Care Home: Lavender House Retirement Home For The Elderly

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What the care home does well People are satisfactorily assessed on entry to the home, though not through all of the available methods. They are provided with a working care plan for staff to follow. They are supported with health care that meets their needs and their expectations. They are protected from possible harm due to taking the wrong medication, because they have their medication handled by the staff in the home, and the staff follow robust practices and procedures.People experience good levels of privacy, have their dignity maintained, and their right to make decisions respected. They are encouraged to maintain contact with family members and friends and enjoy visits from these people any time of the day, and they are encouraged to exercise choice and control over their lives where possible, but this could improve more. People enjoy adequate food provision, which matches their expectations and preferences, but also offers a satisfactory level of nutrition. They are confident their complaints will be listened to and acted upon. People are protected from abuse by robust recruitment and selection procedures and practices. People experience a safe, clean and well-maintained environment. A sufficient number of care staff with the recommended qualifications and training work in the home on each shift to meet the needs of people. The manager runs the home in the best interests of people living in the home, safeguards their financial interests, and maintains their health, safety and welfare. What has improved since the last inspection? Key workers are now being involved with care plan compilation and development. The type and variety of activities offered in the home is better than it has been in that there is now movement to music, tales from the past every two weeks, on screen reminiscence, bingo and chance to `pat` a dog. The service is giving people more chance to say what they would like for their meal on a daily basis. The property has been tidied up and the gutters to the front of the house cleared of collected matter. The performance in providing a laundry service has improved. Efforts are continuing to ensure people do not have mix ups with their laundry. The service is now recruiting staff more effectively. The recruitment practices in the home have improved since the last inspection. All staff now have at least a preliminary safety check done before they start working in the home. The service is providing a staff team with improved competence to care for people. All staff have completed first aid training since the last inspection and are soon to update this in January 2008. The home is maintaining a safer environment by having electrical safety checked. A full electrical safety inspection was carried out in November 2007. What the care home could do better: The service must improve on the completing of the AQAA so that it contains more detail about the home, the people living there and especially the staff working there. Date, places, training done, who with, what assessments and care plans include etc. should all be included in the AQAA. Each standard must contain information that demonstrates how well the service is meeting it, a list of the evidence to back this up and what plans there are for the future to improve on the performance. The service could make sure there are contracts in place for everyone. The service could make sure assessing peoples` needs is consistent and records of any assessment must be held for everyone. The service could make sure all care plans meet requirements of standards 7.2 and 8 and are in line with assessments at standard 3.3. The service could make sure any medication waiting to be returned to the pharmacist is more carefully stored and not put altogether in one unlabelled receptacle. Also that sharps tins in use do not allow for needles to be accessible to anyone. The service could encourage people to be more self-determining in their daily choices and decisions. The service could continue with more improvements in the activities on offer. Perhaps people would like to go out more often as well. The service could encourage people to make more requests when compiling menus. The service should continue to seek a solution to ensure call bells are reachable without the need for modification extensions. The service should continue to seek a solution to provide everyone with a lock and key to their room, that can be overridden in need of emergency access. The manager could make an application to become the registered manager, so that people know there is consistency of management and the home is being run in their best interests. The service should make sure a legionella water test is carried out every three years so people are free form the risk of infection. CARE HOMES FOR OLDER PEOPLE Lavender House Retirement Home For The Elderly 69 Welton Road Brough Hull East Yorkshire HU15 1BJ Lead Inspector Janet Lamb Key Unannounced Inspection 18th January 2008 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 Lavender House Retirement Home For The Elderly DS0000019688.V355240.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. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lavender House Retirement Home For The Elderly 69 Welton Road Brough Hull East Yorkshire HU15 1BJ 01482 666013 F/P01482 666013 Address 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) Quality Care UK Limited Vacant post, being filled by Sarah Warrington (unregistered). Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one service user under 65 years Date of last inspection 7th December 2006 Brief Description of the Service: Lavender House is a Georgian style care home on two floors, set in the heart of the village of Brough. There are twenty-four single bedrooms, eight of which have en-suite facilities, and four shared rooms, three of which have en-suite facilities. There are flowerbeds and parking to the front with a small garden to the side of the building. Local amenities are close by, including shops, pubs, and rail and bus services. The home is registered to provide care and accommodation for 32 older people, some of whom may have dementia. Nursing care is not provided. Should such care be required on a short-term basis the Community Healthcare Services will provide it. The fees for the home range from £286.00 to £350.00 depending on the assessment of need and room chosen for occupancy. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2-star. This means the people who use this service experience good quality outcomes. The Key Inspection of Lavender House has taken place over a period of time and involved sending an ‘annual quality assurance assessment’ (AQAA) document to the home in September 2007 requesting information about people and their family members, and the health care professionals that attend them, as well as asking for numerical data held in the home. We received the requested information on 12th October 2007 and survey questionnaires were then issued to a selected number of people and their relatives, their care manager, their GP and any other health care professional with an interest in their care. This information obtained from surveys and information already known from having had contact with the home over the last few months, was used to suggest what it must be like living there. A site visit was made to the home on 18th January 2008 to test these suggestions, and to interview people, staff, visitors and the home manager. Some documents were viewed with permission from those people they concerned, and some records were also looked at. A total of three people, two staff, and the manager, were interviewed during the site visit and two people and one visitor were spoken to briefly, while several more people living in the home were observed. All of the information collected, in conversations, through observation and in survey questionnaires was collated to determine what it must be like living in Lavender House. What the service does well: People are satisfactorily assessed on entry to the home, though not through all of the available methods. They are provided with a working care plan for staff to follow. They are supported with health care that meets their needs and their expectations. They are protected from possible harm due to taking the wrong medication, because they have their medication handled by the staff in the home, and the staff follow robust practices and procedures. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 6 People experience good levels of privacy, have their dignity maintained, and their right to make decisions respected. They are encouraged to maintain contact with family members and friends and enjoy visits from these people any time of the day, and they are encouraged to exercise choice and control over their lives where possible, but this could improve more. People enjoy adequate food provision, which matches their expectations and preferences, but also offers a satisfactory level of nutrition. They are confident their complaints will be listened to and acted upon. People are protected from abuse by robust recruitment and selection procedures and practices. People experience a safe, clean and well-maintained environment. A sufficient number of care staff with the recommended qualifications and training work in the home on each shift to meet the needs of people. The manager runs the home in the best interests of people living in the home, safeguards their financial interests, and maintains their health, safety and welfare. What has improved since the last inspection? Key workers are now being involved with care plan compilation and development. The type and variety of activities offered in the home is better than it has been in that there is now movement to music, tales from the past every two weeks, on screen reminiscence, bingo and chance to ‘pat’ a dog. The service is giving people more chance to say what they would like for their meal on a daily basis. The property has been tidied up and the gutters to the front of the house cleared of collected matter. The performance in providing a laundry service has improved. Efforts are continuing to ensure people do not have mix ups with their laundry. The service is now recruiting staff more effectively. The recruitment practices in the home have improved since the last inspection. All staff now have at least a preliminary safety check done before they start working in the home. The service is providing a staff team with improved competence to care for people. All staff have completed first aid training since the last inspection and are soon to update this in January 2008. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 7 The home is maintaining a safer environment by having electrical safety checked. A full electrical safety inspection was carried out in November 2007. What they could do better: The service must improve on the completing of the AQAA so that it contains more detail about the home, the people living there and especially the staff working there. Date, places, training done, who with, what assessments and care plans include etc. should all be included in the AQAA. Each standard must contain information that demonstrates how well the service is meeting it, a list of the evidence to back this up and what plans there are for the future to improve on the performance. The service could make sure there are contracts in place for everyone. The service could make sure assessing peoples’ needs is consistent and records of any assessment must be held for everyone. The service could make sure all care plans meet requirements of standards 7.2 and 8 and are in line with