Inspection on 19/09/06 for WCC - The Lawns

This inspection was carried out on 19th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 18/07/07

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 Jean Thomas Key Unannounced Inspection 19 September 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address WCC - The Lawns DS0000041886.V310579.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.V310579.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.V310579.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 January 2007. 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. 6th February 2006 Date of last inspection Brief Description of the Service: The Lawns is a 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 near by. 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 £90.65 £369.11 per week and payable usually in advance by either cheque, direct debit or standing order. The fees do not include newspapers, toiletries, chiropody or hairdressing. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The inspection visit was unannounced and took place on Thursday September 28th 2006 commencing at 09.30am and concluding at 4.45pm. The inspection involved: • • • Discussion with two senior care officers and three care workers, kitchen assistant and cook. Observations at a mealtime. Two residents were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. An inspection of the environment was undertaken, and records were sampled, including staff training, health and safety, staff rotas, complaints and fire records. The inspector spoke with one visitor and two visiting health care professionals about their experiences of the home. • • The inspector had the opportunity to meet most of the residents and talked to three of them about their experience of the home. The residents were able to express their opinion of the service they received to the inspector. General conversation was held with other residents, along with observation of working practices and staff interaction with residents. A number of residents with cognitive impairment or dementia were unable to express their views or experiences of the service provided, therefore placing greater emphasis on observation and interaction between residents and of staff. Because of sickness absence, the Registered Manager and the Acting Manager were unavailable. In their absence, a temporary Deputy Manager supplied by an employment agency had been appointed to manage the care home and had recently returned following five-weeks sickness absence. At the time of the visit, two senior care officers were available and cooperated fully with the inspection. Since the last inspection on February 6 2006, we have not received any complaints or reports of alleged abuse and were notified by the home of one incident involving an error in the administration of medication. The home had received one complaint. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 6 Before the inspection visit, 35 questionnaire surveys were sent to residents and their relatives. At the time of writing this report, 21 residents and six relatives had responded. An audit of information held on the questionnaires found the majority of residents liked living in the home and all indicated they were well cared for and had their privacy respected. One resident commented: Very comfortable and convenient, people are kind and friendly to each other Relatives also expressed general satisfaction with the service provided comments noted include: • • • • I am very pleased with the care my wife gets. I visit twice a day and get 2 cups of tea Excellent care all-round Very pleased with the staff and general ethos It’s a really wonderful care home. Mom is so lucky to be at such a warm friendly place. Everyone is so good and we are always made so welcome. A big thank you to all of them Although “very satisfied” with the overall care provided one relative expressed concern that the home was short staffed at weekends and the care staff have to do extra work by the cleaning and washing as well is receiving more visitors. They do their best but this must have a knock-on effect. A number of requirements and recommendations against the regulations or minimum standards were outstanding from the last inspection report. The inspector would like to thank staff and residents for their cooperation and hospitality. What the service does well: All residents had received a pre admission assessment and were invited to visit the home before making a decision to move there. The trial period following admission enabled the individual to decide if the home was the right place for them. Residents said they were treated with dignity and respect, were comfortable in the home and with the people supporting them. They were smart in their appearance, with clothes looking fresh and clean. Staff presented as kind and caring and the food provided was nutritious and plentiful. Residents were able to personalise their rooms and could bring small items of furniture into the home with them. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 7 Although the staff appeared rushed, the home had a warm and caring atmosphere. What has improved since the last inspection? What they could do better: The home was in urgent need of refurbishment and decoration to enhance the environment for those living in the home. Gaps were identified in care planning, recording and monitoring care practices. Information held on care plans needs to be expanded to reflect the complexity of the care to be provided and provide staff with clear instructions as to how individual needs are to be met. Daily records and monitoring records must also demonstrate how individual care needs have been met and include lifestyle choices, so that we can be sure residents are safe and their care needs met. Further work is necessary to make sure risk assessments are carried out for all residents and suitable preventative care plans developed where required. There is an absence of social and therapeutic stimulation therefore residents are not engaged and do not have opportunity to pursue hobbies or to develop