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Inspection on 17/10/08 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 17th October 2008.

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

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

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

What the care home does well

There was evidence of some improvements in the review and development of care plans. Programmes of activity and social care were in place. The premises were well maintained and appropriate health and safety procedures were carried out by designated staff working at the home.

What has improved since the last inspection?

The appointment of a candidate as registered manager and submission of an application to be registered with the commission was seen as a significant move forward in the management of the service. The manager demonstrated a commitment to the post she had been appointed to and indicated she was aware of the areas of management and development to be addressed. The organisation had reviewed all staffing arrangements and was in the process of appointing unit managers, reviewing staffing levels, the roles of qualified staff and use of agency staff.

What the care home could do better:

Procedures required reviewing to ensure people assessed needs and support plans were being adhered to and their needs met. Information since the last inspection and some of the findings on this visit, identify break downs in care delivery. This is as a result of poor internal monitoring of care plans and adherence to advice from interested parties, lack of direction and accountability due to the absence of sustained lines of management at unit level and overall management of the home. Staff deployment required monitoring to ensure that people have the support they need from staff who have the necessary skills, experience and knowledge of the specialist needs of people they are supporting. The meal and menu arrangements must ensure peoples` personal, cultural and dietary needs are known by all staff and acted upon. Peoples` personal wishes and preferences should be identified and recorded. Where specific advice and support has been provided by other professionals, there should be evidence that this has been acted upon and sustained by all staff. It is recommended that unit managers are involved in the admission process and the drawing up of staff rotas for the units they work on. Changes in management has affected delivery of formal supervision and development plans for staff. This requires monitoring and formalising by the new manager.The home should ensure each person receives confirmation that the care home is suitable for the purpose of meeting their needs.

