Care Home: The Lawns, Brixton

Similar services:

• The Vicarage
• Fairfields Country Rest Home
• 7 Hyde Road
• 5 Seafield Road
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home

What the care home does well People have clear, well organised care plans that tell staff what care they need and how to provide it. We saw that people were clean and well groomed and happy with the care they were receiving. People`s nutritional needs and choices are well catered for. People`s relatives have ready access to the home and are generally welcomed by staff. The staff are generally popular with people who use the service and their relatives. Training is well organised so that any gaps can be identified. What has improved since the last inspection? People`s privacy has been better preserved by keeping individual records secure and fitting locks to individual rooms. Practices concerning the administration of medicines have improved Records of complaints have improved so that these can be reviewed and audited. What the care home could do better: The home needs to ensure that sufficient recorded assessment information when people are admitted so that their needs can be accurately identified by all staff. Care planning needs to include consideration of people`s capacity to consent and make decisions. Work on the activities programme being undertaken by the manager needs to be completed. Specific risk assessments are needed to make sure the home is a safe place for people to live. Work on the terrace needs to be completed soon so that people have access to outside space. Locks fitted to people`s doors need to be eased so that they work easily. The safety of the home and working practices need better monitoring to make sure people are kept safe. Key inspection report Care homes for older people Name: Address: The Lawns, Brixton The Lawns, Brixton Brixton Plymouth Devon PL8 2AX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Graham Thomas     Date: 1 2 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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, Brixton The Lawns, Brixton Brixton Plymouth Devon PL8 2AX 01752880465 01752880465 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wells House Limited, Name of registered manager (if applicable) Mrs Janet Trinick Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The Home is registered as a Care Home with Nursing for a maximum of 22 Service Users in the categories of PD(E) 18, OP 8, TI(E) 4 Date of last inspection Brief description of the care home The Lawns care home is situated in the village of Brixton, in the South Hams area of Devon. The home is a detached country house, set in its own grounds. Accommodation is provided on two floors with a mezzanine floor between. The home provides 16 single and 3 double bedrooms. Communal facilities comprise a lounge, conservatory and dining room. Most parts of the home are wheelchair accessible. There is a shaft lift to all floors and a stair lift on the main staircase. The home is registered to accept a maximum of 22 persons, aged over 65 years of either Care Homes for Older People Page 4 of 34 Over 65 8 18 0 0 2 9 0 5 2 0 0 9 Brief description of the care home gender with physical frailty, illness or disability. The Lawns provides a comfortable friendly atmosphere. People living at the home are encouraged to furnish their rooms as they choose, and each room is individual in its character. The last inspection report is displayed in the entrance foyer at all times for people to read. Fees vary depending on the degree to which nursing care is required. Contracts clearly break down the fees charged and what is included in the fee. Contracts are issued to every person whether they are publicly or privately funded. 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: one star adequate 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: Before we visited the home the Registered Provider sent us a completed Annual Quality Assurance Assessment to tell us about the home. We examined our records and information we have received since our last visit. This included information sent to us by the home about incidents in the home such as deaths. These are called notifications and are required by law. We also received completed surveys from 8 relatives and 5 staff. We visited the home and spent 7 hours there. We looked at a sample of peoples care plans, staff records and other records about the running of the home. We toured the premises and spoke with people living in the home, relatives and staff. Our assessment of the home takes into account the registered providers very prompt response to the findings of our visit in addressing the issues we identified. However, our requirements and recommendations will remain in place until they are reviewed Care Homes for Older People Page 6 of 34 fully. This report is based on a sample of the evidence available during our inspection process. It does not provide a comprehensive risk assessment of the home. Registered persons are reminded that it is their responsibility to assess and manage risks in accordance with the Care Homes Regulations 2001 and other relevant legislation. