Inspection on 19/12/07 for Laurel Court

This inspection was carried out on 19th December 2007.

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 05/06/06

Laurel Court 13/01/06

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 Key Unannounced Inspection 19th December 2007 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.V351856.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 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.V351856.R01.S.doc Version 5.2 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 5th June 2006 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 small 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 activities co-ordinator arranges a weekly programme of social events. The provider makes information available through a company leaflet and service specific booklet about the home. CSCI reports, Statement of Purpose and Service User guide are displayed in the entrance to the home and available for all to read. The current fees charged range form £586 - £695 per week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. This information was provided in December 2007. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over 9.5 hours on one day. Manager, Mrs Watts, was present throughout. The Registered Before the inspection the information about the home was received from the file held in the office, surveys received from 21 people who use the service; 22 relatives and one GP. The last two inspection reports were reviewed together with the completed Annual Quality Assurance Assessment (AQAA) form, from the provider. We (The Commission) also reviewed all correspondence and regulatory activity since the last inspection. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with 16 residents, 7 relatives, and 6 staff; observation of practices, and review of documents relating to care, recruitment and health and safety. Of the 30 resident surveys sent 21 were returned. This is a high return rate and reflected the residents’ contentment with the home, and the positive outcomes they experience. All were satisfied with the care they received and said the home is clean and fresh. All but one said they feel the staff are available when needed and they listen or act on what they say. One resident did not know who to speak to if they were unhappy. Comments from residents were “the staff are friendly and kind”, “I am very happy here”; “they are all wonderful”. One or two spoke of their frustration at not being able to go out for walks as often as they would like, while another spoken to said, “the gardens are lovely and nice to look out at this time of year. In the summer we go out in them and can have tea out there””. All relatives spoken with felt welcomed at the home and that they were consulted regarding their relatives care and needs. Comments included “the staff are very pleasant and friendly”, “the staff’s kindness and care help my relative to settle in”. Of the 30 relatives surveys sent 22 were returned and all felt that their relatives were well cared for by competent staff. Comments from relatives were “the staff provide professional and friendly care and I have every confidence in them”; “the staff activities are excellent and the building never smells”. All 22 relatives felt they were kept up to date with important issues. Comments of concern were about the staff’s availability to spend time with residents, e.g. “make the key worker role better to give more individual time to residents”. “Staff levels always short – more staff needed”. Another area of Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 6 concern was the food with relatives saying, “food could be better presented e.g. hot tea not warm”; “food needs better balance”; “china not always clean”. All residents and staff spoken with told us 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”; “it’s a good staff team and they provide care that takes account of residents wishes and preferences”. What the service does well: What has improved since the last inspection? Since the last inspection the home have employed a maintenance man to ensure all health and safety issues are addressed in a timely manner, for the safety of residents. A gardener has also been employed and the grounds and garden are looking good, with residents saying how much they enjoyed using them in the summer, and looking out on them at this time of year. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 7 Contracts of residency have been reviewed so that they clearly state the fees to be paid; showing a breakdown of what is to be paid to make up the weekly rate and by whom, thus providing clarity for residents and their relatives. Since the last inspection the cook has worked hard in the food provision and presentation with a majority of residents really enjoying their food. Plate guards are now routinely provided for any resident who experiences difficulty getting the food from their plate onto their fork or spoon. The infection control practices in the home have been reviewed, for the safety of residents, and all foot operated waste bins are now in working order and ensure the protection of residents from harmful waste products. 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. The summary of this inspection report can be made available in other formats on request. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 (6 N/A) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Information about the home is comprehensive and provided in a variety of formats to ensure prospective residents and their families can make an informed choice. Visits to the home to support this choice process, are encouraged. The home’s assessment process is thorough and person centred to ensure the home can meet the needs of prospective residents’ needs. EVIDENCE: Prospective residents and their relatives are provided with an information pack about the home. This contains the comprehensive Statement of Purpose, Service User Guide, brochure about the home and a copy of the last inspection report. These documents are also available in large print, audio form and Braille, and are on display in the front hall of the home. During the inspection we were given an information pack that contained all the above, and were shown the availability of other formats. Two residents that Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 10 had recently moved