Care Home: Lawrence House

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What the care home does well Lawrence House provides people with a well maintained, clean and homely environment that has been equipped to ensure that people can be as independent as possible. Care and support is delivered by a staff team who understand the needs of the people they support. They have good training and supervision offered on a regular basis. The home provides an excellent range and choice of meals and people are encouraged to be involved in cooking, shopping. All eight surveys returned from people living at the home said something complimentary about the food. People have opportunities to be involved in a range of activities and staff work hard to ensure that activities are geared to meet the needs of the individuals including their diverse needs socially and culturally. The home is well run with good systems in place for ensuring that individuals views are listened to and acted upon. The management approach is open and inclusive and both individuals who live at the home and staff feel their concerns and ideas are listened to and acted upon. What has improved since the last inspection? The home has developed more formal ways of ensuring the views of the people who live at the home are considered when reviewing the quality of care. This includes regular meetings and the use of questionnaires as well as one to one key worker time. What the care home could do better: The easy read plans of care need to be updated and reviewed in line with the regular plans of care so that they have up to date needs and wishes recorded. Any hand written changes or entries into medication records should be double signed to help prevent against errors. The use of Disability Living Allowance needs to be better recorded so that there is a clear audit of how this money is being used to support people to access the local community. Key inspection report Care homes for adults (18-65 years) Name: Address: Lawrence House Landkey Road Barnstaple Devon EX32 9BX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 2 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Lawrence House Landkey Road Barnstaple Devon EX32 9BX 01271377189 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Linda Harvey care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: To provide personal care to twelve (12) service users between the age of 25 and 65 years with learning disabilities (LD) Date of last inspection Brief description of the care home Lawrence House provides 24-hour residential care for 10 people who have learning disabilities. At night-time there are two staff sleeping in. Lawrence House is a large detached Victorian house standing in its own grounds and is a short walk away from the centre of Newport. There is a ramp leading up into the rear entrance of the Home. Wheelchair users cannot easily be accommodated. Individual bedrooms are on the ground and first floors. All vary in size and have an outlook over the garden. The current fees range is dependent upon individual assessed needs, can can be discussed with the home directly. Additional charges are made for hairdressing, chiropody, toiletries and newspapers (dependent upon individual requirements) and Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 12 Brief description of the care home transport. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in December and a second day in January. During this time we spoke to 6 people about their experiences of living at the home. We spent time observing how care and support was being delivered to people, including the lunchtime period. We also spoke to three care staff, the manager and the assistant manager. We looked at some of the key documents including plans of care, pre admission assessment information, staff recruitment and training files, records relating to medication and individuals monies. This helps us to understand how well the home is run and managed. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. Care Homes for Adults (18-65 years) Page 6 of 25 It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. During the inspection 2 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 8 people living at the home, and 2 from staff and 2 from relatives. Their comments and views have been included in this report and helped us to make a judgment about the service provided. Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are only admitted to the home once a needs assessment has been completed to ensure that they can meet all assessed needs. Evidence: We looked at the pre admission information for someone who had more recently moved into Lawrence House. We saw that the care management assessment and care plan had been obtained as well as a person centered plan that had been written in a format that the individuals could understand. We saw that the manager had completed her own assessment of needs, although this could be improved and expanded to include what introductory visits have been done and any planned transition days. Plans of care are developed from the needs assessments and are then used to inform staff what the persons needs are and how these should be met. We spoke to the individual who said they enjoyed living at Lawrence House and they appeared to be settling in well. Staff we spoke to and those who returned surveys said that they were always given Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: updated information about how individuals were and what they needed to help them, and that this was the case with new people coming to the home. Care Homes for Adults (18-65 years) Page 11 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and support is well planed and risk assessed to enable individuals to lead a an independent life as possible. Evidence: We looked at the plans of care for two individuals. One person who has complex needs and is reliant on staff for most activities of daily living. We saw that the plan had a very clear and detailed section that included the persons morning and evening routines. This was very informative and helps staff to provide Care and support in a consistent way. The plans are written in a symbol and pictures format so that people can easily understand them. These need to be kept under review and some need to be updated as they did not always reflect the current needs. For example one of these said the person enjoyed a variety of activities that in fact they no longer attend. The written information for staff to refer to was up to date, but the easy read plans need to be kept up to date also. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Individuals we spoke to and those who returned surveys said that they were able to make choices and decisions in their lives. One person told us I like to spend some time in my room, I like to be on my own sometimes. When asked people said that staff knocked on their door before coming in. We saw that individuals were being assisted to get up at a time that suited them. One person said they had enjoyed a lay in that morning as it was cold and they did not want to get up early. Eight out of ten surveys were completed by people who live at the home. They had all ticked yes to the questions can you do what you want during the day, evening and at weekends. Two surveys were returned from relative and one commented The care at Lawrence House is excellent. Two surveys were returned from staff and in answer to the question what does the home do well they said Always lets them know it is their home, very caring toward individual needs. Treats the residents with respect. Has an awareness and works to the individual needs of each resident. We saw that as part of the plan of care risks assessments had been completed to ensure that any identified risks had been clearly highlighted with actions of what should be done to minimize those risks. Care Homes for Adults (18-65 years) Page 13 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals divers and social needs are well met Evidence: People who live at Lawrence House enjoy a variety of activities and trips that involve them with other groups and people and accessing the local community. Some of the individuals who live at the home have reached or are nearing retirement age and do not wish to busy and active every day. Staff try to balance activities with what is age appropriate and what people enjoy and wish to continue to do. Some people enjoy