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Inspection on 15/10/05 for Laurel Court Nursing Home

Also see our care home review for Laurel Court Nursing Home for more information

This inspection was carried out on 15th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

Care assessments, care planning and risk assessments were generally used to ensure that the home gave a good level of care to residents` delivered by staff that were aware of their needs and how these should be met. This meant also that residents had as much control as possible over their own lives and were able to spend the day as they wished, taking part in the good organised activities programme if they choose to do so. Good relationships between relatives and staff were based on the fact that relatives were confident in the care residents were receiving.

What has improved since the last inspection?

A care manager has been employed to oversee the delivery of care in the home and ensure that it meets the required standard. She also has a training role to ensure that staff had adequate underpinning knowledge to do their jobs well. The home has also employed a second activities person to extend the availability of activities to residents.The home are continuing to move towards having 50% of care staff (excluding trained nurses) with NVQ level 2 as now 38% of staff have this. Also cleaning staff have all obtained a NVQ level 1 which should help ensure that they understand the role they do and how this improves the home for the residents.

What the care home could do better:

The care planning throughout the home must be consistent to ensure that the needs of all residents and how these should be met are stated within all the care plans and are available to staff. Meals must be improved to meet residents` wishes and needs. The refurbishment of the building including the unit kitchens and resident areas must be continued to ensure that the building is nice to live in. Sufficient staff should be available in order to meet residents` needs and the staffing notice staff are not working excessive hours, which could put resident`s, staff and the home at risk. All staff currently employed must have had a required criminal record check to ensure that residents are not put at risk from unsuitable staff.

