Inspection on 25/02/08 for The Laurels Nursing Home

This is the latest available inspection report for this service, carried out on 25th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Laurels Nursing Home 71 Old London Road Hastings East Sussex TN35 5NB Lead Inspector June Davies Unannounced Inspection 25th February 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address 71 Old London Road Hastings East Sussex TN35 5NB 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) 01424 714258 01424 434413 The Laurels Nursing Home (Hastings) Ltd Mrs Christine Boniface Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (0) of places The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older Person (OP) Nursing (N), not falling within any other category (OP) (N) The maximum number of service users to be accommodated is 29. 2. Date of last inspection 9th November 2006 Brief Description of the Service: The Laurels Nursing Home is a large detached property set back from the road at the end of a small cul-de-sac in a residential area of Hastings. It changed ownership in June 2006 and provides nursing and personal care for up to 29 residents of an older age. The accommodation is arranged over two floors: a passenger lift enables access to all parts of the building and all areas are accessible for those with limited mobility. Hoists and bath hoists, as well as grab rails and disability aids are in the bathrooms and toilets. There are 21 single rooms, eight of which have en-suite facilities and four double rooms, all with en-suites. The lounge on the ground floor looks out onto a small garden area. The Home is set in large well-maintained gardens, which can be accessed from some of the bedrooms on the ground floor and enjoyed through large picture windows on the first floor. At the front of the Home there is parking space for approximately ten cars. A main bus route is nearby, enabling access to the shops and sea. The home welcomes prospective residents or their representatives to look around and discuss their needs with the Manager as well as spend time with the staff and residents. Weekly fees range from £525 - £770 as at 25/02/08, for full nursing care. Hairdressing, chiropody, manicures and any sundries such as newspapers, or personal shopping are charged as extras. Information about the service is available at the home and can be obtained by contacting the Manager. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. The Inspector arrived at the Service at 9:30 and was in the Service for seven hours. It was a thorough look at how well the Service is doing. It took into account detailed information provided by the registered manager and any information that CSCI has received about the Service since the last inspection. There are two Required Developments at the end of this Report. What the service does well: The Laurels provides a good caring service for its residents. Prospective residents are given clear information about the home prior to moving in. The registered manager gains comprehensive information regarding the prospective resident’s physical, personal and social care needs prior to them moving into the home. This information is then used to assess if the home has the appropriately qualified staff to meet these needs and also on which to base the prospective residents care plan. The health care needs of the residents are well met, with the registered manager accessing specialists from the external multi disciplinary team if this should be required. Menus are regularly reviewed and run on a four-week rotary basis. From viewing these menus the inspector was able to see that residents’ are offered a varied and nutritious diet. From discussion with cooks they were able to confirm that they would be able to cater for specialised diets when required. The home has a good complaints policy and procedure and evidence was available to show that any complaints made are recorded, investigated and responded to in accordance with the homes policy and procedure. The gardens of the home are well tended and planted which on the day of this key inspection showed that Spring was well on the way. This is much appreciated by some of the residents in the home. The staff team consists of qualified nurses, health care assistants and ancillary staff, and it was evident that all staff work well together as a team. There is only a small turnover of staff in the home. All staff are well qualified and trained to carry out their work in accordance with their job descriptions. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 6 The home carries out all the appropriate health and safety checks as well as making sure that all equipment used in the home has current maintenance certificates. What has improved since the last inspection? What they could do better: The registered manager must ensure that the receipt, administration and storage of medication is properly managed, to ensure that residents are not placed at risk. Residents should not have any form of restraint used unless a qualified person has appropriately assessed the need for restraint, risk assessments have been drawn up that will clearly guide staff as to how the element of risk can be reduced to a minimum. The appropriate written permissions must be sought either from the residents and or their next of kin. This particularly applies to the use of cot sides. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 8 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 Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6 People using this service experience good quality outcomes in this area. The homes statement of purpose and service user guide is well written. They provide residents and prospective residents with the information they need to make a decision about moving into the home. Residents move into the home knowing that their needs can be met and that their independence will be maximised and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide has been updated to reflect the new ownership of the home, which occurred in 2006. This document is now available in each resident’s room. The registered manager confirmed that the service user The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 10 guide will be kept under review on an annual basis so that each resident and prospective residents are kept up to date with any changes made in the home. Pre-admission assessments of three residents were seen. These showed that the registered manager ensures that she gains comprehensive information prior to a resident moving into the nursing home, together with care manager assessments. These pre-admission assessments are used to set up the initial care plan, and to ensure that the home can meet the care needs of the resident. The home does not offer intermediate care. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, and 9 People who use this service experience good outcomes in this area. There is a clear care planning system in place to adequately provide staff with the information they need to satisfactorily meet the residents’ needs. The health needs of the residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Personal care is offered in a way to protect residents’ privacy and dignity and promote independence. The systems for medication administration need some improvement to ensure that residents’ are not placed at risk This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 12 The three care plans viewed show detailed information of the care that each resident receives in the home. This includes personal care, nursing care and social care, with clear steps given to staff as to how the care should be delivered. Care plans have appropriate risk assessments in place. It is noted however that in one care plan, of a resident who has cot sides, there is not a permissions letter or a risk assessment and this will be referred to under Standard 18 in this report. All care plans are reviewed on a monthly basis. The residents’ health care needs are well met; with evidence that care staff do attend to all aspects of residents personal hygiene needs, including teeth, hair, nails, washing and bathing etc. Nursing staff are well trained in checking for tissue viability and where there is cause for concern, appropriate action is taken immediately. During a tour of the building the inspector noted that residents are supplied with pressure relieving equipment – specialised mattresses and cushions to prevent the occurrence of pressure areas. Many of the RGN nurses employed in the home have received continence training and care of catheters. Continence care is regularly reviewed for each resident. At the present time none of the residents’ in the home have mental health issues that would require a psychiatrist or community psychiatric nurse. The manager said that should an issue arise where there were concerns regarding a resident’s mental health this would be referred in the first place to the general practitioner who would in turn refer to the psychiatrist. Opportunities are available in the home for residents to participate in music and movement exercises. Nutritional screening takes place on a monthly basis for each resident in the home, and is recorded in his or her individual care plans. Where there is concern regarding weight loss or weight gain this is reported to the general practitioner. There is evidence that residents have regular access to opticians, chiropodists, physiotherapy and occupational therapy. In the case of one resident admitted from hospital the registered manager accessed the assistance of a physiotherapist, and the outcomes have been very beneficial for the resident. Medication in the home is generally well managed. The inspector noted that during an observation of the lunch time medication round, an RGN was signing off medication prior to observing the resident taking the medication, this was pointed out by the inspector and the RGN immediately changed her procedure The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 13 to ensure that the medication was only initialled as having been administered once she had observed the resident taking the medication. The home uses blister packed medication from the a local pharmacy, this comes into the home on a 28 day cycle, but where medication is prescribed by the general practitioner mid month, this is not always properly signed in on the MAR sheet, with the amount of medication prescribed, the date of receipt or the initials of the person receiving the medication into the home. On a MAR sheet for one resident there was some confusion regarding an analgesic medication, the resident had been prescribed co-codamol, the general practitioner had then changed this to paracetamol, and this had been written into the same box on the MAR sheet as the co-codamol, when a new box on the MAR sheet should have been used. On inspection of the medication fridge the inspector found out of date Latanoprost eye drops, on investigation it was found that these eye drops were not on the resident’s MAR sheet, but was entered onto the resident’s care plan. This was discussed with the registered manager who will investigate as to what is happening regarding these eye drops. Once opened these eye drops should not have been kept in the medication fridge, and staff must be vigilant in reading instructions. There was another instance where a prescribed dose of Fybogel had been changed to one daily on the MAR sheet, but no indication whether this had been agreed with the general practitioner. In two instances medication given three times a day and four times a day, had been entered as tds and qds respectively, these terms should not be used but clearly written as three times a day or four times a day. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People who use this service experience good outcomes in this area. The home provides good activities, which supports and enriches the lives of the residents. The open visiting policy encourages residents to maintain links with their families and friends. The meals in this home are good offering both choice and variety and catering for specials diets. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each month the registered manager publishes an events sheet, with all the activities on offer in the home. From viewing the events sheet, this shows that residents are offered almost daily activities for the whole month. The part-time housekeeper works extra hours as the activities co-ordinator. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 15 Residents who spend most of their time in their bedrooms have regular room visits, and the deputy manager told the inspector how she likes to spend time with the residents, carrying out personal care, doing manicures and hair care. A few of the residents spend time in a small lounge watching television, reading newspapers. One resident has budgie that is mainly kept in the small communal lounge because residents like to watch him. Throughout the home there was evidence of art and craftwork that the activities co-ordinator helps residents to do. The frame of the residents’ notice board was covered in a very interesting collage that residents had produced. The manager holds a monthly coffee morning for the residents and a three monthly coffee morning for friends and relatives. Residents are also invited to attend regular resident meetings, and minutes of these meetings are available in the manager’s office. The deputy manager described how she takes some residents out in a wheelchair for walks, when time is available and the weather is nice. Some residents who prefer to spend time in their bedrooms commented on how they enjoyed the garden, and being able to watch people come and go. From the residents surveys sent out by CSCI three were returned and residents comments were: ‘There are always sufficient activities to take part in.’ ‘There are usually sufficient activities to take part in’ and one resident responded, ‘There are never any activities to take part in.’ Residents spoken to on the day said that they were happy with activities on offer. The home has an open visiting policy, and friends and relatives are welcome at any time. The registered manager ensures that those residents who wish to maintain contact with their religion are enabled to do so. The residents’ notice board has a list of contact numbers for all types of religious beliefs. The manager does not act as appointee for any of the residents. The residents have made their own arrangements for relatives or solicitors to look after their personal finances for them. Information is available on the table inside the main entrance to inform friends and relatives how they may contact an advocacy service if required. Residents may have access to their own care plans if they should wish to do so. A four-week rotating menu is display in the front entrance hall, and copies are also place in the service user guide. These menus are reviewed three times a year. From menus viewed on the day of this key inspection and observing lunch, the inspector found that residents are offered a nutritious and wholesome diet. None of the residents require liquefied food, but some are on soft diets, and these served in an appetising manner. None of the residents require peg feeds. From discussion with residents and resident surveys, the majority of residents said that the food they receive is good, and that they are given choices. The majority of residents prefer to eat in their own bedrooms, and some residents require help in eating. From observation staff who help residents with feeding attended to this task appropriately by sitting at the same level as the resident, and there was good interaction. The cooks told the inspector they try to provide as much fresh food as they can, and occasionally use frozen vegetables, but these are always served with The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 16 one fresh vegetable. All deserts and cakes are home made, with exception of gateaux. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People who use this service experience good outcomes in this area. The home has a satisfactory complaints system with some evidence that residents’ feel that their views are listened to and acted on. Staff have a good knowledge and understanding of safeguarding vulnerable adults issues which protects the residents’ from abuse. This judgement has been made using available evidence including a visit to this service. . EVIDENCE: The registered manager was able to show the inspector a recently reviewed complaints policy and procedure, which is also included in the service user guide, and displayed appropriately in the home. The home has had three small complaints since the last inspection, and these were recorded, investigated and replied to appropriately and in line with the complaints policy and procedure. Three surveys returned to CSCI by residents stated that they did know how to make a complaint. The home has good policies and procedures for safeguarding vulnerable adults, and there is also a flow chart with contact telephone numbers available for staff. This clearly indicates what actions they need to take should they suspect The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 18 abuse has taken place. There is also a whistle blowing policy and procedure. The home has a copy of East Sussex County Councils Guidelines and Protocols for Safeguarding Vulnerable Adults, and the registered manager has requested a more up to date copy. There have been no adult protection issues since the last inspection. 