and participate in any new interests. An annual quality audit seeking the views and opinions of the residents, their relatives and other stakeholders should be carried out and an internal audit WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 8 and a copy of the findings should be distributed to stakeholders and a copy displayed in the home. In the absence of the Registered Manager, the Registered Provider must ensure the staff have appropriate levels of support and instruction necessary to carry out their duties and responsibilities appropriately and effectively. In order to make sure the staff are appropriately trained and attend regular updates, staff training records need to accurately reflect what training has occurred and identify any gaps in learning. The absence of regular fire drills/practice in the home is unsafe and action to make sure the staff attend regular fire drills/practice is required so that we can be sure people in the home are not placed at unnecessary risk. Appropriate pre-employment security checks were not always carried out therefore an audit of staff recruitment files is required to determine whether all the relevant information necessary to determine fitness has been secured so that we can be sure residents are protected. 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. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Prospective residents and family members are encouraged to visit the home before admission. A care needs assessment is undertaken to determine whether the home is able to meet the individuals needs. EVIDENCE: Before moving into the home prospective residents have their initial care needs assessed by a social worker and are encouraged to visit the home before making a decision whether to move in. There is an agreed trial period of usually four weeks and a review date set as soon as the resident moves into the home. In addition, the Registered Manager and a senior care officer also visit prospective residents in their own home to assess their care needs and to provide information about the home. A record of the initial care needs assessment was held and used to determine whether the residents care needs can be met. Three out of four residents spoken with said they had been given WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 11 the opportunity to visit the home before admission but had chosen not to do so preferring instead to have family members visit on their behalf who had then shared their views and opinions of the service. One resident spoken with could not remember whether she had been invited to visit the home and had moved in after being discharged from hospital. The resident did not think she would have been well enough to make the journey to and from the home. The home also provides a respite care service and people using this service also have their needs assessed prior to the first admission to the home. Regular routine assessments are not always carried out prior to any further admission for respite care therefore staff may not be aware of any changes in the service users personal care needs or circumstances. The shortfall was identified during the last inspection and remains outstanding. Two initial care needs assessments examined held some information about the residents background; personal circumstances and care needs, but was limited and failed to include key information about the residents abilities and limitations: what aspects of personal care they could manage themselves and what if any practical assistance was needed. The initial care needs assessment forms the basis of the resident’s care plan, which is recorded and agreed shortly after admission. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 10 and 11 Quality in this outcome is poor. This judgment has been made using available evidence including a visit to the home. Residents are treated respectfully and their right to privacy promoted and maintained but the absence of accurate and detailed care plans and risk assessments place residents at risk of not having their care needs met. EVIDENCE: The personal profiles and care records of two residents identified for case tracking were examined. The range of information held in the care plans varied and did not always provide staff with the information they required to meet the residents care needs for example: the care plan states needs assistance with personal care but failed to identify the nature of the support or assistance required. Plans were not revised to reflect any changes, for example information held on daily records found that a resident diagnosed with dementia often presented as being agitated and disorientated and that staff sometimes applied ointment (Sudocreme) to an area regularly referred to as red and sore. Details of the residents mental state or of the need for treatment was not included in the care plan and there was nothing to suggest that medical advice from a GP or community nurse regarding the residents care had been sought. The care plan identified the need to go to the toilet WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 13 regularly but failed to include frequency. Discussion with a senior care officer found that the residents needs had changed and regular toileting was no longer considered appropriate. This information was also not included in the care plan. A second care plan highlighted the need for ‘Haloperidol’ medicine to be given when necessary but failed to identify the circumstances when the medicine was to be administered. Daily records seen did not show what care and support had been given to the residents, so it is not clear whether these needs were being met. Risk assessments for the prevention of pressure sores and moving and handling were in place, but a risk assessment for the prevention of falls had not been undertaken for a resident assessed as being prone to falls or another resident identified as having challenging behaviours and identified as being at risk of harming themselves or others. A risk assessment dated July 2005 reported, does not move around in bed the care officer spoken with said