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1, 3 and 6 The service does check that it can meet peoples needs before they move in and makes sure it updates these assessments. However, a more robust approach to information gathering and the involvement of the Registered Manager in assessments would help the home better prepare to meet peoples needs when they move in. Evidence: While at the home we saw a the homes Statement of Purpose and Service Users Guide. There was also a brochure providing information about the home including the type of accommodation and services provided, the aims and objectives of the home and the philosophy of care. Information was also provided about staffing. We noted that the Registered Manager is described as the Care Manager in these documents. The Information about independent advocacy services was on display in the homes foyer. Care Homes for Older People Page 10 of 34 Evidence: Of the eight surveys that were returned to us by people living in the home or their representatives, six stated that they had received enough information about the home before they decided to move in. One flet they did not have enough information and one did not know. We looked at the homes admission procedures. When we arrived at the home we were told that a new person was to move in that day and that this was a planned admission. This person was known by the Responsible Individual from time spent at another home under the same ownership. However, the Registered Manager had not met the person and had not been involved in a pre-admission assessment of the persons needs. However, we have subsequently been informed that she had spoken at length with a relative. Some basic information was held in the homes diary but the file containing detailed written information was not available until the Responsible Individual brought it to the home in the afternoon. The Registered Manager was performing Nursing duties on the day of the admission. This meant that there was limited time available for the manager and staff to familiarise themselves with the details of the persons needs and prepare for the admission. We also looked at the file of a person who had been moved into the home at short notice and left shortly afterwards following an accident. The pre-admission information was not complete and had not been completed before the persons unexpected departure. It is the homes current practice in the instance of an emergency admission for Nuses to make an assessment shortly after the person moves in. However, we would recommend a robust approach to obtaining as much information as possible from the referring agency to assist in uderstanding and meeting peoples needs. We saw other files of people who had lived in the home for a longer period. Detailed assessments regarding, for example, nutrition and moving and handling, had been completed and updated since these persons had moved into the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10 People living at The Lawns may receive very good care. However, poor practice in some areas may place them at risk. Evidence: In the eight surveys returned to us, seven people stated that the needs of people living in the home were always met and another stated that this was usually the case. One comment was that The home keeps my mother safe (and) secure with (a) choice of food. My (relative) is prompted to help herself with some of her care needs....The home tries hard to live up to a standard of good care and the staff work hard at trying to accommodate the residents needs. Another person listed those things they thought the home did well including Caring, clean smelling, good food, friendly and helpful staff Care Homes for Older People Page 12 of 34 Evidence: We case tracked three people. This means that we looked at their records and checked to see if they were receiving the care and support that was planned for them. One persons records showed that they had severe continence needs and required substantial prompting with personal care. We saw that this persons plan provided carers with clear guidance on how to provide the care the person needed, including those areas that the person could manage themselves. We visited the person in their room and found them to be clean and well groomed with clean nails and hair. Items were within reach as described in their plan. There was no odour at all which suggested their continence needs were being well managed. The person was seated on a pressure relieving cushion in accordance with the described risk to their skin integrity. In addition, medication records showed that prescribed skin creams had been regularly applied. This person was at risk of falling at night as a result of a tendency to wander at this time. We noted that the person was accommodated on the ground floor. An alarm had been fitted to the persons door to alert staff if the persons bedroom door was opened. There were also records of consultation with a specialist falls Nurse. She had recommended changes in the persons medication which were being followed through. A physiotherapist had also provided an exercise plan with which the person was being helped by a relative. The persons records showed that their weight and nutrition had been regularly monitored. Their low weight on admission had been noted and the records showed a weight gain in two reviews in 2010. We noted that the home has suitable weighing equipment including sitting scales. Another persons records contained a detailed personal history and profile. This plan was also clear, detailed and regularly reviewed. The plans included methods to help the person maintain their independence. We saw how a red area had been noted on the persons leg and that this had been followed up. There were also records of consultation with a GP and treatment regarding a urinary infection. Evidence of monitoring of the persons diabetes were seen in the persons plan. Kitchen staff had not had any specific training in this topic but were knowledgeable about individual dietary