Inspection on 13/01/06 for Laurel Court

This inspection was carried out on 13th January 2006.

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

Laurel Court 10/11/09

Laurel Court 19/12/07

Laurel Court 05/06/06

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Laurel Court Brockway Nailsea North Somerset BS48 1BZ Lead Inspector Patricia Hellier Announced Inspection 13th January 2006 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 Laurel Court DS0000064861.V271389.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 Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Laurel Court Address Brockway Nailsea North Somerset BS48 1BZ 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) 01275 859556 01275 859557 Southern Cross Healthcare (Kent) Ltd Mrs Marie Ann Watts Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (62) of places Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. May accommodate up to 31 persons aged 65 years and over requiring nursing care on the ground floor. Staffing Notice dated 08/05/2000 applies Manager must be a RN on part 1 of the NMC register May accommodate up to 31 persons aged 65 years and over requiring personal care on the first floor. May accommodate 2 people aged 60 years and over with physical disabilities 12 April 2005 Date of last inspection Brief Description of the Service: Laurel Court provides nursing care for up to 31 residents, and personal care for a further 31 residents..The home was purpose built and is owned by the Southern Cross Healthcare group. It is situated in a suburban position, close to shops and leisure facilities. The home is fully wheelchair accessible. All accommodation is in single rooms with en suite facilities. The accommodation is arranged over two floors. Residents who require nursing care are accommodated on the ground floor; those requiring personal care are accommodated on the first floor. Communal space on the ground floor is provided in a large dining room, with adjoining seating area, and two separate lounges. On the first floor there is a similar dining room, separate sitting room, and smokers’ lounge. In addition there is a small private dining room. A passenger lift provides easy access to all areas of the home. There is a pleasant enclosed garden to the rear of the building. An activites co-ordinator arranges a weekly programme of social events. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over nine hours on 13 January 2006. Before the inspection the information about the home was received from the pre inspection questionnaire and comment cards from relatives, residents and health professionals. 39 residents, 30 relatives and 3 Health Professionals returned comment cards. Most residents said they liked living here; feel safe and well cared for. The food received a lot of comment with 60 saying they like the food sometimes. Comments received about the food were, “it can be unpalatable”; “on good days it is excellent”; “not always well presented”. The other area that received a lot of comment was the activities with 40 saying they were not always happy with the activities, although all acknowledged that the activities coordinator works hard to provide a service. Other comments were “it’s the next best thing to living at home”, the nursing care is excellent”. Relatives comments related to staffing levels, saying “there are not always enough staff on duty at weekend or evenings”. The overall satisfaction rate with the home was high (90 ), with all saying, their relatives were receiving “very good care”. Many said “they had noticed an improvement since Mrs Watts appointment”. The three professionals agreed with this. All residents and staff spoken with told the inspectors that the home was very good and the staff very kind. Comments received were “it is very homely and comfortable”; “my relatives care needs are well met”. The inspector toured the premises; spoke to 6 members of staff, 24 residents 4 relatives and inspected a number of records. Since the last inspection the Commission has investigated a complaint relating to poor medication practice. The complaint was upheld as historic evidence of poor practice was seen. Practices have since changed and current practices are fully compliant with the regulations. What the service does well: Residents told the inspector that they were very well cared for. They spoke very highly of the staff, which they said “can’t do enough for you”, “are wonderful” and “take good care of me”. Residents receive help promptly. Call bells were answered quickly and staff were seen to take initiative and stop what that were doing in order to check if residents were alright. Residents live in a very comfortable, safe and homely environment. It is decorated and furnished to a high standard and there are many homely touches. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 6 Residents described Laurel Court as “home from home” and said they felt settled and relaxed. Many residents commented that the home is spotlessly clean, and they appreciated this. There is strong team spirit and work ethic at the home. Meeting residents’ needs is given priority. There are good communications systems and there is strong leadership. Staff training is encouraged. 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. Laurel Court DS0000064861.V271389.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 Laurel Court DS0000064861.V271389.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): 1,3 The home has a Statement of Purpose and Service User Guide that is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is thorough and ensures that it is able to meet residents’ needs. EVIDENCE: Residents are provided with a comprehensive Residents’ pack containing the Statement of Purpose, Service User Guide and all the information required to ensure they, or their relatives, have access to the relevant information at all times. This is also on display in the entrance hall. Care needs are well met through a full assessment process and the completion of a care plan from this information. The assessment includes all the elements listed in the standard. Social Services care plans had been obtained where relevant. A comprehensive assessment was seen for a recently admitted resident. The resident when spoken to said ‘I am well looked after, they know what I need’ Laurel Court DS0000064861.V271389.