Care Home: The Lawn

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What the care home does well Residents enjoy varied lifestyles, undertake activities and social events. These and family contacts are well managed and reflected residents wishes and choices. The home provides a good reliable service to residents by a well managed, stable, well trained, supported, committed and qualified staff team who are recruited in a manner that protects residents. A safe, well equipped, maintained, clean and suitably furnished home set in a well tended attractive garden is provided for residents which meets their needs. What has improved since the last inspection? All of the previous outcomes areas asessed as good have retained this rating apart from Life and Social Activities (standards 12-15) and the Envirronment (standards 1926) both of which we assessed as excellent at this visit. What the care home could do better: There were no areas of concern noted or requirements and recommendations made as a result of this visit. However, the number of of CRB reports and their dates should be more available in the individual member of staffs file. Key inspection report Care homes for older people Name: Address: The Lawn 119 London Road Holybourne Alton Hampshire GU34 4ER     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: Peter McNeillie     Date: 1 5 0 9 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: The Lawn 119 London Road Holybourne Alton Hampshire GU34 4ER 0142084162 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: manager@thelawn.fote.org.uk www.fote.org.uk Friends of the Elderly care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home The Lawn is a care home owned and managed by Friends of the Elderly registered to provide accommodation, personal care and support for up to thirty-one older people in the North Hampshire village of Holybourne, near Alton. The home is a large listed Georgian building set in seven acres of land which was built in 1807 and was once the home of the Victorian novelist Elizabeth Gaskell. The home also has purpose-built extensions and provides thirty-one single bedrooms with en-suite facilities, a drawing room, library and dining room, its own chapel (where weekly interdenominational services are held) and guest rooms that can be hired by residents visitors. A tributary Care Homes for Older People Page 4 of 27 Over 65 31 0 Brief description of the care home of the river Wey runs through well kept gardens which has a number of sitting areas from which residents are able to enjoy the extensive views. Ample on site parking is available at the rear of the home. 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: This report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, previous reports, examining residents and staff records. Additional information was provided by the manager in her responses in the homes pre inspection Annual Quality Assurance Assessment. (A.Q.A.A.). During this inspection which took place on 015/09/09 between the hours of 09:15am and 13:45 pm all of the designated key standards for older persons were inspected. As a result of this visit no requirements or recommendations have been made. The results and findings contained in this report which we discussed with the manager at the conclusion of our visit will determine the frequency and type of future Care Homes for Older People Page 6 of 27 inspections. 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. The home has a comprehensive system of assessing and identifying residents need and any attendant risks which ensures residents assessed needs can be met safely. Intermediate care is not provided so this standard does not apply. Evidence: The manager informed us that residents were only admitted in accordance with corporate pre admission policy that requires a detailed written assessment of need and risk being carried out by a member of the homes management team in consultation with the prospective resident. To confirm compliance with their own policy and procedure and the National Minimum Standards we viewed a sample of four residents pre admission assessments of persons admitted since our last visit. Care Homes for Older People Page 10 of 27 Evidence: These took into consideration residents care, nutritional, spiritual and communication needs, wishes, choices, mobility, medical history, medication, aspirations as well as any attendant risks. Records also confirmed that potential residents are consulted about and were involved in the assessment process. As part of the admission process management also liaise with external health and social care professionals regarding any care needs, risks, equipment and aids, that need to be considered and included when developing the care plan. Where the resident is funded by a local authorities Social Services department this would also include an assessment by a care manager. Records also confirmed ongoing assessments of need and risk for all residents are carried out on a regular basis and care plans (Section 7-11 of this report refers) updated to reflect any changes to ensure needs can continue to be met safely. Intermediate care is not available in the home. 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. The home has a well-developed system of planning and reviewing care, which reflects residents, wishes, and aspirations and ensures residents needs are met within a risk management policy and procedure that involves residents in decisions that affect them. Evidence: As part of our inspection plan, we viewed a random sample of four residents care plans chosen at random. All of the detailed care plans which included confirmation that residents were involved in producing, were reviewed at least monthly were based on pre admission assessments to identify what help and support individuals needed and any attendant risks and any other issued that could affect their welfare as described in the previous section of this report. In discussion, some residents verbally confirmed they were consulted about and participated in the production of the plan, others could not remember. Care Homes for Older People Page 12 of 27 Evidence: All of the residents spoken with and responses to our pre inspection satisfaction survey confirmed