Care Home: The Lawns

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What the care home does well The home had a calm and relaxed atmosphere about it. Visitors are made welcome therefore people living there are able to choose and maintain relationships that are important to them. Information is available for people who are thinking of moving into the home and an assessment of care needs is carried out. A keyworker system is in place whereby a named carer has a special interest in each individual residing at the home. This is important as it helps to ensure that care needs are monitored. Activities are available within the home. These take into account people`s interests and personal tastes and therefore stimulate people living in the home. A choice of meals are provided and people are encouraged to serve themselves therefore maintaining people`s independence. Meal times are a positive experience for people living in the home. The registered manager is aware of adult protection procedures and a staff training programme is in place. This helps ensure that people are safeguarded against abuse. The Lawns is well maintained, clean and tidy. What has improved since the last inspection? Written references are in place therefore ensuring that people living in the home are protected against staff who may be unsuitable. The reporting of significant events since our last visit helps us maintain a better understanding of how the service is operating. What the care home could do better: We found that care plans needed to be kept up to date better. This helps to ensure that people`s needs are met appropriately. Improvement was also needed in the recording and management of medication. The registered manager took immediate action in relation to our findings regarding both care plans and medication to improve systems and ensure that people receive a safe and quality service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Lawns School Lane Alvechurch nr Birmingham Worcestershire B48 7SB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 2 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 34 Information about the care home Name of care home: Address: The Lawns School Lane Alvechurch nr Birmingham Worcestershire B48 7SB 01214454098 Telephone number: Fax number: Email address: Provider web address: chris@thelawnscare.co.uk Name of registered provider(s): Mrs Lisa Marie Oliver,Mr Darren Terence Oliver care home 40 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide the following category of service only: Care home only: Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia : Code DE (40) Old age, not falling within any other category: Code OP (40) 2. The maximum number of service users who can be accomodated is: 40 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 34 Physical Disability (PD) 34 Dementia (DE) 34 Care Homes for Older People Page 4 of 34 Over 65 0 40 0 40 0 40 Date of last inspection Brief description of the care home The Lawns is registered to provide residential care for up to 34 older people, who are unable to live independently, who may have a physical or sensory disability, or who may experience mental health problems. The home is also able to offer care to people who may have a dementia type illness. The house is a large detached property, originally built in 1856 as a Rectory for the adjacent Parish Church in the village of Alvechurch. The building is well maintained, and has been sensitively upgraded and extended to provide a very pleasant environment for the people who live there. The home stands in lovely gardens, which are well laid out and kept to a high standard. They are accessible to people residing within the home and well used, particularly in the summer months. The home is also situated within walking distance of the local shops and services. The home is owned and run by Mr Darren & Mrs Lisa Oliver. Mrs. Christine Caldicott is the registered care manager, and has responsibility for the dayto-day running of the home. The stated aim of the management and staff at The Lawns is to create a warm, welcoming, friendly and safe environment, where the very best care and attention is provided, in an environment as close as possible to home conditions. At the time of this inspection phase two of a major change was almost complete. The current fees range from 495 to 695 pounds per week. Care Homes for Older People Page 5 of 34 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 last key inspection at The Lawns was carried out during February 2007. Since that date we have carried out one Annual Service Review (ASR). We, the commission carried out this inspection over a period of two visits to the home. The inspection was unannounced therefore nobody within the home knew we were going to visit. The focus of our inspections is upon the outcomes for people who live in the care home and includes peoples view of the service provided. The process we use considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to our visit we looked at the information that we have received since the last ASR. We requested an Annual Quality Assurance Assessment (AQAA) from the home prior to our visit. The AQAA is a document completed by the home and provides us with Care Homes for Older People Page 6 of 34 information about the home and how they believe they are meeting the needs of people living there. We looked around the home. We viewed records in relation to some people living in the home such as care records, risk assessments and medication records. We also viewed records relating to some members of staff and others regarding health and safety matters. We spoke to the registered manager and one the registered providers. We also spoke to some members of staff, visitors and people living in the home. 