needs and were clear how these were to be met. In plans we examined, we noted that consideration had not been given to issues of the persons capacity within the framework of new mental capacity legislation. The Mental Capacity Act makes this a requirement. Information was seen in the home about this recent legislation but it had yet to be applied to the homes practice. Care Homes for Older People Page 13 of 34 Evidence: A third persons plan described their need for support in personal care such as cleaning nails and hair washing. When we met this person in their room we saw that their nails and hair were clean and that they too were well-groomed. The person had some sight loss. Their glasses were clean as described in their plan and at the time of meeting the person they were enjoying a large print book from the homes library. We saw that the person had a jug of juice to hand and they told us that Staff tell me I have to keep drinking. We also saw plenty of fluids available around the home and hot drinks being served. We looked at how medication was managed in the home. The medicines were securely stored in a dedicated room. A secure trolley was in use. For medication requiring cool storage, a separate refrigerator was available. We looked at three peoples medicines. Records concerning these medicines were up to date and in good order. Controlled drugs were recorded in a separate register with double signatures when they were administered. Where the life of medicines was limited a record had been made of when the medicine had been opened. In one instance we saw a risk assessment for a person who was able to administer their own medicines. The Manager told us that all medicines are administered only by trained staff and we saw samples of signatures of those staff with this responsibility. As described above, considerations of mental capacity and consent to treatment under the Mental Capacity Act were not evident in plans about the management of individuals medicines. We looked at how peoples privacy and dignity was respected and promoted. At our last visit we found that care plans were not securely stored , thus placing peoples privacy at risk. On this occasion we saw that plans were securely stored in the homes office which was fitted with a keypad. During our visit we saw that staff generally addressed people in a kindly and respectful manner. We saw staff knocking on doors before entering rooms. People we spoke with felt that they were treated with respect by staff. At our previous visit none of the individual rooms had locks on the doors and some bathrooms and toilets were also without locks. On this occasion we found that individual rooms had been fitted with locks and all but one shared toilet. During our tour of the home we saw that equipment was available for safe moving and handling. However, we saw two staff assisting a person to transfer from a lounge chair to a wheelchair. They did not use the handling belt that was available in the room but instead supported the person under their arms. This is poor practice as it places both the individual and staff at risk of injury. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15 People living at The Lawns have good opportunities to make choices about daily routines and their meals. There are generally good arrangements for welcoming visitors into the home. However, work on developing activities needs to be completed. Evidence: We looked at how peoples autonomy and choices were promoted. As mentioned in the previous section of this report, care plans identified how people were to be supported in managing as much of their own personal care as they could. People appeared to be able to follow their chosen routines. For example, one person living in the home told us that they liked to get up early and go to bed late. They preferred to spend time in the lounge in the mornings and spend time in their room later in the day. These preferences were noted in the persons plan and they confirmed they were able to follow this routine. Information about external organisations was available for relatives and visitors in the homes foyer. We have previously referred to the need to apply the principles and guidance of the Mental Capacity Act in matter of choice and decisionmaking. At this inspection we received many comments about the lack of activities and Care Homes for Older People Page 15 of 34 Evidence: entertainment for people living in the home. Other comments received related to the lack of trips out of the home. For example, one relative told us The only entertainment is at Christmas which is good, but I feel stimulus is needed year round Another commented I feel at the Lawns there is a lack of activities.... There could be a lot more simple activities like reading to a client one to one (..or..) writing a letter for them A number of staff also made comments suggesting that there should be more activities and more entertainment. In our tour of the home we saw that there were many books and other items of interest around the home. One person with whom we spoke was enjoying a large print book and another was looking at a book about rugby which had been identified as a particular area of interest in their care plan. During our visit we saw that a notice board listed weekly activities. However, the board was too high to be read by most people living in the home. The list of planned activities included current affairs discussion, manicure, games, quiz, and video. Neither of the two activities listed for the day of the visit went ahead. We note that this also occurred during our last