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Inspection on 28/04/08 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 28th April 2008.

CSCI found this care home to be providing an Poor service.

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

The home employs two activity organisers, one person working specifically on the young person`s unit. The other member of staff facilitates social and leisure events on the remaining units, with some joint events for all units. People spoken to said they liked living there. Relatives of some people did compliment the home on the care and supported offered to them. A contract or statement of terms and condition of placement is provided to people living in the home.

What has improved since the last inspection?

Some programmes of refurbishment had been carried out since the last inspection and were ongoing at the time of this visit. The grounds are safe and pleasantly landscaped. There was evidence of sustained programmes of social and leisure care for people being supported on the young physical disabled unit.

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 28th April 2008 10:00 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.V361162.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.V361162.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 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.V361162.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 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. The maximum number of service users requiring personal care only shall be 25, accommodated on the first floor. 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. 28th January 2008 3. 4. 5. 6. 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 first floor is used to provide personal 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 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. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 5 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.V361162.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The inspection of the home started on the 28 April 2008 and was unannounced. A further visit was made on the 29 April to conclude the inspection. Formal feed back on the inspection was carried out on the 7 May 2008. Two inspectors conducted the visits. The inspection included a tour of the four units within the home and discussions with staff and people living on each of the units. The opportunity was also taken to meet people visiting the home at the time of the inspection. The inspection also included an evaluation of action taken by the home to address requirements and recommendations made at the last inspection. A number of files, (minimum of two from each unit) relating to care and support offered to people were examined. Records and procedures relating to health care, medication records, staff recruitment and development were also examined to ensure procedures were in place to meet the assessed needs of people and to protect them. The home had provided the Commission with a completed self-assessment form referred to as the Annual Quality Assurance Assessment prior to the previous Key inspection. Comment cards were forwarded to the home for distribution to staff and people living in the home as part of this inspection. Staff returned four completed comment cards. No comment cards were received from residents or their relatives. The home does not have a registered manager at present. The requirement to appoint a manager in day to day charge of the home, who is registered with the Commission remains outstanding and dates back to 2002. Failure to address this may result in enforcement action being taken by the Commission. What the service does well: The home employs two activity organisers, one person working specifically on the young person’s unit. The other member of staff facilitates social and leisure events on the remaining units, with some joint events for all units. People spoken to said they liked living there. Relatives of some people did compliment the home on the care and supported offered to them. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 7 A contract or statement of terms and condition of placement is provided to people living in the home. What has improved since the last inspection? What they could do better: Records must be retained to show effective monitoring and review of the care needs for all people living at the home. This is required as information received prior to and assessed as part of this inspection failed to evidence that some people’s needs were being met Records must also be retained to evidence that staff have the necessary skills, experience and knowledge when supporting people. Care plans need to reflect the personal wishes and preferences of people and that support provided respects people’s dignity, ability and aspirations. The home must ensure staffing levels are regularly reviewed and monitored to ensure people have the necessary support relating to their personal and social care needs. Training programmes need to evidence that each member of staff is provided with necessary training to respond to people’s assessed needs. Unit managers are not routinely involved in the pre admission and assessment process. This process should be reviewed to include unit managers as a further means of determining whether peoples’ needs can be met. During discussions with staff they said they had not received structured programmes of supervision. Evidence should be retained that formal and structured programmes of development have been provided for all sections of the staff team. The meal and menu arrangements should be reviewed to ensure that they at all times reflect people’s choices and preferences. In addition dieticians should support the catering staff in the planning and delivery of meals to reflect people’s choices, health care needs and preferences. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 8 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.V361162.R01.S.doc Version 5.2 Page 9 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.V361162.R01.S.doc Version 5.2 Page 10 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): 3, standard 6 does not apply. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre admission and assessment procedures should be reviewed to ensure people’s needs are fully assessed and are able to be met. Information provided by the home should evidence that people have been assured their needs will be met. EVIDENCE: Admission procedures indicate assessments of needs are discussed and planned for, and people, or their representative visit prior to deciding about moving to the home. 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. However, the pre admission procedure and assessment of people’s needs should be reviewed to include involvement of the unit managers. At present Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 11 unit managers are not involved in or consulted on admissions to the units they have responsibility for. It is recommended that unit managers are involved in this process to ensure they are fully aware of the referred person’s needs, how they will be met, compatibility with existing service users and staffing arrangements. This had also been identified on the previous Random inspection. The home’s Statement of Purpose and Service Users Guide had been reviewed to reflect further changes in the management arrangements for the home. The information specifically related to a further change in the management arrangements of the home. Information in the health and personal care section of this report and the staffing section, demonstrate that from a random selection of people’s files, the needs of people were not being met. People with specialist needs were not being supported by staff with appropriate skills and training and people were not being consulted on how they wished to be supported. As indicated in the last inspection of the service each person should receive confirmation that the care home is suitable for the purpose of meeting their needs including details of the individual’s diverse needs and how these were to be met. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Care planning, assessment and review required monitoring to evidence the assessed personal and health care needs of people were at all times being provided for. EVIDENCE: Policies and procedures were in place in relation to health and social care. However there was poor evidence that the care delivered to people met their health care needs. Inspectors examined a minimum of two care plans on each of the units, looking at information from the person’s admission to how needs were being met at the time of this visit. Information in care plans examined evidenced a lack of action by the home to address plans of support identified by health professionals. The shortfalls in the way the home responded to and addressed assessed needs and plans of Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 13 support, identified as an area to be monitored on a previous inspection, had not been addressed. 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. Where specific intervention plans had been advised as part of support plans for individuals, insufficient evidence had been retained to indicate this had been addressed or monitored. Shortfalls in staffing levels on each unit also resulted in identified risks not being appropriately addressed through recorded intervention. Files for two service users identified the need for a specialist invasive technique. There was no evidence of staff having had training to undertake the task, and the need for this training had been identified by a member of the Primary Care Team (PCT) in September 2007. One person who needed this intervention had also expressed concern to staff at how it was being carried out and no action had been taken to address the concern. This issue was referred to Manchester’s’ adult safeguarding team for investigation. One example related to a high risk relating to nutritional intake and weight loss. The plan indicated a record and tracking sheet to be used regarding fluid and diet intake. The information on the day of the inspection indicated a fluid record was being maintained, however dietary intake was not being recorded. The record was only set up by manager at the time of this visit following this shortfall in the records being highlighted. Where additional plans were drawn up these were not dated. This needs addressing to ensure time frames are clear and assist in the review process as to the effectiveness or otherwise of planned intervention. The review of care plans was carried out on a monthly basis. However the content of the review information was the use of a single statement which had been repeated consistently for each 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. Reporting styles also required monitoring and support offered to staff on report writing. One example used related to an entry, which read, “refused to go to”. It is suggested such entries may be more appropriately reported as “chose not to”, to evidence that person had some choice. Programmes of intervention to support a person on a pressure management plan identified that no turning was undertaken during a specified agreed period. It was reported to the person who had drawn up the plan of support that there were only two staff on duty during that time and that the workload was too much to ensure that all turns were done on time. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 14 As a result it is necessary for all plans of support to be reviewed and monitored to ensure information is current, amended and informs staff of the level of support required by each person. Staffing levels must ensure plans of support are adhered to. Failure to address this has the potential to place residents at risk. It is recommended that improvements could be made to the plans to a more person centred approach, to evidence that people have been consulted about how they want to be supported with their health and social care needs. Records relating to pressure care management should specify on each plan the agreed periods of time when transferred from side to side or side to back. These plans of support had been identified and advised by the Tissue Viability Nurse and must evidence that the plan had been followed to ensure people’s health needs are being met. The risk assessment for hoists was not dated and did not specify the equipment to be used for people. Staff commented “ lack of equipment is a major problem, for example at the moment