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): 7,8,9,10 Residents benefit from care plans that are well formulated and give clear information to enable staff to meet residents’ health and social care needs. Personal and environmental risks are identified but not managed or translated to the care plans. The systems in place for the management of medicines are good. Respect and dignity are well maintained by kind and caring staff for the most part. EVIDENCE: Individual records are kept for each of the residents, which includes a social history. Four care plans were inspected and all reflected clearly current identified health and social care needs. Clear actions to met identified needs were recorded and regular evaluation noted. Two of the four care plans showed resident involvement. This practice needs to be extended to all residents or their relatives. All care plans contained well-formulated risk assessments for Manual Handling, falls nutrition and pressure areas, however there was no follow up of the identified risk in the form of a plan of care to met the need identified, and reduce the risk. Daily records were up to date and written in a respectful manner. The medication standard was fully inspected during a recent complaint investigation. The current medication administration practice was found to be Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 10 satisfactory. A risk assessment had not been completed for residents who self medicate. This is recommended Most residents spoken with felt that kind and caring staff respected their dignity and privacy. Two residents said, “the staff are sometimes too busy and rush in before knocking”. Laurel Court DS0000064861.V271389.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): 12,13,14,15 Social activities are well managed, creative and provide daily variation and interest for people living in the home. Residents right to choice and control over their lives is well respected, and encouraged. Friendly staff always welcomes relatives and visitors. The standard of the food is variable. EVIDENCE: An excellent range of activities is provided with posters displaying information of forthcoming events throughout the home. Residents spoken with said, “we have plenty of choice and variety, there are quizzes and things to help keep your mind active, also regular outings.” Feedback from residents interviewed on the day was that they liked the activities and the choice to join in, or not as they wish. Care records recorded personal preferences and routines. During the inspection a number of residents were seen enjoying “Happy Hour” – pre lunch drinks and a sing-a-long. Activities were observed to have a high profile in the home and the activities co coordinator works had to provide for all tastes. Residents views received from feed back cards is that they do not always feel that the activities are appropriate. The activities coordinator was seen spending some one to one time with residents during the inspection. Several visitors were seen coming and going during the inspection. Relatives spoken with said they could come any time and felt that their relatives were well looked after by friendly staff. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 12 Feedback about the standard of meals provided in the home was mixed. Some residents said they enjoyed the meals, and were always given a choice. Other residents said that the meals were ‘very hit and miss’. Some days they were fine, and others not. The meal provided during the inspection looked and smelt tasty. Since the last inspection a new cook has been employed and she told the inspector that she was renewing the menus in discussion with the residents. Some residents said the food is poorly presented. The cook and manager said they are addressing this with the care staff. Laurel Court DS0000064861.V271389.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 are confident that they are listened to and their requests acted upon. Staff were not fully aware of the homes adult protection policy and procedures and this potentially places residents at risk. EVIDENCE: The home has a comprehensive complaints procedure that is well displayed and all residents have a copy of. There have been 2 complaints since the last inspection and the commission has been involved in both. The issues have been satisfactorily resolved. Residents stated that if they were not happy about anything they would speak to the manager. Staff and residents spoken to, say the manager is very approachable and understanding. One service user said ‘I’ve nothing to complain about, it’s the best home I’ve been in”. A clear record of complaints received with actions taken and outcomes is kept. The home has a copy of the local “No Secrets” guide and Adult Protection guidelines, but does not have its own policy for clarity for staff. The development of this is recommended. Three members of staff interviewed were unclear of how to deal with a situation of abuse should it arise. Training in this is recommended. Staff are aware of the Whislteblowing policy in their staff handbooks and said they would report any concerns to the manager. Staff said they had never seen any signs of abuse in the home and demonstrated understanding of what abuse is. Consent for the use of bedrails and lap belts had not been sought from residents or their relatives for the use of this form of restraint. Photographic evidence of medical concerns was seen in a care record, but no evidence of the residents’ permission for these had been recorded. Consent must be sought to maintain the rights and protection of vulnerable people. Laurel Court DS0000064861.V271389.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): 19,21,22,26 Residents are provided with safe, comfortable surroundings. The home has suitable equipment to maximise resident independence. Robust Infection Control practices are followed. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The living accommodation is well decorated and homely. Residents’ rooms are personalised and comfortable. Two of the three baths on the first floor are unusable the inspector was told, due to residents inability to use them. There is one specialist bath available on this floor for 32 residents. While all residents have ensuite facilities this does not provide choice of bathing facilities for residents. It is recommended that the bathroom use be reviewed. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility and aid independence within the home. All resident rooms are provided with locks that are accessible to staff in an emergency. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 15 The home was clean and free from offensive odours throughout. The laundry facilities were well organised. Staff interviewed and observed demonstrated good understanding of Infection Control procedures and practices and maintained a clean and hygienic environment. Laurel Court DS0000064861.V271389.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): 27,29,30 The home’s staffing levels are sufficient to manage the current care needs of residents. The procedures for the recruitment of staff are robust and provide the safeguards to offer protection to people living in the home. Training is provided and staff encouraged to attend. EVIDENCE: Copies of two weeks staffing rosters were supplied to the inspector. Staffing levels rostered are in accordance with CSCI requirements. A sufficient team of ancillary workers supports care and nursing staff to ensure the smooth running of the service. Feedback from residents and staff is that there are sometimes, especially in the evenings and at weekends, when there are insufficient staff on duty. The manager should keep the staffing levels under review against the changing needs of the residents. Residents said they would like staff to have more time for a chat; to meet their psychological needs. The home has a Key Worker system in place for all residents. Residents and staff were aware of the role and said, “it worked well”. Staff morale has improved since the last inspection and some staff attributed this to all staff now working on both floors of the home, giving a more “together feel”. Recruitment procedures are robust and all four files inspected contained the required documentation. All staff interviewed stated they had contracts of employment and job descriptions. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 17 Newly appointed staff confirmed they had completed an induction programme and evidence of this was seen in personnel files. Other staff spoke of the encouragement they have received to undertake their NVQ training. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 18 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): 31,32,36,38 The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. Propping fire doors open is one area that may cause a potential risk. EVIDENCE: The manager has been in post for a year. Feedback from all residents and relatives say, “the home has improved under her leadership”. She gives clear leadership, guidance and direction to staff. Residents feel the manager is approachable, available and seeks to ensure all their needs are met. Staff interviewed stated that they felt well supported by an approachable manager. The manager is currently undertaking her Registered Managers Award qualification. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 19 The home has a supervision policy but no records of clinical supervision were seen. Staff spoke of informal supervision and working with senior staff. The formalisation of supervision was recommended. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that regular fire instruction and drills had taken place. The inspector noted that some fire doors were propped open. This could provide a potential hazard for residents. The advice of the Fire Safety Officer should be sought. With the fire regulations due to change in April 2006, the home’s fire risk assessment will need to be updated A number of staff have received First Aid training. The manager analyses the accident records on a three monthly basis and seeks to find trends and thus ways of reducing potential accidents and incidents, for residents and staff. This is to be commended. Hot water outlets to baths, showers and in resident’s rooms are not thermostatically controlled. This is recommended for the protection of resident from potential harm and to reduce risk of burns and scalds. There were no records of bath temperatures available. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 20 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 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 3 X 2 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 X 3 Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 21 NO 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 OP38 Regulation 13.4 Requirement Seek advice from the Fire Safety Officer in relation to the propped open fire door to the kitchen Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 Refer to Standard OP7 OP9 OP15 OP18 OP18 OP21 OP27 OP36 Good Practice Recommendations The translation of risks identified into a care plan with actions and outcomes The uses of an assessment tool for residents wishing to self medicate. To review the handling and presentation of food by care staff To implement a Home specific Adult Protection Policy incorporating the local guidelines To provide Adult Protection training and ensure staff maintain knowledge of training received. Review the bathing facilities available for residents use on the first floor. To keep staffing levels under review and adjust according to changing resident needs. Provide regular, documented, clinical supervision for all DS0000064861.V271389.R01.S.doc Version 5.0 Page 22 Laurel Court staff. Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Laurel Court DS0000064861.V271389.R01.S.doc Version 5.0 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!