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Inspection on 29/09/05 for ICS 2 Laurel Drive

Also see our care home review for ICS 2 Laurel Drive for more information

This inspection was carried out on 29th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides a homely and spacious environment for a small group of people with learning disabilities and varying degrees of physical disabilities. The consistent staff team showed a good knowledge of service users` day-today needs, and were very positive, supportive, and caring towards them.

What has improved since the last inspection?

There have been environmental improvements to the home, maintaining and improving the already high standards in this respect. The kitchen has been refurbished to a high standard, a walk-in shower room is now in place as an alternative to the bath.

What the care home could do better:

Although service users are well-cared for by keen and dedicated staff in the home, their safety and well-being is currently compromised by a number of issues. Serious shortcomings were identified in the administration and recording of medication. These must be rectified; further training is required throughout the home to ensure that proper and safe procedures are adhered to in dispensing medication. The system for disposal of clinical waste must be reviewed to ensure it is minimising infection risks. The home must ensure that hazardous materials are stored safely and securely at all times. Hazardous substances must be securely stored in a locked cupboard at all times. Fire safety is to be improved by installing alarm-activated closures on bedroom doors that service users wish to keep open.

CARE HOME ADULTS 18-65 Ics - Laurel Drive, 2 2 Laurel Drive, The Bridleways Hartshill Nuneaton Warwickshire CV10 0XP Lead Inspector Martin Brown Unannounced Inspection 29th September 2005 02:30 Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 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 Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 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 Adults 18-65. 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. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ics - Laurel Drive, 2 Address 2 Laurel Drive, The Bridleways Hartshill Nuneaton Warwickshire CV10 0XP 02476 393496 01527 546888 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) Individual Care Services Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th March 2005 Brief Description of the Service: 2 Laurel Drive is a purpose built bungalow situated in a small residential estate in the village of Hartshill, near the town of Nuneaton in Warwickshire. The home is registered for five younger adults with learning disabilities. The home is within walking distance of local facilities and amenities. The home has use of its own transport, which can accommodate wheelchairs. The shared space in the home consists of a lounge, dining room, kitchen, two bathrooms and shower room. There are six bedrooms, one of which is used as a sleep in room for staff. There is also a utility room housing the laundry facilities. There are well-maintained gardens to the rear and sides of the property. Service users receive all services necessary to deliver personal care and the promotion of independent life skills. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on a Thursday afternoon between 2.30 and 6pm. The inspector was made welcome by residents, staff and the manager. Two residents were at day services, but returned in good time to be seen and spoken with. There are four people currently living at the home, following the death of one gentleman earlier in the year, who was spoken fondly of by staff and residents who were able to do so. What the service does well: What has improved since the last inspection? What they could do better: 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. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 Service user assessments and service user contracts support the home in meeting individual needs. EVIDENCE: There have been no new service users since the previous inspection, when a person had just been admitted. An assessment was seen that had been made prior to the last person’s admission. Her needs have changed considerably since then, and continue to change, making assessment a constant process, involving outside professional support. Contracts, in the form of resident/service agreements, were seen to clearly detail information as to what service can be expected. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 There are well-maintained care plans with relevant information. Service users, their supporters, and staff, may benefit from information also being available in service user-friendly formats, such as life story books, activity books, and/or communication diaries. Where a service user has rapidly changing needs, extra effort is needed to ensure that these needs are recorded and met. EVIDENCE: Care plans continue to be in place for long established residents, detailing needs and how these are met. Few details are available in a user-friendly format. Risk assessments were seen to be clearly related to individual risk and the management of individual risk. These were supplemented, where necessary, by behavioural guidelines. These were seen to be in place for a sample of service user files. The most recently admitted service user is going through a sustained period of rapidly changing need. This is not clearly documented. The home must ensure that the recording of assessments, risk management and the meeting of changing needs are adequately documented. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 The home supports service users in activities they enjoy, supports outside contacts, respects rights and responsibilities, and offers and encourages a healthy and varied diet. EVIDENCE: Two service users returned later in the inspection from day services that they regularly attend. One service user had not gone to her regular day service following what staff described as a ‘disturbed’ night for her. The other service user has activities provided for by the home. There is a minibus provided by the organisation, for which service users pay a monthly fee, covered by Disability Living Allowances, which allows them wider accessibility to the community. Service users all recently went on a holiday to Butlin’s, which those staff who went said was enjoyed by all, to the extent that they are considering similar next year. The evening meal was sampled with the residents. It was a relaxed, easygoing meal, but with staff working hard to ensure service users were properly supported throughout the meal. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 10 The meal, and menus and food stocks, show that service users are offered a healthy diet that they enjoy. The timing of the meal was brought forward slightly by staff recognising a service user’s non-verbal cues that she was ready to eat. The home supports family involvement and contact by relatives, and where a service user does not have any such contact, staff have made extra effort to involve themselves and their families with this service user. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Evidence of good, positive work in personal and health care support is undermined by poor practice in the administration of medication. There is no evidence of any harm coming to service users in this respect, but, until practices are improved and procedures adhered to, this remains a possibility. EVIDENCE: Records show that outside specialist support is available and sought when appropriate. Observation demonstrated that staff provided help and support in a positive manner, paying attention to service users’ wishes, encouraging independence, whilst offering care and support as needed. Discussion with staff and management demonstrated a pro-active response to particular health needs. Examination of medication showed serious deficits. The ‘blister pack’ system is used, which should minimise the chances of error. In spite of this, it was noted that a total of five tablets were unable to be accounted for, and two tablets had been administered from the wrong place in the respective blister pack. There was an instance of medication ceasing under medical instruction, but without any written advice or amending to the recording sheet. Staff were aware of the instruction, and no further administration had been recorded, but the lack of clarity, added to the shortcomings noted above, raised further concerns. An immediate requirement was issued for the manager to investigate these shortcomings, and respond with an action plan to ensure that they are rectified and do not occur again. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not looked at on this occasion. EVIDENCE: Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Service users enjoy a spacious but homely well-maintained environment. Its overall cleanliness and high environmental standards are compromised by poor practice in respect of the disposal arrangements of clinical waste, which constitute a potential infection risk. EVIDENCE: The home continues to be furnished, decorated and maintained to a high standard. The kitchen has recently been refitted, there is a new three-piece suite in the lounge, the dining room is currently being redecorated, and service users now have the choice of a specialist bath or a walk-in shower room. The home is spacious, allowing room for service users with mobility needs, as well ensuring service users have plenty of personal space. The home was clean and hygienic, with no unpleasant odours. It is noted that the fuse box is sited in the laundry room, above the boiler. The washing machine is of a type equipped for managing soiled laundry. There is a weekly collection of clinical waste, which is stored within yellow bags in two large bins. The initial storage is in bags in a small, worn plastic bin, which also contained cigarette ends, just outside the laundry door. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The training of staff was not fully looked at on this inspection. However, in view of the shortcomings identified in standards concerning medication, control of hazardous substances, and infection control, to ensure service user safety, all staff need refresher training in these areas. EVIDENCE: Three staff have had dementia training. The manager advised that relevant training is being booked for other staff, to meet service user needs. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 15 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,42 Quality Assurance feedback indicates a high level of satisfaction with the service offered by the home. Fire safety is compromised by fire door being kept open by anything other than alarm-activated closure devices. Evidence of gas safety is lacking in the absence of a current certificate. EVIDENCE: The manager’s registration application is currently being processed. Quality Assurance questionnaires and results were seen. Those from relatives and other agencies were particularly positive. A ‘service user friendly’ format has been devised for service users, which has been used. The needs of the service users are such that considerable assistance, usually by staff, needed in their completion. Several bedroom doors are wedged open by attractive door wedges that the manager advised are only in place during the day to ease access to rooms for residents. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 16 Heating and boiler checks from British Gas were seen from each previous July on a regular annual basis. There was not a current one. The manager advised that this had been done, but the certificate had not yet arrived. The cupboard containing hazardous substances was not locked when I inspected it. It was locked by the manager when this was pointed out. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23 Score X x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ics - Laurel Drive, 2 Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x DS0000004249.V254549.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9YA6 Regulation 15 Requirement The home must ensure that the recording of assessments, risk management and the meeting of changing needs are adequately documented. Deficiencies in the administration and recording of medication must be rectified by an action plan forwarded to the Commission for Social Care Inspection that details how this is to be done, including refresher training of all staff. Dementia training is required for those staff who have not yet had this. The home must review and improve its practice and procedure for the disposal of clinical waste, and purchase, where necessary, new equipment. Alarm-activated door closures must be fitted on all fire doors that the residents wish to be left open at specific times. The home must have evidence of a current gas safety check. DS0000004249.V254549.R01.S.doc Timescale for action 10/11/05 2 YA20 13(2) 10/10/05 3 4 YA35 YA30 18 13(3) 10/11/05 10/10/05 5 YA42 23(4) 10/11/05 6 YA42 23(2) 10/11/05 Ics - Laurel Drive, 2 Version 5.0 Page 19 7 YA42 23(2) Hazardous substances must be securely looked away when not in immediate use. 10/10/05 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 2 Refer to Standard YA6 YA42 Good Practice Recommendations The home is recommended to include individual information about service users in more user-friendly formats. The home is recommended to consult regarding the advisability of the main fuse box being sited in the laundry room, above the boiler. Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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 Ics - Laurel Drive, 2 DS0000004249.V254549.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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