Inspection on 18/07/07 for WCC - The Lawns

This inspection was carried out on 18th July 2007.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

WCC - The Lawns 30/10/08

WCC - The Lawns 19/09/06

WCC - The Lawns 06/02/06

WCC - The Lawns 15/08/05

WCC - The Lawns 10/03/05

WCC - The Lawns 08/12/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE WCC - The Lawns 1 Gleave Road Whitnash Leamington Spa Warwickshire CV31 2JS Lead Inspector Lesley Beadsworth Key Unannounced Inspection 18th July 2007 10:00 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 WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCC - The Lawns Address 1 Gleave Road Whitnash Leamington Spa Warwickshire CV31 2JS 01926 425072 01926 831577 jillturley@warwickshire.gov.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) Warwickshire County Council, Social Services Department Mrs Jill Turley Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That Mrs Jill Turley achieves NVQ level 4 in management and care including the Registered Managers Award, by May 07. That Mrs Jill Turley notifies the Commission for Social Care Inspection upon successful completion of the above-mentioned award and immediately in the event of failure to achieve the award or cease, for whatever reason, to complete the award. 19th September 2006 Date of last inspection Brief Description of the Service: The Lawns is a purpose built care home providing personal care and accommodation for 35 older people. This includes a 5 bedded respite / short stay unit which is situated on the ground floor. Warwickshire County Council Social Service Department owns and manages the home. The home is in Whitnash on a housing estate, near to Leamington Spa. A local bus service, which circulates between Whitnash and Leamington Spa, stops nearby. All bedrooms are single, 26 of which have en-suite facilities. A passenger lift enables access to all levels. At the time of the inspection the fees charged were in the range £94.45 to £380.24 per week. The fees do not include newspapers, toiletries, chiropody or hairdressing. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a visit to The Lawns. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Some of the information contained within this has been used in assessing actions taken by the home to meet the care standards, and included in this report. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 10.00am and 8.00pm. What the service does well: As a Local Authority service referrals are made directly via Social Services following an assessment of need carried out by the allocated social worker. One of the home’s senior staff then makes a pre-admission visit to the prospective resident to assess that the home is able to meet their needs and the prospective resident is invited to visit the home before deciding if they want to live there. Residents spoken with confirmed that they or their relative had visited the home prior to moving in. Assessment records covered the required assessment areas in sufficient detail to formulate a care plan. All of the care files seen had a care plan that had been devised from the assessments of the individual resident. Evidence was seen in documents looked at that staff have attended training related to Dementia, Parkinsons Disease and Diabetes in order to have the knowledge and skills to meet these specialist needs. Discussion with staff and comments in the AQAA showed that staff undertake training related to Equality and Diversity to assist in the understanding and WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 6 meeting of specific needs of residents related to, for example, race, gender, disability, sexual orientation, religion and age. Risk assessments devised to identify the action required to minimise risk were seen to be in place for falls, moving and handling (assisting the transfer of a person who is unable to do so independently), nutrition and any specific risk to an individual. One resident had a risk assessment related to the use of a wheelchair and for the affects of the sun. Another resident had a very detailed risk assessment regarding their challenging behaviour, which would assist care staff to manage this behaviour. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. Any preferred name of a resident is included in their care file and was used by staff, showing that residents’ wishes are respected. Twice a year the home offers all residents the opportunity to go on short holidays. Five residents are able to go on each occasion as staff accompany on a one to one basis. Those residents who are unable to afford the holiday are assisted from the residents Welfare Fund (money that has been raised by staff, residents and the home’s League of Friends). Visitors spoken with said that they were made to feel welcome and other residents confirmed that this was also the case for their visitors. Visiting was at any reasonable time. Residents were able to make choices in their daily lives, for example in when they get up and go to bed, in choice of meals and where those meals are taken. They were also able to bring in personal possessions that could be safely housed in their rooms. A meal was taken with residents on the second floor of the home. The mealtime was lively with staff ensuring that it was a social event for the residents. The meal of the day was liver with new potatoes, broccoli, and cabbage, with an alternative of sausage or cheese salad if preferred, and followed by plums and custard or ice cream. The meal was tasty, nourishing and well presented. Residents made positive comments about the food such as, “The food is good.” The home offers the people living there comfortable surroundings, which apart from some minor shortfalls are clean, free of offensive odour and generally safe and well maintained. There are several areas of the home that have recently been decorated, refurbished and recarpeted to improve the comfort for the residents. There are further plans for improvement of the surroundings. The home had appropriate hand washing facilities with disposable towels and soap dispensers to maintain infection