CARE HOMES FOR OLDER PEOPLE Laurel Court Nursing Home 1a Candleford Road Off Palatine Road Didsbury Manchester M20 3JH Lead Inspector Joe Kenny Unannounced Inspection 17 October 2008 09:30a. 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.V373356.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 Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 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 laurelcourt@SouthernCrossHealthcare.co.uk Ashbourne Homes Ltd Manager post vacant 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.V373356.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users requiring nursing care shall be 86. The service users requiring nursing care by reason of physical disability shall be accommodated on the lower ground floor. 28th April 2008 Date of last inspection 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 home is purpose built consisting of accommodation on four floors. The ground floor has been adapted for residents requiring care by reason of physical disability. The home has extensive gardens that were 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. The registered provider is Ashbourne Homes Limited which is owned by Southern Cross. 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. Fees are set in accordance to the assessed needs of individual residents and the service being referred to. Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. The inspection of the home was carried out over two days, started on the 16 October and the 17 October 2008. The inspection was unannounced. A further meeting was held on the 23 October 2008 to give formal feed back on the inspection. Two inspectors conducted the visits. The inspection was carried out as a key inspection looking at core standards and also included the findings of the pharmacist inspector who visited the home unannounced on the 10 October 2008. This inspection involved a tour of the four units, random inspection of up to two service users files on each unit, discussions with relatives, service users, staff and senior managers. The inspection also included an evaluation of action taken by the home to address requirements and recommendations made at the last inspection. Records and procedures relating to health care, complaints and staff recruitment and development were also examined. Discussions were also held with the manager who had recently taken up her post at the home. The manager had provided the Commission with a completed self-assessment form, the Annual Quality Assurance Assessment (AQAA) before the visit. Comment cards were received from staff and information from other interested parties was received. The information received forms the basis of this inspection and its findings. What the service does well: There was evidence of some improvements in the review and development of care plans. Programmes of activity and social care were in place. The premises were well maintained and appropriate health and safety procedures were carried out by designated staff working at the home. Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Procedures required reviewing to ensure people assessed needs and support plans were being adhered to and their needs met. Information since the last inspection and some of the findings on this visit, identify break downs in care delivery. This is as a result of poor internal monitoring of care plans and adherence to advice from interested parties, lack of direction and accountability due to the absence of sustained lines of management at unit level and overall management of the home. Staff deployment required monitoring to ensure that people have the support they need from staff who have the necessary skills, experience and knowledge of the specialist needs of people they are supporting. The meal and menu arrangements must ensure peoples’ personal, cultural and dietary needs are known by all staff and acted upon. Peoples’ personal wishes and preferences should be identified and recorded. Where specific advice and support has been provided by other professionals, there should be evidence that this has been acted upon and sustained by all staff. It is recommended that unit managers are involved in the admission process and the drawing up of staff rotas for the units they work on. Changes in management has affected delivery of formal supervision and development plans for staff. This requires monitoring and formalising by the new manager. Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 7 The home should ensure each person receives confirmation that the care home is suitable for the purpose of meeting their needs. 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 Nursing Home DS0000021556.V373356.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 Nursing Home DS0000021556.V373356.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 and 3 Standard 6 not assessed. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Procedures are in place which would ensure peoples’ needs were assessed before admission to the home so that they know they cold be met. Information about the home available to people needed updating. EVIDENCE: In the period since the last inspection there have been no new admissions to the home. The process for dealing with admissions enables service users or their representative to be involved in decisions relating to their move. The admission process included use of standard documents to assess people’s needs and receipt of the care manager’s assessment for the person being referred. Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 10 The information in the home’s statement of purpose and service user guide had been reviewed in respect of the new manager. Information relating to unit managers needed to be updated and information indicating that two activity organisers were in post needed changing as only one activity person is now employed. It is advised that unit managers are actively involved in the planning and admissions process. This is necessary to ensure they are aware of the needs of people being referred and can plan for the level of staffing required on the unit they manage. Procedures following admission required monitoring to ensure needs were being met. Information received on inspection and from other interested parties indicated this may not always be addressed. Examples are included in the health and personal care section of this report. All written documents and care plans must be reviewed and monitored to ensure information is current amended and inform staff of the level of support required by each person. Failure to address this has the potential to place residents at risk. Laurel Court Nursing Home DS0000021556.V373356.