Care Home: Lavender House

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What the care home does well We received many positive comments about the home. One resident told us : `they care for us so well`, another that: `I enjoy living here, it`s as good as home`. One relative commented: `the staff are cheerful and very welcoming. They all create a lovely homely atmosphere. Activities, events, trips are arranged regularly and relatives and friends are involved.` One nurse commented in the home`s own questionnaire: ` as a community nurse I have nothing but praise for the staff, they are always helpful kind and very good with the residents`. Information about the home is available in a variety of formats giving people the information they need to decide if it is right for them. Residents` care plans are detailed, comprehensive and reviewed regularly ensuring that staff are able to offer personalised and consistent care and that residents` health care needs are monitored closely. This is a home that meaningfully consults its residents, their relatives and staff and actively responds to their suggestions, giving them a real say in how the service they receive is run. The owners and manager of the home are committed to providing a high standard of care and have a clear and modern vision of how this home should run. What has improved since the last inspection? There were no requirements made at our last inspection. However there have still been improvements since we last visited. The home has worked hard to improve its end of life care for residents, and residents are now given the opportunity to talk openly about the formalities they want observed when death approaches. The home also organise an annual memorial service to remember residents who have died in the last year, giving their relatives and current residents a chance to grieve and remember their friends and loved ones. Staff have also received training in the Mental capacity Act giving them an understanding of this important piece of legislation. All residents now have a mental capacity assessment when they are admitted to the home so that staff can ascertain their decision making capabilities. Staff have also received training in this important piece of legislation. What the care home could do better: Records made when medication is given to residents must be accurate and complete to ensure that they receive their medication as prescribed. The actual amount of variable dose medication given to residents must be recorded so it is very clear how much medication they have received. Staff should have a good understanding of the adult protection system in their local area and the part they play should the need arise. Better signage and orientation aids should be provided around the home (especially to communal areas) to hep residents find their way about more easily. Residents` names should be on bedroom doors so they can identify their rooms. Night staff must be given the opportunity to practice fire drills so that they know what to do in the event of the fire alarm sounding. Staff should only start working at the home once a full CRB disclosure has been obtained to ensure that only the right people are employed to look after vulnerable adults and so that residents are protected. Key inspection report Care homes for older people Name: Address: Lavender House 205 Broadway Peterborough PE1 4DS     The quality rating for this care home is:   three star excellent 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: Janie Buchanan     Date: 3 0 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 24 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 24 Information about the care home Name of care home: Address: Lavender House 205 Broadway Peterborough PE1 4DS 01733564989 01733895551 amarjara@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Baldev (David) Marjara care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Lavender House is situated in a residential area, close to Peterborough city centre and provides accommodation and personal care for 30 older people. An extension has already been added to the original building and the proprietors have recently built a second extension to create two further bedrooms. The home is on two floors, with the first floor being accessed by a stair lift. Attractive grounds surround the property. Fees vary between £387and £475 depending upon residents needs. A copy of the most recent inspection report is available in the entrance hallway of the home. 0 0 Over 65 3 33 Care Homes for Older People Page 4 of 24 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: three star excellent 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: For this inspection we (The Care Quality Commission) looked at all the information that we have received, or asked for, since the last key inspection. This included the annual quality assurance assessment (AQAA) that was sent to us. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. We visited the home and talked with residents, staff, the manager ,the owners and a visiting district nurse. We undertook a tour of the premises, checked medication recording and storage, and viewed a range of documents. We also took lunch with residents to check the quality of food and observe how staff assisted them. We also received 27 completed questionnaires (a good response rate) from residents, their families and staff working at the home. Care Homes for Older People Page 5 of 24 What the care home does well: What has improved since the last inspection? What they could do better: Records made when medication is given to residents must be accurate and complete to ensure that they receive their medication as prescribed. The actual amount of variable dose medication given to residents must be recorded so it is very clear how much medication they have received. Staff should have a good understanding of the adult protection system in their local area and the part they play should the need arise. Better signage and orientation aids should be provided around the home (especially to communal areas) to hep residents find their way about more easily. Residents names should be on bedroom doors so they can identify their rooms. Night staff must be given the opportunity to practice fire drills so that they know what Care Homes for Older People Page 6 of 24 to do in the event of the fire alarm sounding. Staff should only start working at the home once a full CRB disclosure has been obtained to ensure that only the right people are employed to look after vulnerable adults and so that residents are protected. 