control. Protective clothing was available WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 7 and staff have attended Infection Control training to give them the knowledge to further maintain cross infection and safeguard residents. The home has ancillary staff with between one and three domestic assistants during most of the daytime and between one and two catering staff covering the hours of 08.30am and 06.15pm. This reduces the chances of care staff being taken away from time with residents to carry out domestic or catering tasks. The home is on target for the required 50 of the care staff having achieved National Vocational Qualification in Care Level 2 or 3, with 47 already having done so and a further 14 working towards the qualification. This shows that the staff are competent in carrying out their role. The registered manager said that staff supervision was on target to be given six times a year and this was evidenced in the care files that were looked at. Supervision gives staff the opportunity to discuss their role in the home, their practice, professional development and training needs and to address these as required. Comments about staff made by residents spoken with included, “They’re wonderful” and “They’re good girls.” What has improved since the last inspection? All care plans looked at had been signed by the resident, indicating that they had been involved in drawing up the plan and approved of the care to be provided. They had also been dated and signed by the members of staff who had written them. Care plans were more detailed and provided more specific information than at the last inspection. Systems of management and administration of medication were observed were generally in good order. Senior staff had audited medication and a random audit carried out at the visit on medication, including controlled drugs, was satisfactory. Those staff responsible for medication had completed Medication Distance Learning programmes to give them the knowledge and skills to safeguard residents. The home had an effective key security procedure that included evidence of who was responsible for the keys at all times. There was evidence that complaints were managed promptly and records were maintained as to the content of the complaint and the action taken to resolve it. Staff had attended training related to adult Protection in order to give them the knowledge and skills required to identify, and protect residents from, abuse. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 8 Whilst not every bedroom had a second chair for visitors the registered manager advised that there is always a chair available for them to take to the resident’s bedroom. A rota is now kept showing whether the hours have been worked or not but the capacity in which each member of staff works needs to be added. All files examined contained the appropriate information with evidence that Criminal Records Bureau and Protection of Vulnerable Adults checks had been carried out before the person was appointed, in order to safeguard residents from unsuitable employees. The registered manager stated that environmental improvements in the last 12 months included seven bedrooms and the dining rooms on the first and second floors having been decorated and recarpeted. Some new dining room furniture had also been provided. The registered manager said that staff supervision was on target to be given six times a year and this was evidenced in the care files that were looked at. Supervision gives staff the opportunity to discuss their role in the home, their practice and their professional development and training needs and to address these as required. Random health, safety and welfare checks were made. All records related to fire prevention and detection were up to date; hot water temperatures had been taken and were close to 43°C to prevent accidental scalding; hoists had been services and checked at appropriate intervals. Regulation 37 notifications are now completed for any relevant incidents that occur in the home and forwarded to us. Copies were also available in the home. What they could do better: Due to the formats used the care plans were difficult to extract information from because of the volume of documentation, some of which was repetitive. Discussion with people working at the home confirmed that they would have to look through a large amount of records before finding the specific information they wanted. The section for personal hygiene did not include headings for nail and foot care and this creates the risk of these areas not being met. Whilst the policy of the home was that care plans were to be reviewed at a minimum of monthly those looked at had not been reviewed for two months and had not been brought up to date, creating the risk of the appropriate care not being provided. Those residents’ care files looked at did not include a pressure sore (a break in the skin due to pressure, which reduces the blood supply to the area) risk WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 9 assessment. These omissions have the potential for pressure sores not being prevented. There is a key worker system, which should enable staff and residents to build up a relationship and for needs to be better met. However one person said that they did not get a bath when their key worker was away. Other residents spoken with were not sure if this happened to them or not. Some creams in the home were not named or did not have the date of opening on them. Both of these are necessary to prevent cross infection if used by more than one person and because the contents can become unstable if they have been open for too long. Some eye drops were also not dated on opening. This is needed as they should to be disposed of after 28 days both for infection control purposes and because the drops can become unstable after this time. There does not seem to be a consistent approach to activities provided at the home. a few residents join the activities in the day centre but there is no designated activity organiser for the residents and care staff have to find the time to facilitate