Care Home: The Lawns Nursing Home

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What the care home does well The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 The Lawns is set in large grounds so that people have nice surroundings to enjoy, especially when the weather is good. Lots of people talked to us about the enjoyment they are getting from the new vegetable garden which has been developed this year. This is looked after by several people who live at The Lawns with support from staff. People told us that they are well looked after by the staff and find them caring and hard working, for example one person wrote in their survey - "I have found that all nurses and carers give 100% they are very friendly, helpful and most of all the residents always come first." The Lawns is a friendly home and relatives we spoke to said that they are made welcome. Two people told us they visit every day and that the staff do everything they can for them as well as the people they visit. The following comment from a relative in a survey gave a positive overview of the service the home provides to the people who live there "Open and welcoming. Very clear and helpful. Staff are friendly and respond quickly to requests and questions. Home is clean, food is good. We are generally very pleased with the service. I think the service is excellent value. My mother went to The Lawns for emergency respite care. We consider ourselves very lucky that there was a bed available in such a pleasant well run and well caring home. The staff were very kind and helpful and continue to be so." A varied menu is provided and good attention is paid to people`s dietary needs. There is an emphasis on home baking and providing fresh produce and using local suppliers. Some of the salad and vegetables used are grown by the residents` gardening club. A varied range of activities are arranged; some of these are group activities but people also have time spent with them individually too. Domestic staff work hard to keep the home clean and free from unpleasant odours. One person we spoke to told us that a cleaner cleans her room every day except Sunday and that she is very pleased with the overall cleanliness in the home. What has improved since the last inspection? Carol Harris has worked hard since her appointment to improve the quality of the service provided at the home and to rebuild an effective team of staff who had gone through lots of changes in the last two years. The surveys from staff and from some relatives indicated that there has been a marked improvement in morale and job satisfaction. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 One member of staff wrote in their survey - The Lawns is a friendly and supportive place to work in. Many of the clients, visitors and relatives comment on the friendliness of staff and state they miss the company when their relative or spouse dies. I have been at The Lawns for several years and have seen many changes. It has been stressful at times but with the present management I feel the changes are more positive and they listen to what is said. A lot of work has been done to build on previous improvements in the quality and detail of information in the written information about the care people need. This means there is clear and detailed information for staff to refer to. The information in the records reflects people`s specific needs and shows that staff see them as individuals. Carol Harris wants to develop this by making the records easier for people who live in the home to understand and getting the care staff more involved in supporting the nurses with the records. The records about nutrition and injuries (such as bruises or wounds) have been improved to ensure there are clear records of the care being given. Accidents and incidents are being monitored and trends identified so risks can be reduced. The social care coordinator has continued to develop the number and range of things that are provided for people to do during the day. This includes one to one time as well as group activities. She is particularly pleased with the popularity and success of the residents` garden club. Staff are receiving regular focussed supervision to make sure that they are aware of how things should be done at the home. The owners have continued to make improvements to the quality of the accommodation. This has included upgrading of fire safety safeguards, redecorating of some rooms and the provision of 21 new `profiling` beds to help staff provide care safely and comfortably in beds that can be adjusted according to individual need. Carol Harris has reviewed the overall care needs of people living in the home and daytime and night-time staffing levels have been increased as a result. What the care home could do better: We identified some issues where improvements would be beneficial; some of these are issues that the service already knows it needs to develop. In view of the improvements made since our last inspection and in particular since CarolThe Lawns Nursing HomeDS0000004121.V377122.R01.S.doc Version 5.2 Harris was appointed we are confident that the service has the ability and will to continue to make these improvements. It is possible that some people may not have had information such as the service user guide and contract before moving to the home. Similarly, a few people may be unaware of the complaints procedures. Some staff may need to be reminded to fill in the `carried forward` boxes on medication record charts and to date boxes of medication when they are started; this helps to provide a clear audit trail. Most staff are doing this but we found a few examples of this not being done. Creams prescribed for acute problems are being recorded but this is not happening in all cases when creams are used long term. It would be good practice for the cook to be more directly involved in speaking with people who live in the home about their food likes and dislikes and nutritional needs. Storage facilities in the building are limited and this results in equipment having to be stored in a bathroom; identifying more suitable storage could help to make the facilities more attractive and comfortable for people. Some people told us they don`t think there are enough staff and that this affects the way care is given at times; Carol Harris has already started looking at staffing levels and as a result more staff are rostered at night and during the day. This needs to be kept under review to check that the recent increases are sufficient. One or two people who returned surveys raised a problem of occasional lapses in communication between staff resulting in messages not being passed on. This is an important area for the manager to address. Key inspection report CARE HOMES FOR OLDER PEOPLE The Lawns Nursing Home Main Road Kempsey Worcester Worcestershire WR5 3NF Lead Inspector Denise Reynolds Key Unannounced Inspection 11th August 2009 10:00 DS0000004121.V377122.