the risk assessment was out of date as “the resident did move around in bed and now has bed rails fitted to reduce the risk of falling out of bed”. The absence of risk assessments to prevent falls, the safe use of bed rails and care plans for managing challenging behaviours is unsafe and place residents and staff at risk of harm or injury. Examination of the care plans; daily records and other documentation found residents had regular access to GPs; community nurses; optician; chiropodist dentist and community psychiatric nurse. Two visiting health care professionals spoken with said they visited the home regularly to carry out health care treatments such as wound dressings, administering insulin injections and monitoring a urinary catheter site for signs of infection. Comments noted include: • Health care treatments and consultation are carried out in private • Staff follow any instructions and seek advice when necessary • I think residents are well cared for • The staff are kind caring and Ive never been concerned Advice about continence management is sought from the community nurse who carries out an initial assessment of needs and then if necessary further advice is sought from the continence team based at the rehabilitation Hospital in Royal Leamington Spa. Residents with diabetes have their blood sugar levels monitored by staff at the home that had been trained by community nurses or a physiotherapist. The level of care provided to residents with life limiting illness was described as being excellent very caring. A range of equipment and adaptations that encourages and promotes independence are available, for example: grab rails; raised toilet seats; bath WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 14 hoist and a mechanical hoist used to assist with transferring. Residents requiring specialist equipment such as a pressure relieving mattress, cushion or hospital type bed have their needs assessed by the community nurse who also provides any equipment deemed as necessary to promote the health and well-being of the resident. A number of staff were spoken with and all were able to demonstrate an acceptable level of knowledge and understanding of the individual needs of the residents in their care. Observations of staff practices found staff responded promptly and sensitively to the individual needs of residents. A number of residents experienced some degree of cognitive impairment or had been diagnosed as having dementia and were not therefore able to express their views of the service to the inspector. Three residents spoken with were able to express their views and said the staff were always kind and considerate and responded appropriately to any request for assistance. None of the residents spoken with were aware of their care plan two residents said they had been involved in a review shortly after admission to the home. Observations of staff practices found that residents had their personal care needs attended to in private and discussion with two residents confirmed consultations with health care professionals or treatments were carried out in the privacy of the residents own room. Residents were appropriately dressed and their clothes clean and generally well cared for. Examination of the storage and handling of medication found that although medication was generally well managed there were a number of shortfalls noted that may place residents at risk of not having their health care needs met for instance: • The date eye drops were opened was not recorded therefore, we could not be sure they were being used within the timescale identified by the manufacturer. • The absence of records detailing the number of Co-codamol tablets administered to a resident prescribed one or two tablets to be given when necessary is unsafe and may place the resident at risk. • 28 Omeprazole tablets had been received by the home five were administered and 24 tablets remained therefore medication was not always administered as prescribed. • The medication administration record states Adcal to be administered twice a day and the instructions on the box holding the medication state daily. Discrepancies in the administration of medication should be identified when the medication is received by the home and clarification about dosage sought from the dispensing pharmacist. Since the last inspection, we were notified by the home of one incident involving the misadministration of medication that resulted in a resident being given the incorrect amount of medication for two days. Observations in the dining room on the ground floor found the medication trolley and keys were WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 15 left unattended. This was brought to the attention of a senior care officer who said, “this should not have happened” and would make sure the medication trolley and keys were always held safely and securely. The inspector was told that only appropriately trained and designated staff administered medication. The absence of the Registered Manager, Acting Manager and more recently the relief Deputy Manager was identified by staff as a contributing factor to the shortfalls identified above. Staff spoken with said they had not had sufficient resources or the guidance needed to: review and update risk assessments; care plans or to monitor the content of staff daily recording effectively. The shortfalls in outcomes for residents identified during the last inspection remained outstanding and must be addressed so that we can be sure residents needs are being met safely and appropriately. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. Residents are offered a varied and nutritious diet and choose how and where to spend their time but the absence of social stimulation and recreation may affect residents’ sense of well being. EVIDENCE: Examination of documentation and discussion with residents and staff found that shortfalls identified during the last inspection had not been fully addressed for example: Although an activities programme had been introduced, the choices made available to residents were limited. There were no regular daily activities and nothing to engage or stimulate residents. There were no opportunities to pursue hobbies or to explore any new areas of interest. The activity programme for September invited residents: to attend the autumn fete; take communion; purchase clothing from a visiting retailer or attend a music and movement activity. A weekend away to Southport was planned for five residents who could afford to go. The home did not employ an activities organiser and the provision of social and therapeutic stimulation was the responsibility of the care staff. Comments from four residents spoken with include “there was not much to do” “ I get bored I spend a lot of time sleeping in the chair. Observations found a number of residents spending time asleep in their armchair. A number of residents were watching TV, two WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 17 were reading newspapers and one was reading a library book. Residents meetings were no longer held regularly and the last recorded meeting took place on November 10, 2005. A senior care officer said she had consulted with residents before Easter to determine their preferences before planning the Easter festivities but failed to record the occasion. Staff spoken with said residents could choose how and where to spend their time and had no restrictions imposed on them. Residents spoken with confirmed there were no limitations placed on them. A number of residents with cognitive impairment or dementia were spoken to but were unable to express their views and in the absence of detailed care plans or daily recording we could not identify how residents spent their time or have knowledge or understanding of preferences and lifestyles. This shortfall must be addressed so that we can be sure all residents have their needs met. The home has a flexible policy on visiting that takes into account the individual needs of residents. Residents spoken with said they could receive visitors at any time and could meet with their visitors in communal areas of the home or in the privacy of their own rooms. One visitor spoken with said they were always made to feel welcome and were often offered a hot drink. A visit to the kitchen found a cleaning schedule in place to make sure all areas of the kitchen were regularly cleaned. Food preparation areas were clean and tidy. The storerooms, fridges and freezers held a variety of provisions. The menu was displayed in each of the three dining rooms so that residents were aware of the alternatives available. On the day of the inspection, the main meal of the day was cauliflower cheese; potatoes; carrots and peas or egg salad followed by gooseberry crumble and custard, fresh fruit was also available in some communal areas of the home. The home also caters for a number of specialist diets including diabetic, liquidised and gluten-free. Examination of documentation found that food offered to residents was nutritious and well balanced. One care worker spoken with said residents were made aware of the alternatives each morning and their preference recorded and given to the Cook. Observations at lunchtime found the staff reminding residents of alternatives should they wish to change their mind. Liquidised meals are cooked in advance and frozen and residents requiring a liquidise diet were not made aware of alternatives or of what they had been served. Residents requiring liquidised meals should be given alternatives and have the right to choose. A number of residents chose to take their meals in their rooms and a number required assistance to eat their food. Although appearing rushed the staff were generally available to provide residents with the assistance they needed. Cold drinks were available at lunchtime and hot drinks made available at other times during the day. Four residents spoken with said the food was always very good and they had no complaints. The food was transported to each unit WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 18 in a hot trolley, plated up in a kitchenette and served to residents either in their room or in the communal dining areas. Residents wishing to add salt or pepper to their meal had to request this from the staff as condiments were not available on the dining tables for offered to those residents taking their meals in their rooms. Discussion with the Cook found that all staff working in the kitchen had completed basic food safety training and the cook had completed training in Hazard Analysis Critical Control Points (HACCP). WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome is adequate This judgment has been made using available evidence including a visit to the home. The home has appropriate policies and procedures for the protection of residents, but the absence of staff training in recognising; preventing or responding to any possible abuse may place residents at risk. Complaints are listened to but may not always be responded appropriately. EVIDENCE: Since the last inspection on February 6 2006, we have not received any complaints or reports of alleged abuse. The home had received one complaint on July 19, 2006 and was about an unexplained injury to the leg and wrist of a resident. Examination of documentation failed to disclose details of any investigation or identify whether the complaint was upheld or whether the complainant was satisfied with the outcome. Information about how to complain is displayed in the home. A number of residents spoken to were not aware of the complaints procedure, but were aware of their right to complain and said they would do so if dissatisfied with any aspect of the service. Residents also said they felt listened to and felt that any concerns raised would be taken seriously and responded to appropriately. Staff spoken with said they were aware of the residents right to complain and would report any concerns to the senior staff. A comments and complaints box is available in the reception area of the home and enables residents or visitors to raise any concerns and to do so anonymously if they so choose. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 20 The home has a procedure for responding to allegations of abuse that provides clear guidance for staff. Three staff spoken with said they would refer any issues of concern about the safety of residents to the senior staff who would inform the Assistant Service Manager at Social Services. One staff member spoken with had only limited knowledge of how to identify any potential abuse and was unable to describe the different types of abuse that may occur. The staff member had not undertaken training in understanding adult protection or the prevention of abuse and was unaware of the ‘whistle blowing’ policy and procedure. Examination of documentation found that training on adult protection is to take place in October 2006 and one senior care officer allocated a place. The Registered Provider must ensure that gaps in staff knowledge are addressed appropriately and in a timely manner, so that we can be sure any potential risk to residents is minimised or eliminated. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24 and 26 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. Residents do not benefit from living in a well-maintained environment and access to some areas of the home including toilets and showers is restricted. EVIDENCE: A tour of the premises found that the environment was in need of some refurbishment and redecoration as the home was not kept in good decorative order and visitors spending time with residents in their room did not have a chair to sit on. A number of carpets in the home were in need of cleaning or replacing and the absence of sufficient storage facilities for wheelchairs and moving and handling equipment resulted in bathrooms being used for storage. A mechanical hoist stored in a shower room denied residents access to the toilet. A propane mattress and propad cushion were stored under the stairwell on the ground floor and directly under a sign stating strictly no storage in this area. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 22 Residents were encouraged to personalise their rooms and had brought some small items of furniture into the home with them. Three residents spoken with said they were very comfortable and had been able to choose the layout of their room. One resident invited the inspector into her room and to see the room after a family member had redecorated it for her. The room was clean bright and airy and had many personal possessions including an armchair, photographs ornaments and pictures hanging on the wall. In response to shortfalls identified during the last inspection, residents had been given a secure storage facility in their room in which to store medication or personal items and the home was free of offensive odours. A number of toilet doors had picture images displayed making them easier to locate. Three washing machines and a tumble dryer were used to manage the laundry service, which was generally well managed. The home employed a laundry person Monday to Friday 11am - 2pm and in the absence of the laundry person, care staff include the laundry tasks in their daily routines. Before it was returned to residents, clean laundry was placed in containers with a residents name on or on coat hangers on a clothes rail. Soiled linen was held in red bags and laundered separately at appropriate hot water temperatures to reduce risk of infection. Staff wore disposable gloves when carrying out personal care tasks or when handling soiled linen, and protective clothing when handling or serving food. Liquid soap and paper hand towels were available in the toilets and the laundry room and incontinence pads and clinical waste held and disposed of safely and appropriately. Examination of staff training records found that staff received training in the control and prevention of infection. Two staff spoken with were aware of the need to promote good hygiene practice at all times and of how to minimise the risk of cross contamination. For example making sure, they washed their hands before handling or serving food and after assisting residents with personal care tasks. Sluice rooms were available on the ground and first floor and used by staff to empty and clean any commodes and in response to shortfalls identified during the last inspection, the doors to the sluice rooms were secure. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. The absence of rigorous staff recruitment procedures is unsafe and residents do not benefit from having their care needs met by appropriate numbers of qualified or trained staff. EVIDENCE: Observations and discussion with staff found that although the home accommodated a number of residents with cognitive impairment or dementia, training in dementia care was not included in the staff training programme. The absence of appropriately trained staff may lead to residents care needs not being understood or met. Therefore, the staff-training programme should be reviewed and revised to include dementia care training. The organisation has a programme of National Vocational Qualification (NVQ) awards but the current number of qualified staff falls below the minimum standard expected. For example, a minimum ratio of 50 of the care staff should have been trained to NVQ level 2/3 or equivalent by 2005. Of the 24 care staff employed; eight have completed a NVQ level 2 in care and four are working towards achieving the award and completion would increase the number of qualified staff from 33 to 44 . The inspector was told that the home had been promised a further seven places for this year and completion would further increase the number of qualified staff to a ratio of 70 . Residents do not therefore currently benefit from having their care needs met WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 24 by sufficient numbers of suitably trained or qualified staff. Three members of staff spoken with were enthusiastic about training and keen to explore any opportunities made available to them. Two of those spoken with said they had completed a NVQ level 2 award in care. Four residents spoken with all said they thought the staff were kind and caring and understood their needs. Examination of the