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the care planning procedures and delivery of care to ensure peoples’ personal and health care needs are fully met. EVIDENCE: A minimum of two care files were examined on each unit. There were some improvements to evidence recent reviews of care and development of clearer records of how people should be supported. However, where advice and support plans were in place provided by health professionals, these had not been taken forward in the delivery of care or provision of training to staff. Information relating to people supported on a specialist invasive technique had improved to evidence people had been consulted as to who should support Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 12 them. However, not all staff providing this support had received relevant training. Another example related to a high risk relating to nutritional intake and weight loss. The records of weight were not clear and in some cases large variations in monthly weight were incorrectly recorded. On examination of records relating to specific intervention by staff such as pressure care turning programmes, it is advised that the record specify the turning routine and the interval between each turn. The plans of intervention had been identified by health professionals and the home must evidence that the plan have been followed to ensure people’s health needs are being met. To ensure programmes of support reflect people’s preferences and wishes, plans should be developed in a more person centred approach. Reviews are carried out on a monthly basis and it is advised that the reviews on risk assessments contain more information relating to outcomes as opposed to a signature and date for the month. There is a need to encourage staff to develop a more narrative report and review statement, which provides evidence of the effectiveness of the care provided. The content of records also required monitoring and support offered to staff on report writing. This related to an assessment for one service user who was at risk of leaving the unit. The records referred to “escaping” another entry read “tried to escape twice and the importance of securing the doors”. It is suggested such entries may be more appropriately reported. All records should be clearly dated to assist in monitoring and reviewing plans of intervention and support. Staffing levels must be reviewed to ensure staff have the necessary skills and knowledge to support people. A member of staff on duty on the third floor had not been inducted or trained in moving and handling procedures. As a result the member of staff was not available to assist people getting up in the morning. The key working model of care delivery is used to support service users. During discussions with a relative, she referred to the key worker system and referred to it as “not working” as her relative did not have a named support worker. There was a need to evidence that systems employed by the home were effective in establishing links between people who use the service and relatives on agreed plans of support. During discussions with relatives some expressed concerns that instruction relating to how people should be supported were not known by staff in relation Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 13 to use of specialist equipment and the type of equipment to be used. Examples given were related to the use of hoists and appropriate slings. Issues relating to choice and the need to ensure care plans contain a mental capacity assessment were also identified as areas to be addressed to ensure that people’s capacity to make decisions is assessed and recorded as required under the Mental Capacity Act. Procedures relating to medication were assessed by the pharmacist inspector on a visit conducted on the 10 October 2008. The operations manager, on duty at the time of the visit, was present throughout the inspection and was aware of the findings. Issues identified related to the following.: There was evidence of some medication received late by the home for administering. There is a need to update the sample signatures for staff responsible for administering medication. All signatures/initials should be clearly recorded on the medication administration record and distinguishable from codes used. This related to use of ‘E’ on one record which could be taken as a signature or could mean refused or destroyed. Prescribing directions and strengths of medication must be checked to ensure correct dosage is given. There were two examples of potential double dose administration for a medication and a gel. There is a need to ensure stock balances are brought forward. When medication is opened, the date should be recorded to ensure it is given within viable dates. A food additive recorded on the medication administration records for one person had no supporting record to indicate the person was prescribed this. Other food additives, which were prescribed, were not received, but were signed as given. For creams to be administered in the morning and evening there was only evidence of administration in the evening. It was reported that care staff apply creams in the morning but do not record its administration. Disposal procedures for discontinued or surplus medication need to be monitored. Variable dose records were good as were records of discontinued medication. However, records relating to discontinued medication should evidence that this was based on the instruction of the person’s general practitioner. The findings on the visit on the 16 and 17 October related to delays in the times people received their medication. Specific examples were, one person receiving morning medication at 11:58 hours and one other person receiving mid day medication at 14:30 hours. Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 14 Such delays have the potential to influence the effectiveness of prescribed medication if taken at varying times and irregular intervals due to administration procedures. Specific instructions relating to nutritional risk assessments and prescribed supplements must be detailed in service users care plans and on medication administration records regarding the frequency of administration. Relatives also expressed concerns that prescribed creams were not being administered in accordance with prescribing directions. Medication storage arrangements on the third floor had improved and had been relocated to an alternative cooler storage area. The door to the new area was however left unlocked during administration procedures. On examination of care plans there were areas of risk relating to ongoing care issues (relating to risk of choking and hypoglycaemia) and no clear guidelines in the plan or risk assessment as to the action to be taken by staff. The specific areas identified were raised with senior staff at the time of the inspection, who took action to provided staff with supporting advice. This again evidenced the reactive rather than proactive approach to issues of care to ensure people are safe and protected. Laurel Court Nursing Home DS0000021556.V373356.