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lawns Nursing Home Address Main Road Kempsey Worcester Worcestershire WR5 3NF 01905 821388 01905 828171 lynettekeen@heritagemanor.co.uk Heritagemanor.co.uk Heritage Manor Limited 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) Carol Harris Care Home 40 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (40), Physical disability (40) of places The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Physical disability (PD) 40 Dementia (DE) 8 The maximum number of service users who can be accommodated is: 40 Age: Physical disability (PD) age 50 and above. 2. 3. Date of last inspection 12th August 2008 Brief Description of the Service: The Lawns is situated in the village of Kempsey near to the City of Worcester. The home is registered to provide nursing care for 40 older people. The building was originally a regency manor house which has had a purpose built extension. It is set in 3 acres of well maintained gardens providing pleasant surroundings for people to enjoy. Bedrooms are situated on the ground and first floors and there is a passenger lift to take people between floors. Sitting and dining areas are situated on the ground floor and there is a large entrance hall where some people like to spend their time so they can see all the comings and goings at the home. The service aims primarily to cater for people with general nursing care needs arising due to the general ageing process or specific health problems. A small number of people with dementia related needs may be accommodated within the service registration but the comfort of physically unwell people at the home would be taken into account in deciding if a person with dementia could be accommodated. The service user guide details that the range of fees payable are from £532 to The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 5 £710 a week and explains what happens when people are eligible for a contribution for assessed nursing care needs. Information is available in the entrance hall to tell people about our inspection reports being available at the home if they want to read them. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a full inspection of The Lawns to look at how the home is performing in respect of the core national minimum standards (the report says which these standards are) and the quality of the service that the people who live there experience. We call this type of inspection a key inspection. The inspection was on a weekday and lasted all day; we did the inspection without telling the home that we would be going. The home completed an Annual Quality Assurance Assessment (AQAA) earlier in the summer. This is a document services are required to complete annually and describes what they consider they do well, what they need to improve and their plans for developing the quality of service people receive. We used information provided in the AQAA to help us plan our inspection. We took into account information in surveys that were returned to us. We sent surveys to a sample of people and these were completed by nine people who live at the home, six families, seven staff and 4 health and social care professionals. This was an average response rate of over 50 . During the inspection we visited a person who is cared for in bed and spoke with her relative. We also spoke with four other people who live at the home and relatives of two of these. While we were in the home we were able to see and hear what was happening and the way that the staff treat people who live there. We met a number of staff some in private and others as they went about their work during the course of the day. These included registered nurses, care staff, the social care organiser, cook, domestic staff and Carol Harris the manager. We inspected parts of the premises and looked at various records such as care records, staff files and records to do with the premises. What the service does well: The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 7 The Lawns is set in large grounds so that people have nice surroundings to enjoy, especially when the weather is good. Lots of people talked to us about the enjoyment they are getting from the new vegetable garden which has been developed this year. This is looked after by several people who live at The Lawns with support from staff. People told us that they are well looked after by the staff and find them caring and hard working, for example one person wrote in their survey - I have found that all nurses and carers give 100 they are very friendly, helpful and most of all the residents always come first. The Lawns is a friendly home and relatives we spoke to said that they are made welcome. Two people told us they visit every day and that the staff do everything they can for them as well as the people they visit. The following comment from a relative in a survey gave a positive overview of the service the home provides to the people who live there Open and welcoming. Very clear and helpful. Staff are friendly and respond quickly to requests and questions. Home is clean, food is good. We are generally very pleased with the service. I think the service is excellent value. My mother went to The Lawns for emergency respite care. We consider ourselves very lucky that there was a bed available in such a pleasant well run and well caring home. The staff were very kind and helpful and continue to be so. A varied