staff file of a recently appointed night care worker found some induction had occurred but the worker had not spent any time in the home during the day to learn about: the needs of the residents; the daily routines of the home; health and safety policies and practices. For example, there was no confirmation of the worker receiving instruction about fire procedures to include: the alarm system; emergency exits; emergency lighting; the location and use of fire fighting equipment; access to a phone to call the emergency services. The acting deputy manager and a senior care officer demonstrated a commitment to ensuring that the new worker received appropriate health and safety training. The absence of a structured staff induction programme was discussed with the acting manager and a senior care officer who were not fully aware of what was expected of them as this task was outside of what was considered to be there ‘normal’ roles and responsibilities and would usually be carried out either by the Registered Manager or under instruction. The Registered Provider must ensure new workers have a structured and appropriate induction into the workplace so that we can be sure residents’ health and welfare is promoted and maintained. A staff rota was maintained but did not include the name or the role of the worker as required and it was therefore difficult to determine whether there were sufficient, numbers of staff available to meet the individual needs of residents. Examination of the staff working rota and discussion with a senior care officer found that on the morning of the inspection there were 30 residents and a staff complement comprising of: two senior care officers; six care workers; a cook; two kitchen assistants; two domestic assistants; a laundry person and an administrator. Staff and residents spoken with and comments noted on a questionnaire survey from a relative found there had been difficulties securing appropriate numbers of staff more especially during any unplanned absence and gaps are filled by agency staff. A number of concerns were raised about the amount of time care staff spend carrying out secondary tasks at weekends and reducing the time available to meet the personal care needs of residents. The laundry person works Monday to Friday and outside of these hours responsibility for carrying out laundry tasks rests with the care staff. The number of care hours allocated at weekends did not take into account the additional tasks required of care workers and as the individual care needs of residents were unchanged the number of staff allocated should reflect the continuing care needs of residents. The Registered Provider should review the number of staff hours spent on laundry and other secondary tasks and ensure sufficient care hours are allocated to meet the needs. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 25 Three residents, four staff and one health care professional spoken with were of the opinion that the number of staff available was generally sufficient to meet the needs of residents but due to ill health staff absence within the senior team had placed additional pressures on the rest of the staff. One resident said, they are very good to us, nothing is too much trouble. Most of the interaction between staff and residents took place when staff were performing a caring task, there was insufficient time available for staff to spend time with residents just to socialise, chat and provide appropriate psychological support. Having made her way to a toilet a resident was heard calling for assistance and unable to locate a care worker the inspector activated the call alarm. The resident was in some distress and in the absence of a response by staff the inspector went to the office on the ground floor and requested someone respond to the residents call for assistance. The failure of staff to respond place residents’ health and welfare at risk and calls for assistance must be responded to in an appropriate and timely manner. The personnel file of a recently employed worker found that although a number of pre-employment checks, including a Criminal Record Bureau (CRB) disclosure and Protection of Vulnerable Adult (PoVA) had been secured a reference was not sought from the most recent employer and no exploration of gaps in employment history or current photograph held of the worker. Examination of a second staff file of a senior care officer employed for nine years failed to confirm whether a CRB disclosure or PoVA check had been carried out. Therefore, a notice requiring that the Registered Provider take action urgently to comply with the regulations and safeguard residents was left. Shortfalls identified during an inspection on January 31, 2005 resulted in a requirement that the Registered Provider carry out an audit of staff files to ensure documents and information required under regulations were maintained and available for inspection. This requirement remains outstanding and must be addressed. WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 36,37 and 38 Quality in this outcome is poor is judgment has been made using available evidence including a visit to the home. Residents do not benefit from having their care needs met by staff that are supervised and whose practices are monitored. Quality assurance monitoring is not regarded or implemented as a core management tool. EVIDENCE: Due to ill health, the Registered Manager had been absent since January 2006. In her absence, the Assistant Manager had acted up for a short period and in her absence (a number of weeks), a temporary relief Deputy Manager from an employment agency was appointed to manage the home. During a five-week period when the relief Deputy Manager was absent two, full-time and one parttime senior care officers were responsible for managing the home. Staff spoken with said they were all doing the best they could but were finding it difficult. Senior care officers were not aware of all the policies and procedures and some of the decisions being made may not have been in line with the WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 27 