CARE HOME ADULTS 18-65
The Lawrence 316-318 Bradford Road Wrenthorpe Wakefield West Yorks WF2 0QH Lead Inspector
Tony Railton Unannounced Inspection 23rd November 2005 08:30 The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Lawrence Address 316-318 Bradford Road Wrenthorpe Wakefield West Yorks WF2 0QH 01924 369164 01924 383811 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) Johnston Care Limited Mrs Elizabeth Richardson Care Home 14 Category(ies) of Learning disability (14), Physical disability (3) registration, with number of places The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th April 2005 Brief Description of the Service: The Lawrence continues to provide personal care and accommodation for up to 14 people who have a learning disability, and three may also have a physical disability. Set back in its own grounds these two joined very large period terrace houses provide accommodation on three floors. There are two small gardens to the front one extending around the side and there is parking provided to the rear. The main entrance is also found at the back of the home. There is a large lounge to the rear and a smaller quiet lounge to the front. There is an adjoining dining room to the larger lounge next to the office. All accommodation offered is single, however, there are no en-suite bedrooms and the washing and bathing facilities are shared. The care provided by the home is underpinned by ordinary living principles and there is an expectation that residents do as much for themselves as possible in the pursuit of living an ordinary lifestyle and to maintain their independence. There are only a few local shops nearby including a public house. However, the home is on a main bus route and is only a few minutes journey from the centre of Wakefield and all services and amenities. The home is also close to the M1/M62 link roads. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a very positive and encouraging unannounced inspection which commenced at 08.30 to give the inspector the opportunity to observe the usual morning routines. The inspector was pleased to note a number of improvements to the physical environment and to the care management practices within the home. These improvements mean that the CSCI ‘traffic light risk’ assessment rating moves the home from red to amber. The efforts of the service providers, the new registered manager and her staff team in raising standards within the home in such a short period are to be commended. The inspector took the opportunity to speak to almost all residents, one support worker, one senior support worker and the registered manager. There was also the opportunity to examine staff records and residents’ case files including assessments, care plans and reviews. This was an enjoyable and detailed inspection and the inspector would like to take the opportunity to thank residents and staff for their warm welcome, hospitality and co-operation throughout the inspection. What the service does well:
Most residents have lived in the home for a number of years and consider it to be theirs. One resident said that she “likes living in the home” and that she “likes the staff”. Another said that he “likes his bedroom” and was pleased to show me his television and satellite dish. Most residents are very able and could give a good account of life in the home. On the morning of the inspection residents were observed socialising and enjoying each other’s company. Residents were also confident and spoke freely about were they live and the care and support provided. All residents appeared to be happy and comfortable with some enjoying their breakfast and others relaxing in the lounges. The support workers were observed talking to residents throughout the morning and there appeared to be positive relationships fostered between residents and their carers. Staff training records showed that over half of the support workers have a national vocational qualification at level 2 or above and that residents benefit by been cared for by NVQ trained staff. It was also noted that residents are safeguarded and protected by the staff selection and recruitment policies, procedures and practices and that appropriate checks including POVA and CRB are carried out before staff are employed. The daily records are good and contain descriptive words to describe and reflect residents’ choices, preferences, likes and dislikes. They also record when residents make decisions about how they live their daily lives. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection?