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 24 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 24 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. Information available about the home is good ensuring prospective residents have the information they need to decide if it the right place for them to live. Residents needs are thoroughly assessed before they move so they can be assured they will be met at the home. Evidence: There is a detailed Statement of Purpose and Residents Guide which give good information about the services on offer and the facilities available in the home (although these should be updated to include details of the Care Quality Commission rather than CSCI) . Both these documents have been produced in large print and enhanced by photographs to make the information more accessible to readers. Prospective residents are given a brochure and information pack which provide information about the fees payable, a sample menu and a typical activities schedule. Each resident is also issued with a contract that clearly sets out the terms and conditions of their stay at the home. There is very useful website Care Homes for Older People Page 9 of 24 Evidence: www.peterboroughcare.com giving good information about the home and also providing a key point checklist which is an excellent tool listing things to consider when choosing a residential care home. As part of the homes quality assurance program each resident and/or their family is given a questionnaire asking them to comment and rate the quality of their assessment and admission. Responses to this questionnaire have been used to improve the experience for people. Residents who completed our survey told us they received enough information about the home to help them decide if it was the right place for them. One resident told us: Amar (one of the owners) showed me around and gave me full information. Another commented: when I came to look round I was given a cup of tea and everyone was so nice. Residents files that we checked contained good pre-admission information about their needs. Care Homes for Older People Page 10 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are clearly recoded in their plans ensuring staff have the information they need to provide personalised and comprehensive care. Evidence: We checked the care plans for three residents. Residents daily needs and preferences in relation to, amongst other things, their personal care, mobility, activities, food, sleep, and mental health were clearly recorded in detail ensuring that staff had the information they needed to provide person centred care. Each care plan contained detailed risk assessments for residents ensuring that any risks to their well being had been identified and measures taken to reduce them. The plans also contained a comprehensive end of life assessments ensuring that residents were given opportunities to discuss their preferences about end of life issues and to have these recorded so they can be respected. Each year the home holds a memorial service to remember residents who have passed away in the last year there. This is excellent practice. One relative commented in the homes own questionnaire: we were very pleased to see representatives from Lavender House at mums funeral. All the plans we viewed had been fully reviewed every month ensuring that changes in residents Care Homes for Older People Page 11 of 24 Evidence: needs were picked up quickly. In addition to this, every four months the care plans are discussed formally with residents and/or their relatives to ensure they got an active say in planning and reviewing their care. The plans contained good evidence that residents health care needs were closely monitored with their weights, Waterlow scores, nutrition and blood pressures checked monthly. There were also detailed records of GP, chiropodist and district nurse visits. Residents who completed our survey stated that the home makes sure they get the medical care they need. We checked medication storage and a sample of residents medication administration records (MAR). We found the following shortfalls: the amount of variable dose medication actually given was not recorded meaning there was no accurate record of how much medication some residents had received; for one resident the amount of antibiotics he had received did not tally with the amount recorded on the MAR sheet; staff had signed that one resident had received their medication even though the resident was actually in hospital at the time; for another resident staff had signed to indicate they had given medication every day even though the prescribers instructions were that they were to have it once a week and the date on which liquid bottles of medication had been opened had not been recorded. Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities in the home provide stimulation and entertainment for residents and mealtimes are relaxed and enjoyable. Evidence: The home employs a specific member of staff to organise activities for residents and there are regular quizzes, bingo, knitting, and arts and crafts. Residents also have access to a spa bath and sensory room, both of which are used for therapeutic sessions. In addition to this, there is a yearly Halloween party, fireworks display, Christmas pantomime trip and summer fete. At least once a month entertainment is provided in the home by singers, actors and comedians. Christmas was a busy time for events with school children and the Salvation Army visiting to sing carols to residents and a trip to a local shopping centre. There was also a recent visit to a Chinese restaurant for lunch. One resident told us: they look after our outdoor activities and there is plenty of activities inside the home. However, another resident we spoke to told us: I dont enjoy pasting things onto Christmas cards: I did that with my children, and its no good offering me bingo. Two relatives also told us they felt there should be more activities available in the home. Both residents and relatives commented on the good quality of the food provided. One Care Homes for Older People Page 13 of 24 Evidence: relative told us: the menus are varied and nourishing. Water/squash are available and warm drinks served regularly. Last week my mother and I had a tray of tea and biscuits mid afternoon individually brought in. We took lunch with the residents which consisted of celery soup followed chicken pie with carrots, mashed potato and cabbage, and a dessert. The food was plentiful and nutritious and the gravy and vegetables were served separately allowing residents to choose what and how much they wanted. Aids such as plate guards and cups were available for those residents that required them to eat independently Care Homes for Older People Page 14 of 24 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. Residents have access to a complaints procedure and their concerns are taken seriously. Evidence: Details of how to raise complaints are contained in the homes statement of purpose and residents handbook (a copy of which is available in each bedroom). The procedure is also on display in the main entrance hall and residents and relatives who completed our survey told us they knew how to make a complaint if they needed to. We viewed the homes complaints log and recent concerns regarding noise, the food temperature, and missing items had all been investigated and responded to appropriately. The home has a satisfactory policy about adult protection which covers the different types of abuse, how to recognise signs and contact numbers, and all staff receive one supervision a year based on protecting vulnerable adults. Staff we spoke to showed a good knowledge about the different types of abuse an older person can face and also felt confident about reporting it. However, their knowledge of the adult protection procedures in their local area and other agencies involved in protecting