CARE HOMES FOR OLDER PEOPLE Laurel Court Nursing Home 1a Candleford Road Off Palatine Road Didsbury Manchester M20 3JH Lead Inspector Leslie Hardy Unannounced Inspection 15th October 2005 03:00 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 Nursing Home DS0000021556.V256990.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 Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Laurel Court Nursing Home Address 1a Candleford Road Off Palatine Road Didsbury Manchester M20 3JH 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) 0161 446 2844 0161 446 2873 Ashbourne Homes Limited Care Home 86 Category(ies) of Old age, not falling within any other category registration, with number (75), Physical disability (11) of places Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users requiring personal care only shall be 25, accommodated on the first floor. The maximum number of service users requiring nursing care shall be 61. The service users requiring nursing care by reason of physical disability shall be accommodated on the lower ground floor. The service users requiring nursing care by reason of old age shall be accommodated on the second and third floors. Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice of Variation of Conditions of Registration dated 8th March 2005. Personal care staffing levels will remain in line with those currently in place. One named service user requiring personal care is accommodated within a nursing unit. This place will revert to nursing care once this service user no longer requires this accommodation. 4. 5. 6. Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 5 Date of last inspection 19th May 2005 Brief Description of the Service: Laurel Court is a care home providing nursing care, personal care and accommodation for 75 older people and nursing care for 11 adult service users who require care by reason of physical disability. The first floor is used to provide care only to older adults, and the second and third floors care with nursing to older adults. The home was opened in 1994 and is purpose built consisting of accommodation on four floors. The ground floor has been adapted to residents requiring care by reason of physical disability. The home has extensive gardens that are well maintained and readily accessible for residents. Ample car parking is available at the side and rear of the home. Each floor is served by two passenger lifts. Laurel Court is operated by Ashbourne Homes Limited, a subsidiary company of Ashbourne Consolidated Group. The home is located in a residential area of Withington, South Manchester. Local amenities are available in Withington village and the area is served by an excellent bus network into the city centre. Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, which was unannounced was carried out by two inspectors on Saturday 15 October 2005, started at 3pm and lasted for 5.25 hours. During the inspection, 26 residents, 16 visitors and 10 staff were spoken with. The picture this gave was of a well run home with residents who were happy with the care and attention they received from staff. Words like “super” “very good” and “marvellous” were repeated used to describe the home. Residents and their visitors frequently said that they were glad they had chosen the home. The majority of the recommendations from the previous report had been implemented. The home is an appropriate building to deliver the care that residents needed and it is generally kept well maintained, clean and tidy. During this inspection only a selection of key National Minimum Standards were assessed therefore to gain the full picture of how the home meets the needs of residents, this report should be read with the previous and any future reports. What the service does well: What has improved since the last inspection? A care manager has been employed to oversee the delivery of care in the home and ensure that it meets the required standard. She also has a training role to ensure that staff had adequate underpinning knowledge to do their jobs well. The home has also employed a second activities person to extend the availability of activities to residents. Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 7 The home are continuing to move towards having 50 of care staff (excluding trained nurses) with NVQ level 2 as now 38 of staff have this. Also cleaning staff have all obtained a NVQ level 1 which should help ensure that they understand the role they do and how this improves the home for the residents. 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 Nursing Home DS0000021556.V256990.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 Court Nursing Home DS0000021556.V256990.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): 3 The use of appropriate assessments prior to and following admission ensured that the home only offered care to those residents whose needs they can meet. EVIDENCE: Before new residents were admitted to the home they were assessed by the referring agency and also, if admitted for nursing care, by a funded nursing care assessor from a NHS Primary Care Trust. A senior member of staff from the home also undertook an assessment. These assessments were used to ensure that the home was able to meet the needs of residents following admission and to identify equipment and facilities that needed to be available. Reassessments were undertaken on residents who had been in the home for over a year to ensure that their needs were continually met and any newly developing needs were not missed. Laurel Court Nursing Home DS0000021556.V256990.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,and 8, The home delivered good a good standard of care with in the most of the home care plans used effectively to guide that care. EVIDENCE: Each resident had a care plan that in most cases clearly identified their health, personal and social care needs. Some care plans on the first floor were not as clear as others in that needs and how staff should met those needs was not clearly recorded. Care plans had been formulated using the assessments mentioned previously and included comments made by residents on their care needs. Risk assessments were undertaken according to residents needs and actions to be taken as the result of risk assessments were documented. Both plans and assessments were regularly reviewed and the review documented. These plans and assessments meant that in most cases clear guidance was available to staff on how to meet resident’s individual needs. The home involved external specialists including nurses to meet identified needs. Seven residents in the home had pressure ulcers, two of these, which were both low grade, had been acquired in the home; the other five were recorded as having been acquired in hospital. All were being actively treated and tissue viability nurses from the local NHS Primary Care Trust (PCT) were involved in directing care. Laurel Court Nursing Home DS0000021556.V256990.