visit though some people with whom we spoke said that activities do take place occasionally. Staff told us people did not want to particiapte on the morning of our visit and in the afternoon they just wanted to snooze. Some staff told us that there should be a separate staff member to coordinate activities and entertainment. The Registered Provider subsequently told us that a member of staff had attended training in providing activities has responsibility for this. At the time of our visit, an Easter raffle and other activities were being planned for the Easter period. Following our last visit we recommended that the homes activity programme should be more closely linked to peoples individual needs and abilities. We saw evidence that some work had been undertaken to find out about peoples individual histories and interests. The manager told us that this was something that she planned to develop further though time to do this had been limited. Access to space outside the home was limited at the time of our visit. At the time of the visit an extension was being built at the back of the home which had further Care Homes for Older People Page 16 of 34 Evidence: reduced the outside space. This meant that the only usable external space was the homes terrace. Work to increase safety in this area had yet to be completed and existing safety features had been removed to facilitate this work. This meant that there was no safe, usable external space when we visited the home. The Registered Provider has informed us that the new extension will provide additional external seating along with other facilities. Relatives told us that staff were generally friendly and welcoming and that they could visit the home at reasonable times. One relative told us that they are always invited for events at Christmas time. We saw that there is a pay phone available in the hall though this is not private. Staff told us that portable phone is also available for private calls. Some people also have telephones in their own rooms. Staff and people living in the home confirmed that regular services are held in the home by a local vicar. One person who is a Jehovahs Witness also receives visits from people sharing her faith. In surveys returned to us, people told us that they always or usually liked the food in the home. We also received a number of positive comments which referred to good food, excellent food and referring to the choice on offer. We saw that there was a four weekly menu with choices for the main meal such as Lancashire hot-pot or pasta bake; chicken and vegetable pie or lasagne or salad; grilled liver and bacon or fish pie or salad. A daily vegetarian option was also available. Our discussion with the cook confirmed that there was a free choice of breakfast with one person, for example, choosing grapefruit while another chose a cooked option. We saw that meals were attractively presented and that a liquidised meal whose constituents were presented in individual portions in accordance with good practice. We saw staff helping one person to eat. Whilst providing this help the staff member maintained eye contact and talked to the person. The meal was unhurried and at a pace which appeared to suit the person being helped. The cook told us that he had not received specialist training but thought that some was planned. Nonetheless he appeared knowledgeable about peoples individual needs and well organised. Details of peoples individual dietary needs and preferences were held in the homes kitchen including specialist requirements for people with diagnosed conditions such as diabetes. During our tour of the home we saw plenty of drinks available in lounges the dining area and peoples individual rooms. One person told us how they were continually Care Homes for Older People Page 17 of 34 Evidence: encouraged to take drinks. 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. Standards 16 & 18 The home has a clear complaints procedure and complaints are recorded appropriately. Staff are trained in protecting vulnerable adults from abuse and know what to do if abuse is witnessed or suspected. Evidence: We have received no concerns or complaints about the home since our last visit other than one issue that had yet to be resolved at the time of our visit. Details of this issue had been recorded in the homes complaints log. There were no other complaints recorded. We discussed this with the Registered Manager and concluded that, as a matter of best practice, the recording system should include a record of minor issues and concerns. When we visited the home we saw that the complaints procedure was prominently displayed. We also saw details of Care Aware and advocacy services similarly displayed. Details of the homes complaints procedure are also included in information provided by the home to people who might be planning to move in. At our last visit we recommended that the staff training programme in protecting vulnerable people from abuse should be completed for the current staff group. This had been done. We discussed with five staff how they would respond if they witnessed or suspected abuse. All were clear about reporting such concerns and were clear about Care Homes for Older People Page 19 of 34 Evidence: contacting external agencies if they were unable to resolve the matter satisfactorily with the homes management. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19 and 26 Generally good standards of cleanliness and hygiene are maintained at the Lawns. However, when we visited, risks in the homes environment were not being well managed. Evidence: The Lawns is set in its own grounds with a terrace, and car parking outside. At the time of our inspection a new extension was being built at the rear of the home. When copleted this extension will provide additional facilities such as more communal space, a new passenger lift and a hairdressing salon amongst others. At the time of our visit, the terrace was awaiting remedial work to improve the safety of the area following a risk assessment required at our last inspection. This was restricting safe access to the terrace. Inside, accommodation is arranged on two floors with a mezzanine level in between. A shaft lift provides transport to all floors and three stair lifts are also provided. Most parts of the home are accessible by wheelchair. The home is decorated in a traditional comfortable and homely style. We saw that rooms had been individualised with peoples own furniture, possessions, pictures and photographs. People responded to our surveys told us that the home was always or usually fresh and clean and two people made further specific comments about the homes cleanliness. During our tour of the home we saw that cleaning was taking place and Care Homes for Older People Page 21 of 34 Evidence: that all areas were cleaned to a reasonable standard, including the kitchen, toilets, bathrooms and individual commodes. One person with whom we spoke during our visit told us Ive never come in and found there to be a smell. One person felt that the outside of the home could be kept more tidy. Some staff and peoples relatives commented that the decor of the home needed improvement in some areas. The Registered Manager was aware of this and it was included in planned maintenance. We looked around the home to check whether the environment was safe, well maintained and hygienic. At our last inspection, we were told that an issue with the homes heating had been resolved. However, one person told us that the homes radiators did not always work consistently. On the day of our visit the heating was on and the home was warm. The Registered Manager told us that work to fit radiator covers was ongoing We found that some of those fitted were loose, posing a risk if people with impaired mobility leant on them for support. At our last inspection we noted that individual rooms and some shared toilet and bathroom facilities were not fitted with locks. At this visit we found locks had been fitted to all individual rooms and all but one shared facility with a sliding door. A solution was being sought to the issue of fitting a lock to this door. We found that some locks on individual rooms were difficult to operate. While checking this, a duplicate key was required. These were held in a bag in the homes safe with many other keys. There was therefore a significant delay in identifying the right key to open the door. This poses a significant risk in the case of an emergency such as a fire when a locked door might need to be opened rapidly. We were subsequently informed that the manager was carrying a master key which had been forgotten in the heat of the moment bacause the system was recent. In one bathroom, we found that the hot bath tap was running at just under fifty degrees (using the homes own thermometer). It was too hot to hold a hand under the water. The Registered Manager told us that a new boiler had been fitted and that the temperature needed adjustment. One individual room we examined on the first floor overlooked the paved terrace. This room had a bay window with a large pane at the front of the bay with both tilting and hinged opening capability. At our last inspection this and another similar window in a neighbouring room had been locked. The side panes had restricted opening. There was therefore no risk posed by these windows. On this occasion, we found the large front pane unlocked. This room was awaiting the arrival of a someone who was moving into Care Homes for Older People Page 22 of 34 Evidence: the home that day. With a knee-height sill and large opening this posed an immediate and extreme risk. For reasons described above, the key to this window could not be located. An immediate requirement was issued and the window opening had been restricted by the time we left the home. On this occasion we noted that free-standing wardrobes in some rooms were not secure and posed the risk of toppling. In one room we saw a free standing radiator. The manager confirmed that there was no risk assessment for its use. Access to the laundry was highlighted as a potential risk at our last inspection visit. A keypad had been fitted to the door of the laundry to restrict access. However, during our visit we saw that this door was left open. During our tour we saw that aprons, antibacterial gel and gloves were avilable for staff use when required. Five staff with whom we spoke confirmed that they were routinely supplied with the materials and equipment they needed according to individual needs. Liquid soap and paper towels were generally in use though bar soap only was available for staff in the laundry. Liquid soap is recommended as safer because it reduces the risk of cross-infection. The laundry was well-equipped, clean and tidy. We discussed the handling of soiled laundry with the Registered Manager. Soluble red bags are recommended for infected laundry but these were not available. It is recommended that these should be available. Care Homes for Older People Page 23 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. Standards 27, 28, 29 and 30 The Lawns now operates a robust recruitment procedure to protect people living there. There are