assessments at standard 3.3. The service could make sure any medication waiting to be returned to the pharmacist is more carefully stored and not put altogether in one unlabelled receptacle. Also that sharps tins in use do not allow for needles to be accessible to anyone. The service could encourage people to be more self-determining in their daily choices and decisions. The service could continue with more improvements in the activities on offer. Perhaps people would like to go out more often as well. The service could encourage people to make more requests when compiling menus. The service should continue to seek a solution to ensure call bells are reachable without the need for modification extensions. The service should continue to seek a solution to provide everyone with a lock and key to their room, that can be overridden in need of emergency access. The manager could make an application to become the registered manager, so that people know there is consistency of management and the home is being run in their best interests. The service should make sure a legionella water test is carried out every three years so people are free form the risk of infection. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lavender House Retirement Home For The Elderly DS0000019688.V355240.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 Lavender House Retirement Home For The Elderly DS0000019688.V355240.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People’s individual and diverse needs are assessed so they are confident needs will be met. They receive sufficient written information in the form of a statement of purpose and a service users guide so they can decide if the home is the right place for them. EVIDENCE: Discussion with people in the home, the manager and the staff and viewing of files with people‘s permission, reveals people do not always have their differing needs assessed by the placing authority assisting with fees, or by the home manager. Documents viewed in those files identified for sampling fully support this, in that there is an assessment form compiled by Lavender House for one person, but not the other and there is an assessment form produced by the placing authority for one person, but not the other. The assessing of needs is inconsistent and must be addressed. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 11 Where there are assessments in place the placing authority one is clear and precise and the home’s one covers seventeen areas of need from hygiene to diet, mobility, behaviour, social activities etc. These are satisfactory. When interviewed one person said, “I came here in an emergency and Sarah asked me about my needs, but then I’ve since been re-assessed only two weeks ago. I know there are some forms and information held about me.” Another said, “Dr ____ asked me what help I need, but I’ve never been asked about things here or had a meeting with anyone. I’m not aware of a care plan.” This person has been in the home for about a year. One file viewed belongs to a person that was placed from another area of the country and the manager informs us that no community care, care assessment form was ever received. The other file viewed belongs to a person that pays privately for their care, and similarly no assessment was ever done by the authority. The provider and manager are advised to seek a copy of the assessment done by the authority for the first person and to make sure all new admissions are supported with such forms in the future. A file viewed for a third person is considered satisfactory, in that it contains both of these assessment documents. There is also some inconsistency in holding of contracts with people as well. One file has both the council and the home’s contracts of residence, while another file has neither. Where people are privately paying for their care it is essential they have a contract and terms and conditions of residence with the provider, that meets the requirements of standard 2.2 and complies with regulation 5. A statement of purpose and service user guide is available and posted on the notice board for people to view as they wish. The provider and manager must make sure these are kept up to date and any reviewing of these requires them to post new copies to the commission. The manager needs to bear in mind the changes in contacting the Commission from January 2008. Standard 6 is not applicable to the home. Lavender House Retirement Home For The Elderly DS0000019688.V355240.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service receive good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People have their health and social care needs fairly well documented in care plans, so they are confident their identified needs will be met. No one takes the opportunity to self-medicate, but peoples’ medication needs are well managed. They enjoy good levels of privacy and their dignity is well maintained by staff, though not always by visiting health professionals. People are confident their overall quality of life is good. EVIDENCE: Discussion with people in the home, the manager and staff and viewing of case files with peoples’ permission reveals there are care plans in place for everyone compiled by the home manager. Care and health care plan needs are met on a daily basis, medication administration is satisfactorily managed and people are able to receive assistance in private and with dignity. Care and health care plans include health and personal care needs in areas such as mobility, diet, social activities etc. but they do not show specific detail of the action plan to be carried out to meet each need. They do not meet the Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 13 requirements of standard 7.2 and cover all points listed in standard 3.3. They should be developed further to make sure standard 8 is fully covered too. Care plans need