Care Home: Lawfords House

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What the care home does well People can visit Lawfords House to see if it is the right place for them before they move in. The home carries out assessments before people move in, so that people can be confident that the home is able to meet their needs. People have access to a range of social and leisure activities, and the home supports people to maintain their local social networks. The home provides home-cooked food which is nutritious and gives a balanced diet. People can be confident that the manager will listen to their concerns and do her best to resolve them. Staff at the home are kind and caring. The manager works hard to provide a homely atmosphere at Lawfords House. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 What has improved since the last inspection? Care plans are regularly reviewed to make sure that they reflect the level of risk which has been assessed. This helps to make sure that people receive the care that they need. The fly screen in the kitchen has been replaced and an electronic fly killer installed. This will help to prevent any infection risk. What the care home could do better: Some aspects of care are not always managed well, which may mean that people`s needs are not fully met. Some medication procedures do not protect people from the risk of harm, and staff are not always trained to administer specialist medication. There are some shortfalls in training so that people cannot be sure that staff have the skills and knowledge necessary to meet their needs. The owners do not provide the manager with a training budget so that staff can receive all the training they need. There are no staff who are trained in first aid, which means that people may not receive the correct emergency assistance in the event of an accident. Some health and safety issues are not fully addressed, such as regular servicing of equipment and ensuring a safe environment at all times. This could place people at risk of harm or injury. Key inspection report CARE HOMES FOR OLDER PEOPLE Lawfords House Walford Road Ross on Wye Herefordshire HR9 5PQ Lead Inspector Sarah Blake Key Unannounced Inspection 5th August 2009 09:30 DS0000024721.V377061.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 2 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 Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawfords House Address Walford Road Ross on Wye Herefordshire HR9 5PQ 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) 01989 566811 01989 566811 lawfordcarehome@yahoo.co.uk Miss Mary Eileen Wilson Mr Peter Donald Vine Mrs Jill Madley Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) 15 The maximum number of service users who can be accommodated is: 15 19th August 2008 Date of last inspection Brief Description of the Service: Miss M Wilson and Mr P Vine (the service providers) and Mrs J Madley (the manager) are registered in respect of Lawfords House to provide accommodation and care for 15 older people whose main care needs are due to the physical ageing process. They may not accommodate people whose main needs are due to the effects of dementia illnesses or mental health problems. The accommodation is provided in a medium sized period house about a mile from Ross on Wye town centre. The town is within walking distance for people living there who have good mobility or use mobility aids such as motorised scooters. However, as in most of Ross, the route is not level. The house is a converted building and is in need of refurbishment and upgrading. One of the bedrooms has been set aside for use as an office. This means that no more than 14 residents can be accommodated at present. Ross-on-Wye is a market town and most of the people who move to Lawfords House are local people who have lived in the area for many years or have moved there to be nearer to relatives. The current range of fees for Lawfords House can be requested from the home. Additional charges are made for transport, hairdressing, chiropody, magazines and newspapers. A copy of this inspection report can be viewed at the home. Lawfords House DS0000024721.V377061.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 one star – adequate service. This means that people who use this service experience adequate outcomes. This was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to support good practice and to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for three people. This included observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We also received completed survey forms from people who use the service, their relatives and staff who work at the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. What the service does well: People can visit Lawfords House to see if it is the right place for them before they move in. The home carries out assessments before people move in, so that people can be confident that the home is able to meet their needs. People have access to a range of social and leisure activities, and the home supports people to maintain their local social networks. The home provides home-cooked food which is nutritious and gives a balanced diet. People can be confident that the manager will listen to their concerns and do her best to resolve them. Staff at the home are kind and caring. The manager works hard to provide a homely atmosphere at Lawfords House. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 6 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. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 7 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 Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 8 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 People using the 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 can visit Lawfords House to see if it is the right place for them before they move in. The home carries out assessments before people move in, so that people can be confident that the home is able to meet their needs. EVIDENCE: The home produces a brochure to give people some brief information about the service. The Statement of Purpose and Service User Guide give more detailed information about what life is like at the home. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 9 People have the opportunity to visit the home before making any decisions about living there, and one person told us that they had been made very welcome at this initial visit. People told us that the staff had helped them to settle in and that they had quickly felt part of the homes community. One person told us that they had chosen the home because of its size, and said were lucky having such a small number of people; we all get on with one another. The home has not had any new admissions since the beginning of the year. We looked at the files for three people who live at the home, and these showed that the manager carries out an assessment of peoples needs before they move in. This means that the home can be sure that it can meet peoples individual needs, and that people can be confident that staff will know how to provide care for them. These assessments were thorough and included all the details that staff would need to know. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the 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 home generally provides a high standard of care, but there are some shortfalls which could place people at risk of harm. Some medication procedures do not protect people from the risk of harm. EVIDENCE: People living at the home told us that the staff provide a high standard of care. We looked in detail at the records for three people who live at the home. We saw that each person has a care plan which includes information about the care that staff need to provide and also gives details about how they like their care provided. For example, the care plan for bathing one person explained what temperature they like the water, how much assistance is required and Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 11 the fact that they like bubble bath. One person told us they give me the chance of having a soak, Im not rushed. This shows that staff take care to make sure that peoples individual wishes are followed. Care plans are written so that staff will be able to understand how peoples needs should be met. For example, the care plan for one person who has difficulty in speaking states listen and take your time, do not speak for A (name of person) as this can make her very frustrated. The care plans are regularly reviewed by the key workers and we saw that amendments had been made to the care plans whenever peoples condition changed. At the previous inspection, we required the home to make sure that the care plans reflect the level of risk which has been assessed. We saw that where risks had been identified, the care plans clearly explained how to manage the risk. The records showed that the home asks for advice and support from healthcare professionals such as GPs and District Nurses whenever it is needed. We saw records which showed that one person had fallen on several occasions. We would expect the home to review and update the risk assessment following a fall, in order to make sure that all risks have been identified, and reduced as far as possible. We saw that the persons risk assessment had not been updated, and this could have put them at risk of further falls. The home keeps records of peoples weight, and the care plans make clear that any significant weight gain or loss should be referred to the persons GP. Records showed that one person had recently begun to have seizures, and that the GP had been called out on two occasions to advise. There was no risk assessment or care plan in place to tell staff what to do in the event of a seizure. We saw that the GP had prescribed medication for the staff to administer if necessary. The manager had written the instructions for staff on the Medication Administration Record (MAR) sheet as please give once if twitching or seizure is very bad. This instruction does not give enough detail for staff and should be supported by a care plan which clearly indicates under what circumstances the medication should be given. The medication has to be given rectally, and records showed that the person had been given the medication on one occasion, but there was no evidence of any training for staff. The manager confirmed that staff had not been trained on this procedure. If people have any allergies, it is important that staff are fully aware so that there is no risk of the person being exposed to anything which might cause an allergic reaction. One person had a sheet in their file stating in large capitals important information - allergic to penicillin, but the care plan stated allergies: salicylates. Salicylates include any medication containing aspirin. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 12 This information is inconsistent and could mean that the person is at risk of harm if they are given a medication to which they are allergic. The manager told us that a relative had told her that the person was allergic to penicillin, but was not sure where she had read that they were allergic to salicylates. She said that she would check with the persons GP. Medication records showed that the home generally keeps accurate and complete records of the receipt and administration of medication. We saw that one person manages their own medication, and that a risk assessment had been carried out to make sure that this was being managed safely. It is good that the home supports people who wish to self-medicate, as this promotes independence. During the inspection, we saw that staff were courteous and promoted peoples privacy and dignity. One relative told us of an occasion where they had raised concerns because a person was being washed whilst on the toilet, a practice which does not promote dignity or privacy. The manager had immediately taken steps to stop this, and it had not happened again. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the 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 have access to a range of social and leisure activities, and the home supports people to maintain their local social networks. The home provides home-cooked food which is nutritious and gives a balanced diet. EVIDENCE: People living at the home told us that they have plenty to do to keep them occupied. One person told us the home provides an excellent programme of events, usually something going on most afternoons. Some people told us that they prefer not to join in with organised activities and that the home respects their choice. The manager produces a monthly activities plan, which is given to each person. This includes activities such as skittles, bingo, quizzes, wine tasting, a Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 14 visit from a musician and armchair aerobics. We saw that people had planted sunflower and tomato plants in pots in the garden. Some people go out locally to take part in leisure activities, and the home encourages people to continue any previously enjoyed social activities. The home has just started a monthly newsletter, which is written in a friendly, chatty manner and includes information about activities and peoples birthdays. One person, whose faith is very important to her, is supported to go to church every week. The local vicar visits for Communion every month, and the home will make every effort to support people who wish to practise their faith. People told us that their visitors are made welcome, and that they are free to spend their time as they wish. We saw that lunch on the day of the inspection was a hot meal of haddock, poached egg, cheese sauce, potatoes and fresh tomatoes, followed by pear and ginger crumble with evaporated milk. There was a choice of cheese or egg salad for anyone who preferred a cold meal. There is fresh fruit on the menu at every meal, and people told us that they were provided with plenty of fresh vegetables. People said that they can ask if they would like something which is not on the menu, and the cook confirmed that she is happy to try to meet peoples preferences. The manager has introduced a new idea to give people more choice over their food. She has asked everyone living at the home for their favourite meal, and twice a month one persons chosen menu is cooked as one of the days choices. The manager has produced laminated menu cards for these meals, and we saw that people had chosen meals such as cooked ham with mash and beans, and lamb chops with fresh vegetables. Twice a month the home has Round the World meals where people are encouraged to try food from different countries. The manager said that they try to do some crafts such as making flags, to link in with the theme, and staff sometimes dress up for example, wearing hats with corks for an Australian themed barbecue. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the 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 can be confident that the manager will listen to their concerns and do her best to resolve them. Staff do not always receive up to date training in how to protect vulnerable people. EVIDENCE: The home has a complaints procedure which clearly states how to raise any concerns or complaints. People told us that they knew how to complain, and everyone identified the manager as the person they would go to if they needed to raise any issues. We, the commission, have received one complaint about the home in the past year, which we asked the provider to investigate. Records showed that the manager carried out a full investigation and responded to the person appropriately. The home makes sure that all the necessary checks are carried out to make sure that only suitable staff are employed at the home. This helps to protect Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 16 people from the risk of abuse. It is important that staff know their responsibilities in respect of protecting people from abuse or neglect, and it was disappointing that the home has not taken up the offer from Herefordshire Council of up to date training for staff and the manager in this area. When we spoke to staff, they showed a good knowledge of how to report any possible abuse or neglect. We say more about training in general in the Staffing section of the report. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 26 People using the 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 home provides people with a generally safe environment, but parts of the home are shabby and in need of some refurbishment. Some parts of the home do not meet peoples needs. Infection control is well managed. EVIDENCE: The home has a friendly and informal atmosphere, but some parts of the home would benefit from upgrading and refurbishment. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 18 The garden at the home is well kept and there was a gazebo in the garden, which the manager told us could be used by people living at the home. The only time we saw it being used was for staff smoking breaks during the day. It contained four garden chairs, no table and two large ashtrays with many cigarette stubs. We saw that the hall and stairs had been newly carpeted, and that all the communal rooms were clean and tidy. There were new dining chairs in the dining room, and the tables were laid with lacy fabric cloths. Throughout the home, silk flower decorations, ornaments and pictures give a homely atmosphere. The kitchen was seen to be clean and tidy. The home was awarded a Food Hygiene rating of four stars in November 2008. At the previous inspection, we had noted that the fly screen in the kitchen was not adequate to prevent flies entering. We saw that the fly screen has been mended and an electronic fly killer installed. The home has a large lounge with armchairs arranged round the edge of the room, facing the television. In our surveys, two people told us that they felt that the armchairs needed replacing, and we saw that some of them were rather shabby. We saw that peoples personal belongings, such as knitting and magazines, were kept beside their chairs, and this added to the homely atmosphere. There is a quiet lounge next to the main lounge, with a new three piece suite. Although the suite is very comfortable, the chairs and sofa are very low and might be difficult for anyone with mobility problems to get up from. The manager identified this room as the place where reviews are often carried out, but there is no door between this room and the main lounge, so it would not be suitable for a confidential conversation, such as a review. We saw that the home has installed a sluice sink in a cupboard upstairs, which means that staff can clean commodes out safely and hygienically. The upstairs communal bathrooms were not suitable for people to use on the day of the inspection. One bathroom contained a cupboard with a door which was in danger of falling off and could have injured anyone standing in front of it. The manager told us that she would remove the door until it can be repaired. The second upstairs bathroom was being used for storing a hoist, which meant that the toilet was completely inaccessible. The manager told us that the toilet is not used. In questionnaires completed by people living at the home, three people said that there were not enough toilets upstairs. The manager agreed to move the hoist so that people could access the toilet. At the last inspection, we also commented on the inappropriate storage of items of equipment in bathrooms, and it is disappointing that this has not changed in the past year. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 19 We saw that people had personalised their bedrooms with ornaments and items of their own furniture, and some people had their own televisions in their rooms. People told us that their bedrooms were kept clean and tidy. Infection control is managed well, and as soon as we entered the home, staff reminded us to use the hand gel which is kept beside the visitors book. During the inspection, we saw staff using protective equipment, such as gloves and aprons, appropriately. This means that the home is taking good precautions to limit any cross infection. Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are kind and caring. There are some shortfalls in training so that people cannot be sure that staff have the skills and knowledge necessary to meet their needs. EVIDENCE: Most people praised the staff for their kind and caring manner, although one person commented that some staff could be a bit brisk, a bit sharp. Other comments included lovely, very kind, all of them and theyre all very nice to me. People told us that there are always enough staff on duty to meet their needs. One person said if you want help, somebody comes in a short while, and another told us they always come if I need them. On the day of the inspection, all four staff on duty in the morning (two care staff, the manager and the cook) took their break at the same time. They Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 21 spent their break smoking in the gazebo in the front garden. One visitor told us that they felt that it was unprofessional to smoke in such a public place. We were concerned that there were no staff within the home. Whilst the staff were outside smoking, one of the people living at the home came to the office to tell us that she was concerned about another person in the lounge, but could not find any staff to help her. We discussed this with the manager, who felt that she and the staff were accessible enough because the front door was open. We do not agree with this, and have required the manager to make sure that staff are available within the home. The home operates a key worker system, where each person is allocated a key worker. One member of staff explained to us how this system works. The key worker keeps care plans up to date, and if they need changing she informs the manager and makes the change, she also completes the communications book to alert staff that there is a change. Key workers are sometimes involved in reviews with Social Services. The key worker system works well, and means that people know who to talk to if they have any queries. The home has not recruited any new staff since the last inspection, but at the last inspection we saw that the home makes sure that all the necessary checks are carried out before new staff are employed. These checks include a Criminal Records Bureau (CRB) check and two references, one of which is from a previous employer. This means that people can be confident that staff are suitable to work with vulnerable adults. Training records show that there are some areas of concern. The manager confirmed that none of the staff have current training in First Aid. It is a requirement in care homes for there to be at least one member of staff qualified in First Aid on duty at all times. This is so that immediate assistance can be given to anyone who injures themselves or becomes ill. In the AQAA, the manager told us POVA training is updated for all staff on a yearly basis, but records showed that the last time staff had training in the protection of vulnerable adults was in 2007. Herefordshire Council told us that they had written to the home twice in the last year to offer this training free of charge, but that the home had not replied. We spoke to staff, who showed a good knowledge of the signs of abuse and how to report any concerns, but it is good practice to make sure that staff are up to date with current guidelines. Herefordshire Council also provides training for managers to help them play their part in the prevention and reporting of abuse or neglect, and the manager has not attended this training. The manager told us that she is a qualified moving and handling trainer. We saw no evidence of any staff having undertaken current moving and handling training, and the manager told us that she does not provide structured training, but trains staff on peoples specific needs. Whilst it is good practice to provide training on peoples individual needs, staff should also receive Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 22 training in general moving and handling, so that they are not at risk of harming themselves or the people living at the home by the use of unsafe techniques. One positive innovation in training has been a distance learning course in dementia care which some staff are undertaking. Staff told us that they found this training very interesting and believed that it would help them improve their practice. The manager told us that the owners, Miss Wilson and Mr Vine, have not provided specific funding allocated for training, in spite of the fact that this has been recommended at the last two inspections. This means that the manager has to balance the needs of the people living at the home against staff training needs when trying to make best use of the funds available. Lawfords House DS0000024721.V377061.