organisation’s policies and procedures. However, from speaking to staff it was clear they were committed to providing the best possible care to the residents and although staff morale was low, one worker said, “we are doing our best to keep spirits up. Some of the staff spoken with also said they felt unsupported and isolated. Following the recent return of the relief Deputy Manager it was anticipated that the senior care officers’ would be able to spend more time supporting the staff and attending to the care needs of residents. The absence of regular staff supervision and appraisals reduces the opportunity for the staff to discuss care practices, clarify policies and procedures and identify any learning or development needs with their line manager and may lead to poor outcomes for residents. Two staff spoken with said they felt supported by the senior care officers but would like to spend time with a senior to discuss any training opportunities that might be made available to them. The senior staff were unaware of a formal quality assurance system and were unable to clarify whether the views of residents, family members and other stakeholders had been sought. Four residents and one visitor spoken with said their views and opinions of the service had not been sought. Two residents said, the care was very good they work very hard and are very thoughtful The home had a policy and procedure for safeguarding residents finances. Monies held for safekeeping was stored safely and securely. Records of all financial transactions were available and apart from money paid for hairdressing individual receipts for items and services purchased on behalf of the resident were held. The administrator was responsible for managing residents’ finances and following discussion agreed to raise this issue with the hairdresser to make sure individual receipts confirming payment were obtained and held on residents’ personal record files. Two residents were subject to power of attorney and one was being supported by a professional advocacy service (Advocacy Alliance). Family members supported a number of other residents to manage their finances. The organisation ensures that tests for Legionella are carried out and regular checks carried out on portable electrical appliances, electrical and gas systems and passenger lift. Examination of documentation found tests on the fire alarm and fire doors generally took place weekly but checks had been missed for the two weeks before the inspection. Action must be taken to ensure that regular checks on the fire alarm and fire doors are maintained so that we can be sure equipment is in good working order. The last recorded staff fire drills at the home took place on September 20, 2005 and September 27, 2005 and was carried out by PCM Fire Defence. Staff WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 28 attendance at regular fire drill/practice is essential for making sure the staff are familiar with emergency procedures and to reduce the risk of people in the home sustaining accidents or injuries. Therefore, a notice requiring that the Registered Provider take action urgently to comply with the regulations and safeguard residents was left. Records were held of fridge and freezer temperatures, which were monitored twice a day to ensure they did not fall below an acceptable level. Examination of documentation confirmed that shortfalls identified during the last inspection remained outstanding i.e. the absence of accurate training records and confirmation that staff received regular mandatory training. These issues must be addressed by the Registered Provider so that we can be sure staff receive appropriate health and safety training and any updates necessary to carry out their duties safely and responsibly. Three staff spoken with said they had attended moving and handling training which included the use of a hoist. One senior care officer said she had been trained to carry out risk assessments but was unsure who else was suitably qualified. The inspector was told that further hoist training was due to take place later this year. Only two senior care officers and two care staff held a current first aid certificate as others had expired. One senior care officer was to attend a full first aid training course as the timescale for an update had expired. To make sure residents are safe and the staff able to respond appropriately to accidents or any health care emergency the Registered Provider must make sure there is always a qualified First Aider on duty. Accidents or incidents were not always reported to the commission as required for example: a complaint received by the home referred to an injury sustained by a resident. We were not made aware of the incident or of the possible circumstances, which may have caused any such injury. WCC - The Lawns DS0000041886.V310579.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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x 2 x x 3 x 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 1 x 1 WCC - The Lawns DS0000041886.V310579.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 Timescale for action Unless it is impracticable to carry 30/11/06 out such consultation, the Registered Person shall after consultation with the service user, or a representative of his’ prepare a written plan (the service user’s plan) as to how the service user’s needs in respect of its health and welfare are to be met. The Registered Person must ensure: service users are consulted about their care plans; care plans identify how each service users needs are to be met; care plans contain sufficient detail to enable staff to complete the required action to meet the individual care needs of service users. (Outstanding since 31/02/05) Requirement The Registered Person shall ensure care plans are regularly reviewed and updated to reflect any change in needs. (Outstanding from 15/03/06) WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 31 2. OP7 13(4) The Registered Person shall ensure that any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The Registered Person must ensure risk assessments are