sufficient trained staff to meet peoples immediate care needs. Evidence: Six people living in the home or their relatives who returned our surveys told us that staff were always available when needed and that they listened to and acted upon what what said. The other two stated that this was usually the case. We received a number of very positive comments about staff including, for instance: ...all the sisters/ carers / cleaners have become friends and family, and I wanted to come to The Lawns because I have always lived in Brixton and I shall end my days here with my husband. I am really happy with the care and attention from the staff. Since we last visited the home, one member of staff who had previously worked at the home had been re-employed. We looked at this persons file and found that a new police check had been obtained before the person commenced duties. Two references and a full employment history had also been obtained. Care Homes for Older People Page 24 of 34 Evidence: The home is staffed by care assistants with a qualified Nurse on duty at all times. Domestic, kitchen, and maintenance staff provide ancillary services. We saw staff rotas which confirmed the numbers of staff on duty at different times of the day. Evidence from other parts of this report suggest that there are sufficient staff on duty to provide for peoples immediate care needs. However, the lack of social activities and trips suggests that there may not be enough time for staff to provide this kind of attention. This was a view expressed by one relative and suggested in responses from staff. In surveys returned to us staff felt that qualified nursing staff did not spend enough time on the floor whilst on duty. Staff had individual training records and there was a training matrix which showed overall training needs. Induction training for all staff includes induction to the home and the homes philosophy of care. In addition, this training includes the principles of care, moving and handling, health and safety and safe working practices. Five staff with whom we spoke confirmed that they had received training in topics such as dementia, the Liverpool Care Pathway, visual impairment and moving and handling. Training shortfalls identified during our last inspection regarding safeguarding people from abuse had been addressed. The Registered Manager had identified that update training was required in first aid for most staff. This was being planned. Training arrangements are in place for Registered Nurses who receive a contribution towards their training. Care staff are supported to follow NVQ courses in care. This was confirmed in the records and in discussion with staff. Our discussion also confirmed in house courses in such topics as incontinence, dementia, moving and handling and infection control. Care Homes for Older People Page 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38 during this visit we found shortfalls in the homes safety arrangements. However the provider has worked well with the Commission to assure us that very prompt work has been undertaken to address the issues we identified. Evidence: Ms. Janet Trinnick is the Registered Manager of The Lawns. She is a Registered Nurse with many years experience in the care of older people and is currently undertaking a management course. She is supported in this role by the Resposible Individual, Jean Jones who is the General Manager of Wells House Ltd. (Care Homes) and who previously managed The Lawns. Ms. Jones holds a RSA management Diploma. Though each has a job description with clear lines of accountability, we found that there was some confusion amongst some relatives as to who is the manager of The Lawns. For this reason we have recommended that these roles should be clarified in the literature provided to people planning to move in. Care Homes for Older People Page 26 of 34 Evidence: The policy of the home is to encourage relatives to take responsibility for peoples monies where they lack capacity to manage it themselves. Some small cash amounts are held for people living in the home. We saw that this money is kept securely in a safe and records of a running balance. The manager checks and signs the record monthly. Each person has a lockable facility in their room for monies and valuables which can also be stored in the homes safe if necessary. We looked at the safety of working practices in the home. We saw a number of individual and environmental risk assessments. We saw labels and other records indicating that safety equipment such as hoists and electrical appliances were being checked regularly. We found that staff receive training in health and safety topics such as moving and handling and fire safety. We also saw that the home had responded to requirements we made at our last visit concerning, for example, risk assessing the terrace area and fitting a lock to the laundry. However, this report has highlighted a number of concerns regarding the safety of the home and working practices. These included: Observed poor practice in moving and handling Failure to identify the extreme, immediate risk posed by a first floor window (though this was remedied following our immediate requirement). Failure to monitor and implement effectively safety measures which had already been put in place in response to a previous requirement regarding access to the laundry. In addition, on this occasion during our tour of the premises we saw that hazardous cleaning materials were left in a corridor unattended for a prolonged period. We looked at how the quality of the service is monitored and improved. Plans