into the home, and their realties told us they felt they had received plenty of information on which to make their choice. One lady said, “ I really enjoyed coming for lunch, and the day, before coming to stay. It helped me settle in”. Contracts for the five residents case tracked were inspected and they all clearly stated the fees to be paid; showing a breakdown of what is to be paid to make up the weekly rate and by whom, thus providing clarity for residents and their relatives. When talking to these five residents three were aware they had a contractual agreement two were not. One said “I leave that side of things to my son” .In feedback from the surveys 16 of the 21 respondents were aware they had received a contract. Care needs are well met through a full assessment process as evidenced in the five care plans inspected. The assessment information is clearly documented in all aspects of physical, mental, social and emotional needs providing staff with a good knowledge base from which to provide person centred care. A plan of care to meet the new residents needs is developed from the assessment information. The assessment includes all the elements listed in the standard. Not all assessment records had been completed with the same attention to detail. In one care plan the social profile was incomplete and two of the assessments had not been dated and signed for accountability purposes. The assessments seen contained the key details for person centred care and the outcome of the assessment, stating that the home could meet the identified needs. Residents spoken with told us “ staff are very kind and know what I need”. Staff when interviewed were able to provide us with full and clear information about the needs, personality and preferences of the individuals. Care practices observed showed that staff were fully aware of the residents needs as stated in their assessments. The home does not provide Intermediate Care. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans that are well formulated and give clear information to enable staff to meet residents’ health and social care needs. . Risks to residents are fully assessed and actions to minimise these planned, for the safeguarding of residents. Respect and dignity are well maintained by kind and caring staff. EVIDENCE: Individual records are kept for each of the residents, which include a social history. Five care plans were inspected and all reflected clearly current identified health and social care needs. All of these records showed clear evidence of Interprofessional working with other Health Care Professionals to provide full, holistic, care to residents. Visits by the dentist, chiropodist and optician were recorded in four of the care plans. Wound care plans are clear and contain all necessary details of the wound and its progress. These good practices are to be commended. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 12 Evidence was seen that social and psychological needs are well met. One care plan showed the resident was suffering from depression. The reason for this was recorded together with a variety of actions to assist staff to meet the resident’s need. This good practice in the interest of the resident is to be commended. A full time activities coordinator assists staff in facilitating residents to maintain and pursue their hobbies. One resident told us how “the matron provided me with a room with a wide windowsill as she knows I like stamps and this gives me the space to do them”. Another resident told us “ we go to the local club now and use the Community bus. Its nice to get out more”. Clear actions to meet identified needs were recorded and regular evaluation noted. One care plan showed confusion in relation to how to assist a resident to move, with the Moving and Handling assessment saying to use the hoist and the care plan stating to use the stand aid. This confusion was reflected in the resident’s daily notes from staff. The resident when spoken with told us that their standing ability varied depending how they were feeling, and some staff asked before assisting while others did not. The manager told us that she would address the issues immediately to ensure that all staff were aware of the best and preferred way to assist this resident in a safe manner. Three of the five care plans did not show resident or relative involvement. All care plans contained Manual Handling, nutrition, falls and pressure sore risk assessments, with the outcomes being used to inform the provision of care. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence as able. Daily records were up to date and written in a respectful manner. All residents were neatly dressed, and attention had been paid to hair and nail care. Detailed conversations with six of the residents confirmed a good standard of nursing and personal care. Comments made were – “”the home is excellent, no improvements needed”, “staff are always kind and approachable – nothing is too much bother”; “I’m very happy here”; “you can have a laugh with the staff they are very good”. One relative praised the home for the way in which their mother is cared for, “it’s like the best of hotels, and they have all the specialist equipment needed to help mum”. Care practices observed showed caring interactions and good communication skills from staff. Choices and preferences were observed being discussed and offered. One resident said ‘they always do things the way I like, and if I want to get up later they let me’. A member of care staff when asked about the care of this resident, informed the inspector they had asked for a lie in and had not been disturbed before 11am. The management of medicines is satisfactory and the home has a policy for the receipt, recording and storage of medication. The nursing staff who deal with Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 13 this were clearly able to describe the process and policy, thus demonstrating that the policy is adhered to for the protection of residents from the mishandling of medications. There has been one error in medication administration since the last inspection. When noticed by the manager she took immediate and appropriate action to ensure the safety and well being of the resident. The management issues of poor medication practice were addressed and staff reminded to adhere to policy for the safety of residents. Regular monthly