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 set out 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 34 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 34 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. Information about the home is available to help people make a choice about whether they would like to live there. The needs of people who may use the service are assessed prior to their admission so that they and their relatives can be assured that these needs can be met and an initial care plan established. Evidence: We were given a copy of the homes service users guide during our visit. We saw copies of the guide in bedrooms. The guide contains useful information about the service which could help people reach a decision about whether the home can meet their care needs. Currently the guide is not available in any other format. The registered manager is aware that once further bedrooms, currently in construction, are registered the guide will need to be amended. At the time of our inspection the registered manager was working on a range of new brochures and a newsletter. The service users guide states that people normally come to the home on a trial Care Homes for Older People Page 10 of 34 Evidence: period of one month. This period of time is seen to be an opportunity for both parties to see if they are satisfied with the situation. We viewed the assessment of a person recently admitted into the home. The assessment contained sufficient information and detail to enable an initial care plan to be set up on admission. We saw evidence that the home seeks the views of the individual as well as relatives and social worker. A copy of the community care assessment completed by the social worker was also on file and available for staff to refer to as needed. An initial care plan was completed on the day of admission. In addition to the care plan we saw a brief morning, afternoon and night time routine, a social history and a pressure ulcer risk assessment. We saw evidence that care is taken to ensure that the designated bedroom is ready for when a person arrives at the home as a check list is in place for this purpose. Care Homes for Older People Page 11 of 34 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. Staff understand peoples needs and encourage independence where possible. However there is a risk that some needs are not being met consistently because of shortfalls in care planning and medication records. Evidence: Each person residing at The Lawns had a written care plan. This is a document designed to guide staff about the level of care required by each individual to ensure that identified needs are met and people receive the support they require. We viewed a number of care plans, risk assessments and other associated documents such as daily records. Care plans were generally comprehensive and covered many aspects of care in relation to identified needs. We saw risk assessments and systems of work which described how many care staff are needed to perform certain tasks safely. The care plan in relation to somebody recently admitted into the home followed on Care Homes for Older People Page 12 of 34 Evidence: from the initial assessment and gave carers clear instructions as to how to meet care needs. We saw evidence that the home has a key worker system in place whereby one carer takes a particular interest in each person residing in the home to ensure that needs are met. Each key worker has a supervisor who has a responsibility to ensure that the care plan is kept up to date. Staff had recorded that care plans had been reviewed on a monthly basis. However on reading the daily notes we came across a number of issues that were not being addressed adequately in the plans. It was evident that one person had, for a period of time, a community nurse visiting her at the home to provide treatment. Carers had however noted a further concern. We found no evidence that this matter was brought to the attention of a medical person. We saw evidence that some treatment was prescribed but it was not evident how this had come about. We could find no care plan and no instructions regarding the care regime implemented. The medication records gave no guidance as to where cream was to be applied and one cream was not applied as frequently as the Medication Administration Record (MAR) sheet stated it should be. The registered manager took immediate action as a result of our findings. Contact was made with medical services as soon as it was possible to do so. The care plan was up dated along with other records to ensure that staff had the correct instructions. We found some similar themes on another care plan whereby it was difficult to establish what had happened following some observations made, as no follow up action was recorded and the care plan was not up dated. We were told that the home is supported by community nursing services and we saw evidence of this and of input from other professionals. A visiting professional told us that peoples feet are always nice and clean. Care records evidenced that referrals for equipment such as wheelchairs are made as necessary to ensure that people have the items they need. As part of this inspection we assessed the management and administration of medication. Medication is currently stored both upstairs and downstairs. We looked at bottles in a medication trolley and found them to be clean and not sticky. Medication administered from its original box had the date of opening