were in place to review and address staff training needs and the maintenance of the environment. We saw completed questionnaires giving feedback about the service. A monitoring tool is in place to collate the results of the surveys and feedback is provided to people using the service and in the Service Users Guide. However, the above concerns highlight ineffective monitoring of quality of the environment and working practices. We have also noted that developments in legislation and good practice guidance regarding mental capacity have yet to be implemented in the home. Although the manager has started work on improving social and cultural activities in the home, this remains a concern for relatives and staff. Care Homes for Older People Page 27 of 34 Evidence: On the day we visited, the registered manager was working on the floor as a Nurse, preparing for a new admission and responding to our arrival to inspect the home. When discussing management issues with the Registered Manager, we learned that she is allocated to nursing duties on three days per week. The evidence found at this inspection suggests that this is not sufficient time to perform the duties of a registered manager, monitor practice effectively and develop practice in line with current guidance and legislation. Our rating of adequate takes into account the very positive and prompt way in which the service has responded to the initial findings of our visit. However, the original requirements will remain in this report and will be revisited in ourfuture assessment of the service Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 19 13 Access to the sluice and laundry areas must be restricted. This is to reduce the risk of accident and injury to people living in the home 17/08/2009 Care Homes for Older People Page 29 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 1 19 13 The Registered Person must 12/03/2010 fir restriction to the front bay window in room 6 so that it is not possible to fall or climb from it This is to eliminate an extreme risk to the safety of people living in the home. 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 8 13 The Registered Person must ensure that moving and handling practice conforms with current good practice guidance This is to protect people living in the home and staff from injury. 08/05/2010 2 19 13 The Registered Person must ensure that measures put in place to restrict access to the homes laundry are implemented consistently. This is to reduce the risk of injury to people using the service 30/05/2010 Care Homes for Older People Page 30 of 34 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 3 19 13 The Registered Person must ensure that bath water is maintained at a temperaturethat does not pose the risk of scalding. This is to reduce the risk of injury to people using the service 30/05/2010 4 19 13 The Registered Person must ensure that keys to individual rooms and windows are easily identifiable in an emergency This is to reduce the risk of injury to people using the service 30/05/2010 5 19 13 The Registered person must 30/05/2010 assess the risk posed by free standing wardrobes and carry out any work necessary to reduce identified risks This is to reduce the risk of injury to people using the service 6 19 13 The Registered Person must produce updated risk assessments for all radiators, including those that are fixed and free standing. This must include the safety of covers. Work must be undetraken to 30/05/2010 Care Homes for Older People Page 31 of 34 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 remedy any risks identified in these risk assessments This is to reduce the risk of injury to people using the service 7 38 13 Hazardous substances must be inaccessible to people living in the home and locked away when not in use. This is to protect people living in the home from the risk of harm. 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 13/05/2010 1 3 Where a planned admission takes place, the full recorded detail of pre-admission assessments should be made available to the Registered Manager in a timely way so that the persons needs can be understood by all staff and preparations made for their admission. Where people move into the home at short notice, the Registered person should ensure that there is a robust approach to requesting full information about the persons needs Plans concerning individual needs should include a consideration of the persons mental capacity in accordance with the Mental Capacity Act and associated guidance. The Registered Person should ensure that work on developing the activities programme is completed. Locks fitted to individual rooms should be eased where necessary so that they are easy to operate 2 3 3 7 4 5 12 19 Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 7 8 9 21 26 26 31 Work to improve the safety of the terrace should be completed at the earliest opportunity. The Registered Person should reassess the benefits of using soluble red bags for soiled laundry Liquid soap should be provided for staff use in the homes laundry The Registered Provider should review the allocation of management time for the registered manager to ensure there is sufficient time available to perform her duties as a registered manager. Information provided to people using the service should make clear the respective roles of the Registered Manager and Responsible individual. The Registered Person should ensure that quality monitoring in relation to safety and working practices is robust and effective. 10 31 11 33 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!