Care Home: Elstree Lawns Nursing Home

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What the care home does well We observed some of the staff interact with residents in a manner that promoted their dignity and independence. We saw that some of the staff enhanced the experience of the residents, this was evident through the smiles and laughter they generated. On the day of the inspection the home was clean, fresh and odour free. Staff were well recruited with all the appropriate checks being carried out. What has improved since the last inspection? There has been no improvement since the last inspection. What the care home could do better: All aspects of the running of this home need to improve. More care needs to be taken to ensure all records pertaining to the care of the residents are up to date, this includes making daily records and a review of all the resident`s needs and wishes. If there has been no change to the care of the resident`s care this must be clearly noted. Daily life must revolve around the needs and wishes of the residents and they should have access at all times to objects of stimulation and comfort. This is important because stimulation enhances the emotional and mental well being of the person. The dignity and independence of the residents must be promoted at all times. Meals must be served at a temperature that will allow the residents to enjoy their food. All staff must be trained to understand and meet the needs of all the residents, particularly those who have a dementia. The senior management of this service have responded to our feedback vey promptly and sent us an action plan that includes ensuring the temperature of food served is appropriate, raising the kitchen and catering standards, introducing clothing protectors that will not take from the person`s dignity and ensuring the resident has an option on wearing them. They have ensured medication is audited regularly, and that staff will complete dementia training drawn up in association with the Alzheimers Society, who are experts in the caring for people who have a dementia. We were told that the new home manager will undertake an advanced course in the care of people who have a dementia. They have told us that they will ensure, activities and occupation are freely available and that they plan to improve the environment. Had we not received this action plan this home would have been awarded a zero star rating. Key inspection report Care homes for older people Name: Address: Elstree Lawns Nursing Home Barnet Lane Elstree Hertfordshire WD6 3RD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marian Byrne     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 22 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Elstree Lawns Nursing Home Barnet Lane Elstree Hertfordshire WD6 3RD 02082073255/3271 02082071149 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: This home may accommodate people (aged 50 or over) with a diagnosis of pre-senile dementia who require nursing care. Date of last inspection Brief description of the care home Elstree Lawns Care Home is sited in a large, three-storey building, which has been converted and extended to provide nursing care for people who have a diagnosis of dementia. The top floor of the building is no longer used for accommodation. All bedrooms are for single occupancy and 29 have en-suite facilities. The home is reached at the end of a long, secluded driveway and there is ample parking available in front of the building. There are gardens and patio areas to the rear of the home and these have been modified for the safe use of the residents. The home is set back from a busy road and is near to the village of Elstree and the town of Borehamwood. Facilities for shopping and leisure are within a short drive and there is a nearby bus service. The current accommodation charges ranged from GBP550 to GBP900 GBP1000 for respite per week in December 2007. Current fees are available from the home. A Care Homes for Older People Page 4 of 22 Over 65 54 0 Brief description of the care home copy of the homes most recent CQC inspection report, Service User Guide and Statement of Purpose is displayed in the foyer of the home. Care Homes for Older People Page 5 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by two inspectors. We spoke to the people who live in the home, their visitors, staff and the manager of the home. We looked at the records pertaining to the recruitment and selection of staff, the care plans of the residents and the records of the upkeep and maintenance of the home. We observed the interaction between staff and the residents. We observed the lunch being served and we tasted the food. We made a tour of the premises including the kitchen area. We sent our surveys to the people who use the service. We also sent out an Annual Quality Assurance Assessment. This is a legal document that tells us what has happened in the home during the year. This was due back on the 5th January 2010, to date we have not received it. Care Homes for Older People Page 6 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 22 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use this home can be sure that their needs and wishes will be identified and that they will be offered a review to ensure their needs are being met. Evidence: We looked at the pre-assessment details of three residents and found that they contained good information on the person and their identified needs. All residents are reviewed after six weeks to ensure the home is meeting their needs and the residents are happy with the home. The home provides good information for prospective residents. A Statement of Purpose and a Service Users Guide is available in the reception area. Care Homes for Older People Page 9 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the people who live in this home can be sure that their health needs will be met. Evidence: Care plans we looked at detailed the needs of the residents in a person centered manner. By this we mean the the care needs were drawn up with the person or their representative. Details were given to staff on how the person wanted their care administered rather than the tasks to be carried out. Daily notes were written, though some were not up to date. We looked at the care plans of a person who needed a soft died. The care plan did not give staff sufficient information on what a soft diet consisted of. The kitchen staff were not fully informed about this either. We have been told that this has been addressed. All residents are registered with a local GP. Medication was stored, administered and recorded appropriately. This means that the people who live in this home can be sure that they get their medication in the amount prescribed and at the time prescribed. Care Homes for Older People Page 10 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the people who live in this home cannot be sure that their daily needs will be recognised and met. Evidence: On they day of the inspection there were two staff on duty specifically to engage the residents in useful occupation they took three residents out of the home on a outing. We saw that the environment in the communal areas of the home lacked magazines, newspapers and objects that could offer residents engagement and comfort. On the first floor there was an activities room that is full of objects of interest and comfort this room was locked throughout our visit. We saw residents sit about with no objects for engagement or entrainment. When we asked why the residents were not offered access to the room staff could not give us an answer. Rummage boxes that were in use at the last inspection had been removed. We did observe some staff engage very well with the residents. Other staff appeared to be more task led. By this we mean that the staff were more involved with carrying out tasks that engaging and connecting with the residents. We saw staff walk into the sitting room and not make any eye contact or speak to the residents. It is important that staff speak to the residents and it acknowledges that they are working in the residents home and it is also important for the residents self esteem that they are Care Homes for Older People Page 11 of 22 