these. An out of date activities programme was on display in the home. Apart from residents not having any information about forthcoming activities, this could be misleading and disorientating for them. No activities were seen to be taking place during the visit, although the day centre was not visited where some residents join in the activity sessions. Relatives spoken to during and after the visit felt that there was not sufficient activity to stimulate people living at the home. Although there are written copies of the complaint procedure available to residents and visitors one person spoken with said that they were concerned about making a complaint in case there were repercussions. The management needs to ensure that all residents and visitors are fully aware that they do not need to feel intimidated into not making complaints about the care or other services provided. Staff had attended training related to adult protection in order to have the knowledge and skills to identify abuse and to safeguard residents from abuse. The carpet in the ground floor dining room was very soiled and there was a faint offensive odour in the room. This needs to be addressed. Not all ensuite facilities had a towel for residents to use during the day and creams, pads, disposable gloves and wipes were stored on the floor and cistern in one ensuite. Pads were stored indiscreetly in some of the other bedrooms looked at. Better storage space needs to be considered. Staff rotas provided did not all include the capacity in which the member of staff worked. The majority did not include the surname of the member of staff. A separate rota was written for each department of staff but some of these were not titled. Whilst the people working at the home would recognise who worked where this is not sufficient for inspection purposes. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 10 The rotas and discussion with the registered manager showed that there are meant to be five to six care assistants on duty in the morning and five in the evening but on occasions at weekend there are only two or three in the evening. Discussion with visitors/ relatives during and after the visit confirmed that there had been occasions when there was not enough staff available to take residents to the toilet when they asked and that their relatives had been told that the staff were too busy. There are two waking care staff on duty during the night. The registered provider needs to consider and monitor if this is sufficient to meet the needs of residents in a timely manner given the number of residents and the accommodation being provided over three floors. A resident was struggling to understand an overseas employee despite the sentence being repeated several times. The member of staff was caring and gentle but the resident became embarrassed about not knowing what was being said. The home needs to ensure that all necessary support is given to improve the English of any overseas staff and that in the meantime there is a system in place that supports the residents to be able to understand what is being said and to be understood. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 11 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 WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 Quality in this outcome area is adequate. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met although there were some shortfalls. Some effort is made to have the knowledge and skills to meet specialist, cultural and religious needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As a Local Authority service referrals are made directly via Social Services following an assessment of need carried out by the allocated social worker. One of the home’s senior staff then makes a pre-admission visit to the prospective resident to assess that the home is able to meet their needs and the prospective resident is invited to visit the home before deciding if they want to live there. Residents spoken with confirmed that they or their relative had visited the home prior to moving in. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 13 Three care files were examined during this inspection visit as part of the case tracking process. These files confirmed the process described in the AQAA, and included copies of the social worker’s assessments and records of the home staff visit to the prospective resident. Residents spoken with confirmed that they or their relative had visited the home prior to moving in. Assessments covered the required assessment areas in sufficient detail to formulate a care plan. All of care files seen had a care plan that had been devised from the assessments of the individual resident. However not all relevant information was included in the assessments, for example the past medical history of one assessment did not include a serious condition that was referred to by the manager, and as this information was therefore not in the care plan could lead to any related physical or emotional needs not being recognised or met. The home also caters for short stay residents on the ground floor of the premises. The registered manager advised that many of these short stay service users stay regularly at the home and become well known to staff. They are visited prior to their first visit to the home but the registered manager also advised that it is not always practicable to make a pre-admission assessment visit on each occasion although records looked at showed these are revised and updated on each admission. Evidence was seen in staff files that they have attended training related to Dementia, Parkinsons Disease and Diabetes in order to have the knowledge and skills to meet these specialist needs. Discussion with staff, looking at training records and the AQAA showed that staff undertake training related to Equality and Diversity to assist in the understanding and meeting of specific needs of residents related to, for example, race, gender, disability, sexual orientation, religion and age. Observations made at the visit confirmed that the needs and preferences of these people living at the home are addressed. Church services are held at the home and the AQAA states, “each church in the Whitnash area has been invited into the Lawns to carry out services for those service users who practice their religion”. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. There are shortfalls in care plans that carry the risk of residents’ needs not being met. Medication procedures and practices safeguard residents. Residents have access to health care professionals and are cared for in a respectful manner although some concerns were raised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. Each had a detailed care plan in place in order that care staff have the information they require to provide the care to the residents, with specific details as the type/amount of care required. It was difficult to extract information from the care files due to the number of forms used and the amount of information required to be recorded in them. staff confirmed that it was laborious to work through this to find the specific information they wanted. The section for personal hygiene did not include WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 15 headings for nail and foot care and this creates the risk of these areas not being met. All residents are allocated a key worker and the care plans are drawn up with this worker and the assistance of a senior member of staff. All care plans looked at had been signed by the resident, indicating that they had been involved in drawing up the plan and approved of the care to be provided. They had also been dated and signed by the members of staff who had written them. Whilst the policy of the home was that care plans were to be reviewed at a minimum of monthly those looked at had not been reviewed for two months and some were not up to date. For example one resident had a pressure area problem that was not referred to in the care plan or in the review and had not been added to a wound care record. This resident’s care file and that of other residents’ looked at did not include a pressure sore (a break in the skin due to pressure, which reduces the blood supply to the area) risk assessment. These omissions have the potential for pressure sores not being prevented. Risk assessments were seen to be in place for falls, moving and handling (assisting the transfer of a person who is unable to do so independently), nutrition and any specific risk to an individual. One resident had a risk assessment related to the use of a wheelchair and for the affects of the sun. Another resident had a risk assessment regarding their challenging behaviour. This was carried out in detail and a copy was displayed in the resident’s ensuite to ensure that staff had instant access to what care to put in place if the resident presented with any of the behaviours that had been identified as a concern. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for although one resident was seen to need nail care. One resident case tracked was unable to express their opinion of the services provided but a relative in the home at the time of the visit said that they were happy with the care provided and that their relative was well looked after. Systems of management and administration of medication were observed and were generally in good order. Tablets had been audited and a random audit carried out at the time on general medicines and controlled drugs was satisfactory. Discussion with senior staff, and comments in the AQAA, showed that although all staff receive training from the pharmacist about the medication system WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 16 used at the home and that those staff responsible for medication complete a Medication Distance Learning programme to give them the knowledge and skills to safeguard residents. Some creams in the home were not named or did not have the date of opening on them. These are necessary to prevent cross infection if used by more than one person and because the contents can become unstable if they have been open for too long. Creams should be disposed of two months after opening and ointments containing an active ingredient should be disposed of one month after opening. Some eye drops were also not dated on opening. These need to be disposed of after 28 days both for infection control purposes and because the drops can become unstable after this time. Residents were seen to be cared for in a respectful manner throughout the visit but one person spoken with said that although most of the staff were “very good” they had heard a member of staff speaking inappropriately to a resident. The person had not wanted to report this in case there was some come back on their relative. Another person said that they would not call for assistance at night again as staff told them how busy they were and asked “why are you calling us again?” This is not an acceptable response and does not treat the person with respect. However other residents spoken with answered yes to the question of whether staff treated them respectfully. Any preferred name of a resident is included in their care file and was used by staff. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. There is not a consistent approach to activities in order to stimulate and occupy residents. Visitors were made welcome. Residents had choices and control over their daily lives. Residents enjoyed the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have a designated activity organiser and care staff are responsible for making activities possible for residents. The registered manager advised that she is hoping that a planned recruitment of a member of staff in the day centre will also provide hours to be used in this capacity. The registered manager advised that a few residents did attend the day centre to join in their activities. An activity programme was displayed in the ground floor dining room and although this included pictures that would be useful to residents with either visual impairment or limited understanding it was for the two months prior to WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 18 the inspection visit. This meant