recorded upon it. We were told that 6 of the day time staff and 4 night carers are able to administer medication to people living within the home. We viewed the current months MAR sheets. A photograph was in place with each individual MAR sheet. We checked one persons medication against his discharge Care Homes for Older People Page 13 of 34 Evidence: papers from the hospital and found that they matched. The MAR sheets checked upstairs were all completed to a satisfactory standard. We audited one item stored within the controlled drugs cupboard. The number of drugs held balanced correctly with the records that the home had maintained. On checking some of the MAR sheets held downstairs we had some concerns regarding the recording. One course of antibiotics had a missing signature for one dose. The MAR sheet stated course finished. Staff at the home had not noticed the error. We noted occasions when staff had signed for medication as administered (therefore stating that the person had taken the medication) and then signed over the top of that signature with a code indicating that the individual was on social leave and therefore not in the home. We also saw that one person who was due to have medication at 7.30 am was not receiving it as staff were recording asleep on the MAR sheet. This was not mentioned on a care plan and we could not find any evidence or indication that staff had brought this matter to the attention of a doctor. Medication was seen to be booked in and we saw a stock of medication due to be returned. We noted that handwritten entries on MAR sheets did not have a second signature to confirm the entry. This is an additional safeguard to ensure that records are correct. We were able to carry out an audit of some drugs however as carry forward totals were not recorded audits of some drugs were not possible. We discussed our findings with the registered manager who acknowledged our concerns and undertook to address the shortfalls around recording without delay. As a consequence of our visit the registered manager has since our inspection told us that she has arranged for a major High Street chemist to supply training to staff that dispense medication. In addition the pharmacy also supplied the manager with information regarding self administration and risk assessing tools as some concerns were discussed during our visit. People using the service told us that staff are respectful towards them and that issues around privacy and dignity are addressed. These comments were confirmed by our own observations during the visit. Staff encourage people to be as independent as possible. One person told us that the home has a family atmosphere about it. We did, at one point find, some confidential notes on people using the service left unattended in an area temporally used as a staff rest area. This area is freely assessable to everybody as it formed part of the upstairs landing. We had some concern about a Care Homes for Older People Page 14 of 34 Evidence: personal care task which was been carried out on somebody by a member of staff from the opposite sex. We could not see any indication that this matter had been considered or any consultation to show that people were happy with this arrangement. The registered manager took action to address these concerns at the time of our visit. Care Homes for Older People Page 15 of 34 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. People are encouraged and supported in social and recreational activities which reflect their personal preferences. Evidence: People we spoke to told us that they were happy with the daily routines and the activities within the home. We also spoke to staff, including the activities co ordinator, who were satisfied with the range of social and leisure activities available. Information was on display in the hallway about recent and forthcoming events. Planned events included listening to the piano, people playing the harp and saxophone, a talk by a retired policeman, flower display, sing along, quizzes, games and keep fit. During our time in the home people were involved in decorating cakes and displaying some spring flowers. Two people living in the home were at one point displaying and sorting items for the Easter raffle in order to raise money for the funds. Facilities for watching television are provided although generally watching tv is not seen as an activity within the home. Plans are however in hand to obtain film of Birmingham in bygone years which will be shown on a large screen. Care Homes for Older People Page 16 of 34 Evidence: Religious care needs are met by the minister from the church next to the home visiting. In addition people from a local Baptist church and Roman Catholic church also visit. The Lawns continues to be involved in a system called Have Your Say where advocates visit the home and seek peoples views. We were told that meetings take place involving people who live in the home. These meetings do not involve the manager who receives any comments afterwards. Although no meeting has yet taken place this year we were told that in the past the meetings have discussed fund raising as well as any concerns people might have. The meeting is also used as a consultation exercise regarding food. We were told that people have, in the past, requested items such as spotted dick which have later appeared on the menu. We saw a number of photograph albums in the hallway showing pictures of parties and events in the past. Plans were well underway for somebodys forthcoming 103rd Birthday party. The manager plans to introduce a range of new information leaflets regarding the home once