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 and 15 Residents are enabled to control their own day, receiving visitors when they want. Visitors were very positive and confident about the about the good level of care given. The food served in the home did not fulfil residents’ needs and wishes. EVIDENCE: Residents said that they were able to do what they wanted during the day. They had control over when they got up and when they went to bed and where they spent their day. Residents freely moved around the home from communal areas to their own room. Some residents stated that they preferred their own company whilst others preferred to mix for at least some of the day. Resident’s hobbies and interests were identified in their care plan. A second activities organiser had been employed since the last inspection to ensure that the needs of residents were met more frequently. A good range of activities were available, ranging from coffee mornings to yoga in the home, and educational classes and shopping and sight seeing trips out of the home. A lot of visitors were seen in the home. Visitors confirmed that they could come and go as they wished. They spoke of being involved in the home and Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 12 one visitor was delighted that on celebrating their ruby wedding anniversary the home had provided a lot of nibbles as a surprise for his wife and himself. A number of negative comments were made by both residents and visitors about the food. These ranged from “there were a lot of stew type meals” (the main choice at the inspection was a stew), to the “meat is often tough and difficult to chew” to “I eat in my room and usually the meal is not warm, particularly the potatoes”. It was also noted from one residents daily record who is a diabetic that on a particular evening their “dinner not sent up from kitchen. When I (the unit manager) rang the kitchen told the chef had gone home and the menu could not be found. Brown bread jam and tea served” One visitor said they supplemented the diet of the resident they visited with biscuits and sweets and commented that “food is a highlight of the day and this is not satisfactory”. The provision of meals, their quality and edibility must be audited, a report made available, and an action plan implemented to improve food served to ensure that it meets residents needs. Laurel Court Nursing Home DS0000021556.V256990.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): None of these standards was assessed at this inspection. EVIDENCE: Laurel Court Nursing Home DS0000021556.V256990.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, 25 and 26 The home was generally clean. Ongoing attention to refurbishment of the fabric in the building must continue to ensure that a good standard is maintained. EVIDENCE: The home has its own handyperson and also its own decorator who also did some work in other Ashbourne Homes locally. The general standard of maintenance in the home was satisfactory but there was generally a lot of scuffing to walls doors and doorframes by wheelchairs, which must be attended to. The manager stated that they had a programme for ongoing replacement and refurbishment. The manager said that the kitchens on each unit are to be refurbished which is required as they are in poor condition with doors broken or removed and the outer material on the surfaces missing exposing the inner material. The programme must be adhered to prevent deterioration in the fabric of the building and ensure that it continues to meet the needs of residents. The home was generally kept clean, however, the ground and first floor being noticeably less clean than the other two floors. Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 15 Some carpets were found to be soiled but should be replaced in the ongoing refurbishment. There was no offensive odour in the home. Staff were aware of the need to dispose of soiled items appropriately and to deal with laundry effectively. Laurel Court Nursing Home DS0000021556.V256990.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, 28, 29 and 30 The home has a competent workforce with appropriate numbers of staff on duty but by working excessive hours some of the staff could put residents, themselves and the home at risk. The home takes its ongoing training of staff seriously. Employing staff without CRB clearance could put residents at risk from unsuitable staff. EVIDENCE: Staff had a good knowledge of resident’s needs and how these were to be met. Residents and visitors spoke highly of staff and how they attended to their needs. One resident spoke of having to wait on occasions for attention if they were short of staff. The home was meeting at least the minimum requirements of the current staffing notice. This did seem to be met by a small number of staff working a lot of hours. Some trained staff have an “Old” contract for 48 hours a week. A registered nurse on one unit was on holiday and other registered nurses were undertaking more hours to cover, in one case one nurse was working sixty hours a week for two weeks. This does provide cover by nurses who know the residents but could put residents at risk from staff who were overtired. Files of two new members of staff were seen showing that two satisfactory references had been obtained and Criminal Records Bureau (CRB) including Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 17 Protection of Vulnerable Adults (POVA) clearance obtained before the person commenced employment. Files were found to contain required information. It is of concern that there are still some staff at the home that were there prior to CRB clearance commencing who have not had CRB clearance as they will not bring in required documentation. This must be undertaken to ensure that staff are suitable. The home has an ongoing programme of mandatory training for staff, and recently a number of carers achieved NVQ level 2 in care, making 38 of staff with this qualification. A number of other carers are undertaking the training currently, which is important as the standards state that homes should have at least 50 of carers with NVQ level 2 to ensure a appropriately trained workforce delivering good care to residents. A number of cleaning staff have recently achieved NVQ level 1 in an appropriate course. Laurel Court Nursing Home DS0000021556.V256990.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, 33 35 and 39 The home was well run with care to residents found to be at the centre and the commitment by the home to a care manager was delivering positive results. Regular servicing and maintenance of equipment ensured a safe environment. EVIDENCE: The home had appointed a care manager since the last inspection whose role is to lead the care team and ensure that care standards are maintained, which was found to be the case. The general manager was known by residents and visitors alike who felt able to approach her with problems. She is currently undertaking an appropriate management qualification that she expects to obtain by the end of 2005. The home was found generally to run well and a number of visitors commented that they felt confident when they left the home that the resident was being care for well. Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 19 The financial affairs of residents whose monies were managed by the home were found to be managed in a satisfactory manner. The home ensured that the required regular servicing of equipment and installations was undertaken to safe guard residents. Laurel Court Nursing Home DS0000021556.V256990.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X 3 3 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 X 3 X 3 X X 3 Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 21 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 2 Standard OP7 OP15 Regulation 14 16 Requirement All care plans in the home must include information on how residents needs will be met The provision of meals, their quality and edibility must be audited, a report made available, and an action plan implemented to improve food served to met residents needs. The satellite kitchens on each unit must be refurbished. The pace of general refurbishment of the home must be continued. The number of hours worked by staff must be reviewed to ensure that residents or staff are not at risk. All care staff must have C R B clearance Timescale for action 01/01/06 15/12/05 3 4 1 OP19 OP19 OP27 23 23 18 01/03/06 01/03/06 15/12/05 6 OP29 18 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. Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 22 No. 1 2 Refer to Standard OP28 OP31 Good Practice Recommendations The Responsible Individual should continue to take steps to that at least 50 of carers have at least NVQ level 2. The manager should obtain a NVQ level 4 or equivalent in management by the end of 2005. Laurel Court Nursing Home DS0000021556.V256990.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Nursing Home DS0000021556.V256990.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. 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