being out and about much more including meeting up with other groups for games, arts and crafts The AQAA states We actively try to promote opportunities for the residents to experience as full and as stimulating a life as possible within a normal family type Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: setting. the residents are enabled to develop their independent living skills and we assist them to access activities both in house and off base which develop the socially,educationally and stimulate them as much as as we can. Several people did say in their surveys in answer to what could improve the service that they would like to go out a bit more. We spoke to people and they said they had recently enjoyed a trip to the pantomime, going to craft sessions, bowling, out for coffee and occasional meals. When activities are not on outside of the home, staff engage people in helping around the house, preparing meals and in craft sessions. We spoke with two visiting relatives who said that they could visit at any time they liked and that they were always made welcome. They said that the home puts on events for relatives to join in and they thought this was really good. We saw that people are offered a well balanced diet with a good variety of choice. Most people who completed a survey made a positive comment about the food including Good food, lovely dinners, nice food Care Homes for Adults (18-65 years) Page 15 of 25 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs are well met Evidence: We saw that some plans had really good information as to individuals daily preferred routines. We said this should be expanded for all individuals and by the second visit to the home this had been implemented. The information gives staff clear instructions about how people like to be assisted to get up, washed and dressed, what drinks and food they enjoy and how much they should be supported. Individuals are encouraged to be as independent as possible in their personal care. We saw that individuals style and dress sense is honored. Staff give guidance as needed, but people are bale to choose what they want to wear, how they style their hair etc. The AQAA INFORMATION STATES All residents have a personal care plan and body map which ensures that all personal care is delivered in accordance to the residents needs and preferences.The staff are extensively trained in delivering personal care.Where necessary outside agencies are brought in to help develop staffs skills in various areas. The home has various aids and adaptations to enable the residents to Care Homes for Adults (18-65 years) Page 16 of 25 Evidence: remain as independent as they can whilst remaining safe.All residents are treated with dignity and respect and whilst we have a bathing rota to ensure all residents receive adequate baths etc the staff have a flexible approach and respect the residents wishes.All staff receive medical training before administering meds etc.Staff act immediately on any ailments shown by residents and appropriate action is taken. We saw that plans of care detail individuals health care needs. Some of this information was not easily accessible in their main plan but was within their main folder. We have recommended that any essential health care information is included as part of the individuals main plan of care so that staff have easy access to this information. We saw that staff record how they monitor individuals health and emotional well being day to day in their daily records. We saw evidence that health care appointments are followed up and that if specialist support or advice is needed this is sought. For example one person has been referred to and been assessed by the speech and language therapist for swallowing difficulties. We checked medication storage and records and found these to be in good order. We would recommend as good proactive that when medications are changed, that any hand written changes or entires into the medication records are always double signed. This will help prevent against errors. Care Homes for Adults (18-65 years) Page 17 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views are listened and acted upon Evidence: Individuals we spoke to and those who returned surveys said they could talk to staff, their key worker or the manager about any concerns. The home have a simple complaints process, but the details about how to contact CQC need to be updated. The home have not had any complaints in the last 12 months and the commission have not received any. Staff have training in the protection of vulnerable people and know what to do should they suspect abuse occurring. Care Homes for Adults (18-65 years) Page 18 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lawrence House provides people with a clean, safe and well maintained environment Evidence: During this inspection we looked at all communal rooms and some of the individual bedrooms. We saw that the home is kept clean, warm and made homely. Individuals are encouraged to contribute to personaising their own rooms and communal areas. There is evidence of art work pottery and photos all around the home not just in individuals bedrooms. Policies and procedures are in place to ensure that good hygiene and infection control is followed by staff. We saw that staff had gloves and aprons available. Care Homes for Adults (18-65 years) Page 19 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and supported to do their job Evidence: The home has sufficient numbers of staff on duty per shift to ensure the needs of the current people are being met. There is normally two staff per shift as well as a manager or senior member of staff on duty. There are two sleep in staff at night. Staff have a good skill mix and the home ensures that their training is kept up to date so that they can do their job safely. A sample of four staff recruitment files were looked at, all but one had all the relevant checks and references in place. One did not have their CRB, but the registered manager has assured us that it was applied for and that if they are unable to find this, they will apply for a new one. They do use a consultancy to assist them with their recruitment and employment processes and part of this is getting staff to sing to say they have no known disclosures. This was completed in this instance. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. Evidence: The registered manager is also the registered provider of the home. She is qualified and experienced to run the home but says that she is looking to change her management structure. She wants her assistant manager to do more of the administration and to act as a check for her to ensure that all necessary checks and monitoring systems are in place. Staff that we spoke to and those who returned surveys said they felt valued as a member of staff and that the manager was open and inclusive in her approach. The manager says she works very hands on with people and those we saw and spoke to said that they could talk to the manager about their concerns or suggestions. The home do now ensure that quality assurance includes formally detailing the views of people and their relatives via regular meetings and surveys. This helps the home to Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: understand what changes may be needed to improve the quality of care and support. We saw that there is a good auditing system for ensuring that individuals monies are kept safe. We have recommended that more detailed records are kept of how individuals Disability Living allowance is sued to help then access the local community. The AQAA gives us information about how well the home is maintained, what servicing of equipment takes place and what polices, procedures and training is in place to ensure a safe environment. We saw that new staff follow a nationally recognised induction programme and that staff have regular updates in health and safety training to ensure they can do their job safely. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 3 6 20 Assessment documentation could be improved to include any transition days and introductory visists. The home should keep easy read formats of plans of care updated so they reflect current needs and wishes. Any hand written changes to medication records should be double signed to help prevent errors occurring. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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