vulnerable adults was variable. Care Homes for Older People Page 15 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable safe and well maintained environment. Evidence: The home offers a variety of communal areas for residents: there is a spacious sitting room to the rear of the property and a smaller brighter one at the front, as well as two separate dining rooms. Appropriate aids and adaptations have been provided throughout the home including handrails, grab rails, toilet frames and assisted baths. The home is fully accessible to residents and access to the grounds outside is available by ramp and there is a chair lift for the stairway. Residents have access to a garden one relative stated: the garden could be more colourful- but it is easily accessible and is used by able bodied residents and social events in the summer. We spoke with one resident who was walking up the corridor looking for the homes lounge and we noted there were no signs or orientation aids in sight to help her find it easily. Another resident told us they found the corridors too long. We noted that not all bedroom doors had residents names on them perhaps making a little difficult for some residents to identify their own room. One upstairs bathroom could not be locked from the inside, denying residents privacy whilst using it. Care Homes for Older People Page 16 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are looked after by competent and well trained staff in sufficient numbers to meet their needs. Evidence: There is a stable and consistent staff group at the home and agency staff are never used. There are four care staff on throughout the day, and two waking staff on at night to meet the needs of 30 residents currently. Residents who completed our survey and those we spoke to told us there were enough staff around when they needed them. One staff member told us that their workload felt manageable and another that they rarely felt rushed or too busy. Residents we spoke to told us that staff supported them in a way that they liked and had a caring approach. One relative commented: the carers all know all residents needs and requirements: very impressive. Staff we spoke to told us they received lots of training and files we checked for three showed that they had received a variety training relevant to their role. Of 19 care staff, 13 hold an NVQ level 2 or 3 in care which is well above the national minimum standard. We checked the personnel files for two recently employed members of staff which showed us that appropriate references had been sought. However, both these staff Care Homes for Older People Page 17 of 24 Evidence: had started working before their full CRB disclosure had been received. Although this is allowed in exceptional circumstances only (DOH guidance) it is not best practice to do so and puts residents at unnecessary risk. Care Homes for Older People Page 18 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live a well managed home where their views are actively sought their health and safety is promoted and where staff are valued and supported Evidence: The manager of the home is a registered nurse with good experience of working with older people. Staff described her as supportive, professional ,organised and good at sorting problems out quickly. Staff told us they felt supported the sample of staff files we checked showed us that they received regular supervision. The quality of these supervision sessions was excellent with specific care topics discussed (such as adult protection, taking blood sugars ,dementia) followed by a questionnaire to test staffs knowledge on the topic and to keep them up to date with new practices. Staff we spoke to clearly found their supervisions useful and one told us: the manager explains to me what Im doing wrong. There are regular meetings with residents where they are able to make suggestions Care Homes for Older People Page 19 of 24 Evidence: and raise concerns. We viewed the minutes of the meeting held in September 09 where issues such as activities, communication, staff attitude and the menu were discussed meaningfully. Twice a year each resident is given a detailed questionnaire to complete which gives them the opportunity to comment upon and rate many aspects of the home. Questionnaires are also sent to relatives staff and other people with an interest in the home. Once these questionnaires have been received their views and comments are analysed closely and used to create an action plan to improve the service. We viewed the most recent questionnaire and issues raised for improvements to how residents are admitted and the contract of residency they receive had been quickly actioned by the management team proving that they actively listen and act upon suggestions from respondents. The home holds money for some residents and we checked a sample of residents cash sheets. All financial transactions undertaken on behalf of residents were clearly recorded and appropriate receipts were kept. We checked a sample of records in relation to health and safety (including gas, hoist and lift servicing, water temps and fire) which showed us the home regularly maintains and services its equipment to ensure its safety and effective working. However night staff do not regularly practice fire drills. The homes kitchen has been awarded four stars by the local environmental health officer ensuring that residents receive food that has been prepared in a safe and hygienic environment. The home continues to let us know about things that have happened since our last key inspection and they have shown that they have managed issues well. They work well with us and consult us appropriately when needed. Care Homes for Older People Page 20 of 24 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 21 of 24 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 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 9 13 The actual amount of variable dose medication given to residents must be recorded. You must do this to ensure there is an an accurate record of how much medication someone had been given. 08/02/2010 2 9 13 Records made when medication is given to residents must be accurate and complete . You must to do this to ensure people get their medication as prescribed. 08/02/2010 3 36 23 Night staff must be given the opportunity to practice fire drills. You must do this to ensure they know what to do in the event of a fire. 09/02/2010 Care Homes for Older People Page 22 of 24 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 1 18 Staff should have a good understanding of the adult protection system in their local area and the part they play should the need arise. Better signage and orientation aids should be provided around the home (especially to communal areas) to hep residents find their way about more easily. Residents names should be on bedroom doors so they can identify their rooms. Staff should only start working at the home once a full CRB disclosure has been obtained to ensure that only the right people are employed to look after vulnerable adults and so that residents are protected. 2 19 3 29 Care Homes for Older People Page 23 of 24 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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