menu is provided and good attention is paid to peoples dietary needs. There is an emphasis on home baking and providing fresh produce and using local suppliers. Some of the salad and vegetables used are grown by the residents gardening club. A varied range of activities are arranged; some of these are group activities but people also have time spent with them individually too. Domestic staff work hard to keep the home clean and free from unpleasant odours. One person we spoke to told us that a cleaner cleans her room every day except Sunday and that she is very pleased with the overall cleanliness in the home. What has improved since the last inspection? Carol Harris has worked hard since her appointment to improve the quality of the service provided at the home and to rebuild an effective team of staff who had gone through lots of changes in the last two years. The surveys from staff and from some relatives indicated that there has been a marked improvement in morale and job satisfaction. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 8 One member of staff wrote in their survey - The Lawns is a friendly and supportive place to work in. Many of the clients, visitors and relatives comment on the friendliness of staff and state they miss the company when their relative or spouse dies. I have been at The Lawns for several years and have seen many changes. It has been stressful at times but with the present management I feel the changes are more positive and they listen to what is said. A lot of work has been done to build on previous improvements in the quality and detail of information in the written information about the care people need. This means there is clear and detailed information for staff to refer to. The information in the records reflects peoples specific needs and shows that staff see them as individuals. Carol Harris wants to develop this by making the records easier for people who live in the home to understand and getting the care staff more involved in supporting the nurses with the records. The records about nutrition and injuries (such as bruises or wounds) have been improved to ensure there are clear records of the care being given. Accidents and incidents are being monitored and trends identified so risks can be reduced. The social care coordinator has continued to develop the number and range of things that are provided for people to do during the day. This includes one to one time as well as group activities. She is particularly pleased with the popularity and success of the residents garden club. Staff are receiving regular focussed supervision to make sure that they are aware of how things should be done at the home. The owners have continued to make improvements to the quality of the accommodation. This has included upgrading of fire safety safeguards, redecorating of some rooms and the provision of 21 new profiling beds to help staff provide care safely and comfortably in beds that can be adjusted according to individual need. Carol Harris has reviewed the overall care needs of people living in the home and daytime and night-time staffing levels have been increased as a result. What they could do better: We identified some issues where improvements would be beneficial; some of these are issues that the service already knows it needs to develop. In view of the improvements made since our last inspection and in particular since Carol The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 9 Harris was appointed we are confident that the service has the ability and will to continue to make these improvements. It is possible that some people may not have had information such as the service user guide and contract before moving to the home. Similarly, a few people may be unaware of the complaints procedures. Some staff may need to be reminded to fill in the carried forward boxes on medication record charts and to date boxes of medication when they are started; this helps to provide a clear audit trail. Most staff are doing this but we found a few examples of this not being done. Creams prescribed for acute problems are being recorded but this is not happening in all cases when creams are used long term. It would be good practice for the cook to be more directly involved in speaking with people who live in the home about their food likes and dislikes and nutritional needs. Storage facilities in the building are limited and this results in equipment having to be stored in a bathroom; identifying more suitable storage could help to make the facilities more attractive and comfortable for people. Some people told us they dont think there are enough staff and that this affects the way care is given at times; Carol Harris has already started looking at staffing levels and as a result more staff are rostered at night and during the day. This needs to be kept under review to check that the recent increases are sufficient. One or two people who returned surveys raised a problem of occasional lapses in communication between staff resulting in messages not being passed on. This is an important area for the manager to address. 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. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 10 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 The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 does not apply to The Lawns). People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Before being offered a place, people have their care needs carefully checked to make sure the home can provide the right level of support and staff know what care the person needs when they arrive. EVIDENCE: We saw care records filled in before people came to live at the home that showed a lot of detail had been gathered so staff would be able to provide the right care when people arrived. We saw that the home uses the assessment information provided by the local authority if they are funding a persons care as well the assessment that staff from the home do. A survey from a social The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 12 care professional gave us the following information in response to a question about what the service does well Assess each patient