CARE HOMES FOR OLDER PEOPLE
Laurel Bank Nursing Home Main Street Wilsden Bradford West Yorkshire BD15 0JH Lead Inspector
Pamela Cunningham Announced Inspection 10th November 2005 10.00a 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 Laurel Bank Nursing Home DS0000019861.V266710.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. Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Laurel Bank Nursing Home Address Main Street Wilsden Bradford West Yorkshire BD15 0JH 01535 274774 01535 274035 laurelbamksnurs@aol.com 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) Victorguard Care plc Mrs Sarah Rose Knott Care Home 40 Category(ies) of Physical disability over 65 years of age (40) registration, with number of places Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2/06/05 Brief Description of the Service: The home is situated in a rural location and has ties with all aspects of the local community. It is close to the Post Office, Garden Centre, Pharmacy, village hall and churches. There are Dentist, opticians and pubs within easy reach. It is on a bus route and there is parking for visitors cars. Entry to the home is ramped for easy access. There are three lounge areas with one being used for people who choose to smoke. The dining areas offer comfortable and congenial settings for the residents. There are gardens to the front of the home, which the residents have been involved in developing. They are well maintained and complement the overall appearance of the home. There are twenty six single rooms, ten with en-suite facilities and seven double rooms , two with ensuite facilities. The rooms are over three floors but are easily accessed by the passenger lift and internal ramp. Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection, which was announced, was undertaken by one inspector on the 10th November 2005. The inspection started at 10.00am and finished at 3.30pm. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents. Comment cards were taken to the home on the day of the inspection to give people the opportunity for residents and relatives to comment anonymously. It is expected that a number of these will be completed and returned. The inspection consisted of reviewing care documentation and staff files, talking to management, residents, visitors and staff, and looking around the premises. What the service does well:
Each resident has a very comprehensive care plan in place with their needs clearly identified, along with how these needs should be met. Clear instructions are given and risk assessments are in place where needed. Communication within the home is excellent and staff spoken to, showed a good awareness of the needs of the residents. Regular staff meetings and formal supervision sessions are held. The activity programme within the home continues to be of an excellent quality, with everyone being involved including families if they wish. Residents spoken to said that they are able to go to bed/get up at the times they choose, and are able to go out with family or have them visit with no restrictions. All of the residents spoken to said that they feel respected by staff and that they are well looked after. One lady resident said that she took a long time to settle, but that the staff showed a “lot of love understanding, and patience”. One gentleman resident said, “He has not rued one day since deciding to live at Laurel Bank.” His relative said he is made very welcome and can visit any time, and is always offered drinks. Another gentleman visitor who was visiting his mother who has lived at the home for 4yrs said he is very happy with the care she was receiving, and that despite now being four years older and almost 101yrs of age her general health appears to have improved. He said that he could always talk to the manager if he has any concerns, and that she is most helpful. Everyone said that they feel happy to speak to the manager or staff if they have any Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 6 concerns/worries. Residents said they are happy with the meals stating that there is sometimes too much of it. There is a commitment to training and the staff confirmed that they have been provided with updates in compulsory training, and have regular formal supervision. Most of the care staff are involved in NVQ training, and one member of staff said she had completed a manual handling assessors course, was intending to progress to NVQ level 4, and is currently undertaking a certificate in management and Health and Social Care. Residents continue to choose not to have their own meetings, and said they were always kept up to date with any changes the home intended to make, and so did not feel the need to have their own meeting. The atmosphere within the home was one of congeniality, yet professional. What has improved since the last inspection? What they could do better:
Undertake enhanced CRB disclosures on all those staff that have had a standard check done. Ensure all new residents admitted to the home have a plan of care prescribed within 48 hours.
Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 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. Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 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 Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 6 All residents have a contract of residency. The home does not provide intermediate managed care. EVIDENCE: The contract of residence provided for inspection purposes identified it was complete and contained all required information. Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 10 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, 8, 9, 10 and 11. The health care needs of residents are met and care plans provide clear and detailed instructions for staff to follow. Residents are treated with respect and their privacy is upheld. The home is able to meet the health and personal care needs of service users. The health care needs are identified and monitored. Residents are treated with dignity and their privacy is maintained at all times. Staff are aware of the residents’ needs. EVIDENCE: Care plans reviewed were well written with residents care needs clearly identified. However case tracking identified the needs of one resident had not been identified, and a plan of care not written until 40 days following admission to the home. This could have resulted in health care needs not being identified and met. Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 11 Detailed pre-admission assessment information was present in all care documentation reviewed, as was evidence of all necessary risk assessments, and records of visits from other professions allied to medicine. There was evidence that those residents who were involved in administering their own medication had been risk assessed in order to establish their competency to perform this task. Residents spoken to during the inspection said the staff were all very kind, treated them with respect, always made sure their dignity was preserved, and always knocked on their bedroom door before going in. This was observed during the visit. Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 12 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, 13, 14 and 15 Residents are consulted about any new developments, and are encouraged to maintain links with family and friends. 24 hour visiting is implemented. A good nutritious diet is provided. EVIDENCE: The home held a themed “Spanish night” on November 4th to which relatives and friends were invited. Residents said the enjoyed it more than the usual bonfire night celebrations. They said they had wonderful food, brandy liqueurs and sangria, an appreciated all the hard work that had been put in to make the night a success. Residents also said they enjoyed the food at the home and could have a choice of where they wanted to eat and what they preferred. Residents’ religious needs are met. Religious ministers visit the home and are made welcomed. An interdenominational service is held on a monthly basis and well attended. Some people go out with family and friends where this has been agreed in their care plan. Choirs both local and from the city visit to entertain the residents. Laurel Bank Nursing Home DS0000019861.V266710.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 and 18 Complaints are dealt with appropriately. Overall, service users are protected from abuse with the majority of staff aware of adult protection. Residents and their relatives have their view listened to, taken seriously and action is taken to resolve issues. Residents are protected and feel safe living in the home. Residents are aware of the complaints procedure and how to use it. The home has a detailed complaints and adult protection procedure which is robust and protects service users. EVIDENCE: No complaints have been received since the last inspection. One visitor said he had been made aware of the complaint procedure but felt no need to formally complain as he was confident the manager would deal with any concerns he made to her in person. The appropriate policies and procedures were seen to be in place and the manager said that staff have had Adult Protection training. Staff spoken to during the visit said they knew what to do if they suspect any abuse Laurel Bank Nursing Home DS0000019861.V266710.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): All the above standards were inspected. The home offers a safe, well-maintained environment for the residents and provides appropriate bathing and toilet facilities. EVIDENCE: The home continues to be decorated and furnished to a very high standard throughout and evidence was seen of a regular maintenance programme in place. There is a call system in all areas of the home for residents to summon help. There is level access throughout, and residents are able to easily access the parts of the home they need to via a shaft lift. The bedrooms are large enough for residents to be able to follow their own lifestyles and offer comfort and safety. Residents all had plenty of their own possessions around them including family photographs and pictures, thus making their rooms very personal. Everyone spoken to said that the staff knock on the doors before entering. The rooms all have a pleasant outlook and where two people are sharing a privacy curtain is in place.
Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 15 There are various toilets throughout the home but there continues to be a problem in one area where residents have to wait. Residents have been offered alternative toileting facilities but have declined. The home is extremely clean and tidy throughout and recesses are built in certain areas, for the storage of wheelchairs and mobility aids. Nothing was seen that could cause hazard to residents, staff or visitors. There were no offensive smells present at the time of the inspection. Laurel Bank Nursing Home DS0000019861.V266710.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): All standards were assessed. Staff are trained and competent to do their jobs. Staffing numbers and skills ensure that residents’ needs can be met. Recruitment procedures need addressing. EVIDENCE: There were sufficient staff members on duty at the time of the inspection and everyone spoken to said that this is mostly the case. However comments on resident surveys recently undertaken commented that the home would benefit from having more staff on duty at certain times. The manager said that numbers are always made up, and that sick leave is normally covered by other staff unless it is too short notice, and then agency staff are used There is a mixture of nursing and care staff working on each shift and rosters seen confirmed this. One member of the care staff is also a qualified hairdresser, and attends to their hair two days each week. She is replaced as a care member of staff during this time. Residents said they liked her doing their hair, as she was familiar with their likes and dislikes. It was identified when reviewing CRB’S that ancillary staff had only had a standard CRB undertaken. All staff in care homes who have regular contact with residents should have an enhanced CRB. All other relevant information however was in place. Laurel Bank Nursing Home DS0000019861.V266710.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, 32, 33, 35, 36 and 37 The home is well managed and the manager is well able to discharge her responsibilities. She offers good leadership to the staff and ensures the residents are protected and cared for in a correct manner. EVIDENCE: The manager is open to ideas and suggestions and residents, staff and visitors all confirmed that they are able to speak to her and express any concerns/worries. She in turn stated that she receives excellent support from the owner of the home. Evidence of this was seen, as the owner was present at the inspection. The home does not take responsibility for residents’ monies but anything that the resident requires that necessitates payment is recorded and relatives billed. This policy is well documented in the information booklet issued to prospective residents. Records were all up to date.
Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 18 There is an awareness of health and safety in the home and staff are trained in this area. Hoists and moving equipment are available and are positioned throughout the home where staff can access them quickly in the case of emergency. The home has recently purchased an additional electrical hoist. The recent quality assurance exercise carried out produced some very positive answers and comments. Individual negative comments had been discussed where possible and the problem sorted out. Nineteen out of forty questionnaires were sent back. The inspector was handed a letter in a sealed envelope by one relative who could not be present during the visit. The writer of the letter praised the nursing staff and carers, and commented on the activities and stimulation provided for the residents. They said it was a “real family home”. Laurel Bank Nursing Home DS0000019861.V266710.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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 X Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 20 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 OP29 Regulation Schedule 2 Reg. 19 Requirement The Registered Provider must ensure that all staff employed in the home who have regular contact with residents have an enhanced CRB disclosure Timescale for action 31/01/06 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 Laurel Bank Nursing Home DS0000019861.V266710.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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