we have a hoist between two floors (ground and 2nd). Residents can’t get up when they want because we are waiting for the hoist, they can’t even go to the toilet for that matter”. Medication administration procedures were assessed on each level. There had been an improvement in the length of time taken to administer medication on each unit. Medication is administered by the unit manager on duty for each floor. It was of concern that medication on the third floor was not being stored at the appropriate temperature. It was held in a small poorly ventilated and warm area, reading 30 degree centigrade on the day of the inspection. It was planned for this to be moved to a more appropriate area in the week following the inspection. A number of people were on a prescribed medication, which required compliance to specific prescribing instructions. This information should be recorded on the Medication Administration Record (MAR) for each person to ensure staff are aware of the directions. Examples of use of correction fluid were seen on medication administration records; this practice must cease. Staff signatures on the medication administration record on the second floor did not correspond with sample signatures. Two signatures appeared as a single letter, which may be mistaken for codes at the base of the MAR sheet. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 15 Prescribed medication and controlled drugs are held securely and transferred on each unit using a medication trolley. Medication is stored in the office specific to each unit. The controlled drug record on unit 3 required attention to ensure records are maintained in accurate page sequence to assist in auditing and checking records. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Improvements had been made in areas relating to meeting people’s social care needs. Evidence should be retained that people are consulted on choices and preferences at meal times. Catering staff should be supported by input from a dietician. EVIDENCE: An area of sustained improvement related to the provision of two designated activity organiser’s supporting programmes of social care and leisure. There is now a designated activity person working 20 hours per week with people on the Young Physical Disabled (YPD) unit. During discussion with staff and people using the service they spoke about the events and activities they had participated in and welcomed the opportunity to get out and about in the local community. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 17 Although there was positive feed, back further development was needed in this area to include accessing public transport and internal use of minibus to access a wider range of choices in venues for trips out of the home. Internal leisure and activity events are held on a more regular basis and staff conducting the events keep a record of the event and people participating in such sessions. A programme of events is also planned for the remaining units and people are supported to attend the unit the event is taking place on. The records on files also contains a plan of activities undertaken by people, this is completed by staff using codes. This document had not been filled in for some files examined. The meal and menu plans should evidence that people are regularly consulted on their choices and preferences at meal times. All catering staff should be supported by input from a dietician in relation to development of individual menu planning for people with specific health care needs. 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 meet with people on a daily basis to seek their choice of two dishes. There was no evidence of people being offered an alternative to the 2 menu choices. One person was provided with culturally appropriate meals brought into the home. However, one other resident was buying in their preferred choice of food. Meals are served from a heated trolley on each unit’s dining area. The breakfast on the 3rd floor and YPD were observed. It was evident people could come to the dining area for their breakfast when they wished. However the choices on offer remained on the hot plate or in the microwave, as was the case on the YPD, a long time after they had been prepared. This related to porridge and fried eggs. The kitchen area was suitably stocked with provisions and all ordering and receipt of food provisions is overseen by catering staff. The kitchen is suitably equipped and staffed to meet all catering arrangements. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure enabled people to raise concerns about the service they received. Staff require further training regarding safeguarding procedures to protect people. EVIDENCE: People spoken to said they would speak to staff or the manager if they had a complaint. The procedure for dealing with complaints is set out in the home’s Statement of Purpose, Service Users guide and on notices located in the home. The register of complaints received from individuals is not always completed, as was the case for two complaints. As a result the outcomes and investigation are not properly logged. The complaints register should also contain an additional column to evidence the complainant had been consulted to determine if they were happy with the outcome of the investigation. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 19 On the previous inspection the home was advised to access copies of the Local Authority’s adult protection procedures and guidance for each of the units to ensure they were available to all staff. On inspection of each unit no copies of the local authority guidelines were available. The feed back from staff, during discussions, identified a need for revised training in adult protection procedures. A selection of scenarios relating to abusive practice were used during discussions and the responses made by some staff raised concerns that agreed procedures may not be complied with. In the period since the last inspection two issues had been referred to the Safeguarding team; a further two safeguarding alert were identified and referred to the local authority following this inspection visit. The home must ensure all staff have received induction training or refresher training in adult protection procedures. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 20 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 r older people requiring residential care and two units provide nursing care. A unit manager and designated staff team is assigned to each unit. Each unit has its own designated dining and lounge areas, bedrooms and toilet facilities. A small satellite kitchen is located in each unit. A large reception area is located in the foyer and allows access to stairs and lift to all levels. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 21 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, weather permitting. 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. Each unit has a designated office. Information is recorded on notice boards in the office with a number of boards easily visible from the corridors. In a number of cases personal and confidential information is recorded. The use of such boards must be reviewed to ensure information is held securely and confidentially. 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. However the hoist on the YPD should be checked to ensure it is functioning correctly as it operates as a weighing scale. There is a need to ensure that each floor has the necessary equipment, slings and records to support staff when assisting people with such equipment. The obstruction on the exit doors in the staff room remained in place and had not been addressed since it was identified on the last inspection. The home is advised to liaise with the local fire service and take appropriate action. Maintenance contracts were in place for servicing of equipment. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 22 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 and 30. 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 reviewed in terms of number and deployment of staff to ensure people’s assessed needs are being met. EVIDENCE: There have been a number of changes within the staff team since the last inspection. This included changes in the manager in day-to-day charge and staff working on each unit. An application must be submitted by the organisation to register a manager in day to day charge of the home. Failure to address this may result in enforcement action being taken by the Commission. A vacant post existed for a unit manager on the third floor. There was further evidence, at the time of the inspection, of staff moving between floors to cover where staff had not turned up for duty and no additional cover provided to the unit where the member of staff had moved from. There is a need to review deployment arrangements on all units to ensure staffing levels are appropriate to meeting peoples’ assessed needs. The manager of the YPD stated that staffing hours are not increased when the unit reaches its full occupancy, i.e. staffing on the YPD is presently set at one unit manager and two carers, plus the hours of the activity person. This will not be Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 23 increased when vacancies on the unit are filled. The existing hours require reviewing in light of the high dependency needs of people on the unit. A clear indicator being high dependency when moving and transferring people, personal turning and pressure relieving plans and personal and social care needs. It is recommended that unit managers are involved in drawing up rotas for the units they have responsibility for. It is further advised that the acting manager is involved in this process. At present rotas are drawn up by a designated project manager. The staff rotas must reflect at all times the actual deployment of staff on each unit. On the day of the first visit there were two clear examples of shortfalls in deployment, one the day of the visit and the night prior to the inspection. Comments received by staff on the visit and from completed comment cards were very negative in relating to deployment of staff and their perception that there was insufficient staff to meet peoples’ needs. At the time of the inspection the deputy manager was on long term sick leave. On level three there was no designated unit manager as person had left employment, the post had been vacant for four weeks. During discussions with staff they spoke about not having received regular supervision sessions with their line manager. A random selection of staff files was examined in relation to recruitment and selection procedures. This included reference checks, application form, CRB clearance information, and training and supervision records. On checking references on one file it was noted that the references appeared as faxed documents. There is a need to set in place receipt of a hard copy version of the references. The current manager indicated that meetings are held with the unit managers and head of catering, maintenance and housekeeping. The findings at the time of the visit raised a number of areas, which should have been identified through such meetings. Training programmes required monitoring and reviewing to ensure staff had received induction training and or refresher training in a number of areas. It is recommended that more training be provided in areas associated with the conditions relevant to older age. This will provide staff with the knowledge and skills necessary to safely meet the assessed needs of people living in the home. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 24 Comments received from staff contained some negative feedback with staff saying “they need more staff, more training and a lot more communication with staff and the management”. One commented, “The major problem is staffing levels”. There is a need for unit managers and management systems to ensure the views of staff are taken on board. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 25 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 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management and administration procedures failed to evidence that the home was being run in the best interests of people living and working at the home. EVIDENCE: The quality of care provided in a care home is influenced and directed by management style and support offered by the manager of the service. The most significant concern in relation to management and administration of Laurel Court is the fact that there has not been a registered manager in day to day charge since 2002. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 26 A high turn over in applicants to the post of manager and designated project managers managing the service has failed to offer continuity and consistency to people living there, relatives and staff working at the home. The absence of a recognised manager fails to evidence that the home is meeting its stated purpose, aims and objectives. Failure to address the appointment of a manager who is registered with the Commission may result in enforcement action being taken. The home is required to appoint a designated manager. The home is currently managed by a designated project manager. During the course of this inspection the manager identified areas for development and systems to move the service forward. However, during the course of the site visits and random audit of records, procedures and care practice, Inspectors were concerned that their findings had not been brought to the attention of senior management staff. Staffing arrangements required constant monitoring to ensure staffing levels and deployment were appropriate to meeting people’s needs. Training programmes required auditing to ensure all staff had the necessary skills, experience and advice to support them in the delivery of care. Evidence must be retained to evidence people are consulted on their preferences and choices in all aspects of their care and daily living. Procedures relating to managing peoples finances continue to be overseen by administrative staff and the manager who will periodically audit records. The head of maintenance is responsible for various aspects of the environment. This includes health and safety checks on fire safety arrangements, weekly tests and checks on fire system and hot water feeds. The lifts were last serviced in November 2007, with some recommendations at that time. There is a need to confirm that the work identified by the lift engineer has been addressed. Appropriate insurance liability cover was on place. 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.V361162.R01.S.doc Version 5.2 Page 27 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 28 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 14 Requirement 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. (Previous time scale of 30/12/06 still applies) 2 OP7 12 Information in care plans must evidence that plans of support identified by health professionals has been taken forward in the delivery of care and provision of training to staff. Arrangements for the recording, handling, safekeeping and safe administration of medicines as detailed below; must be made to ensure the health of people. Medication administration procedures must ensure compliance with specific prescribing instructions. Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 29 Timescale for action 28/04/08 01/07/08 3 OP9 13 01/07/08 Use of correction fluid on medication administration records, must cease. Staff signing the medication administration record must ensure signatures correspond with sample signatures. The controlled drug record on unit 3 required attention to ensure records are maintained in accurate page sequence to assist in auditing and checking records All staff must have induction training or refresher training in adult protection procedures. Staffing levels and deployment of staff must be regularly reviewed and monitored to ensure people have the necessary support to meet their assessed personal and social care needs. (Not met in previous timescale 03/12/07 which still applies) 4 OP18 12 01/07/08 5 OP27 18 28/04/08 6 OP27 18 Evidence must be retained that all staff have received supervision and appraisal on a regular basis. (Previous time scale of 30/12/06 still applies) 28/04/08 7 OP19 13 The home must ensure individual 01/07/08 equipment such as slings for moving and transferring are available to named people and DS0000021556.V361162.R01.S.doc Version 5.2 Page 30 Laurel Court Nursing Home that the service user’s name is recorded on each sling. 8 OP31 8 The registered provider must appoint an individual to manage the care home. (Previous timescale 24/03/08 not met) 28/04/08 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 It is recommended that unit managers are involved in the admission process to ensure they are fully aware of the referred person’s needs, how they will be met, compatibility with existing service users and staffing arrangements. 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 were to be met. Plans of support should be dated to ensure time frames are clear and assist in the review process as to the effectiveness or otherwise of planned intervention. 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. Risk assessment for hoists should be dated and staff should have immediate access to equipment when supporting people. The meal and menu plans should evidence that people are regularly consulted on their choices and preferences at meal times. DS0000021556.V361162.R01.S.doc Version 5.2 Page 31 2 OP3 3 OP7 4 OP7 5 OP8 6 OP15 Laurel Court Nursing Home 7 OP15 Catering staff should be supported by input from a dietician in relation to development of individual menu planning for people with specific health care needs. It is recommended that a copy of the Manchester multiagency procedure and relevant contact numbers be held on each of the four units. Information on notice boards in the office should not contain personal and confidential information. It is recommended that unit managers are involved in drawing up rotas for the units they have responsibility for. A hard copy of references should be kept on staff files. It is recommended that more training be provided in areas associated with the conditions relevant to older age and equality and diversity. There is a need to confirm that the recommendation made following the lift service in November 2007 by the lift engineer has been addressed. 8 OP18 9 OP10 10 11 12 OP27 OP27 OP27 13 OP38 Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 32 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. Extracts may not be used or reproduced without the express permission of CSCI Laurel Court Nursing Home DS0000021556.V361162.R01.S.doc Version 5.2 Page 33 - 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. 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