current building work is completed. We also saw a draft issue of a planned newsletter. We saw a number of people visiting relatives or friends. Visitors were seen to be made welcome and they seemed to be at ease with the staff. People living at The Lawns are able to bring in personal possessions to make their own rooms more homely and personal. The menu was on display in the hallway as well as written on a chalk board leading into the dining area. We were able to join people while they were having lunch. People told us that the food was a lot better and that they now have a choice of either a hot or cold tea. The meals we had were warm and tasty. People generally served themselves from vegetable dishes. The meals were unhurried and staff assisted where needed in a very discreet style. The manager and the cook came around the dining room asking people if they were enjoying the meal. This did not seem out of place or different to the normal routine within the home. Following the main meal people were offered a small range of different sweets from a trolley which had the feel of a hotel like service about it. Small individual pots of tea were served which added further to the experience. A considerable amount of chatter Care Homes for Older People Page 17 of 34 Evidence: went on during the meal which made it a social event which seemed to be enjoyed by people in the room. Drinks were available throughout the day. In addition to hot drinks served during the day cold drinks were available in the lounge and in some of the bedrooms we viewed. We saw the dry food store area. This was clean and tidy and contained a good supply of tined food. The supply of food included small tins of baked beans and spaghetti which suggests that these items would be made available on an individual basis if requested. Fresh fruit and vegetables were available. Care Homes for Older People Page 18 of 34 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 are aware of how they can make a complaint and can be confident that these will be addressed. Staff have sufficient knowledge about safeguarding procedures in order to protect people from potental abuse. The training provided for staff in safeguarding should ensure that people are safe and protected from the risk of abuse. Evidence: We have not received any complaints about the service provided since our last key inspection. The AQAA document stated We have no complaints. The registered manager confirmed during our visit that she had not received any complaints. In August 2008 we wrote an Annual Service Review (ASR) on The Lawns. Prior to the ASR we sent some surveys to people using the service. Within the ASR we concluded that People know how to complain and who to complain to if they need to. The homes complaints procedure was on display in the entrance hall as well as in the lounge near to the dining area. The procedure was clear and made reference to the commission at our new address in Birmingham. Furthermore it mentioned that people can refer their complaint to us at any stage. The procedure within the service users guide was not so clear. As this document will need to be amended once phase 2 of the building work becomes registered this would be an ideal opportunity to up date this part of the guide. This review could also include making the procedure available in other formats. Care Homes for Older People Page 19 of 34 Evidence: While at the home we were able to spend some time with a small group of people residing within the home. The discussion was relaxed and people appeared comfortable to be talking about the service they receive. People were confident that if they had any complaints that the manager would listen to them and sort what ever the problem was out. People also told us about meetings within the home during which any concerns or requests could be made. People are able to access an external advocacy service should they need such a facility. A recommendation made at a previous inspection, was for all compliments received at the home to be recorded. This then gives a balanced view of the service. A separate file is held for this purpose and was freely available in the reception area of the home. We were told that arrangements for postal votes had just been made to ensure that people retain their right to be involved in the election process. We have not received any safeguarding alerts or referrals since the previous inspection and we are not aware of any incidents within the home which would of needed such a referral. The registered manager informed us that 6 members of staff have recently undertaken a distance learning package on the protection of vulnerable adults. We were told that the course is valid for three years following completion. A further 6 members of staff are to be enrolled onto this training in the foreseeable future. We saw a copy of the work book completed by staff undertaking this training. The training consists of a number of modules covering a range of areas such as the Protection of Vulnerable Adults (PoVA) list and understanding abuse and neglect. We had a brief discussion with the registered manager regarding the forthcoming changes with the PoVA list and the introduction of the Vetting and Barring Scheme and the Independent Safeguarding Authority. We spoke to a number of members of staff about the action they would take if they were aware of actual or potential abuse taking place. The responses were sufficiently suitable for the role people were employed as within the home although a greater understanding may be the result once the training has developed further within the home. Care Homes for Older People