to be developed to ensure a clear audit trail exists showing a ‘starting point,’ which is the assessment, ‘a middle,’ which specifies the action needed to meet needs and ‘an end,’ which shows how and when the plan is reviewed and if necessary, changed. Plans should also follow the requirements of standard 7.2, which are tied in with standard 3.3 and the areas for assessment. Each area assessed must have a care plan and action plan to meet it. When interviewed one person said, “I don’t need much help with personal care, except to have a bath, help in and out of course. The staff are helpful.” Another said, “I don’t need any help, nor does _____. We both care for ourselves.” This person does receive some support and care with mobility and personal hygiene and it is quite extensive. There is a policy and a procedure for administering medicines in the home, which also shows a list of the staff with responsibility to administer. There are seven in total that are trained in safe administration and records and certificates held back this up. Where staff medication training is more than one year old it is advised staff be given up-dated training on an annual basis. There is a monitored dosage system in use in the home, medicines are kept in a safe storage place and there is an appropriate fridge for those drugs requiring colder storage. Medication administration record sheets are available and used appropriately and those seen for identified people are satisfactorily maintained. Unused drugs are returned to the pharmacy but the practice of storing them all together in one bottle should cease, as it is impossible for the collecting pharmacist to identify and verify what is actually being returned in relation to the list. There is a sharps tin held in the medication room, which is used by the visiting district nurses, but the lid is inappropriate and allows easy access to used needles. This needs discussing with the DN services and an alternative one supplying. People interviewed said, “The home takes care of my medication. It’s not a problem.” Another said, “Staff give my tablets to me when I want them. I prefer them to look after them. That way I don’t forget.” People are observed to receive assistance and support in a dignified manner and personal care is usually given in private. Care staff uphold this view where possible. However on the day of the site visit a GP was observed examining someone in the lounge and did not allow staff time to assist people to their room for this to take place. Staff and the manager must try to influence visiting professionals to carry out examinations and treatment in privacy. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Outcomes for people regarding daily life and social activities are satisfactory so they enjoy doing the things on offer, see visitors regularly, make their own decisions as much as possible and are fairly positive about the food provision. EVIDENCE: Discussion with people, a relative, staff and the manager, observing of interaction between people, between people and staff and people and their relatives, and viewing of plans, records and files is how evidence for these standards was obtained. This reveals people lead fairly quiet lives, though have some opportunities to engage in activities, receive plenty of visitors, exercise some control over their lives and enjoy satisfactory food provision. There is a basic activity plan for all people to join in with, although there is no individual plan for anyone not wishing to. Staff join in with such as quiz afternoons, as observed and people very much look forward to seeing family members. There is evidence that people receive visitors on a daily basis and that some people go out to stay with family members. Some people do not leave the home at all, but this is by choice. One person said, “I prefer to be in my room, but I always come out for some part of the day to let staff clean it. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 15 Visitors come when they like. No one stops them.” Another said, “I never go out, but I don’t want to. I just like to sit here and watch the world go by.” There are plenty of visitors to the home on a daily basis. Relatives usually visit and spend time in the lounge, as seen on the day of the site visit. One spoken to stated the service of care given to her father is quite satisfactory. She said, “The home is very good, it’s clean and comfortable and never smells. Dad is quite settled here and I’m sure he would tell me if anything were wrong. I come at different times and it always seems quiet and relaxing.” Another visitor observed seemed to make herself at home and spent a long while chatting to her relative and other people in the home. The atmosphere is very relaxed and homely, and staff seem to go about their chores efficiently. There is a certain amount of routine in the home, but people are able to choose when they get up, go to bed, what they do and when. Routines run around meal times and sometimes around sleeping etc. No one made any adverse comments about making up their own minds, though some presented as not having high expectations or many desires to be active. There is contact with the local community, the church and local schools, especially at seasonal times. Where possible people handle their own finances, though those spoken to have money looked after by their relatives or the home. One said, “My pension book is held by the home and I just ask if I want any money. I’m not worried.” Another said, “We both look after our own money. Though I am worried about having to pay my rent again soon and pay for living here.” Where people do have money held in safekeeping a record of in/out and a running balance is maintained. No records were viewed. People have a limited choice of food, as the menus show only one main meal at midday, but an alternative is offered if people do