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Inspection on 06/10/05 for Laughton Croft Nursing Home

Also see our care home review for Laughton Croft Nursing Home for more information

This inspection was carried out on 6th October 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 home is well managed and there is an emphasis on utilising researchbased practice to improve the standards of care provision. The home provides a relaxed and comfortable environment for residents. The staff team are well trained and demonstrate an understanding of individual needs.

What has improved since the last inspection?

Since the last inspection the manager has developed and introduced a comprehensive pre-admission assessment format. There have been improvements to medication administration formats, which now include allergies and contra-indications for medications. There has been improvement in the opportunities for social, leisure and therapeutic intervention following the appointment of an activities coordinator, and outside space has been made more accessible and appropriate for the residents. The home has also improved access to appropriate training for staff and now produces a clear annual training programme.

What the care home could do better:

It is acknowledged that the home have made many improvements to the management approaches and care practices within the home during the past year, however there needs to be a clearer demonstration of consultation in the development of care plans, with the resident and/or their representatives, wherever possible. There could also be improvements made to the recording of end of life arrangements and to the recording of resident`s personal property.

CARE HOMES FOR OLDER PEOPLE Laughton Croft Nursing Home Laughton Croft Gainsborough Road Scotter Common Gainsborough Lincs DN21 3JF Lead Inspector Wendy Taylor Unannounced Inspection 6th October 2005 09:00 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 Laughton Croft Nursing Home DS0000002541.V256162.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 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. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Laughton Croft Nursing Home Address Laughton Croft Gainsborough Road Scotter Common Gainsborough Lincs DN21 3JF 01724 762678 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) Croft Carehomes Limited Michelle Rathbone Care Home 36 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0) Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users in each category is as follows:Old Age, not falling within any other category (OP) (Personal Care) - 8 Dementia - over 65 years of age DE(E) (Personal Care) - 8 OP/DE(E) (Nursing) - 18 Dementia (DE) (Nursing) under 65 years of age - 2 The category DE (Nursing) under 65 years of age applies to two named service users. The service user to which this recommendation (3/8/05) applies is aged 62 years of age. The service users in the category OP (Nursing) resides in the main home The service user in category DE (Nursing) resides in the extension The maximum number of service users to be accommodated is 36 2. 3. 4. 5. Date of last inspection 04 May 2005 Brief Description of the Service: Laughton Croft is a single storey building situated about a mile from the village of Scotter, half way between Scunthorpe and Gainsborough. Accommodation is provided in thirty-four single rooms and one double room each with en-suit facilities. The home is set in a rural location surrounded by wooded and grassy areas. There are car-parking facilities to the front of the building. The home provides transport for residents to access local facilities. The registration is for a care home with nursing for older people and for people who have dementia. Croft Care Homes Limited owns the home and the Registered Manager is Michelle Rathbone. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in October 2005 and is the second inspection for this year. There was one outstanding requirement from the previous inspection, although it is acknowledged that some work has been carried out. The manager of the home is now registered with the Commission. Residents and staff files were looked at, a selection of residents, relatives and staff were spoken to and a tour of the building was carried out. General observations of interactions and care practices were made throughout the visit. The atmosphere in the home was relaxed and comfortable throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: It is acknowledged that the home have made many improvements to the management approaches and care practices within the home during the past year, however there needs to be a clearer demonstration of consultation in the development of care plans, with the resident and/or their representatives, wherever possible. There could also be improvements made to the recording of end of life arrangements and to the recording of resident’s personal property. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 6 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. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 7 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 Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5,6 The home now provides a clear pre-admission format, which assures residents and/or their representatives that the home will be able to meet their needs. They also benefit from sufficient information about the home to help them to make a choice about where to live. EVIDENCE: The home does not provide intermediate care. There are some local authority contracts and terms and conditions on individual files. The manager continues to collect these from the relevant placing authorities and a requirement made at the last inspection remains. Specific pre-admission assessment formats are now in use and the manager is to add a further section to the format relating to leisure activity. The manager said that as it is not always appropriate or possible for the people themselves to visit due to dementia needs, relatives are also encouraged to visit prior to the person moving into the home. One relative spoken to said that they had visited prior to their relatives’ admission and were given ample information about the home. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,11 Residents are protected by medication procedures and record keeping. Although care plans are clear and consistent, there is no demonstration of involvement from residents or relatives, and the home does not provide assurance that end of life arrangements will meet their wishes. EVIDENCE: Resident’s files were clear and well laid out. Care plans included needs such as continence; sleep patterns, challenging behaviour, medication and leisure. There was evidence of monthly reviews for all care plans. Risk assessments were in line with care plans and covered issues such as confusion, wandering and health conditions. Risk assessments are also in place for activities undertaken. There was no evidence of residents or relative’s signatures in care plans and although there is a policy on end of life support, there is no clear information in individual files regarding this issue. Medication records were satisfactory and a new administration record is in use. The new format contains all relevant information such as known allergies and contra-indications for medicines. Copies of medication care plans are kept with Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 10 administration records. There is a contract in place for the disposal of medications. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 Residents benefit from a wide range of social, leisure and therapeutic activities, and they benefit from alternative communication formats that enable them exercise choice and control wherever they are able. EVIDENCE: The home now employs an activity co-ordinator and there is evidence of formal activity programmes in the home. The co-ordinator has developed individual care plans and risk assessments, which are in line with the activities undertaken. There is an orientation board displayed in the hallway with information such as what day it is, who is on duty and what the weather is like. The activity programme is displayed in the hallway, and the home now produces a newsletter to help keep people informed of forthcoming activities such as ‘cream tea’ afternoons, tombolas and ‘pie and peas’ nights. The newsletter also informs people about current good practice for the care of older people with dementia. There is evidence of reminiscence therapy sessions and residents who wish to are encouraged to keep personal scrapbooks. There are new in-house activity resources such as skittles and drafts and the activity room has been made more accessible to residents. There was evidence through alternative communication formats that choice and control were promoted for residents. There was evidence that the activity Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 12 co-ordinator is helping residents to develop new door plaques in a picture and word format for ease of recognition. Staff were seen to offer choices in a way that individual residents could understand and they demonstrated a clear understanding of individual needs by way of by correctly interpreting wishes and needs for those who cannot express themselves clearly. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Residents and relatives continue to benefit from the homes’ responses and cooperation with investigation processes and are assured by way of policies and procedures that they will be listened to. EVIDENCE: One complaint has been made since the last inspection and it is currently being dealt with. Recommendations that have arisen during the process of investigation are contained within this report. A relative said that they can talk to staff about problems and they will be sorted out for them. There is evidence in files of increased communication with relatives. The home has a copy of the local adult protection guidelines and their own guidelines are currently being updated. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21,24,26 Residents enjoy increased involvement in personalisation of their private space, and they are able to enjoy safe and accessible outside space. The home provides comfortable surroundings and pays attention to improving the fabric of the building. EVIDENCE: The home was found to be clean and tidy and had a pleasant aroma. There were flowers on dinning tables and low background music in some areas. The atmosphere throughout the home was relaxed and staff were seen to be observing safety aspects for residents, such as responding immediately and appropriately to alarms and call bells. There are adequate toilet, bathroom and shower facilities within the home and these areas provide adequate space for the use of specialist equipment. Raised toilet seats, hoists, level access showers and grab rails are available in these areas. Some bedrooms also have en suite facilities. There was evidence of increasing personalisation within bedrooms with pictures, ornaments and furniture. There is now an accessible patio area for Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 15 residents with chairs and tables to sit at. There are planters and bird tables around the patio that residents and relatives have helped to arrange. There is a current programme of renewing all windows in the home and the manager said that there would be priority for one resident’s room in light of a risk assessment for window restrictors. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 There is an appropriately trained staff team who are able to meet the resident’s needs, and residents are safeguarded by robust recruitment practices. EVIDENCE: New staff file formats are in place. They are clearly indexed and information is easily found. The files contained all information required by Schedule 3, including Criminal Record Bureau checks. There is a new training plan format, which enables training to be prioritised easily. There is evidence that staff have received basic food hygiene training, as well as training in equal opportunities, values, communication, policies and procedures, tissue viability, diabetes, continence, moving and handling, fire safety and nutrition for the elderly. The manager said that she now has funding for more staff to undertake NVQ training at Levels 2, 3 and 4. Staff spoken to say that they now have improved access to training and they clearly demonstrated their awareness and understanding of identified needs. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,36,37 The home demonstrates a commitment to improving care for residents by maintaining knowledge and implementation of appropriate research, and the residents’ benefit from a well supported and supervised staff team. The home should also be more aware of health and safety issues that may pose a risk to residents or compromise the safety of their property. EVIDENCE: The manager is now a member of the local Primary Care Trust research group. She described current research topics relating to screening tools for falls, wandering and constipation that she is implementing within the home. There are research papers available in the home for staff to read. There are clear supervision contracts and records on individual staff files and staff said that the manager is very approachable and supportive. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 18 The manager said that all policies and procedures are in the process of being updated by the parent company, however the home have developed a local procedure for the administration of ‘when necessary’ medication. An up to date fire risk assessment was seen and records demonstrate that fire alarms and emergency lighting are checked within recommended time scales. Records also demonstrate that fire drills are conducted regularly. Records relating to resident’s personal finances were satisfactory and the manager said that the home is in the process of developing a new finance policy. Not all residents have an up to date property list and a recommendation was made in regard to this. During a tour of the building, toiletries were stored openly in the hairdresser’s room. The manager said that a lock had been ordered for the door but she ensured that the toiletries were removed to a locked area immediately. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 19 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 3 X X 3 X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 3 3 X Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5 (3) Requirement Timescale for action 31/01/05 2 OP7 15 (1) Where applicable, the responsible person must ensure that a copy of the Local Authority agreement for the provision of care at the home and the arrangements made, are available to individual residents. The responsible person must 31/01/05 demonstrate that they developed the care plans in consultation with the residents, or where this is not practicable, with their representatives. 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 OP11 OP37 Good Practice Recommendations It is recommended that personal wishes and relevant information regarding end of life arrangements be recorded in individual care files. It is recommended that property lists are maintained for individual residents and they are updated whenever DS0000002541.V256162.R01.S.doc Version 5.0 Page 21 Laughton Croft Nursing Home necessary, for example when items are disposed of and the reasons why is recorded. It is also recommended that the whereabouts of valuables such as jewellery be recorded, for example if they are kept in the homes safe. Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Laughton Croft Nursing Home DS0000002541.V256162.R01.S.doc Version 5.0 Page 23 - 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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