Care Home: St Lawrence Residential Home

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What the care home does well The people that use the service are encouraged and supported to have a positive experience with their privacy, dignity and respect at the home. The care staff and people that use the service appear to have very good relationships with each other. This means that they trust each other and people that use the service can have confidence that the care staff look after their best interests and protect them from harm. People that use the service are encouraged to maintain contact with their families and friends. The homes policies encourage people to visit the home at any reasonable time. A sufficient number of care staff are available in the home on each shift to support the assessed needs of the people that use the service. What has improved since the last inspection? The management of the home have purchased a new set of scales to allow them to regularly weigh the people that use the service. This will help to monitor their health on an ongoing basis. What the care home could do better: The staff need to take more care in relation to the homes control of infection policies and procedures. This will mean that the people that use the service maintain good health and are free from infectious disease. The management of the home need to develop the individual care plans in the home to include peoples individual needs and how they need them to be supported. Key inspection report Care homes for older people Name: Address: St Lawrence Residential Home 102-104 Oswald Road Scunthorpe North Lincs DN15 7PA     The quality rating for this care home is:   two star good 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: Stephen Robertshaw     Date: 0 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Lawrence Residential Home 102-104 Oswald Road Scunthorpe North Lincs DN15 7PA 01724847082 01724847082 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ajay Kumar Jebodh,Priscilla Devi Jebodh care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home St Lawrence Residential Home is situated close to the town centre of Scunthorpe within easy reach of local amenities. It is registered to provide care and support to twentyfour service users in the category of older people. The home consists of two Edwardian brick built houses extended over two floors, serviced by a through floor lift and stairs. There are two bathrooms with toilets, both of which are assisted, and a walk-in shower room. In addition there is a single toilet facility. All are strategically placed for ease of access to service users. There is a large lounge separated into three individual sections incorporating one large and one small seating area and a dining area. The latter has four separate dining tables to seat four to six people at each. Leading on from the larger seating area is a conservatory with easy chairs and coffee tables and an additional staff room. Care Homes for Older People Page 4 of 27 Over 65 23 0 Brief description of the care home There is a small well-maintained garden to the rear of the building and car parking space for approximately eight cars. Overall the home has a comfortable, homely feel and is generally well maintained. The weekly fees at the time of the site vist were between £345.00 and £365.00. Items not included in the fee are toiletries, hairdressing, chiropody and transport. Care Homes for Older People Page 5 of 27 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit for St Lawrence Residential Home took place on 06 July 2009. the commission were at the home for approximately six hours. At the time of the site visit the commission spoke with people that use the service, visitors to the home, outside professionals, the homes care staff and the management of the home. The Commission also sampled the documentation held by the home that concerned the care of the people that live at the service. This included looking at care plans and assessments of need. The Commission also spoke with the registered provider of the home and directly observed the interactions between the staff working at the home and the people that live at the service. All of the information obtained during the year and running up to the site visit, was Care Homes for Older People Page 6 of 27 used to make a judgement on what it must be like living in the home. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. This means that the people that use the service have their individual needs assessed to make sure that they can be met at the home. needs will be met. Evidence: The Commission looked at all of the information recorded at the home for two of the people that use the service. This included observing the assessments of their individual needs. The assessment information was a combination of the homes preadmission assessment of need and where appropriate the assessment that had been completed by the placing authority. Some of the areas included in the assessments were religion, culture, race, disability, mental health and mobility. Care Homes for Older People Page 10 of 27 Evidence: The homes pre-admission assessments of need could be improved by including more detailed and person centered information. This would help to develop more indivudalised care plans that are suitable to the people that they concern. An example of this is as opposed to stating that a person needs support to have a bath, what is the nature of the support that is required, is it just encouragement or do they need physical support etc. The home does not provide intermediate care to the people that use the service. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The people that use the service have their health and social care needs identified in their care plans, so they are confident all their needs will be met. However some of the care plans that were observed were very generic and did not include any personal information. Evidence: The care plans that were observed by the Commission covered all of the appropriate areas identied in peoples assessment of need. This included personal care, hygiene, mobility, nutrition, medication, mental health and communication needs. There was evidence to suggest that the care plans are reviewed on a regular basis to make sure that they are still appropriate to meet the needs of the individuals that they involved. However most of these care plans were generic in nature and did not identify how Care Homes for Older People Page 12 of 27 Evidence: individuals would like to be supported with their personal needs. The care plans wuld be more appriate if they included more personal detail for example if a person needs support with their mobilty, what is the level of support that they require. The service also completes a daily diary record for all of the people that use the service. This helps to identify any patterns of behaviour for individuls that live at the home and can also monitor any deterioration in peoples physical or mental