they were very satisfied with the care and support they received. They advised us they were contented, liked the staff and management and were treated with respect and dignity. They felt wanted and would recommend the home to anyone. Comments such as I am very happy, No complaints , Care is very good The staff and Manager who came in for particular high praise were described as Very hard working, efficient, kind and look after us all very well Resident also confirmed that their individual privacy was respected and that staff always knock on their bedroom door and wait before entering, a practice we observed during this visit. Residents rights and the opportunity to take risks are seen as fundamental. Residents were supported to make decisions for themselves within a risk assessment framework with the help of staff if required. This process identified individual risks and how the were to be managed. Should any restrictions in place these would also be recorded in the care plan and only implemented if the resident or their representative agreed Staff who had a good understanding of the contents of the care plans and risk assessments and were able to explain how the care plan was put into day-to-day practice Residents informed us were able to see the doctor of their choice including on of the same gender or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses other specialists would be consulted as required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professional and included details of any advice and treatment given. To ensure that race, gender identity, disability, sexual orientation, age, religion and belief are promoted and incorporated into what we do in their AQAA the home told us: We have a multidenominational service in the homes chapel on a weekly basis. We arrange for priests from other religions to come to the home. Full training is given as part of the staff induction to promote the equality of service users and staff and their diversities. This is continuously observed and monitored whilst the staff are n post and with the residents. Further dementia training will be taking place this year. All staff Care Homes for Older People Page 13 of 27 Evidence: receive abuse training All staff have a full 3 month induction period Friends of the elderly have a comprehensive Statement of Visions, Missions and values. Care Homes for Older People Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected residents interests and choices. Evidence: The home acknowledges how important activities and the opportunity for socialising aare to some residents, this was confirmed by residents spoken with expressed how important the activities were and how much they enjoyed them. All also confirmed that participation was up to the individual, no one was forced to join in To support this commitment the home employs an activities co-ordinator who is responsible for organising a programme of activities, which are varied and aimed at all levels of intellect and abilities, include outings to gardens, theatres, shopping, films, an in house library with large print books, quizzes and in house entertainers and garden concerts. There is also an activities room, within which residents have space for crafts, paintings and a potting bench where some look after their plants. The spititual needs of residents is also given a high priority.The home has regular visits from local Church of England and Roman Catholic clergy who conduct services and communion in the fully equipped, well appointed and comfortable chapel. The Care Homes for Older People Page 15 of 27 Evidence: manager informed us, the spiritual needs of members from any other faiths would be, (if required) be catered for but at the time of this visit no members from other faiths were residing in the home. The opportunity for residents to retaining contact with family and friends (if they wish) is considered to be of paramount importance by the home for the wellbeing of the residents. Visitors are activley encouraged, they are always welcome, can share a meals and make drinks freely at any time in one of the numerous small kitchens dotted around the home. To assist relatives who do not live in the area, overnight accomodation is also available that can also be used to remain close to a resident at times of illness etc. Apart from friends and family the home also has a support group of people who raise funds for the home, assist at social functions and on occassions escort residents on shopping tripps. Residents said they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse with visitors of their choice and to make and receive telephone calls in private. The quality, quantity, presentation and choice of food served came in for particular praise from the residents. A written daily menu showing alternatives available based on residents likes and dislikes was displayed. Vegetarian options are always available. Persons on special diets for religious or medical reasons can also be catered for, following individual written nutritional assessments, which are carried out, for all residents as described earlier in this report. In discussion with the manager, we highlighted the need to ensure that the daily menu was displayed in format that all residents would understand. This is of prime importance for persons with dementia who may find the addition of pictures would be beneficial to their understanding and when making choices. The manager in acknowledging this told us at the time of our visit all residents were able to read the menus apart from those with a visual impairment (with who care staff verbally discussed choices available in detail). The manager informed us needs of residents to understand the daily menu would be kept under review and should the need arise changed need to ensure that the menu was displayed in format that all Care Homes for Older People Page 16 of 27 Evidence: residents would understand. We observed residents taking their mid day meal. The food was well presented and residents served themselves from dishes on the table.The meal was conducted in a relaxed unhurried manner with staff available to give any resident assistance should they require it. Residents informed us meals could be taken in their own rooms if they