Page 20 of 34 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 live in a clean and pleasant home with good facilities available to them. Some risks need to be managed more carefully so that the home environment is as safe as possible for people. Evidence: The Lawns is a lovely Victorian building, dating back to 1856, when it was originally built as the Rectory for the adjacent church. In 1953 it became a nursing home, and about 20 years later changed to a residential care home. Pictures of the house are on display in the main corridor. The Lawns has the distinction of being one of the longest established care homes in the country. The house has been sensitively developed and upgraded to provide a pleasant and relaxed environment for people who live there. The home has a large lounge and an extensive all weather conservatory, which is used as the dining area. We were told that the curtains, chairs and coffee tables in the lounge are all new. Lighting throughout the home is domestic in appearance. The carpets in the lounge as well as carpeting in other parts of the home, such as corridors, are going to be replaced once current building work is finished. Care Homes for Older People Page 21 of 34 Evidence: There are lovely views from the conservatory and some of the bedrooms across the pleasant landscaped gardens. The gardens are easily accessed by people using the service. On exiting the dining room people are able to use an extensive court yard area which has garden furniture in place to enable people to relax and enjoy the gardens. The lower garden can be reached by either a ramp or wide steps. Following the completion of phase 1 of extensive changes to the home The Lawns is currently registered to care for 34 people. Phase 1 consisted of providing 7 suites all of which are on the ground floor. Of these suites 3 are able to accommodate a couple. We saw one of these suites during our visit. It consisted of a sitting area, a kitchenette with cooking facilities, fridge and microwave, a bedroom and an en-suite wet room. The manager described the new build as my dream. She described the home as like a small country hotel. Further building work was on going at the time of our inspection. We have received an application to register a further 6 bedrooms as a result of phase 2. As these rooms were not complete this area was viewed on this occasion. We were informed that once the work is finished the temporary corridor to phase 1 will be removed. One person told us of her disappointment that due to the new build she had lost the view of the neighbouring church from her bedroom. The registered manager recognised this disappointment and offered a move to one of the new bedrooms which will afford this view. Due to the current building work the manager was using a bedroom as her office also the hairdressing room was temporally unavailable for use by people residing within the home. Within the original home, bedrooms are located on both the ground and first floor. Rooms on the first floor are accessed by stairs, or for the convenience of people residing within the home who may have limited mobility, a chair lift is provided. We were informed that a passenger lift forms part of the second phase which is currently nearing its completion. People are able to personalise their bedrooms with their own items. We checked the wardrobe in one bedroom and found that it was suitably secured to the wall to prevent accidental toppling. The home was clean and fresh throughout. People using the service told us that they are pleased with the service provided regarding cleaning and laundry. Since the previous inspection a sluice machine has been fitted. We looked at one bed and found it to be clean and well made. We were told that table cloths are changed at the end of every meal and fresh ones used for the next one. Care Homes for Older People Page 22 of 34 Evidence: Radiators are covered to prevent accidental scalding. We noticed that the pipes feeding hot water to the radiators were not covered. The weather at the time of this inspection was unseasonably warm however on touching some of the pipes we found them to be hot. However the risk of scalding in the event of a person falling near to pipe work had not been assessed. There are no hand rails along corridors within the original house however this did not seem to cause any difficulties regarding peoples mobility around the home. Records existed regarding the testing of thermostatic control valves fitted to the baths. We were told that staff check water temperatures before anybody has a bath however the actual testing of water temperature on delivery was only taking place on an annual basis. As these devices are not fail safe it was agreed that the frequency of the testing was insufficient and the registered manager undertook to ensure that this happens on a more frequent basis. We were told that thermostatic controls are fitted to wash hand basins as they are replaced. Several of the communal toilets and bathrooms have been refurbished. We saw one bathroom which had spotlights in the ceiling to make the room look more modern and homely. One bathroom was temporally out of use while refurbishment took place. We had some concern as the contractors had left a bag of tools, a lighter and a Stanley blade unattended. These items could have posed a risk to the health safety and welfare of people using the service. Another bathroom appeared tired in appearance. We were informed that this bathroom is to be refurbished in the near future. We found 1 bedroom window and a bathroom window without any means of restrictor in place to prevent accidental