prior to admission. Plan care in a multi-disciplinary way. Take on board all opinions of people involved. And another said My involvement with The Lawns has always been welcoming, prompt response, good liaison, friendly staff, always able to offer information. From my aspect of using the Lawns service works extremely well. We met one person who had moved in recently and their nearest relative who was visiting. They told us that the process of arranging their move to The Lawns was all very well organised. They told us that Carol Harris visited them to get to know them and find out what help they needed. They said everyone has been very good indeed, its a lovely place. The person and their relative really like their room but staff have approached them about moving to a bigger room which will be more suitable - they felt that this showed that staff think about what people need. So far they are both very pleased - the relative feels welcome when they visit and is given cups of tea. They will be coming to the family meeting Carol Harris is holding tomorrow. They came to the strawberry tea recently and found it was a chance to meet other relatives. The manager showed us an email from the relative of someone who also moved in recently. We have their permission to include an extract - I visited X today and I wanted to say how professional helpful and caring all you team are X looked very clean and well and seems to have settled into the environment very well ……. I wanted to say a big thank you to you and all your team for helping to make the transition so much easier to accept. I am sure X will enjoy her stay with you at the home We telephoned this person and they told us they are still very pleased. They said X always looks clean and nicely dressed and that the staff are great. She has spoken to someone else who lives at the home who has been there for a while and they told her how much they like it. The person told us that family are always made welcome and have been encouraged to bring their dog to visit much to their relatives pleasure. The home has a clearly written statement of purpose and service user guide. These give satisfactory details about the type of care the home provides. Although the home has registration to enable it to accommodate people who have dementia, Carol Harris told us she does not see it as a home aiming to admit people with dementia. This is due to the level of physical frailty of some of the people who are living there. The focus of the home is primarily on people who need nursing care due to their physical needs. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 13 The service user guide details that the range of fees payable are from £532 to £710 a week and explains what happens when people are eligible for a contribution for assessed nursing care needs. In the AQAA the manager told us she wants to make the service user guide more user friendly. At the inspection she told us she is looking into having a recorded version available on CD. In the surveys we had mixed information about whether people had enough information about the home before they moved in. The improvements Carol Harris plans to make to the service user guide may address this for the future. Three of the nine people who sent surveys back said they had not received a contract although four said they had; one didnt know if they had or not. We suggest that the manager checks to make sure people have received this important documentation. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Lawns have their health and personal care needs attended to in a way that respects their individual needs. EVIDENCE: We looked at some examples of the written care records. These contained thorough and detailed care plans. Work has already been done to describe the care people need in a personalised way and to make them easier for people who live in the home to understand if they choose to see them. Carol Harris intends to do more to develop this aspect of practice. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 15 High importance is being given to the prevention of pressure area damage. People who spend a lot of time in bed have pressure relieving mattresses and Carol Harris showed us a weekly audit of pressure area care. The home also sends monthly audits to the Tissue Viability Nurse at the PCT who monitors pressure areas in care homes. Shortly before we left the home we met a person who had been out all day at a day centre. Although unable to have a conversation with us we saw that they smiled and approached Carol Harris when they saw her. The person was relaxed and, when we asked what they thought of The Lawns they smiled, laughed and gave us a thumbs up sign. Earlier in the day we had seen that there was a detailed care plan in place regarding specific aspects of their care. All the care needs identified in the original assessment for the person were reflected in their care plan and we saw evidence that this had been reviewed and updated as changes occurred. We saw another care plan for a person with complex nutritional needs. This showed that staff had been in regular contact with health professionals and had actively sought specialist input from relevant professionals. We discreetly observed staff helping this person with a meal and saw that they were following the information in the care plan. The cook and nurses we spoke to were able to describe the persons dietary needs and further information was available on a whiteboard in the kitchen. We noted that other aspects of the persons care were described as carefully and in an individualised way. Risk assessments were available to help guide the care needed. We saw evidence that staff check peoples care need frequently and make a note of this in the records. We met one person who is cared for in bed. They were not able to communicate with us but their partner told us they are very pleased with the care at the home and said staff cant do enough. They told us the staff are kind to both of them. We commented that the person looked comfortable in bed and were told that staff had just been in and washed the person and changed the bedding. They told us this is always changed