wished. Care Homes for Older People Page 17 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. The home has clear policies and procedures in place which ensures residents can complain and are protected from abuse. Evidence: A safeguarding policy and procedure designed to protect residents from abuse that works in tandem with multi agency procedure produced by Hampshire County Council as the lead agency for safeguarding residents was in place. Records viewed, management and staff spoken with confirmed they had received training in recognising abuse and demonstrated they knew the procedure to follow should they witness or suspect the abuse of any resident. A record of complaints is maintained in accordance with the homes complaints policy and procedure which was prominently displayed in the home. This procedure which is also included in the service users guide contained information on how to contact the Care Quality Commission (CQC) as the regulatory authority. Neither CQC or the Commission for Social Care Inspection (CSCI) as the previous regulator have received any complaints since our last visit. Resident and staff s spoken with stated they felt comfortable in discussing any concerns they had with the homes management and confident any matters raised Care Homes for Older People Page 18 of 27 Evidence: would be dealt with fairly and promptly. In addition to the above all residents are made aware of an independant advocay service that is available.At the time of our visit no resident had felt the need to contact the advocacy service. Care Homes for Older People Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs. Evidence: The home which is located on the outskirts of the North Hampshire of village Holybourne close to Alton is a large listed Georgian Building with purpose built extensions. The home provides care support and accommodation in single en suite facilities for up to thirty one older persons. The home is set in seven acres of ground with plenty of on site parking and surrounded by an immaculately kept safe, mature garden through which a tributary of the River Wey runs. Residents told us how please they were to live in such an idyllic location with such beautiful views and trees to look at.Those responsible are to be commended for their efforts and the pleasure they bring to the residents. This is a very large building housing many staff and residents. Despite this all areas of the home were tidy, clean and free from unpleasant odors and obvious hazards. As one enters the home the visitor is aware from that a strict infection control procedure is in place. Those responsible for the high level of hygiene in such a large building Care Homes for Older People Page 20 of 27 Evidence: used by so many people are to be congratulated. Residents who told us they were satisfied with their accommodation confirmed the home is always clean and smells fresh. Furniture was comfortable, homely and in a good state of repair, in keeping with the decor and met residents individual and collective needs. All communal areas were accessible by residents including the garden previously mentioned. Apart from personal mobility aids a number of communal aids had also been provided to assist residents as described in the first section of this report. These included, a stair lift, a passenger lift, hoists ,grab rails ramps, special beds baths toilets, extra wide corridors and doorways wide enough to accommodate any wheelchair dependant resident. On our tour around the building we commented that some corridors were in need of decoration. We were told by the manager that these areas were due to be attended to in accordance with a rolling programme of maintenance that is designed to ensure that the building is well maintained, decorated and kept safe for residents and staff. Care Homes for Older People Page 21 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. Residents needs needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. Evidence: Following their appointment, records seen confirmed that all staff are subject to an in house and Skills for Care induction and compulsory training programme that include first aid, handling medication, food handling, moving and handling, POVA, infection control and dementia. All staff are expected to undertake a National Vocational Qualification (NVQ) course to at least level two. Information provided by the Registered Manager told us currently 50 of staff has been trained to at least NVQ level two of these 5.5 had also completed NVQ level three, with a further 11.0 waiting to start on a course leading to a level two qualification. The manager informed us at she was encountering difficulties in getting staff on courses that did not involve travel and the shortage of assessors. Care Homes for Older People Page 22 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. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents whose views about living in the home are formally sought. Evidence: The registered manager who has experience of managing resources for older persons for many years been in post for the past seven years. Apart from her experience, the manager holds an NVQ level four in care and the registered managers NVQ level four qualifications. In talking with the manager and staff we were satisfied that the home has a clearly defined management structure, and that staff were aware all of their responsibilities and the limits of their authority. Care Homes for Older People Page 23 of 27 Evidence: Staff spoken with described, the homes management both internal and external as supportive, approachable and accessible and willing to listen to any ideas they may have for the improvement of the service. As part of the homes quality monitoring system, residents and residents representative, staff and visiting social and health care professionals are invited to participate in satisfaction surveys. The views expressed in these surveys are seen as key in highlighting areas that may require improvement or attention and the future development of this service. Care Homes for Older People Page 24 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 25 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 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!