or deliberate falling to ground. We were informed that restrictors may have been removed as part of the refurbishment although the bathroom concerned was one requiring refurbishment. Suitable action was taken with immediate effect to make these windows safe. We briefly saw a risk assessment regarding the building work. Other documents were available but not viewed. Work was taking place outside of the home. Signage and safe passageways for pedestrians were clearly displayed. We saw the kitchen. The area was clean, tidy and designed in line with good practice in relation to food hygiene. New fridges and freezers were seen. We saw that records are maintained in line with Safer Food Better Business. The Environmental Health Department of the local District Council awarded the home 5 stars Excellent in Care Homes for Older People Page 23 of 34 Evidence: relation to their standards in June 2008. Care Homes for Older People Page 24 of 34 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. There are sufficient staff on duty to ensure that people using the service have the appropriate level of support they need. Those managing the service are aware of staff training needs and plan to ensure that all staff are provided with the skills and knowledge they need to carry out their role. Evidence: We were told that currently staffing levels consist of 4 care assistants in the morning, 3 in the afternoon and 2 at night. In addition to care staff are housekeepers, catering and maintenance staff. Our previous inspection report indicated that there had been several staff changes however more stability was apparent in the staffing team. The manager informed us that with the occasional input from agency staff they never run short of the number of care staff neeeded. The manager is however keen to establish a stable staff team in order to ensure that care needs can be met consistently. One person did have some concern regarding the use of agency staff and the fact that they do not have such a good insight into the needs of people using the service. The AQAA stated: Two written references are obtained before any offer of employment. and CRB (Criminal Records Bureau) and PoVA (Protection of Vulnerable Adults) checks are done before any new employee starts working at The Lawns. Care Homes for Older People Page 25 of 34 Evidence: The service user guide states that All care staff at The Lawns have either achieved or are working towards their N.V.Q. (National Vocational Qualification) level 2 and 3 in Health and Social Care.. We looked over the file of one new member of staff in detail and another in less detail. A checklist was in place to assist the manager in ensuring all the required documentation was in place. We found evidence that references were obtained and a full CRB in place. We found evidence that employees have a written contract from the on set of their employment. On one file we found that the application form gave little space for people to detail previous employment, this information was however seen on a separate CV. One carer confirmed that she did not start working in the home until her CRB had arrived. During our inspection the manager confirmed that all carers without an NVQ were now registered to carry out this training. As a result, currently 8 carers out of 15 hold an NVQ level 2. Out of these people 2 have also achieved a level 3 NVQ while 4 of them are working towards that level. Staff members not engaged in providing direct care are also encouraged to obtain an NVQ relevant to the work they are doing. The kitchen manager and chef are working towards a level 3 in hospitality while a kitchen assistant already holds a level 2. In addition housekeeping staff either have or are working towards their NVQ. The manager informed us, on a number of occasions, about her desire to ensure that staff receive the training they require. On the AQAA the manager wrote All staff will continue to develop their skills and knowledge by on going training. The service users guide states All staff receive mandatory training as an on-going program. We looked over training records and saw that staff have attended training however some gaps were identified. We concentrated on moving and handling training and found that, although some staff had received training during April 2008, others had not received training in this area. The registered manager was aware of this and informed us that she had now undertaken suitable training in order that she is able to provide training for staff herself. We were told that she was planning on carrying out this training with staff in the foreseeable future. We were told that some training that had taken place had not been fully recorded and therefore we were not able to fully establish where any other gaps may be. It is therefore recommended that the registered manager carries out a full audit of training and that a training matrix is provided. Once the matrix is complete this would enable an action plan to be Care Homes for Older People Page 26 of 34 Evidence: developed in the event of apparent gaps coming to light. Care Homes for Older People Page 27 of 34 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 service is managed in the best interests of the people living there and the homes environment is generally safe. Evidence: The Lawns Residential Care Home was purchased nine years ago by Mr Darren Oliver and his wife Lisa. Mrs Christine Caldicott, the Registered Care Manager, has responsibility for the day-to-day running of the home. She has been employed at the home since April 2004, and prior to that she had several years experience in the residential