health. The staff spoken to by the commission confimrmed that the people that use the service have their health care needs met though the support of health care professionals that are based in the community. A visiting profesional stated that the home was very good at informing health care professionals of any individual health care needs. The service has a clear medication policy and procedure for staff to follow and this includes self-medication. The Commission directly observed one of the medication administration periods in the home and all good practice and legislative guidelines were adhered to. Medication records in the home were up to date and had been accurately recorded. Each precription held by the home inclues a photograph of the person that it is prescribed for. This is ood practice and helps to make sure that the medication is given to the right person. The home recieves all of its prescribed medication from a local pharmacy and the pharmacy audits the medication held in the home every six months. Staff training records and interviews with the care staff supported the evidence that the only staff that administer prescribed medication in the home had recieved approapriate medication training. Direct observations carried out by the Commission also identified peoples privacy, dignity and respect is upheld at all times at the home. One person told the Commission I always see the nurse in my room. A visiting professional also staed the staff are always very polite and curteous to the people that they are working with. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. This means that people that use the service have flexible routines in the home, however some of the activities are limited. Evidence: People spoken to by the Commission on the day of the site visit were varied in their opinions in relation to activities and social contact in the home. One person said its very nice here, its my home, I dont want to do much though and i dont have to. Another person said Im bored I wish there was more to do. A hairdresser s the home every week and individuals can make appointements to have their hair cut. One person told the Commssion when its a nice day I like to go outside and the staff go with me. another person said sometimes we take walks into town or go to the local shops. Care Homes for Older People Page 14 of 27 Evidence: Television continues to be a constant feature in the main lounge area of the home. although the television was on and the lounge was fairly full noboby appeared to be watching it. however one person said that i like watching Jeremy Kyle in the morning. Several visitors were seen by the Commision during the site visit and the homes visitor records showed that the home is very buy with visitors. The bvisitors that were spoken to by the Commission confirmed that they are always made welcome when they visit the home and one person said the stff are always very friendly and helpfull. One of the meal times at the home was observed by the Commission. a choice of meal was made availbale at lunch and people were given the meals that they had chosen earlier in the day. People spoken to by the commission that that the quality of the meals in the home was usually good and that they enjoyed their meals. There were no cultural or ethnic diets that were required by anyone at the time of the site visit. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. This means that the people that use the service can be confident their their best interests, welfare and health are protected while they are resident at the home. Evidence: The Commission looked at the complaints and safeguarding records that were held in the home. There had been no formal complaints or safe guarding issues identified in the home since the last inspection. The proprietor of the service stated that the philosophy of the home is to encourage an open and honest management and care system. He said that this should encourage people to raise any concerns that they have to the staff group and provide confidence that the concerns would be dealt with professionally and in a friendly manner. The home had clear complaints and safeguarding policies and procedures in position. The manager of the home stated that the care staff receive safe guarding adults training and said that some of this is provided through the local authority. People that use the service that were spoken to by the Commission said that they Care Homes for Older People Page 16 of 27 Evidence: were aware of how to make a formal complaint if they wished to and said that they were confident that their concerns would be listened to and be acted upon. One person said Ive never had a complaint here, but I have told the staff when I wasnt happy with something and they sorted it out. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. This means that the environment of the home is suitable to meet the needs of the people that use the service. Evidence: As part of the site visit to the service, the Commission made a tour of the premises to identify if the environment was suitable to meet the needs of the people that use the service. Generally the management of the home have improved the environment of the home, however there were still some areas of concern in the home. Most of these issues related to infection control policies and procedures in the home. a linen store was seen to be left open. This meant that anyone could access this area and spread any infection that they may have on the clean linen. There were several bins in the home that had lost their lids and this included one of Care Homes for Older People Page 18 of 27 Evidence: the bins in the homes kitchen. The bins should be covered to prevent the spread of infection and possibility of contamination. Several of the bathroom and toilet areas did not have any paper towels in them, and one bathroom included a linen towel. This could cause cross infection if used by several different people. The kitchen had recently had some work completed in it and was waiting to have some new coving fitted. A new fridge freezer had been supplied in the kitchen, however one of the drawer fronts had broken and required replacing. There was no official area in the home for staff to safe keep their belongings while they were at work at the home. This could make them more open to theft. The management of the home needs to provide The communal areas of the home were observed and five of the people that use the service invited the Commission to see their rooms. All of their personal rooms had been decorated and furnished to their own tastes and preferences. One person told the Commission Im very happy here, its my home. care staff were observed knocking on peoples doors and waiting for permission to enter their rooms. Individuals spoken to by the Commission said that they were very happy with the general decoration and cleanliness of the home. The home has a passenger lift and a mobile lifting hoist that is available to the staff group people that use the service. The Commission observed all of the maintenance and service records for these pieces o equipment and they were seen to be up to date. The home had a contract to deal with their hazardous waste and had an up to date certificate for a legionella bacteriological analysis and regular records were maintained for the hot water outlets in the home. Arrangements had been made by the management of the home to have their electrical hard wiring checked and maintained. The gas safety checks in the home were up to date and a recent fire risk assessment had been completed for the service. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. This means that the staff group and the knowledge and skills to be able to safely care for the people that use the service. Evidence: The Commission discussed the staffing levels, ablities and availability with people that use the service, the propritor, manager, visitors and care staff. Everyone stated that the staffing levels in the home were adequate to meet the needs of the people that use the service. The homes rotas also supported the evidence that there were sufficent numbers of staff available to the people that use the service. One person said the girls are lovely and a visitor said there is always someone around when you want to talk to them. We also looked at the staff training and personnel files for three of the staff that work at the home.These showed that the home hd used a rigourous system to make sure that the people that use the service were protected from any potential harm. This Care Homes for Older People Page 20 of 27 Evidence: included interviews, references and appropriate security vetting beffore anyone was employed to work at the home. The management and staff working at the ome are very positive towards National vocational training (NVQ) and approximately 67 of the homes care staff have already achived a minimum of NVQ 2 in care. Both cooks that work in the home have also completed NVQ 2 in food preperation and safety. St Lawrance also employ a part-time activity coordinator to elp to develop more appropriate activties for the people that use the service. Staff training records supported the evidence that the staff recieve the appropriate mandatory and specialist training to make sure that they have the knowledge and skills to be able to safely care for the people that use the service. staff spoken to by the Commision confirmed that they had attended all of the taining that had been identified in their files. One ,member of staff said It seems like we are always training. The managr of the home has developed a training matrix for the home. This helps to identify when staff need to recieve new or refresher training. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. This means that the home is well managed and works for their best interests of the people that live and work at the home. Evidence: The manager of the service has over ten years experience of working in a care setting. The manager of the home is registered with the Commission and has completed NVQ 4 Registered Managers Award. The service has an effective Quality Assurance and monitoring system in position. This includes sending out regualr surveys to people that have involvement with the home. This includes people that use the service, their famlies, outside professionals and staff Care Homes for Older People Page 22 of 27 Evidence: that work at the home. The latest survey carried out by the home was in relation to its housekeeping service in May 2009. The analysis of the surveys are used to create an action plan to improve or maintain levels of service in the home. The results are also presented in graph formats to make them easier for some people to understand. However some of the sureveys are very basic and rely on tick box answers it would benfit te service to develop more open surveys that could provide more detail in their reponces. For example if they dont like a part of the service, why dont they like it. Supporting the homes quality assurance is the fact that the local authority have awarded the home a Gold Award Standard for 2009. The manager of the home also stated that the service is currently being assesed for an Investors In People award. People that were spoken to by the Commission were satisied that when the home was responsible for supporting them with their finances they believed that their finaces were handled appropriatley by the staff. Two accounts in the home were checked and were found to have been accuratelly recorded and the records were up to date. As stated in the environment section of the report the managment of the service maintains up to date certificates, maintenancce records and service histories for all of the equipment in the home. This included the passenger lift and hoist equipment. Staff that were spoken to confimred that they reecieve at least the recommended mimimum for formal recorded supervision per year. Their supervision records and interview with the homes manager also supported that the supervision was up to date and was an ongoing process to make sure that the staff have the right skills and knowledge to be able to safely care for the people that use the service. The manager of the service stated that the staffs annual appraisels were due to be completed and were not up to date and that this was one of her prioities. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 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 3 The registered person should develop the homes preadmission assessments to include more person centered information. This will help to make sure that people receive the care that they need in a way that is acceptable to them. The registered person should make sure that peoples care plans include enough detail to show how they want to be supported with their individual needs. The registered person should make sure that the activities programme in the home is stimulating and interesting for the people that use the service. The registered person should make sure that all of the staff working in the home adhere to the services infection control policies and procedures. This will help to support the health and safety of the people that use the service. The registered person should make sure that the surveys sent out by the home as part of their quality assurance programme are open and encourage people to explicitly express their views on the services delivered by the home. 2 7 3 12 4 19 5 33 Care Homes for Older People Page 25 of 27 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 6 36 The registered person should make sure that all of the staff that work at the home have an annual appraisal of their work to make sure that they are up to date with their training and have the necessary skills and knowledge to work at the home. Care Homes for Older People Page 26 of 27 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). 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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