Since the last inspection the manager has been registered by the Commission for Social Care Inspection. The new manager is currently undertaking the NVQ Level 4 ‘Registered Managers Award’ which she hopes to complete in 2006. The staff team, although some are relatively new, appears to be stable and on the day of the inspection support workers appeared confident and competent. The manager said that residents will benefit by having a more stable staff team and the home will be better placed to offer a more consistent approach to the care provided. Residents care plans have improved greatly since the last inspection. Residents case files including assessments show that care plans now reflect residents assessed care and support needs. The daily records have also improved greatly and carers use descriptive words to reflect and describe residents’ choices, preferences, likes and dislikes. The inspector was impressed with the improvements to the daily records. The manager and support workers are to be commended for their efforts in maintaining such a good standard of record keeping. Residents care plans showed that they are now reviewed on a regular basis discussion with the manager and senior support worker showed that this has been hard work but reviewing the care plans and risk assessments continues to be an ongoing priority. Discussion with support workers and examination of some staff supervision records show that staff are now receiving regular line management supervision. This is another major improvement to the management systems within the home. Discussion with the manager and inspection of the home showed that new bedroom furniture has been purchased. Two residents said that they are pleased with their new wardrobes and chest of drawers. The manager said that all the bedroom furniture going to be replaced and that new beds have also been provided. The service providers and the manager are to be commended for maintaining standard within the home. It was also noted that the two lounges have been re-decorated and provided with new sofas and armchairs. Residents said that they liked the new sofas’ as they are “comfy”. The inspector was also pleased to note that the linking corridor between the lounges has been re-decorated. Throughout the inspection when listing the improvements and in particular when talking to residents, support workers and the manager there was an optimistic attitude expressed about the home and the changes to its appearance and they way that it runs. The manager said that the way the home looks and runs is changing for the better and will benefit residents greatly. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 Prospective residents have their personal and healthcare needs assessed before they are admitted to the home. EVIDENCE: Residents’ case files including assessments, care plans and reviews show that prospective residents care needs are assessed before they are admitted. Records also show that most residents have an Integrated Care Management Programme Assessment also reflecting residents care needs and preferences, choices likes and dislikes. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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): 6,7,8 & 9 Residents assessed and changing needs are reflected in their care plans and they are also involved in making decisions about how they live their daily lives. EVIDENCE: Examination of some residents care plans show that the majority of care plans have been reviewed and updated. This is an improvement since the last inspection. Another improvement is the daily records which use descriptive words to reflect and indicate residents choices and preferences, likes, dislikes and any decision they make on a day to day basis. The manager and staff team are to be commended for their efforts in maintaining such a good standard of daily record keeping. Discussion with the manager indicated that residents are involved with the staff selection and recruitment process, however, there was no documented evidence available to support this. The manager said that she will consider ways of capturing residents’ involvement in the staff selection process and in particular any comments they make about individual candidates. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 11 Residents risk assessments show that they are encouraged and supported to take risks as part of living an independent and ordinary lifestyle The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 & 17 Residents do have opportunities for personal development and to participate in age, peer and culturally appropriate community based leisure activities. EVIDENCE: Discussion with residents and examination of their case files including care plans, activity charts and daily records show that residents are encouraged and supported to participate in appropriate activities. Discussion with the senior support worker and manager indicates that some residents attend local authority run day centres on a regular basis and others attend activity sessions arranged by the service providers. Some residents are very able, can travel independently and can take advantage of the services and amenities offered by Wakefield City centre. Through observation it was noted that the daily routines in the home promote residents independence and that their rights and responsibilities are recognised. Discussion with residents, support staff, the manager and examination of the menus and record of meals provided show that residents are encouraged wherever possible to help in the preparation and coking of meals.
The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 13 On the day of the inspection some residents were observed ‘helping themselves’ and making simple meals. Residents appeared comfortable and relaxed doing things for themselves and having access to all areas of the home including the kitchen and office. One resident said that the meals are really good another told the inspector that he was having stew and dumplings that evening and that he loved it. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 & 20 Residents receive personal support in a way they prefer and require and their physical and emotional healthcare needs are met. EVIDENCE: Residents’ assessments, care plans, risk assessments, medical records and reviews show that their personal and healthcare needs are met by the home. Healthcare records indicate that residents are encouraged and supported to take advantage of ordinary community based healthcare services. However, healthcare records and reviews show that there is specialist advice available from the Community Learning Disability Team and Specialist Social Workers if required. Staff training records show that staff receive training on the ordering, storage, administration and recording of medicines. Inspection of the medicine storage administration and recording systems show that they are managed by competent staff and that residents best interests are safeguarded and protected. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 15 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 & 23 Residents feel that their views are listened to and acted upon and they are also protected from abuse, neglect and self harm. EVIDENCE: The complaints book indicates that the home has not had any complaints since the last inspection. The home provides a complaints policy in a different format using pictures and symbols displayed around the home. Residents said that if they have complaint they go and see the manager. On the day of the inspection one resident was observed expressing a particular concern to the manager who then dealt with her comments appropriately. Staff training records, including induction show that adult abuse training forms part of the induction training for all new staff. Discussion with the senior support worker and care staff showed that they are aware of POVA (protection of vulnerable adults) and what it was about. It was noted that the home has a copy of Wakefield Social Services and Health Multidisciplinary Adult Abuse and Protection Policy and Procedure The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 16 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): 24,25,26,27,28 & 30 Residents live I a home which has improved since the last inspection some parts are homely and comfortable, however, there is still some work to do to make it better. EVIDENCE: Inspection of the home showed significant improvements to the environment since the last inspection. Some bedrooms have new wardrobes and others new drawers and at least five have new beds. Others have been decorated and are waiting for new furniture. Discussion with the manager and senior support worker indicated that the home has taken delivery of new furniture for all the bedrooms. However, these have to be assembled. The manager said that it is her intention to have all the new furniture in residents’ bedrooms before Christmas. The manager acknowledged that the broken furniture in some bedrooms will be disposed of as it is replaced It was also noted that both lounges have been re-decorated and provided with new furniture including sofas’ and armchairs. Residents were pleased with the new sofas’ and said that they are comfortable. These improvements are to be commended.