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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Programmes of social care and meal and menu planning should evidence that people are consulted on their choices and preferences. EVIDENCE: Two activity organisers facilitate all social care and programmes of activity for the four units. It is recommended that activities and events are held on a more regular basis, based on individually assessed needs and interests of people. Records should be maintained of the event and people participating in such sessions. Relatives should also be regularly informed of such aspects of care. At the time of the inspection one relative attended an activity being held and was not aware of a programmed event. Menu plans continue to be developed using a menu plan adopted by all Southern Cross care homes. The plan does provide an alternative at each mealtime. Staff consult with service users on their preferences for each day Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 16 and the information is forwarded to the kitchen to assist in planning and preparation of meals. The meal and menu plans should evidence that people are regularly consulted on their choices and preferences at meal times. During discussion with relatives and catering staff it became evident that specific information in relation to personal choices and preferences was not being adhered to . This specifically related to one service user who did not wish to eat pork for cultural reasons, who was given gammon. Improvements need to be made in how special diets are communicated to kitchen staff, especially on occasions when a relief cook is on duty, who may not be familiar with peoples’ needs. The kitchen area was suitably stocked with provisions and all ordering and receipt of food provisions is overseen by catering staff. The kitchen was suitably equipped and staffed to meet all catering arrangements. Laurel Court Nursing Home DS0000021556.V373356.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure protected people. EVIDENCE: People were aware of how to make a complaint and were confident their concerns would be listened to. A register of complaints and concerns received is kept. In the periods since the last inspection, the home had received and investigated 13 complaints. The information in the register was supported by investigation notes and supporting correspondence with complainants regarding the action taken to resolve their concerns. It is advised that the complaints register and outcome sheet contain an additional column to evidence the complainant had been consulted with to determine if they were happy with the outcome of the investigation. Staff spoken to were of the action to take if there was an allegation of abuse. A copy of the brief “No Secrets” document was available and it is advised that a copy of the complete Local Authority guidance and procedure is made available to all staff. Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 18 The manager was advised to include the topic of protection on the agenda for the next round of supervision and to discuss at the next staff meeting. Laurel Court Nursing Home DS0000021556.V373356.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): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained, clean and comfortable for people living there. EVIDENCE: Laurel Court is a purpose built care home registered to accommodate 86 people. The building is set out in four units. One unit supports younger people with a physical disability, one unit accommodates older people requiring residential care and two units provide nursing care. Each unit has its own designated dining and lounge areas, bedrooms and toilet facilities. A small satellite kitchen is located in each unit. Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 20 A large reception area is located in the foyer and allows access to stairs and lifts to all levels. There are extensive, landscaped grounds and ample car parking located to the front of the building. The grounds offer secure areas for people to access. The premises were found to be generally clean and tidy. A tour of bedrooms was undertaken and the opportunity was taken to meet with people in communal areas. The laundry and kitchen area were suitably equipped and staffed. The home had been suitably adapted and equipment was available to meet the assessed physical needs of people accommodated. This included assisted bathing, hand and grab rails, raised toilet seats, pressure relieving equipment and moving and handling equipment. An action plan had been produced to address advice given in relation to infection control procedures. The proposed completion dates for some sections were set in the future. The home is advised to confirm that outstanding areas have been addressed. On touring the building some walking aids and equipment were seen to be stained and needed cleaning. Fire door self closing arms needed adjusting to prevent doors slamming. Windows in offices and in some bedrooms needed cleaning. Laurel Court Nursing Home DS0000021556.V373356.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): 27,28,29 and30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements must be regularly reviewed in terms of number, staff qualification and experience to ensure people’s assessed needs are being met. EVIDENCE: Since the last inspection a new manager has been appointed. The manager confirmed that application had been made to the Commission for registration in respect of the home. At the time of this visit not all units had a designated unit manager and unit managers recently recruited were undertaking programmes of induction to the home. It was also evident that some care staff had not received training in all aspects of supporting people and as a result some staff were unable to assist in supporting people on personal care issues. One specific example related to staff who had not received training in moving and handling. Staffing levels on each unit must be regularly reviewed and monitored to ensure people have the necessary support and assistance to meet their needs. Discussions were held with the manager in