 Good Practice Recommendations The Registered Provider should review Service User involvement in meal preparation, in the light of discussions with and advice from Environmental Health Services. Staff should receive training the Devon County Council Adult Protection Service in relation to dealing with abuse. All records, including induction records, should be kept for a minimum of three years. The Legionella Risk Assessment, as well as evidence of the DS0000003830.V291495.R01.S.doc Version 5.1 Page 24 The Lawns checks made in relation to the assessment, must be available at the Lawns. The Lawns DS0000003830.V291495.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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