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the 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 manager works hard to provide a homely atmosphere at Lawfords House, but some health and safety issues are not fully addressed. EVIDENCE: The manager, Mrs Madley, clearly has a good rapport with the people who live at Lawfords House. During the inspection, we saw that she knew them all well, and her warm and friendly manner helps to give the home its homely and Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 24 welcoming atmosphere. Mrs Madley clearly works very hard and, as she said in the AQAA, puts 100 into Lawfords House. Mrs Madley is registered with the commission, which means that she has been judged to have the skills and experience necessary to manage the home. Mrs Madley showed during the inspection that she has peoples best interests at heart. Many of the shortfalls at Lawfords House are due to lack of support from the owners, Miss Wilson and Mr Vine. This includes the lack of a structured plan for upgrading the premises, and the lack of a planned annual training programme supported by a budget identified for the purpose. We saw that the providers had identified and implemented some improvements in their monthly visits to the home, such as the new dining chairs, which were provided following comments to the providers from people living at the home. The providers have begun to make regular monthly visits, as they are required to do. The manager returned the AQAA when we asked for it, and it contained detailed information about the home. Some of the information in the AQAA conflicted with the evidence of the inspection, but in general the AQAA gave an accurate record of what the home does well and what improvements can be made. We saw the results of the homes quality assurance questionnaires, which had been completed earlier this year, and these showed that people are generally satisfied with the service provided by the home. The home does not take responsibility for peoples personal finances, but provides locked storage in each bedroom. The fire safety records showed that all the required checks are carried out as required. Accident records had been completed to the required standard. At the previous inspection, the owners had been planning an extension to the home, but this has not progressed any further. The previous history of the home indicates that the owners have often told us that they are planning improvements, but these are not always carried out. The manager did not know what the owners plans are for the future of the home. The home has a hoist, used for transferring people who are not able to mobilise independently, which was being stored in an upstairs bathroom. The manager told us that the hoist was not being used at present. We saw that there was no record of when the hoist was last serviced. Some padding on the hoist was crumbling away, and the manager agreed with us that the hoist did not appear to be safe to use. It concerned us that the hoist was being stored in a bathroom, with no warning to staff not to use it. The manager agreed to move the hoist and to ensure that it was clearly marked as not to be used. As Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 25 the manager is a qualified moving and handling instructor, we would have expected her to understand the potential dangers. Lawfords House DS0000024721.V377061.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Lawfords House DS0000024721.V377061.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 OP8 Regulation 13 (4) Requirement You must ensure that falls risk assessments are reviewed in cases where the person has experienced a fall since the risk was previously considered. This will assist the home in reviewing whether there is any further preventative action they can take following each fall. 2. OP8 13 (2) You must make arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines for the treatment of seizures. This is in order to ensure the safety and well being of people who use the service. 3. OP9 18 (1) (a) You must ensure that staff are suitably qualified, experienced and competent to safely administer medication, including rectal administration, before they administer medication to people in the service. DS0000024721.V377061.R01.S.doc Timescale for action 12/10/09 12/10/09 12/10/09 Lawfords House Version 5.2 Page 28 This is in order to ensure that people who live in the service are protected from harm. 4. OP9 13 (2) You must ensure that information about allergies is accurate, and is recorded in the care plan and in the persons medication administration records. This is so that people are not placed at risk of harm. 5. OP18 23 (2) You must ensure that people have access to safe and sufficient toilet facilities. This is so that peoples hygiene needs can be met. 6. OP28 12(1) You must ensure that staff are available at all times to meet peoples needs. This relates to unsafe practice regarding staff breaks observed during the inspection. This is so that people can be confident that staff are available when needed. 7. OP30 13 (4)(c) You must put a system in place to ensure that staff, who are appointed to work in the home, have been suitably trained in first aid. This is to ensure the safety and well-being of people living in the home and that they are not put at any unnecessary risk of harm. 8. OP38 23 (2)(c) You must ensure that all equipment provided at the care home for use by service users or persons who work at the care DS0000024721.V377061.R01.S.doc 12/10/09 12/10/09 12/10/09 12/10/09 12/10/09 Lawfords House Version 5.2 Page 29 home is maintained in good working order. This is so that people are protected from the risk of injury. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations You should ensure that staff receive regular training on the protection of vulnerable adults. This is so that people can be protected from the risk of abuse or neglect. You should ensure that the manager attends training in her responsibilities with regard to the protection of vulnerable adults. This will ensure that she is kept up to date with good practice in this area and is aware of local procedures. You should ensure that equipment is stored so that it does not prevent people living at the home from accessing the communal areas of the home. You should develop a structured plan for upgrading the premises with an allocated budget and timescales so that the standard of the accommodation improves. You should ensure that staff receive regular, structured training in moving and handling, and that this training is documented. This will help to ensure that people are not put at risk of harm or injury because of unsafe practices. You should have a planned annual training programme supported by a budget identified for this purpose so that staff training is kept up to date. The owners should have a business and financial plan for the Home so that improvements to the service are planned and financed effectively. DS0000024721.V377061.R01.S.doc Version 5.2 Page 30 2. OP18 3. OP19 4. OP19 5. OP30 6. OP30 7. OP34 Lawfords House Lawfords House DS0000024721.V377061.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.westmidlands@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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