audits of the medication are undertaken and outcomes satisfactory. Good practice was observed, in the main, in the dispensing and disposal of medication, during the morning period. One instance of poor practice was observed when an out of date medication had been given, as it had not been correctly checked. Appropriate action was taken and the medication destroyed with a new supply available by lunchtime. Medication Record Sheets (MAR) showed no gaps thus providing accurate records in the best interests of residents. Hand transcribed prescriptions were seen on three of the MAR sheets. One of these had been had been signed by two members of staff when written, but the amount received had not been recorded. The latter does not provide the recommended safeguards for residents. The medications fridge was locked and temperatures recorded had been within the recommended limits providing safe storage of medicines. All residents spoken with felt that kind and caring staff respected their dignity and privacy. One resident stating “they always knock on the door”; and another said, “they are always polite and ask what I would like”. Staff were observed encouraging and supporting residents to be as independent as able, while supporting their needs. In the AQAA we are told that in the last 12 months staff have received training in the principles of care with an emphasis on dignity and rights to ensure residents are truly valued and respected, and feel this. Staff interviewed verified this training had taken place. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. In the AQAA returned the manager told us “Diverse needs are met by individual person centred care planning”. “Our ‘spiritual care policy’ recognises the diverse needs of people in this area and at pre admission prospective residents are asked if they would like the appropriate contacted and informed of their admission”. On the day of inspection a Christian service was being held and staff and volunteers were observed asking residents if they wished to attend in an unpressurised manner. Residnts spoken with and staff interviewed spoke of the wide variety of activities that are provided to meet social and cultural needs and to inform them of issues in different cultures. The home has an equal opportunities Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 14 policy and provide employment opportunites for people that requre assistance in the work place. The staff acknowledgement of these individuals as part of the team and their experience of being an accepted and valable team member supports the statement in the AQAA. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both 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, helping residents to maintain independence. Friendly staff always welcomes relatives and visitors. 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”. One resident said, “the activities are marvellous”, while another said, “there is lots to do, and a nice variety.” Several residents spoke of outings to local garden centres to see the Christmas lights, and to other places of interest. Three residents spoke of the recent calendar activity and preparation, and how much they had enjoyed it. Four other residents not directly involved said how much they had enjoyed it too. Seventy six percent of residents surveyed said they feel that there are usually, or always, activities arranged that they could take part in. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 16 An activities coordinator is employed full time and she ensures that a wide variety of activities to meet resident’s different needs and preferences are provided. The home has a number of posters and photo frames of the various activities that residents have been involved in, displayed in the home. A quarterly newsletter provides a resume of these activities and acclamations for those who have won competitions organised. It also covers staff and home / company news and includes details of resident and relative meetings for the coming year. Spiritual needs are catered for and local religious leaders visit regularly, and as requested. On the day of the inspection there was a church service and many residents were looking forward to attending. Two resident said, “I enjoy the hymn singing and the lady who plays the piano is excellent – and she has no music”. 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. One relative said, “the staff are so patient and residents never look untidy or uncomfortable”. Choice and preference is well respected. There was evidence of a good rapport between residents and staff, with lots of laughter and encouragement. Care records contained clear information about their likes and dislikes and residents’ preferred daily routine. The kitchen is clean, tidy and well organised. The lunch served during the inspection looked appetising and well presented. Good practice was seen in the manner in which care staff were helping residents with their meal. All residents spoken with about the food said ‘it is good’. Many said they “ like the meals, and the choices offered”. Feedback from the relative’s surveys and six residents spoken with said, “I would like a hot cup of tea, not a warm milky one”. The manager said she would look into this and address the issue as needed. Since the last inspection the home have received a visit from Environmental Health (Food) who were satisfied with the standard of provision. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Knowledgeable and competent staff protect residents. EVIDENCE: The home has a comprehensive complaints procedure and all residents receive a copy on admission. The policy is displayed in the front hall of the home for all to see, should they have a complaint. All relatives and residents spoken with were aware of the complaints policy. There have been 2 complaints since the last inspection, which have been fully resolved. All 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 and they would feel able to “air any grumbles to her”. One service user said ‘I’ve nothing to complain about, it’s a lovely home”. Another resident said, “ the manager is always available if things aren’t quite right”. A record of complaints received, with actions taken and outcomes is kept to show residents are responded to, and the information used to inform the running of the home for the residents’ benefit. In the AQAA we are told, “the home encourages an open culture to enable residents and their families to inform is of any thing they feel is a problem”. Minutes and agendas of Resident and Relatives meetings showed this as a Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 18 regular item with issues discussed. The most recent minutes show discussion about the application of window restrictors to some first floor areas. A comprehensive policy and procedure for responding to allegations of abuse is available, together with the Local Adult Protection guidelines. The home also has a Whislteblowing policy and staff said they would report any concerns to the manager. Staff said they had never seen any signs of abuse in the home and demonstrated a good understanding of what abuse is. Staff have received training in the recognition and handling of abusive situations for the protection of residents. Care plans inspected showed that consent for the use of bedrails and recliner chairs had been obtained from residents or relatives thus safeguarding choice, and respecting dignity. All residents spoken with said ‘the staff are very kind’; ‘they take time to help me’; ‘I can’t fault them’. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings and suitable equipment to assisting meeting their needs while aiding independence. Robust Infection Control practices are followed protecting residents from the potential of cross infection. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces in which the results fo the various activites arwe displayed. For example in one lounge area there was a knitted village and christmas scene displayed, and in another area ther were posters and photographs of the “Calendar Grans”. The living accommodation is well decorated, with décor, fixtures and fittings being in excellent order, thus providing residents with a pleasant home. Residents’ rooms are personalised and comfortable to suit individual’s needs and choices. All rooms are provided with ensuite facilities for residents’ privacy and convenience. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 20 Maintenance and refurbishment plans and records are kept, to ensure the homes’ environment is maintained at a high standard. The recent employment of a maintenance man has ensured that all breakdowns in equipment and the general safety of the building are dealt with promptly to ensure the safety of residents. A gardener has also been employed since the last inspection and the grounds and garden are looking well kept and attractive. Three residents spoken with said how much they had “enjoyed being out in the garden in the summer”. Another resident said she liked “to look out on it. The garden gives me so much enjoyment”. In the AQAA we are told, “the maintenance man has been fitting new window restrictors on the first floor in accordance with health and safety legislation” for the safety of residents. 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 a lockable space for securing personal possessions, if desired, and door locks that are accessible to staff in an emergency. The home was clean and free from offensive odours throughout, on the day of inspection. The laundry facilities were well organised providing residents with a satisfactory service. Staff interviewed and observed demonstrated good understanding of Infection Control procedures and practices and maintained a clean and hygienic environment. Training records inspected indicated that only 37 of staff have receive infection control training in the last 12 months, which may potentially puts residents at risk of cross infection from staff who do not have good knowledge or practice in this area. In the AQAA we are told “ staff understand the modes of transmission of infection and the importance of hand washing”. The home has good facilities for ensuring that staff can maintain good hand washing practices, between caring for residents to prevent the spread of infection. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are sufficient to manage the care needs of residents. The procedures for the recruitment of staff are robust and provide the safeguards required for residents’ protection. Staff may not have the necessary training and competence to meet resident’s needs. EVIDENCE: Staff went about their duties in an unhurried manner and were observed spending time talking with residents. Residents reported, “staff make time for a chat when they can.” Staff approached residents with directness, openness and consideration. Each of the resident’s with whom the inspector spoke said, “the staff are very good”. One member of staff was observed helping a resident with memory loss to find her way, and to feel comfortable and settled with the company she wanted. The member of staff gently engaged the resident in conversation and helped her to re-orientate herself and understand where she was. Copies of two weeks staffing rosters were seen and these showed there to be satisfactory numbers of staff on duty to meet residents needs. Feedback from residents was that sometimes there do not seem to be enough staff, although when asked 4 residents said, “they always come when I ring the bell. I don’t have to wait too long”. Call bells were answered promptly during the inspection. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 22 Staff when interviewed said that they “are kept busy, but still have time to chat with the residents”. Four members of staff told us told us that staff levels “can be a problem”. Two members of staff told us “I am aware the manager is trying to get more staff”. A sufficient team of ancillary workers supports care and nursing staff to ensure the smooth running of the service for the benefit of residents. In the AQAA we are told “ the duty rota is planned in advance to ensure optimum levels of staff are maintained, to ensure that the numbers and skill mix provided meet the residents dependency needs taking into account the size of the home and its layout.” A number of staff from overseas are employed at the home and form part of the close-knit team. Staff and residents said their presence brought a breadth of experience and interest to the home. Overseas staff interviewed said they felt very welcomed in the home and enjoyed their jobs. Three residents told the inspector they “liked the mixture of races and cultures represented as they reflected the areas they had come from, and