relation to the need to involve and Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 22 consult with unit managers on staffing levels and deployment of staff on the units they have responsibility for. This should ensure staffing levels reflect the dependency levels of all service users and that staff have the necessary skills and experience to meet the assessed needs. Discussions with staff and completed comments cards returned by staff, identified and raised their concerns in relation to shortfalls in staffing levels. Staff referred to lack of sufficient cover where intensive one to one and two to one support was required by service users. Staff referred to times of the day when it was “hard” to meet peoples’ needs due to the high number of people requiring support in the morning and lack of support to ensure they received their breakfast. As stated in the health and personal care section, people were observed receiving their breakfast, in some cases one hour before the midday meal would be served. There were also serious concerns that people were not receiving their medication at the right time due to staffing shortage. A further issue identified related to gender appropriate staff cover and support to service users. The care plans and rotas should ensure that service user are consulted on who supports them, for example in relation to male staff supporting female service users. During discussions with staff they spoke about not having received regular supervision sessions with their line manager. The files of staff recruited since the last inspection were examined. Files contained reference checks, application form, CRB clearance information, and training and supervision records. The files of staff recently employed did not contain all completed documentation relating right to the right to work in the UK. The manager is advised to ensure all required documents are in place. It is recommended that a tracking sheet is placed on all files to monitor the process and documents required for each file. It is also advised that training programmes required monitoring and reviewing to ensure staff had received induction training and refresher training, if assessed as needed, in a number of areas related to their work. Laurel Court Nursing Home DS0000021556.V373356.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): 31,33,35 and38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed in management and administration procedures to evidence that the home is being run in the best interests of people living and working at the home. EVIDENCE: Since the last inspection, a new manager and project managers has been assigned to the home to monitor care standards and assist in the management of the service. The need to establish clear lines of management within the home is an area where sustained improvement must be achieved in order for the service to Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 24 evidence it is meeting its aims and objectives and responding to the needs of service users. Turn over in the roles of unit managers has also impacted on continuity and consistency in care delivery. Staffing arrangements require constant monitoring to ensure staffing levels and deployment are appropriate to meeting people’s needs. Training programmes require auditing to ensure all staff had the necessary skills, experience and advice to support them in the delivery of care. Evidence must be retained that people are consulted on their preferences and choices in all aspects of their care and daily living. Procedures were in place to ensure health and safety checks on systems and equipment was being carried out. Management and administration procedures must be supported by an effective staff team to evidence the home is run in the best interest of people living there. Laurel Court Nursing Home DS0000021556.V373356.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12 Requirement Information in care plans must evidence that plans of support identified by health professionals have been taken forward in the delivery of care and provision of training to staff. Staffing levels and deployment of suitably trained staff must ensure people have the necessary support to meet their assessed personal and social care needs. Procedures must be put in place relating to choice and the need to ensure that people’s capacity to make decisions is assessed and recorded as required under The Mental Capacity Act. Arrangements for the recording, handling, safekeeping and safe administration of medicine; identified in this report must be addressed to protect people. Medication administration procedures must ensure compliance with specific prescribing instructions. Timescale for action 12/12/08 2 OP27 18 12/12/08 3 OP9 14 12/12/08 4 OP9 13 12/12/08 Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 27 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 OP3 Good Practice Recommendations Information in the homes Statement of Purpose needs to reflect current information in respect of the home, its services and staff. Each person should receive confirmation that the care home is suitable for the purpose of meeting needs including details of individual’s diverse needs and how these are to be met. It is advised that unit managers are actively involved in the planning and admissions of service users. Plans of care should evidence that people have been consulted and reflect people’s preferences and wishes. Plans should be developed in a more person centred way. All records should be clearly dated to assist in monitoring and reviewing plans of intervention and support. Catering staff should be provided with complete information relating to peoples preferences and dietary needs. It is recommended that a copy of the Manchester multiagency procedure and relevant contact numbers be held on each of the four units. Evidence must be retained that all staff have received supervision and appraisal on a regular basis. The home should ensure individual equipment such as slings for moving and transferring are available to named people. Programmes of maintenance and cleaning should be in place to ensure all equipment, such as walking aids are regularly cleaned. It is recommended that activities and events are held on a more regular basis, based on individually assessed needs and interests of people. The care plans and rotas should ensure there is an appropriate gender mix when staff are supporting people. 2 3 OP3 OP7 4 5 6 OP7 OP15 OP18 7 8 9 10 11 OP27 OP19 OP19 OP27 OP27 Laurel Court Nursing Home DS0000021556.V373356.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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