carried out for any activity or health care need that may present as a risk to service users paying particular attention to the prevention of falls, the use of bed rails and the management of challenging behaviours. The Registered Person shall arrange for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Outstanding from 15/03/06) 31/10/06 3. OP9 13 31/10/06 4. OP12 16 The Registered Person shall 14/12/06 having regard to the size of the care home and the number and needs of service users-consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communicate with, their families and friends; consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, and activities in relation to recreation, fitness and training. (Outstanding from 23/03/06) 5. OP16 17 The Registered Person shall DS0000041886.V310579.R01.S.doc 31/10/06 Version 5.2 Page 32 WCC - The Lawns establish a record of all complaints made by service users or representatives or relatives of service users or by persons working at the care home about the operation of the care home, and the action taken by the Registered Person in respect of any such complaint. (Outstanding from 29/03/06) 6. OP18 13(6) 7. OP21 23(2)(l) 8. OP23 23(2)(d) 9. OP24 23 10. OP27 17(2) schedule 4 11. OP27 18(1) The Registered Person shall arrange, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The Registered Person shall ensure suitable provision is made for the purposes of the care home i.e. storage of equipment and other items not in use. The Registered Person must ensure that all parts of the care home kept clean and reasonably decorated. The Registered Person shall having regard to the number and needs of the service user make sure suitable seating is made available for visitors to use when visiting service users in their own rooms. The Registered Person must ensure a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked is kept. The Registered Person Shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that all times suitably qualified competent and experienced persons of working at the care home in such numbers as are DS0000041886.V310579.R01.S.doc 30/11/06 21/10/06 31/01/07 30/11/06 30/11/06 30/11/06 WCC - The Lawns Version 5.2 Page 33 12. OP29 19 Schedule 2 appropriate for the health and welfare of service users. The Registered Person shall not employ a person to work at the care home unless full and satisfactory information is available in relation to him. The Registered Person must carry out an audit of staff files to ensure documents and information required under regulations is maintained and available for inspection. (Outstanding since 31/01/05) 31/10/06 13. OP29 19 Schedule 2 12(1) 14. OP30 The Registered Person must submit an application for a CRB disclosure and PoVA first check in respect of one named worker identified during the inspection. The Registered Person shall, having regard to the size of the care home, the Statement of Purpose and the number and needs of service users ensure staff receive training appropriate to the work they are to perform. The Registered Person must ensure new employees participate in a structured staff induction that takes into account health and safety, roles and responsibilities and the rights of service users. The Registered Person shall ensure that the care home is conducted so as(a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education supervision of service users. The Registered Person must ensure that in the absence of the 29/09/06 31/10/06 15. OP31 12(1) 21/10/06 WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 34 16. OP33 24 17. OP36 18(2) 18. OP38 13(4)(5) Registered Manager a suitably experienced and competent Person is available to manage the home. The Registered Person shall establish and maintain a system for reviewing at appropriate intervals, and improving, the quality of care provided at the care home. The Registered Person shall ensure that persons working at the care home are appropriately supervised. The Registered Person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The Registered Person must ensure accurate training records are maintained and demonstrate that staff receive regular mandatory training. (Outstanding since15/08/05) 31/12/06 30/11/06 31/12/06 19. OP38 37 20. OP38 23(4)(d) The Registered Person must ensure there are sufficient numbers of qualified First Aiders available. The Registered Person shall give notice to the commission without delay of the occurrence of (a) any event in the care home which adversely affect the wellbeing or safety of any service user. Any notifications made in accordance with this regulation, which is given orally, shall be confirmed in writing. The Registered Person shall after consultation with the fire authority ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care DS0000041886.V310579.R01.S.doc 31/10/06 29/09/06 WCC - The Lawns Version 5.2 Page 35 home and, so far as practicable, service users are aware of the procedure to be followed in case of a fire, including the procedure for saving life. The Registered Person must take action to ensure that all staff attend fire drill practice/training within the timescale identified in a letter sent to the Registered Person. 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 OP8 Good Practice Recommendations Staff should be provided with opportunity to receive tissue viability and pressure area care training. Food transported around the home should be covered to reduce risk of infection of contamination. Residents requiring a liquidised diet should be offered an alternative and be made aware of what is being provided. The Home should explore the possibility of improving facilities for hearing and visually impaired residents such as by installing a loop system. The Home should consider reviewing ancillary staffing levels at weekends. Staff training should include dementia care and managing challenging behaviours. 2 OP15 3 4 5 OP22 OP27 OP30 WCC - The Lawns DS0000041886.V310579.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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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