care of older people. We were informed that the registered manager holds the Registered Managers Award which is an NVQ (National Vocational Qualification) level 4 in management. In addition she holds an NVQ level 4 in care as well as the A1 assessors award for assessing candidates within the home undertaking their NVQ. The registered manager told us of her liking for training and that in addition to the above she has also attended the ROSPA (Royal Society for the Prevention of Accidents) safer people handling trainer course. As a result, the registered manager is now able to provide moving and handling training for staff within the home. Care Homes for Older People Page 28 of 34 Evidence: A formal quality assurance system has been introduced at the home. The audit which was described as extensive was over 1300 pages long. At the time of our inspection it was evident that sections within the three files had been assessed. The overall findings were not recorded as part of any action plan to further improve the service offered. The Service Users Guide states that people using the service are advised to make their own arrangements for insuring personal items such as televisions and jewelery. People are advised not to keep large sums of money in the home. People are able to deposit items for safe keeping. The guide states that monies should, where possible, be deposited with a bank or building society. Some people have got money saved on their behalf within the home. Only a limited number of senior or management staff within the home are able to access this money. As part of this inspection we checked the balance held in relation to the records maintained for a small sample of people. Although the balances were correct we made recommendations about how the recording of money deposited and expenditure could be improved. These improvements would assist in safeguarding people using the service as well as staff employed in the home against any allegations of irregularity. Following our previous inspection we made a requirement that we must be informed of certain events that occur in the care home. Although we had received notification of some events we found evidence during our visit incidents about which we had not been informed. We were informed that a new fire risk assessment was compiled following the new suites becoming registered. It was evident that people living in that part of the home had received fire training as requested by the fire officer. We briefly viewed the fire records and found that, although the fire system is tested on a weekly basis, the break glass point used is chosen at random and not in any sequential or structured order. Without having such a system it is possible that certain points get missed out and therefore not tested as frequently as other are. We were told that visual checks of fire fighting equipment are carried out however this was not recorded as evidence. A programme of fitting fire seals to doors was reported to be near completion. We saw a plan of the home used as part of fire training whereby staff have to locate and record things such as fire escapes and fire fighting equipment. This seemed to be a useful tool to ensure that staff have knowledge of where these items are in case of an emergency. Care Homes for Older People Page 29 of 34 Evidence: As reported within an earlier section we found two windows without any means of restrictor to prevent falling to the ground. Suitable systems need to be in place to ensure the health safety and welfare of people using the service are maintained. We discussed similar shortfalls in the system in place to ensure that water temperatures were safe to prevent potential scalding and reducing risk of water borne infections. We saw the gas safety certificate. We were told an identified issue was addressed. Although we did not see evidence during our inspection the registered provider has assured us that all lifting equipment, including hoists and the stair lift, are inspected in line with The Lifting Operations and Lifting Equipment Regulations 1998. Care Homes for Older People Page 30 of 34 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 31 of 34 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 1 7 15 Regulation 15 (2). Care plans must be up to date and identify the care needs of individuals. This is to ensure a consistent and appropriate approach to delivering care. 29/05/2009 2 9 13 13 (2). Medication records must be accurate to show when medication is administered. To ensure that peoples health and welfare is maintained. 29/05/2009 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 30 A full audit of staff training should be carried out in order to identify any gaps. An action plan should be devised to provide any training needed as a result of this audit to ensure that staff have the necessary skills and knowledge to carry out their role. Page 32 of 34 Care Homes for Older People 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 2 33 It is recommended that an action plan is devised if any areas for improvement are identified as part of the homes quality assurance system. This will enable you to monitor the progress made in service development. A review of the system in place in recording money deposited and expenditure made should take place to ensure that personal details remain confidential and on a need to know basis. A review of the current arrangements regarding visual examination of fire fighting equipment and the testing of the fire alarm should take place. 3 35 4 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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