regularly and the person always looks well looked after. Medication is securely stored and temperature records are kept to make sure the temperature is maintained at correct levels. Suitable arrangements are in place for the safe destruction of unused or spoiled medication. Medication charts are tidily filled in. We saw no gaps in the records and noted that a key is used to show when and why medication has not been taken. Information about variable dose medication is clearly recorded. Creams prescribed for an acute need are signed for on the charts signed by the nurses who apply these or support care staff to do so. Other creams are The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 16 applied by carers and not signed for. Carol Harris told us she thought the pharmacy had already set up charts for peoples rooms to be signed as staff applied the creams. She said she would follow this up straight away. We found some medication charts where staff had not filled the carried forward boxes in. We also saw some boxes of medication that had not been dated when they were started (although most had been). We highlighted this as needing to be done in all cases. We checked the contents of the controlled drugs cupboard and book and found that these reconciled. Staff confirmed that all items of medication are kept for seven days after death and showed us a record book kept for these and for wasted medication. These records are checked and signed by two staff. We saw that the home has a written policy about people being safe in bed and how decisions about using bedrails should be made. We recommended that the policy needs to be dated and that it would be good practice to refer to relevant source material consulted to draw it up. During the day we saw that staff on duty were polite and attentive when dealing with people. People we spoke to were very positive about staff. We saw a number of thank you letters to the home which reflect the appreciation of people who have stayed at the home and of families, eg I could not let time go by without extending to you all my very sincere thanks for the love and friendliness I received during my weeks at The Lawns. From the initial warm welcome and throughout the whole time I was with you the care never wavered. Thank you all so much. Information in our surveys gave a generally positive view of the care at the home although the majority of responses were usually rather than always responses. For example six people said they usually get the care they need and three said always and seven said staff usually listen to them and act on what they say and one said always. In respect of medical care, seven people answered that they always get the medical attention they need and two that this is usually the case. The comments people made were mostly positive, for example Comfortably happy and I have been comfortable all my stay. Caring, friendly but professional. The staff try, as near as possible to make their nursing home my home. They personalise everyones care with as little restriction as possible. Some people commented on things that could be improved; one person commented that they would like staff to be more on time bringing their The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 17 medication and another said that staff are not always good about informing relatives about appointments. Comments from relatives were also positive and we had too many comments to record them all here. The following examples give a flavour of what people said Everyone is treated as an individual with their personal needs and preferences taken into account in their day to day care. Independence is encouraged and supported. …………… could not even feed or take a drink un-aided when ….. transferred to The Lawns and we did not expect her to live long. This (person) is now at a stage where we dont have to worry and can take holidays knowing that (person) is in excellent hands. The Lawns have given us peace of mind. The staff at The Lawns care for ……… and by what I observe the other patients as well, with great sympathy, good spirits and professionalism to the point where little more could possibly be expected. Surveys returned by a GP, a social worker and two PCT staff gave positive feedback to us with a majority of always responses to our questions about the quality of care at the home. The GP wrote Manages mental and physical health of patients. Appropriate requests for medical review. Good end of life care. Supportive of relatives. Information in the staff surveys about the care was also positive and can be summed up by these comments Strives to deliver a high standard of care in a friendly, homely and safe environment. The Lawns is a happy home, staff care about the people that they are caring for. Excellent care given by all staff. Nursing care given is always of the highest standard. Its definitely teamwork, everyone is so supportive. The nursing care for general hygiene and pressure care is very good. The clients always look neat and cared for and their clothes are well laundered. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The importance of nutritious enjoyable food is recognised and people at the Home receive a balanced diet and choice of meals is offered. There are things to do to give people enjoyable ways to spend their time. Families and other visitors are made welcome and there is a friendly atmosphere in the Home. EVIDENCE: We met the social care co-ordinator; she showed that she is full of ideas and energy. There are photos displayed in the home and in a new album to show some of the things that have taken place. This included photos of several people involved in growing vegetables, a visit from the local history society, a knitting session, and a basket weaving session. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 19 The social carer explained how she had helped people being looked after in bed to plant runner beans up in small pots so they could be involved in the garden too. The cook told us she has not had to buy salad greens or runner beans all summer because residents grew these in the garden. One person we spoke to told us that she has started to look after a patch of flower bed, the staff bring her a chair so she can sit down to do this. She also likes to watch the others in the vegetable patch and thinks it is lovely that they then have the produce to eat. Another regular activity is going for walks in nearby lanes to pick berries which are also then used in the kitchen for home made fruit pies. The social carer told us she makes sure a TV guide is available in the sitting room and supports people who are in their rooms to watch what they want on television. While we were at the home she spent time with a lady who is in bed showing her photos of activities to keep her involved. She told us she sees everyone who stays in their room each day and spends as much time as she can with people who are unwell eg talking or reading to them. The surveys from people who live in the home told us that five people always have activities they can take part in, three usually so and one sometimes does. The monthly news sheet for August gave information about the following activities • Garden club • Hand massage • 1940s stories • Card making • Bingo • Crosswords • Helping sort photos to be displayed • Meeting with Carol Harris on 12th August • Singer booked 11th August • Birthday wishes • Communion booked 28th August • Discover History 8th November (local history soc talk about Victorian seaside) • Musical entertainment 9th November • Weaving session (saw photos displayed of a previous one) 15th September • Shop 22nd September When we spoke to the cook we found her knowledgeable and enthusiastic about cooking for older people. The cook told us she discusses new people with staff and that staff are very good at telling her if a persons dietary needs change. We suggested that it would be beneficial for her to have more direct The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 20 contact with people when they move in and on an ongoing basis so that she gets to know people. The cook and manager are planning to review the menus and we suggested that this would be another opportunity to get people who live in the home more involved in making decisions. The cook told us she is writing a manual for agency staff to help deliver consistent food quality when the regular cooks are away. She was delighted to have been awarded a 4 star (very good) rating for food safety and hygiene by the councils environmental health department. Information about special dietary needs is displayed on a white board in the kitchen. The information is clearly and tidily recorded and easy to refer to. Fortified milk shakes are freshly made for people who need extra calories and some have prescribed food supplements. This information is also recorded on the kitchen white board. The lunch time meal on the day of the inspection was chicken casserole or Welsh rarebit and salad. The cook confirmed that there is a planned choice on the menu every day but that people can have other things too. For example, that day someone had an omelette, one had ham salad and another asked for her favourite meal of mashed potatoes, cheese and peas. The pudding that day was home made apple pie and custard or ice cream. Tea was going to consist of homemade leek soup, macaroni cheese, sandwiches, lemon mousse, cheese and biscuits, ice cream, yoghurt. The cook told us that all baking is done by the cooks rather than shop bought and was busy making banana and nut loaf for tea. Produce is bought from local suppliers with an emphasis on fresh rather than frozen foods. The cook told us that one mans wife comes and eats with him every week and families visiting can have meal eg Sunday lunch. In the surveys two people said they always like the meals, three usually do, three sometimes do and one never does. One person commented that breakfast can be rushed. This is information that the manager and cook need to use to check with people if there are things they would like added to the menu and to make sure that breakfast time is managed in the best way to make it pleasant for people. People made comments about the social life in the home such as They try to do different activities so that boredom does not set in. The lady who provides occupational therapy services is quite brilliant. And a visiting professional said Lot of activities geared towards service group. One relative suggested that it would be good for new people moving in to be given more support about where they sit so that they can get to know other people more easily. Staff surveys also gave a positive view of the quality of food and the range of activities provided. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 21 The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be safe at The Lawns because the home uses good procedures to recruit staff and makes sure staff know how to recognise and act correctly if they suspect someone is being abused or neglected. Staff are approachable if someone wants to tell them something is wrong. EVIDENCE: Carol Harris told us that the home has not had any formal complaints since she has been working there. She wants to improve the recording of the more informal complaints and comments that people make so that she and other staff learn the lessons they need to when things are not as people want them. A relative told us that they have mentioned a couple of things to staff and these have been dealt with. This person said they find that staff are easy to approach and so is not anxious about asking them. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 23 When we were at the home a relative raised a concern with a nurse who was polite, listened and offered an explanation. This did not entirely allay the relatives anxieties. Whilst the information offered by the nurse was reasonable, the situation shows the importance of demonstrating that things have or will be followed through. This is a good example of the type of concern the manager plans to have dealt with more robustly. Most people who sent surveys back said they know who they can speak to informally if they arent happy with something but half said they did not know about the formal complaints procedure. All the staff who returned surveys said they know what to do if someone approaches them with a concern and people who returned professionals surveys said issues are dealt with appropriately. One person we spoke to at the home told us that she feels safe and that if something was wrong she would tell a carer she gets on with or a team leader. She told us that if they tell staff about a problem they have to go and report it to the manager. The person also told us that they can always speak direct to Carol if needed. Most staff have done training about safeguarding in the past either at The Lawns or in previous employment and more training in this topic is booked in October. We are aware of situations where the home has used the safeguarding reporting procedures in the past and worked in co-operation with other agencies when matters have been investigated. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Lawns have comfortable and clean accommodation which is safe, well maintained and provides a homely environment. EVIDENCE: All the parts of the home we saw when we were there were clean and tidy. We met some of the domestic staff and saw that they were working hard. We found that they came across as professional in their attitude and were all smartly presented. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 25 One person we spoke to in their bedroom told us that someone comes in and cleans her room every day except Sunday and that they are very satisfied with their room. The room was well personalised with a mix of the persons own furniture and some provided by the home. Whilst walking about the home we saw into other bedrooms if the doors were open and could see they were also well personalised. The furniture provided by the service is good quality. Throughout the home we saw evidence of good infection control measures such as liquid soap, paper towels and disposable aprons. We saw staff wearing disposable aprons going in and out of bedrooms and removing them when they had finished the care for each person. We saw a trolley used by staff between rooms equipped with wipes, clean towels, clean flannels, hand gel, bags for soiled items etc We observed some problems with storage because there is not enough space for this and items like commodes and wheelchairs are stored in a bathroom. We were told this bath is not used often but nevertheless consider this highlights a need to review storage options in the building. We saw that the maintenance man was busy around the home all day and on one occasion witnessed part of a conversation with a relative about something that needed to be done in their relations room. The maintenance man keeps records of tests and checks relating to the premises and the sample we looked at showed these are done conscientiously and were up to date. These included records about fire safety, water temperatures and bedrails. In the surveys from people who live in the home they told us that the home is always or usually fresh and clean (five and four respectively). A relative wrote What I like about the home itself is when entering there is a lovely feel and smell. I think this is so important. Staff and professional surveys reflected a similar view although one staff member commented that some areas need to be decorated. Carol Harris told us that there is a continuing programme of refurbishment which will continue. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28. 29, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Lawns are protected by recruitment procedures which minimise the chances of unsuitable people being employed. People are looked after by friendly and professional staff who want to provide good care; staffing levels may need to be reviewed to support this aim. EVIDENCE: Records of staff recruitment showed that people undergo the required checks to reduce the chance of unsuitable people being employed. The records were well organised making it quick and easy to find the information we needed to look at. The staff rota showed that during the day there are two nurses, five/six care staff, the social carer, manager and ancillary team on duty. Carol Harris is asking the companys board of directors for six carers and 2 nurses at all times. They had already agreed to increase night staffing to 1 one nurse and three carers (previously there were two carers and a nurse at night). In the The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 27 surveys from people who live at The Lawns, staff and relatives there was a common thread which indicated that, even with these increases, staffing levels may still need to be reviewed. For example people said Mums thought is that there should be more staff. Im afraid we are understaffed. Sometimes I feel the carers are very stretched in their duties. I am uncertain if this is because of staff shortages or because maybe some of the carers are not as motivated. I am not sure. Some staff mentioned their concerns about the impact of working 12 hour shifts while acknowledging they offer continuity. One person raised a concern about routines for people being dictated by shift change times rather than peoples choice. Clearly this needs to be reviewed as institutional routines will undermine the efforts being made to provide individualised care. The staff training matrix showed that some areas of staff training have not been updated recently. Carol Harris has identified the need to catch up with training; she has prioritised the mandatory topics but is also aware of the need for care related topics to be addressed too. Safeguarding training has been booked for the first week in October 2009 and most carers and nurses did health and safety and COSHH in June/July 2009 and infection control in May 09. Most have done moving and handling and fire safety training in the last year. Staff surveys indicated that staff generally feel that training is happening and that they get the support they need from the manager. People who live at The Lawns gave us a picture of a friendly staff team who are hardworking and helpful The staff are all friendly and welcoming. Ive been here for the past three years and Ive found the staff are exceptional. I have found that all nurses and carers give 100 they are very friendly, helpful and most of all the residents always come first. However a small number of comments highlighted a need for communication to be improved More co-ordination between staff. Sometimes forget to pass on requests or comments to the next shift. When we inspected the home in 2008 we found that changes in the homes management had affected morale and we know that subsequently there were two more changes of manager. The responses we had from staff this year showed that the stability provided since Carol Harris arrived has improved matters. This had also been noted by a professional who wrote - The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 28 Over the last few months I have noticed staff morale increase. They always seem happy which reflects in patient care. Nothing seems too much trouble. Well done. One member of staff said I enjoy going to work. I think that says a lot about the home. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Lawns are experiencing an improved service because the Home is being managed effectively by an experienced manager. EVIDENCE: The AQAA was filled in by the new registered manager Carol Harris and gave us a balanced view of what is being done well, what has improved and the further work planned to develop the service further. It was a well completed The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 30 and informative document and when we inspected we found that it portrayed an accurate picture of The Lawns. As we have already mentioned in the environment section of the report the maintenance records were well organised and all checks we looked at were up to date. The maintenance man has recently been on a ladder safety training course and fire warden training. The evidence at the home regarding dates of various safety inspections such as gas and LOLER testing of the hoists confirmed the information provided in the AQAA. Quality Assurance is not fully established yet in terms of surveys to people who live in the home and other interested parties but Carol Harris is planning to re-introduce a system to obtain peoples views in a structured way. In the meantime she has already started doing a monthly surgery but was disappointed that no-one had been to see her at one of these yet. A meeting with residents and relatives was due to happen the following evening. Carol Harris arranged this to help her meet people, get to know them and to encourage them to feel they can approach her. A lot of work has been done to introduce audits of processes and documents eg medication, pressure area care, care plans, the environment and accident analysis. The latter is being cross referenced to peoples risk assessments to identify trends eg it had been identified that most falls had been from bed at night and Carol Harris told us she used this to support her request to increase night staffing to three carers. We saw evidence that appraisals and regular supervision for staff had got underway. Most staff had received at least one supervision in 2009 but some have had up to four or five sessions. Carol Harris told us she is using the sessions to embed basics eg to introduce new policies and procedures as well as to discuss practice issues. We saw evidence of this in staff files and in staff surveys. Some people have spending money looked after for them by the home. Records are kept of all transactions and receipts are kept. The money is securely stored. Some of the comments we received in surveys gave an overview of the service and covered topics related to several sections of our report. The following example illustrates this Open and welcoming. Very clear and helpful. Staff are friendly and respond quickly to requests and questions. Home is clean, food is good. We are generally very pleased with the service. I think the service is excellent value. My mother went to The Lawns for emergency respite care. We consider ourselves very lucky that there was a bed available in such a pleasant well run The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 31 and well caring home. The staff were very kind and helpful and continue to be so. Information from staff gave a picture of a service that has turned the corner for example At the moment I think the home seems very good. When we think something needs doing better we do our best to make this happen. The introduction of Carol (home manager) and Allyson (deputy) provide stability. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 32 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 X X 3 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 4 13 4 14 3 15 3 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 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 3 The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No 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. 1 Refer to Standard OP1 Good Practice Recommendations It would be advisable to check that each person (or their relative, supporter or advocate) has had all the information they need about the service including the service user guide and complaints procedure. Some staff may need to be reminded to fill in the carried forward boxes on medication record charts and to date boxes of medication when they are started; this helps to provide a clear audit trail. It would be good practice for the cook to be more directly involved in speaking with people who live in the home about their food likes and dislikes and nutritional needs. Storage solutions need to be identified so equipment can be stored without too much encroachment on rooms used by people living in the home. Staffing levels need to be kept under review to check that the recent increases are sufficient. One or two people who returned surveys raised a problem DS0000004121.V377122.R01.S.doc Version 5.2 Page 34 2 OP9 3 4 5 6 OP15 OP19 OP27 OP31 The Lawns Nursing Home of occasional lapses in communication between staff resulting in messages not being passed on. This is an important area for the manager to address. The Lawns Nursing Home DS0000004121.V377122.R01.S.doc Version 5.2 Page 35 Care Quality Commission Care Quality Commission West Midlands Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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