thus made them feel at home”. Comments of concern were received from two relatives surveys in which they told us that communication with overseas staff could be a problem. None of the residents or relatives spoken with during the inspection found this to be a problem. Recruitment procedures are robust and all four files inspected contained the required documentation ensuring that all the necessary safeguards had been completed prior to employment at the home. Newly appointed staff confirmed they had completed an induction programme and evidence of this was seen for all staff in their personnel files. This ensures that all staff are provided with the necessary skills and knowledge, for their level of employment in the home, to safely meet residents needs. The home provides training in mandatory areas of practice for the safety and protection of residents. Staff when interviewed said they had “received some training in the last year”, but were unsure they had attended all the mandatory areas in the last 12 months. A plan of training dates for mandatory topics was seen displayed at the nursing stations. Mandatory training, and evidence of this, is necessary to ensure that staff have the necessary skills and knowledge to meet residents needs. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment, where Health and safety issues are monitored Quality assurance processes in the home are formal demonstrating that the home consults with residents, families and visiting professionals. Residents’ monies are handled safely. EVIDENCE: The registered manager is qualified and competent to run the home. She is a qualified and experienced nurse manager who is familiar with the conditions diseases of old age. The manager gives clear leadership, guidance and direction to staff. Residents feel she is approachable, available, and seeks to ensure all their needs are Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 24 met. Staff interviewed stated that they felt “well supported by an approachable manager”. A formal quality assurance tool was available for inspection in order to demonstrate that the home consults with residents, and that comments from them are acted upon. Regular audits of various aspects of the home are carried out each month. The results of these audits were displayed on the notice boards in the resident lounges showing the areas of praise and those of concern and how they have been addressed by the home. Residents and relatives told us they can “always have their say, and the manager listens”. Residents said they are always encouraged to express their views and “to air any grumbles”. One resident said, “the manager is very proactive and helpful in many ways”. The management of resident monies by the home were inspected and appeared to be managed in the interests and safety of residents. No cash is held by the home as Southern Cross hold a central account for all monies that residents wish them to have custody of. The administrator and the financial department of the company handle this. It was not possible to follow a clear audit trail of the monies as the system has recently been changed over. Supervision for staff takes place on an informal basis during the year culminating in an appraisal. Staff interviewed said, “supervision does take place regularly and when needed”. Records in two personnel files inspected showed that issues relating to resident care, personal and professional development had been discussed and actions planned to address issues raised. Two other files inspected did not have recent records of supervision to evidence staff have the skills and knowledge to meet residents needs. Records inspected indicated regular safety and fire checks are carried out. All staff spoken to told us they had received “regular fire instruction, and drills” had taken place. Records of staff attendance at fire training did not support the staff’s comment that regular training had been provided. The training records showed at least 25 of staff have not received fire training in the last year, but the manager told us the records were not accurate. Accurate records must be kept to demonstrate staff have been given the knowledge and skills to safely deal with any fire emergencies in the home. A number of staff have received First Aid training to ensure all emergencies can be dealt with safely. All accidents and incidents are well recorded and audited by the manager monthly for any trends to assist in maintaining a safe environment. Records indicating regular maintenance to gas and water systems were seen, together with servicing records for all equipment, demonstrating the safety of all systems for the protection of residents. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 25 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 4 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 2 2 3 3 Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 26 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 OP30 Regulation 18.1 (c) Requirement Timescale for action 21/02/08 2 OP38 23.4(d) The registered person must ensure that staff receive training appropriate to the work they are to perform and evidence that this is provided through records. The registered person must 28/02/08 ensure that all staff receive fire training (6 monthly for day staff and 3 monthly for night staff) to ensure they have the skills and knowledge to protect residents in the event of a fire 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. Refer to Standard OP7 Good Practice Recommendations Attention to detail in care plans is needed to ensure that all necessary clear information is conveyed to all staff to ensure that care needs are well met. The risk assessment for residents who are self-medicating needs to reflect how the capability of the resident has DS0000064861.V351856.R01.S.doc Version 5.2 Page 27 2. OP9 Laurel Court been assessed to ensure they are safe to do this. 3. 4. OP27 OP36 Staffing levels should be kept under review to ensure there are sufficient staff to meet residents needs. Records of supervision must be kept to show that staff are supervised appropriately to ensure they have the skills and knowledge to met residents needs. Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laurel Court DS0000064861.V351856.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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