The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 17 The linking corridor between the lounges has been re-decorated and is much more homely. However, the carpet on this corridor is marked/stained and these ‘black’ marks continue up the staircase carpet. The manager said that she does not know what has caused the marks but is aware of the need to have the carpet cleaned. It was noted that the home does not have a carpet cleaner. The service providers and manager are to be commended for their efforts in improving the standard of living within the home. The manager was confident that all of the issues raised at the inspection would be dealt with before Christmas. Inspection of some bedrooms show that they are personalised and residents are surrounded by their own belongings. One residents said that he likes his room and in particular his television and his videos. He was also enthusiastic when showing the inspector his satellite dish on the wall outside his bedroom window. On the day of the inspection all areas of the home were clean and free from unpleasant odours. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 & 36 Residents’ benefit from clarity of staff roles and responsibilities from having the support of competent and N.V.Q trained staff. Residents are also protected by the homes staff selection and recruitment policies and practices. EVIDENCE: Through discussion with the manager, senior support worker and examination of staff training records it was established that over 50 of support workers are trained to NVQ Level 2 or above. The manager said that it is her intention to improve services for residents and to have all staff working in the home with a NVQ qualification. Each member of staff has a training profile which identifies future training needs. Examination of staff induction records show that the training provided meets sector skill workforce training targets. Examination of new staff personal records show that the appropriate POVA (Protection of Vulnerable Adults) list and CRB checks are carried out on all prospective employees before they commence work. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 19 Discussion with the manager and examination of some supervision records show that some supervision has been offered to support workers. The manager said that some new staff are yet to have a planned line management supervision. The manager said that she aims to provide a minimum of six line management supervision sessions per year to all staff. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 & 42 Residents’ benefit by living in a home which is well managed, open and inclusive. Residents also know that their views will be listened to and acted upon. EVIDENCE: On the day of the inspection residents were observed to be relaxed, comfortable and confident. All residents spoken to said that they enjoyed living in the home and liked the people caring for them. The daily records show and reflect residents’ choices and preferences, likes and dislikes. The minutes of residents meetings show that they do have a say in the way the home runs. Through observation the inspector concluded that the way the home runs is open and inclusive. The manager has recently been registered by the Commission for Social Care Inspection. The manager said that she is currently undertaking an NVQ Level 4 Registered Managers Award which she hopes to have completed by the end of 2006. The manager said that the quality assurance monitoring questionnaires are due to be given to residents and their relatives in the new year. She went on
The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 21 to say that previous efforts to gain the views of other stakeholders such as visiting health professionals has been fruitless. The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 2 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 2 3 2 N/A 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Lawrence Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 1 3 2 X X 2 X DS0000006195.V265659.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations Despite nearly all residents care plans having been reviewed signed and dated since the last inspection a few had been missed. The manager should make sure that all care plans are reviewed on a regular basis. The manager said that residents had participated in the staff selection process she should consider ways of capturing and recording residents involvement in the running of the home. Residents benefit greatly by the improvements to the home and the manager should ensure that the new furniture is assembled and in residents bedrooms as soon as is practicable. The old furniture and in particular the furniture that is broken should be removed when it is replaced by new furniture. The corridor carpet linking the two lounges that is stained should be cleaned.
DS0000006195.V265659.R01.S.doc Version 5.0 Page 24 2 YA8 3 YA24 4 5 YA26 YA28 The Lawrence 6 7 8 9 10 YA36 YA37 YA39 YA39 YA42 The manager should make sure that all staff receive a minimum of six line management supervision sessions per year. The manager should inform the CSCI upon completion of the NVQ Level 4 Registered Managers Award. The views of residents and their relatives and other stakeholders should be sought regarding the quality of care provided by the home. The information gathered as part of quality assurance questionnaires should be collated and a report provided that reflects the outcomes for residents. A review should be undertaken to see if some staff require training or update training in Basic First Aid, Moving and Handling and Food Hygiene The Lawrence DS0000006195.V265659.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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