Care Home: The Lawns

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What the care home does well What has improved since the last inspection? Improvements to the arrangements for the management of medicines within the home have been satisfactorily introduced. All the required checks have been carried out on new recruits to the staff team. More staff have been recruited to build up a strong staff team enabling reduction in the use of agency staff giving better continuity for residents. Individual staff supervision has routinely taken place. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Lawns (The) Fernhill Avenue Weymouth Dorset DT4 7QU Lead Inspector Val Hope Key Unannounced Inspection 27th November 2007 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawns (The) Address Fernhill Avenue Weymouth Dorset DT4 7QU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01305 760881 ann.vallins@dorset-cc.gov.uk www.dorsetforyou.com Dorset County Council Ann Christine Maria Vallins Care Home 42 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (30) of places Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. 6th June 2006 Date of last inspection Brief Description of the Service: The Lawns is a purpose built home providing care and accommodation for elderly people, situated approximately ½ mile from the town centre. The home is owned and managed by Dorset County Council Social Services Directorate; Mrs Ann Vallins is the manager and Mr Harry Capron the registered person. The manager has overall responsibility for the home which provides care for up to 42 residents, with 30 places for persons in the category of old age (OP) and 12 places for persons in the category of dementia over 65 years of age (DE (E)). Currently, a maximum of five places at the home are for people needing respite care for short periods; this number will eventually reduce to three in September. Residents are accommodated in 34 single and 4 double bedrooms on the ground and first floor. All double rooms are ordinarily occupied as singles, unless two people wishing to share are admitted to the home (e.g. a couple). All bedrooms contain a wash hand basin and close to all bedrooms are toilets and bathrooms suitable for residents with mobility difficulties. One of the bedrooms has an en-suite toilet. A shower which is suited to the needs of people with a disability has been installed in a former bathroom. The home is divided into three units, each providing a lounge, dining room and kitchenette facilities for the preparation of drinks and light snacks. There is an 8 person passenger lift to the first floor, a stair lift and a wheelchair lift on first floor corridors to enable service users with mobility problems to negotiate the short flights of steps connecting different levels of the first floor. There are level gardens with wide footpaths. There is a car park and a nearby bus stop, for buses to and from the centre of Weymouth. The home’s Service User Guide is part of the information pack that is provided to service users and/or their representative prior to admission. The weekly fees range from £98.50 to £443.00; the amount payable for each individual is determined by a financial assessment. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. The main purpose of this inspection was to assess the home’s compliance with key National Minimum Standards for Older People. Since the last key inspection on 6th June 2006 the home has been subject to a random inspection, which took place on 22nd February 2007. The purpose of the random inspection was to address concerns brought to the attention of the Commission by an anonymous source. The concerns related to the timing of medication rounds, staffing shortages and the door exit system. Copies of random inspection reports are made available upon request. This unannounced inspection was conducted over two days 27th and 28th November 2007 and the inspection process took a total of 13 hours. This was a key inspection. The key standards are identified in the main body of report in each outcome area. At the time of the inspection there were 35 people living in the home. The inspection process included time spent on:• • • • • Preparation work including reviewing the Commissions records relating to the service and the Annual Quality Assurance Assessment provided by the service prior to the inspection; Examination of documents and care records at the service; Talking with residents of the home and visitors and/or representatives; Talking with staff; Reading, collation and analysis of surveys and comment cards. Contact with people using the service and those having an interest in the care of residents was made through direct discussion, telephone calls and the return of surveys and comment cards from:• • • • • 21 residents; 6 members of staff; 13 relatives/representatives; 3 health professionals; 2 General Practitioners. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 6 What the service does well: The Lawns provides a very good standard of care to residents in a warm, relaxed, friendly and supportive environment. The staff team work in a strong cohesive way to support and promote residents of the home as unique individuals. The staff team is led by an experienced, competent and effective Registered Manager. Pre admission assessments of need are always conducted to ensure that the home is able to meet the individuals care needs. The health needs of residents are met and good multi disciplinary working takes place on a regular basis promoting and maintaining (where possible) good health. Most medicines are supplied in a monitored dosage system, with Medicine Administration Record (MAR) charts printed by the pharmacy, and they were stored and taken round the home securely to safeguard people. There is a varied programme of activities providing physical, mental and social stimulation in group activities or one-to-one situations. The home provides a nutritious and varied diet contributing (where possible) to the maintenance of good health. Residents and their relatives feel able to bring to the attention of the management team any issues or complaints confident that they will be addressed thoroughly, promptly “and without fear or favour”. Residents live in comfortable clean and hygienic surroundings suited to their needs and with their own belongings around them for their comfort. There is a strong and cohesive staff group; staff are assisted in carrying out their duties through the leadership and support of the management team. Contact with relatives of people living in the home found - without exception – that they experience very good communication between them and management and staff of the home. Of 13 relatives surveys received in response to the question “Are you kept up to date with important issues affecting your friend/relative” all responded ‘always’. Comments received included: • “Someone telephones straight away for instance [relative] has fell a few times and I am notified immediately”; • “They keep me informed very promptly if there are any problems, it is very reassuring”; • “The Lawns staff are excellent in letting me know”. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 7 There was a very high level of satisfaction with the care and services provided by the home. Comments received included: From relatives: • “It fulfils all of mums needs very very well and it makes her feel happy and not alone”; • “They care very well for the residents in their care taking time to listen to them”; • “The Lawns gives excellent care to my mother. She is very happy there and has settled in very well; • “Food, caring for appearance, clothing kept fresh and clean. Encouraging them to keep ambulant, music and movement, little quizzes, outings all helping to keep the mind as active as possible”. From residents: • “The staff are very helpful with anything you ask and anything you want to do”; • “I feel lucky to get a place in here, I am able to choose what I do or do not do every day. I get all the help I need and am thankful for that”; • “Everyone is so caring and kind, I never feel I am too much trouble”; • “Could not be better, the manager is very effective in her role and all the staff are a credit to their employer”. From Health Care Professionals: • “Residents seem happy and comfortable. They are treated as individuals and care staff know them well. There always seems to be activities going on for resident to participate in”; • “Staff are proactive in responding to or suggestions to aid residents functional abilities”. What has improved since the last inspection? What they could do better: No requirements or recommendations were made as a result of this inspection. However, the Annual Quality Assurance Assessment [self assessment] completed by the home has specified improvements they would like to achieve in order to improve services for residents. These include: Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 8 • • • • • • • • • • • Improve the information pack by providing it in other forms to encompass those who may need another language/Braille; Provide more training for staff in palliative care; More training in bereavement and loss and its effects for residents, carers and staff; Provide more trips out if funding obtained; Provide more hours for the Activity Officer; Find more imaginative ways of informing residents of the complaints procedures and increasing their awareness; Improve and increase storage areas around the home; Improve sickness absences; Maintain and improve the good standard of care; Improved filing system including archiving; Negotiate the use of another computer. The manager is commended for her commitment to continue to strive to achieve the above goals for the overall benefit of residents accommodated and staff of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. The home ensures that it only admits service users whose care needs it can meet by carrying out a thorough pre-admission assessment. This service does not provide intermediate care. EVIDENCE: The manager conducts pre-admission assessments on prospective residents in order to determine if the home is able to meet their care needs. In the event of an emergency placement the home receives a care plan from the referring social worker, containing relevant information about the resident in question. The inspector looked at three examples of pre-admission assessments carried out by the manager and senior staff. All contained the information necessary to enable an informed decision to be made about the suitability of the prospective resident and whether The Lawns would be able to meet each individual’s care needs. Following the assessment, the home writes to the prospective residents or their representative, informing them of the outcome. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Care plans provide sufficient instruction to staff as to how individual care needs are to be met. The health needs of residents are met and good multi disciplinary working takes place on a regular basis promoting and maintaining (where possible) good health. Residents are respected and their right to privacy is supported. Arrangements in place for the recording, handling, safekeeping, safe administration and disposal of medicines are robust and well managed. EVIDENCE: Every resident has a care plan in place developed from an assessment of need. The care of four residents was examined and their care was case-tracked. Care plans were of a good standard containing up to date relevant information to inform social care workers as to how each individuals care needs were to be met. Information regarding dietary needs is recorded on service users’ care plans. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 12 Daily recording was clear and legible and systems were in place to ensure that follow up action, where required, was not missed. Individual risk assessments had been conducted and reviewed as part of the care planning process. There was evidence that care plan reviews take place regularly and that relatives, social and/or health care professionals may attend and a record is made of the outcome. From discussion with staff and looking at records there was evidence of the monitoring of residents health needs and liaison with general practitioners (GPs), community and specialist nurses. Accident records were comprehensively completed, signed and dated and there was evidence of follow-up checks/action having taken place. Residents are enabled to access NHS services and hospital appointments and domiciliary visits of health professionals were recorded appropriately. The random inspection undertaken in February 2007 found that residents prescribed morning medication, were not routinely receiving their medication at or near to the time prescribed by the prescribing General Practitioner [in the main, 08:00]. This was due to the member of staff allocated the duty of administering medication being called away to deal with other issues [see also Staffing standard 27]. As a result it was required that; • • Additional staff must be on duty at peak times of activity during the day; As soon as it is known a vacancy is due to occur, recruitment must commence promptly to provide improved continuity of care for service users. This inspection found that these issues had been satisfactorily dealt with and that residents now receive their medication at the time prescribed. Additionally, given the geography of the home, it had been recommended that a second trolley be purchased in order that medicines could be administered promptly throughout the home. It was found that this recommendation has been met. Observation and discussion with residents and information provided by surveys demonstrated that residents are treated with respect and a good level of satisfaction was clearly evident. Overall, feedback received from all those contacted was very positive. Both residents able to articulate a view and relatives and/or friends of those accommodated highly praised the manager and her staff team for the kindness and caring attitude and sensitive way in which care is delivered. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. The varied programme of activities meets the needs and expectations of people residing in the home. Social, cultural and recreational activities are dependent on individual preferences and the resident’s capacity for involvement. Residents are supported in maintaining contact with relatives and friends through the welcoming approach of the staff towards visitors. The home provides a nutritious and varied diet contributing (where possible) to the maintenance of good health. EVIDENCE: The daily routine is a relaxed one and takes account of residents’ preferences. The home tries to obtain as much information as possible from relatives/friends about resident’s life histories, in order that the home can better provide interesting activities particularly relevant to the individual. An activities organiser is employed to deliver a wide programme of activities mornings and afternoons. The activities officer attends regular formal training to keep up to date with development relating to activities for older people and also is EXTEND trained [gentle physical training specific to the needs of older Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 14 people]. The activities programme is on display and relatives are welcome to join in with their family member. Those people able to voice a view on the social programme all said, without exception, that the provision suits them and meets their expectations. Trips out, visits to the home/involvement with the PAT dog scheme and the Donkey Sanctuary, professional entertainers, involvement of local community groups in projects within the home, Communion services, involvement of family and carers in social events in the home including some trips out, quizzes and arts and crafts are examples of activities routinely on offer. One relative said that they were pleased that staff spend time with their relative to assist with crosswords which are really enjoyed and this is greatly appreciated. During the better weather residents and their visitors are able walk around or simply sit in the enclosed garden which is attractively set out with tables, chairs, umbrellas, BBQ and an arbour. Observation of those unable to express a view upon the activities provided showed that their interest and attention had been attracted and that many of them were able to show one way or another (i.e. facial expression), that they had been ‘engaged’ and had enjoyed watching if not actually physically participating. Residents said that their visitors are always made welcome and are offered refreshments. They are also pleased to be able to take meals with their relative or friend as they once did in their own homes. The kitchen at The Lawns has recently been subject to a complete refurbishment and upgrade resulting in a very high standard being achieved. There are small kitchen dining areas around the home which have also been subject to redecoration and refurbishment to good effect. There was evidence that a very good varied and wholesome menu is provided and that alternatives are provided upon request. Meal times are a relaxed affair; food is served in the dining room from a hot trolley with staff attentively serving food according to residents’ portion control requests. All the residents spoken with were highly satisfied with food provision and said they are consulted about their likes and dislikes which appear to be well known to staff. During the inspection the cook was observed conversing with residents who said that this was a common event and that they feel consulted in relation to the meals provided by the home. Comments received relating to the food provision included: • “The food is wonderful, I have never eaten so well!”; DS0000032130.V354409.R01.S.doc Version 5.2 Page 15 Lawns (The) • • • “I am very happy with what is provided and I like to be given a choice so it suits me”; “The meals are hot, tasty and there is lots of it. They are always willing to do you something else if you don’t fancy what is on offered which is nice”; “Absolutely no complaints, could not be better”. Menus and food stocks were viewed, there was plenty of fresh fruit and vegetables, meat is delivered regularly and staple food stocks were of reputable brands. Stock rotation is clearly routinely practiced. Lunch was observed being taken by residents. Staff were seen helping people in an unhurried and dignified manner where help with eating was required. Those who wish to take meals in their rooms said that they are also served well. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. The home has a complaints procedure that enables residents and/or their representatives to address any concerns they might have. The policies and practices of the home ensure that residents are safeguarded from abuse or harm. EVIDENCE: The home has a complaints procedure that is part of the Dorset County Council Adults Services formal complaints procedure. Details are contained in the information pack that is supplied to residents on admission. Leaflets containing the complaints procedure are also available in the front hall. From talking with residents during the visit and from reading surveys sent to the Commission the inspector gained the view that residents or their representatives would feel free to raise issues with the management if the need arose. One relative said they were confident issues would be dealt with “without fear or favour”. The home has adult protection and “whistle blowing” policies/procedures and a copy of the Dorset County Council “No Secrets” guidance. The topic is covered either in the induction/foundation programme for newly appointed staff or in a subsequent training session for other staff. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 17 During discussions with the inspector staff demonstrated knowledge of the topic and knew what action to take in the event of their having a concern about the welfare of residents. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Residents live in comfortable clean and hygienic surroundings suited to their needs and with their own belongings around them for their comfort. There is ample indoor and landscaped outdoor space with level access creating a relaxing, peaceful environment for residents. A good standard of cleanliness is maintained for the comfort and safety of residents. EVIDENCE: The home is situated in a residential part of Weymouth close to the seafront and near to a range of amenities including shops, post office, churches and pubs. It is approximately half a mile from the town centre. The premises and facilities have been assessed as suitable for their stated purpose of providing care and accommodation for older people in a report from an Occupational Therapist. The majority of the bedrooms are small and this imposes some limitations on the home’s capacity to provide care for physically frail service users who require assistance with hoists. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 19 Upgrading work is continues throughout the premises. The premises are protected by a keypad entry system at the front door and by the fitting of alarms at other exit doors. The purpose is to ensure the security of the service users. The random inspection in February 2007 found that the recommendation made at the preceding key inspection in June 2006 had been met. Residents wishing to enter and leave the building independently are provided with the key code within a risk assessment framework taking into account the safety of the resident concerned. Service users have access to a secure, level rear garden which provides a pleasant area for sitting and walking. In addition to lawns and flower beds a sensory garden has been created for the benefit of the service users. Maintenance of the premises, grounds and facilities is conducted on a regular basis. There is servicing of the equipment such as hoists, bath aids and lifts and checking/testing of the electrical installations and portable electrical appliances. Fire precautions are maintained in accordance with guidance from Dorset Fire and Rescue Service. The fire risk assessment has been updated and reviewed. The kitchen and food storage areas are routinely checked by the Environmental Health officer, in accordance with the risk assessment processes of that department. The home has a suitably equipped laundry room. Residents or their relatives are asked to label their clothes prior to admission to assist staff with laundry duties. The inspector randomly selected a sample of bedrooms and found that items of clothes were correctly labelled. No adverse comments were received about the homes laundry services during the course of the inspection. Residents were suitably dressed in clean and well-laundered clothing. There are sluice facilities to enable the hygienic cleaning and sterilising of commode pots to take place. The home was found to be in a clean and odourfree condition at the time of the inspection. Residents confirmed to the inspector that their rooms were cleaned and their linen was changed regularly. A small number of minor matters were brought to the attention of the manager on day one of the inspection [for example the need to replace a toilet seat, small areas of peeling wallpaper]. All the matters were rectified by the end of day two of the inspection. Comments received from residents included: • “I like it here I am very comfortable”; • “It’s alright, my room is rather small but they cannot do anything about that!”; • “I would rather be in my own home but this is fine really”; • “It is always very clean, they do a marvellous job”; • “No complaints”. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Staffing levels are sufficient to ensure that residents are kept safe and that their care needs are well met. Staff are competent at their work and enjoy the confidence of residents, relatives and external professionals alike. They receive the necessary training to meet residents’ care needs EVIDENCE: Examination of information submitted in the home’s Annual Quality Assurance Assessment, staffing rosters, talking with staff, residents and relatives/friends evidenced that recent recruitment has substantially improved staffing levels. The staff team comprises the manager, 9 senior officers, a clerk, 3 shift leaders, 29 care assistants, 7 night care assistants, an activities coordinator, 5 housekeepers and 5 kitchen staff. An earlier reliance on the use of agency staff has been greatly minimised, this was evidenced through examination of records and discussion with staff and residents. Agency staff are trained by their employer. The agencies give the home a written assurance that all staff sent to work at the home are suitably qualified. It is the intention of the home to recruit more relief staff so that further reduction in the use of agency staff is achieved. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 21 Concern about staffing levels and/or the use of agency staff had been expressed by residents, a relative and staff during the course of the last key inspection [June 2006] and was one reason for the random inspection carried out in February 2007. From observation and looking at staff rosters for both day and night periods it is clear that there are sufficient staff on duty to ensure the safety of the residents. All care staff are given the opportunity to attain a National Vocational Qualification (NVQ) at level 2. It is an expectation that newly appointed staff will prepare for the award on successfully completing a probationary period. At present over 50 of care staff have achieved the award, which is in excess of the National Minimum Standards. Plans are in place for the majority of the remaining care staff members to embark on the award in the near future. Comments from residents and relatives both in person to the inspector and in surveys returned to the Commission indicated that residents considered that they were well looked after. Residents clearly have confidence in the competence and caring disposition of the staff. The following views are representative of such comments: • • • “The staff are very helpful with anything you ask and anything you want to do”; “Everyone is so caring and kind, I never feel I am too much trouble”; “Could not be better, the manager is very effective in her role and all the staff are a credit to their employer”. The inspector looked at the records of two recently recruited staff members. Necessary measures and checks had been carried out, including the completion of an application form, the taking up of two references, conducting and recording the outcome of an interview and the carrying out of police/POVA checks via the Criminal Records Bureau (CRB). All new staff attend an induction programme and care staff go on to complete a foundation training course within six months of commencing employment. This enables staff to attain the necessary basic knowledge and skills to equip them to carry out their work. The manager reported that “refresher” training is ongoing and being organised for experienced care staff to help them to keep up-to-date with current practice. Outside of health and safety topics the main areas that the staff group are focusing attention on are caring for people with dementia, and nutrition. The activities officer already has attended a course in dementia awareness. Training for ancillary staff is arranged in accordance with their particular needs and circumstances. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 22 The care staff spoken with said that the training provision was to a high standard and that it assisted them to carry out their duties with confidence. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. The staff team at The Lawns is led by an experienced and competent manager; this assures residents that they are well cared for. The home seeks views from a wide range of people about the quality of the care that it provides and organisation of administrative tasks and quality monitoring systems implemented ensure residents benefit from an efficient administration. Management practices, records and policies and procedures are in place to promote and safeguard the health, safety and welfare of residents. EVIDENCE: The manager, Anne Vallins, has achieved the Registered Manager’s Award, National Vocational Qualification (NVQ) at level 4. She has a number of other relevant qualifications, including the Diploma in Social Care Management and Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 24 NVQ level 4 in Social Care. She keeps up-to-date by attending training courses that relate to the care of older people; for example, dementia awareness training. She is employed as the full-time manager of the Lawns and does not have responsibility for other establishments. She has a job description that reflects the nature of her responsibilities. The other senior officers also keep abreast of current practice that relate to their care and supervisory duties. There are regular staff meetings for senior staff and the staff group as a whole. Additionally, the manager holds quarterly meetings for the night staff. There is an expectation that staff will attend at least three meetings each year. Most staff members with whom the inspector spoke considered that they were well supported by the management team in general and by the manager in particular. They feel that they can approach the manager informally for advice and guidance and that information is communicated effectively between the staff and management. There is a strong and cohesive staff group. Staff are assisted in carrying out their duties through the leadership and support of the management team. Care staff receive one-to-one supervision from a senior officer and a record is kept of the outcome. Ordinarily, sessions take place at two monthly intervals. This is an opportunity for staff to discuss care issues and for the supervisor to review the carers’ progress. Staff spoken with said that they received regular supervision and that they had found it helpful and supportive The home conducted a detailed survey of the views of residents and ‘significant others’ in July 2007 which concluded that there was a generally high level of satisfaction about the quality of the provision. The results of the survey have been produced and are included in the home’s Service User Guide. The manager and her team also conduct exercises to monitor the quality of the home’s performance in a number of areas, e.g. ensuring that residents care plans and reviews are kept up-to-date and auditing the medication administration and recording arrangements. The home has a procedure for assisting residents to manage their finances. The home does not act formally on behalf of any service users. Dorset County Council has put in place Court of Protection arrangements for three service users. Residents either look after their own finances or have a relative or other representative to assist them. Lockable facilities are provided in bedrooms so that residents may keep money or valuables safe. In most cases the home holds small amounts of money in a secure place on behalf of residents. Records and receipts are held for transactions made. The inspector randomly checked four sets of records and all were correct. Over the course of the two day visit the inspector spent time looking around the building. No hazards or matters of concern were noted. Equipment and cleaning materials/liquids were safely stored. The management has conducted Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 25 a detailed health and safety audit and checks are carried out to ensure that policies and procedures are implemented. Staff receive training in such health and safety topics as first aid, manual handling and food hygiene. Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lawns (The) DS0000032130.V354409.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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