that residents did not have any information about forthcoming activities and this notice could be misleading and disorientating for residents. The activities offered included dominoes, quizzes, video films, card games and contracted entertainment. The AQAA said that family and friends are encouraged to join in any activity, although relatives spoken with were uncertain when and what activities took place and felt that there was not enough going on to stimulate residents. The registered manager and AQAA advised that all local churches of religions followed by residents are invited to visit the home to enable residents to continue to follow their religion. There were currently church services and communion from local Catholic and Methodist churches held at the home. The manager advised that special occasions are celebrated and local schools, Guides, Brownies and the Salvation Army and local churches are encouraged to bring in activities/entertainment for the residents’ benefit at these times. There were no activities observed in the residential part of the home during the day of the visit, although some staff took a break in the lounge in the afternoon and spent the time chatting with the residents sitting there. Twice a year the home offers all residents the opportunity to go on short holidays. Five residents are able to go on each occasion and staff accompany on a one to one basis. Those residents who are unable to afford the holiday are assisted from the residents Welfare Fund (money that has been raised by staff, residents and the league of friends). Visitors spoken with said that they were made to feel welcome and other residents confirmed that this was the case for their visitors. Visiting was at any reasonable time. Residents were able to make choices in their daily lives, for example in when they get up and go to bed, in choice of meals and where those meals are taken. They were also able to bring in personal possessions that could be safely housed in their rooms. This was noted during the tour of the home where it was seen that some residents had brought in small pieces of furniture, including ornament filled glass cabinets, and pictures, photographs and plants. This made their surroundings more homely and personal. There are dining rooms on all three floors with the ground floor having a large area adjacent to the kitchen and a sitting area and which had originally been the only dining room. This and the adjoining sitting area is used mainly by short stay/respite service users. A meal was taken with residents on the second floor of the home. The mealtime was lively with staff ensuring that it was a social event for the residents. However the dining room on this floor was rather small with WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 19 insufficient space for all residents living on the second floor unit to dine there. The staff advised that there were always people who preferred to eat in the bedroom. The meal of the day was liver with new potatoes, broccoli, and cabbage, with an alternative of sausage or cheese salad if preferred, and followed by plums and custard or ice cream. The meal was tasty and well presented. Orange squash was available during the meal and tea or coffee served afterwards with residents enabled to take a leisurely pace. Staff were available to offer assistance if required and this was given sensitively and discreetly. Residents made positive comments about the food such as, “The food is always good.” WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has effective policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure implemented by the Local Authority that is displayed in the home for residents and visitors to know the formal process of making a complaint. This consists of several stages with different time scales from ‘on the spot’ solutions; stage one when complaints made to the home manager needing a written response within ten days; stage two when the complaint is dealt with by the Local Authority’s Customer Relations Team and a response is given within 28 days; stage three when an independent person and two County Councillors review the situation. The procedure is straightforward and easy to follow. Evidence that complaints are dealt with promptly and taken seriously was seen in the complaints records held in the office and in a resident’s file when a response was given the day after a complaint had been received. Most people spoken with said that they knew who to speak to if they had any concerns, although one person said that they were frightened of making a complaint in case there were repercussions as a result. A suggestion box is also in place in the home so that people can make anonymous complaints if they wish. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 21 Staff had attended training related to adult protection in order to have the knowledge and skills to identify abuse and to safeguard residents from abuse. Staff spoken with confirmed their awareness, and what to do if they suspected it had taken place. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,26 Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which apart from some minor shortfalls are clean, free of offensive odour and generally safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Accommodation at the home is on three floors. There is a large reception/ sitting area on the ground floor and the day centre is off this area. Opposite to the day centre is a dining/sitting area and is a thoroughfare to main kitchen. The carpet here was very soiled, looked very old, and was in need of urgent attention. There was also a faint offensive odour in this area. Lighting here was domestic, and very attractive but the light emitted was dull and likely to be insufficient for residents to read or eat by. One of the dining tables and a WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 23 dining chair was raised to accommodate the needs of a resident but this had also isolated the resident from other people dining in the room. Storage continues to be limited and the hoist and a specialised chair had to be stored