Evidence: acknowledged and greeted. We observed lunch and found that the all the residents had protective clothing in the form of a very large disposable bibs. These were placed around the residents necks 30 minutes prior to lunch being served. We saw that staff did not offer the residents an option in wearing these. This did not promote the dignity of the residents. When lunch was brought in, it appeared not to be hot. We tasted it and found some items warm and others cold through. Catering staff took it away and returned 25 minutes later and we tasted it again and found some of the vegetables (mushy peas) to still be cold. . Residents were left sitting at the tables still in bibs and with nothing to engage them 30 minutes prior to lunch being served and then 25 minutes when it was being re-heated. When we tasted the food we also noted that it lacked seasoning. Salt and pepper was not available to the residents had they wanted to use them. However the quality of the food appeared to be good. It is important that the food offered to residents in a manner that encourages them to eat and enjoy their food as good nutrition promotes health and independence. We left an immediate requirement on this and it was addressed before we left the home. Visitors are welcomed to the home at all reasonable times. Care Homes for Older People Page 12 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be sure that their complaints will be taken seriously and that they will be protected from abuse. Evidence: The home has a complaints policy and this is followed in the event of a complaint being made. The home has kept us informed of any serious complaints since the last inspection. Staff have been trained on the Safeguarding Adults Procedure and when asked were able to provide us with what they would do in the event of abuse taken place. Care Homes for Older People Page 13 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home may not always find it is decorated and furnished to offer a comforting and homely environment. Evidence: The reception area of the home was clean bright, fresh and brightly furnished. This is in contrast with the residential area of the home. We did find the home to be clean and without odour, however, the upstairs area of the home is dark and in need of redecoration. We looked at the kitchen and found it to be chaotic. It is very small and does not have sufficient warming areas for the food to be kept hot after being plated up prior to serving.. We have been given an action plan that says the home is going to improve the lightening and the decoration. They told us that they are going to provide suitable signage for the various amienties and put more pictures on the walls. They also told us that new bedding is being provided and memory boxes and rummage boxes left out for the engagement of the residents. They also told us that they will improve the dining area upstairs. Had this not been produced we would have left a requirement on improving the environment. Care Homes for Older People Page 14 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be sure that the staff are recruited appropriately, however they cannot always be sure that the staff are trained to meet the needs of people who have a dementia. Evidence: We were told that staff had been trained in the care of people who have dementia. This was not always evident in the manner we observed care giving and staff interaction with the residents. We found some of the staff to be very caring and saw they engage with the residents in a manner that promoted their independence and dignity. We also saw that some of the staff carried out their duties in a task orientated manner. We saw some staff walk into the sitting room upstairs and not make any contact with the residents there. We saw staff attempt to serve cold food to the residents. We saw residents made to wear protective clothing that looked like large bibs. This did not promote the dignity of the person. We saw residents with nothing to engage or stimulate them. This shows us that some of the staff cannot engage with people who have a dementia or do not understand the need to offer stimulation to them. None of the staff appeared to understand the need for the residents to have constant and free access to objects that offer stimulation and comfort. We were told that residents had up to recently access to rummage boxes but that they were taken away. Rummage boxes contain a variety of objects that offer stimulation Care Homes for Older People Page 15 of 22 Evidence: and comfort to people with a dementia. These are important as they can stimulate memory and create conversation topics. We looked at the recruitment of staff and found that they had been recruited appropriately. The files we looked at contained two references, proof of identity had been seen and a Criminal Records Bureau had been attained. There were sufficient numbers of staff on duty to meet the needs of the residents. Following the inspection we spoke with a senior manager who addressed the issues raised straight away. We have been sent an action plan that includes arrangements for staff to have dementia care training in collaborating with the Alzheimers Society. Care Homes for Older People Page 16 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home cannot always be sure that it will be run in their best interests. Evidence: A new manager has been appointed to this home and she took up her post on the 1 September 2009, therefore she has not been post long enough for us to make a judgment on her management skills. This home has had a period of at least five years where it has not had continued consistent management. The previous manager was in post approximately one year and had made good progress in improving the care of the residents in the home. She left in the summer of 2009 and the home was without a permanent manager for some months. The standard of care in the home at this inspection was seen to have deteriorated since the last inspection. The home would have been awarded a zero star rating had the senior manager for the area not responded so swiftly and thoroughly to our findings. Care Homes for Older People Page 17 of 22 Evidence: The kitchen situation was addressed while we were in the home. We have been told that an experienced chef has been drafted in from another home until the situation in the home is resolved. We were also told that rummage boxes have been left out for the residents and the activities room is now open at all times to allow the residents access to items that may stimulate them. We are updated regularly on how the home is progressing. We have been told that staff who carried out their duties in a task oriented manner are being retrained in the care of people who have a dementia. All maintenance records were checked and found to be up to date and all mandatory checks had been carried out. Care Homes for Older People Page 18 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 19 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 15 18 The Registered Person must 17/12/2009 ensure that food is served to the residents at an appropriate temperature. The temperature must be tested by the staff immediately prior to the residents being served. We have been given evidence that this had been met. You must do this because it is important that the residents are offered food they can enjoy and get the nourishment they need. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 18 The Registered Person must ensure that the residents have objects to engage them and to offer them comfort. You must do this because it is important that the residents have access to objects that offer them stimulation to promote their 21/01/2010 Care Homes for Older People Page 20 of 22 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action mental and emotional health. 2 30 18 The Registered Person must ensure that staff are trained to care for people who have a dementia. You must do this because the residents must be care for in a manner that promotes their health, dignity and independence. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 26/02/2010 Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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