not like what is provided. People are asked to choose each day and this is recorded ready for preparation the next day. The options observed on the day of the site visit were two differently prepared fish dishes. There are three meals a day, plus supper drinks and biscuits at night. The cooks compile menus according to peoples’ likes, but little time is taken to seek their opinion of something different on a regular basis. The manager and the two cooks have all completed a nutrition course since the last inspection and now consider on the menu foods that are healthy and nourishing. The home needs to show that people are being consulted about foods and the way they are consulted needs to be recorded. The meal observed on the day of the site visit was home fried fish or baked fish in white sauce with chips and mushy peas, and either rice pudding or lemon tart with custard. There are no grumbles about food and people spoken to are generally quite satisfied with what is provided. Surveys also back up Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 16 these views. One relative said, “Though my mother is a slow eater, she always seems to enjoy her meals.” Another said, “The food is excellent.” Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Complaint management and protection of service users are satisfactory and more support in dealing with issues is accessed, so service users are listened to and they are confident they will be protected. EVIDENCE: Discussion with people and staff reveal there are appropriate systems for making complaints and representations in respect of protection, and that people are satisfied they will be listened to. There are policies and procedures in place for making complaints and for making protection referrals. The manager must make sure the complaint procedure is updated to reflect the changes in contacting the commission, now the Newcastle office for all contacts. Staff are aware of the mechanics of these systems and have used them in the past. Staff have done safeguarding adults training with the local authority and are clear in interview about their responsibilities to protect people and report any incidents of suspected or actual abuse. One staff has used the whistle blowing procedure in the past and made an assurance it would be used again without hesitation if necessary. Evidence of the staff training is available in their training files. People spoken to about making complaints are very confident about approaching the manager or any of the staff. One said, “One lady is always complaining about the meals, but there is nothing wrong with them, it is her. They do their best for us.” Another said, “People treat me very nicely. I’ve no Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 18 complaints and if I had I would go to the head one. I’ve no grumbles, I would recommend the place.” One relative said in the survey, “To complain I would initially talk to the manager and get any problem sorted. My sister has not raised ay concerns so it does not apply to her.” The complaint record shows there were three complaints between February and September 2007, since the last inspection. All three were resolved and the experiences had as a result show the manager and staff have learned for future similar incidents. Records also show there was one safeguarding adults referral and investigation in the last twelve months. This was an allegation that one individual was being given poor care and that external professional support was not accessed, nor were the appropriate organisations informed. It was investigated and resolved. Practices were changed and relationships with other professionals are being improved. There has been no other issue to consider. One relative said in the survey, “My sister is well looked after, safe and secure in the home, which was the main reason for me to place her here.” Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home is suitable for its stated purpose, and both cleanliness and maintenance are satisfactory, so people enjoy a safe, homely environment. EVIDENCE: Discussion with people in the home and the manager and viewing of some of the communal areas and two downstairs bedrooms, reveals the home is suitable for its stated purpose of providing care and accommodation to older people, some with dementia. Communal areas are clean, well decorated, warm and comfortable and offer either larger or smaller group living. There are twenty-four single bedrooms, eight of which have en-suite facilities, and four shared rooms, of which three have en-suite facilities. Bedrooms are decorated well and house peoples’ personal possessions where possible. Some people prefer to stay in their rooms, but do vacate them for short periods of the day to allow cleaning or to Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 20 have a meal. Some people take meals in their rooms if they choose to. The home is free from odours and hygiene standards are satisfactory. The laundry was not viewed on this site visit, but it was noted at the last inspection that equipment was appropriate, sluicing facilities were integral with the operating cycle of the washing machine, and people were satisfied with the laundry service. It was also noted at the last inspection that the emergency call bell pulls were being extended with the use of ties and that bedroom doors did not have a suitable locking facility to enable people to keep their room private and out of bounds to other people in the home or visitors etc. These issues were discussed with the manager who stated some of the bell pulls still had extensions on them, and doors had not been fitted with suitable locks yet. Locks were being explored with the aid of a local locksmith and the near future should see some changes in respect of offering privacy and security for people wishing to maintain some. Locks still have not been resolved under standard 24. This standard was not properly assessed, however. There are gardens to the rear and side of the house that are accessible in the warmer weather to those that are ambulant. Since the last inspection the gardens and grounds have been cleared of collected rubbish. There are no adverse comments about the laundry or the environment in surveys or interviews for this inspection. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The staffing complement of the home is sufficient to meet peoples’ needs, and there are enough staff with the recommended qualifications, so peoples’ needs are being met. Recruitment and selection practices and training opportunities are good and so people are well protected. EVIDENCE: Discussion with the manager and staff and viewing of staffing rosters, staff recruitment files and training files, with their permission, reveals the staff group are sufficient in number and satisfactorily trained. They are appropriately recruited to ensure people are safe. The residential Staffing Forum figures requires there to be 385.2 care hours per week for 4 high, 5 medium and 6 low dependency people. The home’s rosters show 392 and 401 care hours provided for two weeks in January 2008, so there are sufficient care hours to meet the care and health care needs of people. People in surveys said, “The support I receive is very helpful and all the staff are kind and caring. The day staff and kitchen staff do their best to give a good choice each dinnertime and aim to please. Also the night staff we cannot complain about. We are very lucky to get the attention day or night.” A relative said, “There is always someone available to care properly.” Of the ten care staff named on the rosters six have completed NVQ Level 2 or 3, giving the home a figure of 60 with the recommended award. One carer Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 22 is soon to start the award at level 2. All staff undertake the East Riding of Yorkshire Council induction course, which involves the completing of a very comprehensive workbook and meets the Skills For Care standards. These were not seen, as staff tend to keep possession of them. Staff confirm in interview they have completed induction and make reference to the workbooks. There is a recruitment policy and procedure in place and practice has improved since the last inspection. Staff explain the process in interview and their files, seen with permission, hold all the identification and recruitment documents required under schedule 2. Staff training courses include mandatory ones, such as safeguarding adults, medication administration, fire safety, food hygiene, health and safety and moving and handling. The safeguarding adults training was completed inhouse in October 2006 and also more recently in June 2007 with East Riding of Yorkshire Council. Where possible all staff should do safeguarding adults training with an external trainer and have this updated yearly. Staff also complete other training such as dementia care, use of continence products, and infection control. They also completed Mental Capacity Act training in November 2007. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The management of the home is effective and the health, safety and welfare of people and staff is satisfactorily maintained, so that people know the home is safely run and in their best interests. EVIDENCE: Discussion with the manager and staff, observation of practices in the home and viewing of certificates and records reveal the home is satisfactorily run in the best interests of people and to maintain their health, safety and welfare. The manager is not yet registered with the Commission and is required to submit an application to be registered by the end of February 2008. She has completed the NVQ Level 4 in Health and Social Care and is required to hold a management qualification or begin such a course within three months of being Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 24 registered. She has been managing the home for approximately 16 months and has several years experience caring for older people. She operates a democratic style of management and is always open to discussion for seeking ways of improvement in the service provided. There is a quality assurance system in place that looks at auditing people and their relatives about the care provided. Areas covered include nutrition and menus, communication, the environment, care and personal care, key working, social activities and outside services that are accessed. It also involves taking information from peoples’ meetings in the home, the regulation 26 reports completed and staff supervisions. There is also an allocated day and time each week when people, relatives etc. can visit to discuss any issue relating to the home and the care with the manager and the provider. As part of the quality assurance scheme the home should supply the commission with a copy of the report written in respect of any review it carries out on the quality assurance systems. This will fulfil the requirements of regulation 24(2). The home has recently been awarded part one of the East Riding of Yorkshire Council’s Quality Development Scheme. The home tries not to have responsibility to hold money in safe keeping for anyone, but does hold some small amounts. There is an appointed administrator that deals with the home’s finances and also keeps track of peoples’ money if they are unable to control it themselves. Only a small number have money held in safe keeping for sundries, but almost all have family members that handle finances of a larger responsibility. The standard was met at the last inspection and so records were not viewed for anyone on this occasion. Staff receive regular supervision now following changes made by the manager. Supervision and appraisals are now planned and recorded and interviews with staff