under the stairs. A further hoist was stored in a bathroom. There is also a lounge and a separate dining room on the other two floors. The dining rooms were attractively decorated and furnished but small. The lounge on the first floor had a shabby settee, a variety of different armchairs and two different patterns and styles of window dressing, all detracting from the comfort of those people using the room. A ceiling tile in one of the corridors was stained and in need of repair or replacement. Other ceiling tiles were stained and unsightly. The AQAA stated that improvements in the and last 12 months included seven bedrooms, which were not viewed at the visit, and the dining rooms on the first and second floors having been decorated and recarpeted. Some new dining room furniture had also been provided. During the visit the home was being assessed by a member of the Local Authority with regard to the funding that had been acquired by the home for replacement corridor carpets and redecoration. Bedrooms viewed were personalised and in reasonable decorative state, although one bedroom carpet had a bad stain by the bed. Not all ensuite facilities had a towel for residents to use during the day and creams, pads, disposable gloves and wipes were stored n the floor and cistern in one ensuite. Packets of incontinence aids were stored on full view in some of the bedrooms looked at and should be stored more discreetly in order to maintain the dignity of the occupant of the room. An extension lead was being used in one bedroom as although there were four plug socket sites three of them were single sockets and the occupant of the room had an electric adjustable bed and chair, a radio and a bedside light. A risk assessment needs to be in place for the extension lead. Whilst not every bedroom has a second chair for visitors the manager advised that there is always a chair available for them to take to the room. All areas of the home looked at were clean and, apart from the ground floor dining/sitting room, were free of offensive odour apart from the area already mentioned. The laundry room housed washing machines that had the appropriate cycles for controlling infection although there was no sink/drainer for sluicing soiled clothing or linen. The home had appropriate hand washing facilities with disposable towels and soap dispensers to maintain infection control. Protective clothing was available WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 24 and staff have attended Infection Control training to give them the knowledge to further maintain cross infection and safeguard residents. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are not always sufficient staff on duty to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas provided did not all include the capacity in which the member of staff worked. The majority did not include the surname of the member of staff. A separate rota was written for each staff department but some of these were not titled. Whilst the people working at the home would recognise who worked where this is not sufficient for inspection purposes. The registered manager said that there were meant to be six care staff each morning and four each evening, including staff responsible for respite care/short stay service users. The rotas also showed that there are meant to be five to six care assistants on duty in the morning and five in the evening but on occasions at weekend there are only two or three in the evening. Discussion with visitors/ relatives during and after the visit confirmed that there had been occasions when there were not enough staff available to take residents to the toilet when they asked and that their relatives had been told that the staff were too busy. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 26 At least one senior member of staff is on duty throughout the day and evening, supporting the manager and being in charge of the home in her absence, and a clerical assistant works 20 hours a week. There are two waking care staff on duty during the night. The registered provider needs to monitor and consider if this is sufficient given th eneeds of the residents and the accommodation for residents being over three floors. There is a key worker system, which should enable staff and residents to build up a relationship and for needs to be better met. However one person said that they did not get a bath when their key worker was away. Other residents spoken with were not sure if this happened to them or not. The home has ancillary staff with between one and three domestic assistants during most of the daytime and between one and two catering staff covering the hours 08.30am and 06.15pm. There is therefore less chance of care staff being taken away from time with residents to carry out domestic or catering tasks. The home is on target for the required 50 of the care staff having achieved National Vocational Qualification in Care Level 2 or 3, with 47 already having done so and a further 14 working towards the qualification. This shows that these staff are competent in carrying out their role. Three staff files were examined on the day of the visit. all files contained the appropriate information with evidence that Criminal Records Bureau and Protection of Vulnerable Adults checks had been carried out before the person was appointed in order to safeguard residents from the appointment of unsuitable employees. The staff files confirmed that new staff undertake induction training that meets the required standards. There was also evidence to support that agency staff receive an induction of the home to ensure that they the basic information that they require to carry out their job. Other training undertaken by staff included Food Hygiene, Fire Awareness, Dementia, Parkinsons, Diabetes, Infection Control, giving them the knowledge and skills to meet these needs. During the visit a resident was struggling to understand an overseas employee despite the sentence being repeated several times. The home needs to ensure that all necessary support is given to improve the English of any overseas staff and that in the meantime there is a system in place that supports the residents to be able to understand what is being said and to be understood by staff. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. A person undertaking the appropriate qualification and who has previous management experience manages the home. There is a system in place to ensure that all services operate in the best interests of residents. The health, safety and welfare of residents are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager had been at the home for three years. She had completed the Registered Managers Award and in the process of completing the National Vocational Qualification Level 4 in Management. The completion of this training will give her the appropriate qualifications for the post. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 28 Staff, residents and relatives spoken with said that the registered manager was approachable and staff felt supported by her. The Assistant Manager and four Care Officers support her in the management responsibilities. The home had a detailed Quality Assurance Programme that was implemented by the Local Authority. This seems quite unwieldy and time did not permit a full examination at this visit. The Programme audits all areas of the service against given standards to measure if these are met or to take action if not. The Programme also includes feedback surveys to residents in order to ensure that they are satisfied with the service they receive. Someone who is not connected to the home in order to maintain objectivity carries this out. Regulation 26 unannounced visits take place monthly and reports of the visit are forwarded to us and to the registered manager. This demonstrates that the registered provider is monitoring the service and making changes to improve the service. The registered manager advised that residents are encouraged to look after their own finances and valuables and have a secure space in their bedroom in which to keep them. Some small amounts of money are held by the home on behalf of the residents. This is kept in a secure location in individual packets. Transactions are maintained by the clerical assistant and at the time of the inspection were in good order. The Local Authority no longer carries out a regular independent audit. The registered manager said that staff supervision was on target to be given six times a year and this was evidenced in the care files that were looked at. Supervision gives staff the opportunity to discuss their role in the home, their practice and their professional development and training needs and to address these as required. Random health, safety and welfare checks were made. All records related to fire prevention and detection were up to date; hot water temperatures had been taken and were within the range of close to 43°C to prevent accidental scalding; hoists had been services and checked at appropriate intervals. No other health and safety concerns were identified during the visit. Regulation 37 notifications are now completed for any relevant incidents that occur in the home and forwarded to us. Copies were also available in the home. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X 2 X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Information in residents’ care plans must be able to be easily accessed by care staff. This will enable staff to provide the care required to meet the individual needs of the residents. All residents must have an up to date care plan that is reviewed at monthly intervals and when there is any change in the individual’s circumstances. This will ensure that the residents receive person centred support that meets their needs. 2. OP8 12 All residents must be assessed for the risk of pressure sores. This will ensure that they are safeguarded from these sores occurring. All personal care must be maintained for all residents and their wishes considered. This will ensure that their needs are met. Ointments and eye drops must be dated on opening. This will ensure that residents are safeguarded from receiving unstable medication. DS0000041886.V339251.R01.S.doc Timescale for action 15/09/07 15/09/07 3. OP8 12 30/08/07 4. OP9 13 30/08/07 WCC - The Lawns Version 5.2 Page 31 5. OP10 12(4)(a) When staff speak to residents this must be in a respectful manner. This will ensure that the dignity of the resident is maintained. The home must provide adequate and safe storage for aids and equipment. This will safeguard residents and improve the appearance of the home. All areas of the home must be clean and free of offensive odours. This will give the residents hygienic and pleasant surroundings. The home must have sufficient staff in numbers and skill mix in relation to the number and needs of residents and the size and layout of the home. This will safeguard the health, safety and welfare of the people living and working at the home. The timescale of 30/11/06 was not met. 30/08/07 6. OP22 23(2)(l) 30/10/07 7. OP26 23(1)(d) 15/09/07 8. OP27 18(1) 30/10/07 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. Refer to Standard OP12 OP16 OP22 Good Practice Recommendations All the residents at the home should have the opportunity to be involved in stimulating activity of their choice on a regular basis. Residents and visitors should be made aware that complaints will be listened to without fear of repercussions. The home should explore the possibility of improving facilities for hearing and visually impaired service users such as by installing a loop system. (not assessed on this DS0000041886.V339251.R01.S.doc Version 5.2 Page 32 WCC - The Lawns 4. 5. 6. OP25 OP27 OP38 occasion and outstanding from inspection on 05/02/07) Al light fittings should be of sufficient brightness for the people living at the home. The home should make all efforts to ensure that residents are able to understand residents and that the are understood by staff. A risk assessment should be carried out on any extension leads used in the home. WCC - The Lawns DS0000041886.V339251.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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