77 of nursing and care staff have received protection of vulnerable adults training, with evidence that further training is to take place this year. It is noted however that in one care plan, of a resident who has cot sides, there is not a permissions letter or a risk assessment. Through discussion with the registered manager it has been agreed that permissions will be sought and a risk assessment will be carried out for each resident who uses cot sides. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 People who use this service experience good outcomes in this area. The standard of the environment within the home is good, with recent and future investment planned. The standard of infection control within the home is good, ensuring the residents are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the whole home was carried out on the day of this key inspection. The home is clean, well decorated and furnished in a homely manner. The grounds of the home are very well tended, and have been planted with The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 20 colourful polyanthus. Many of the residents commented on how colourful the garden was and how much they enjoy looking at it. The registered providers have and are in the process of investing in further improvements to the home. A new nurse call system has recently been installed, a new industrial washing machine has been purchased and this has a sluicing and disinfecting programme. There are immediate plans to renew the cooker hood in the kitchen, with a new cooker hood incorporating an external fan extractor, to replace the flooring in the kitchen and to replace the flooring in the laundry and quotes were available for these. Further plans for this year are for an extension to be built, which will provide a large communal lounge and dining room, bathrooms and some further bedrooms. Planning permission has just been gained for this extension. All bathrooms and toilets are fitted with appropriate aids; hoists, toilet hand rails and raiser seats. All radiators are covered, and each room has an accessible nurse call system. Staff are provided with protective clothing, disposable gloves and plastic aprons, when dealing with bodily waste and spillages. All waste bins have lids, with the exception of two, which the manager stated she will replace. Staff are using the appropriate sack for the clinical waste bin, but it was noted that the bin was of a swing lid variety rather than having a pedal opening device. The registered manager stated that she will contact the clinical waste contractor to try and obtain the appropriate bin. The laundry room is well fitted with industrial washing machines, tumble driers, and hand washing facilities with paper hand towels and liquid soap. A sluicing machine is available in the home, but the manager said that while it was working, it needed to be upgraded, so that it could dispose of human waste appropriately The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People who use this service experience good quality outcomes in this area. Staff morale is high resulting in an enthusiastic workforce that works positively with the residents to improve their whole quality of life. Staff are multi skilled ensuring a good quality of care and support. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector viewed the current rotas, and through discussion with manager, found that there was a stable staff team now working in the home. There is always one qualified nurse on duty for all shifts. The morning shift has one qualified nurse and six health care assistants, the afternoon shift has one qualified nurse and three health care assistants and the night shift has one qualified nurse with two waking health care assistants. Residents spoken to said that there was always someone available to attend to their needs. Three resident surveys returned to CSCI stated the following: two said that there The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 22 was always someone available to care for them and one stated that there was usually someone available to care for them. Both nursing staff and health care assistants said that there is sufficient staff on duty to meet the needs of the residents in the home. 64 of health care assistants have achieved an NVQ qualification at level 2 or 3 with further staff working towards this qualification. Two staff files were inspected during the visit. Application forms containing all the appropriate information are in each file and two copies of identification are also available. A ‘Protection of Vulnerable Adults First’ (POVA First) check and an enhanced CRB disclosure are applied for, for all new recruits. References are requested as part of the recruitment procedure. The Manager explained that the induction for new staff is held in a separate building and that staff do not have contact with any residents until their POVA First clearance has been received. They then work with the residents under the supervision of another member of staff until the CRB Disclosure is received. The majority of staff have received mandatory training, and further mandatory training has been arranged to ensure that new staff have this training and other staff have their training updated. There was also evidence that all staff have access to job related training to ensure they are able to meet the needs of the residents in the home. Registered nurses update their training to meet the health care needs of the residents as well as gaining knowledge in personnel issues, such as supervision and monitoring, equal opportunities, recruitment and selection. All staff have induction training, including a ‘Skills for Care’ induction supplied by a consultancy. Evidence of induction training is available in the staff development files. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 People who use this service experience good quality outcomes in this area. The manager is supported well by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The systems for resident consultation are good with a variety of evidence that indicates that relative and stakeholder views are sought. Health and safety in the home is well managed ensuring that residents and the staff working there are not placed at risk. This judgement has been made using available evidence including a visit to this service. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager is a qualified nurse with a wide experience of nursing, both in acute setting, and in the community. She has worked both in this country and abroad in a nursing capacity. The registered manager has obtained her registered manager’s award. From conversation on the day of this key inspection the manager is very aware of the improvements that still need to be made and is working towards meeting these. She is supported by a Deputy Manager who is also a registered nurse. All the staff spoken to and the deputy stated that the Manager is very supportive, and is always available when on duty to assist with any queries. Some staff that have worked in the home for many years, said that they had seen a great improvement in the home since the registered manager has been in post. Residents and visitors spoke highly of the manager and her deputy, and said that they were always kept informed of any changes. The home has developed a good quality assurance system. Questionnaires are sent out annually to residents, relatives and visiting professionals. There is monthly monitoring of systems used in the home, with some of this monitoring carried out by the housekeeper and kitchen staff. The home uses the ‘The Blue Cross Mark of Excellence’, which is a quality assurance manual. Results of surveys are published, but the manager still needs to include the results of monthly monitoring. The published survey results are also posted on the residents’ information board in the home. All staff are supervised on a regular two monthly basis, and are due to receive their annual appraisal in May 2008. The manager keeps a record of all staff supervisions. The home does not hold or deal with any of the residents’ personal allowances. Either relatives or solicitors take responsibility for personal allowances. The home makes purchases on behalf of the residents’, and keeps a receipt of these purchases. There is also a financial sheet for each resident showing what expenditure has been made. The registered providers then invoice relatives or solicitors for the expenditure, and forward copies of receipts of purchase with the invoice. The home has good systems in place to ensure the health and safety of the residents and the staff working in the home. Many of the staff have received COSHH training. It was also noted that domestic staff are supplied with cleaning trolleys, which hold all their cleaning materials and their mobs and buckets. One domestic said how helpful these trolleys are, and that they save a lot of lifting. The inspector viewed up to date maintenance certificates for all equipment used in the home, this included the fire system (panels, fire fighting equipment The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 25 and fire alarm system), lifts, hoists, nurse call system, gas, electrical wiring, portable appliance testing and Legionella check. The maintenance man checks fire call points weekly, emergency lighting monthly and hot water outlets monthly. He also has a regular check rota for meter reading, cleaning the inside of the windows, checking wheelchairs and hoists, bath lifts and de-scaling shower heads. The inspector viewed the Health and Safety accident book as found that all accidents are recorded appropriately. Each month the registered manager is provided with a list of accidents that have occurred in the home, this enables her to investigate and risk assess, where residents are having regular falls, and if there is a health and safety issue that needs to be addressed. All policies and procedures used in the home have been reviewed in the last year or are due for review this year. The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 27 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. 1. Standard OP9 Regulation 13 Requirement The registered manager must ensure that medication is administered in accordance with The Royal Pharmaceutical Guidelines. The registered manager must ensure that cot sides are not used until the appropriate permissions and risk assessments are carried out. Timescale for action 02/04/08 2. OP18 13(4)(c) (7) Schedule 3(p) 02/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Laurels Nursing Home DS0000066577.V357919.R01.S.doc Version 5.2 Page 29 - 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. 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