back this up. Four areas of health and safety were looked at during the site visit: fire drills/safety equipment tests and systems, passenger and hoist lifting equipment, Control Of Substances Hazardous to Health (COSHH) regulations and water temperature controls and legionella test. The home has fire safety policies and procedures and a fire risk assessment, carries out weekly checks on the system and periodic training drills to ensure all staff receive three or four a year. The risk assessment does not have evidence in the form of dates that reviews have been carried out. Staff are aware of their responsibilities and confirmed they receive appropriate training and instruction in fire safety. Training files hold certificates etc. and evidence Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 25 is available of staff completing an annual fire safety-training course with B. Parsons, retired fire officer. The last full Humberside Fire and Rescue inspection was done in July 2006 and all requirements, except one have since been met. Reviewing of the fire risk assessment still needs to be done, but the kitchen door has been replaced, intumescent cold seals have been fitted where specified and self-closing devices have been fitted. There is a passenger lift in the home, a fixed bath hoist and a mobile hoist. All are serviced by a contractor, York Elevator Services Lt. and were last checked on 18/12/07, and 08/02/07 respectively. Staff have policies and procedures to follow in respect of moving and lifting people, and are trained in moving and handling and the use of hoists. Evidence is available in training files. There is a risk assessment document held for each product in the home. All cleaning products used are stored in a locked cupboard and have accompanying information for safe use under the Control Of Substances Hazardous to Health Regulations 1988. A staff member undertakes temperature checks on the hot water outlets on a regular basis and records the findings in a diary. A full legionella water test has not been carried out and so this is a requirement made at the end of the report. Overall there is satisfactory evidence to show that the home is well managed and people and staff have their health, safety and welfare well protected. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 26 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 Requirement The registered provider must ensure all people in the home have a contract of residence, so they know the terms and conditions of their residence and any termination details etc. as well as knowing their residency is protected. The registered provider must make sure all people living in the home have a copy of the local authority community care assessment document and the home’s own assessment document, so they know their needs have been properly assessed and a care plan will be devised to inform staff how to meet those needs. The registered provider must make sure care plans for all people living in the home meets the requirements of standards 7.2 and 8 and are in line with assessments in standard 3.3. The registered provider should make sure any returned drugs are stored separately and are labelled, and that there is no DS0000019688.V355240.R01.S.doc Timescale for action 31/03/08 2 OP3 14 31/03/08 3 OP7 15 31/03/08 4 OP9 13(2) 31/03/08 Lavender House Retirement Home For The Elderly Version 5.2 Page 28 5 OP12 12 6 OP22 16(2)(c) 23(2)(n) 7 OP24 16(2)(c) 8 OP31 8 9 OP38 12 and 13(4) access to needles in the sharps tin, so people and staff are free from the risk of having accidents that may harm their health. The registered provider should continue to consider making activities for people in the home more purposeful to enable them, for example, to remain physically and mentally fit and reasonably motivated, so they know their lives are fulfilled. The registered provider should ensure people have easy access to their call bell systems in rooms, without the use of inappropriate extensions to cords, so they know they are able to summon help at any time. This is particularly important for those at risk of falling. The registered provider should continue to seek ways of making sure the ‘deadlocks’ on peoples’ bedroom doors are replaced with one of a more suitable design that enables staff to have access in an emergency. All bedroom doors should be fitted with an appropriate lock with the occupants of the rooms able to decide whether or not to use them, so they know they are able to have their privacy and dignity maintained whenever they want it. The registered provider should make sure the manager submits an application to become the ‘registered manager’ by the end of February 2008. The registered provider should arrange for a legionella water test on the hot water tank every three years, so people are assured they are free of the risk of disease. This has not been DS0000019688.V355240.R01.S.doc 31/03/08 31/03/08 31/03/08 29/02/08 30/04/08 Lavender House Retirement Home For The Elderly Version 5.2 Page 29 done at all yet. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP14 OP15 Good Practice Recommendations The registered provider should make sure people are encouraged to make more choice in their daily lives and have greater control over the decisions they make. The registered provider should continue to consider ways of making the menus more varied and interesting. A genuine choice of meal should be incorporated within the daily menu. Consideration should be given to providing the service users, particularly the more able ones, with tureens during the main meal so that they can help themselves and thereby further their independence. Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lavender House Retirement Home For The Elderly DS0000019688.V355240.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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