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Inspection on 08/10/07 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 8th October 2007.

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

The inspector 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

During discussions with people living in the home a number said they liked living there. Relatives of some people did compliment the home on the care and supported offered to them and that they were welcomed when visiting and were kept informed on personal and health care issues. People are provided with a contract relating to the care they receive. Staff confirmed that meetings and supervision sessions were provided on a regular basis.Policies and procedures are developed as corporate documents used within all Southern Cross health care homes.

What has improved since the last inspection?

Maintenance programmes continue to be overseen by designated staff to ensure the fabric of the building and grounds are safe and pleasantly presented. The home continues to employ an activities organiser to provide social activities for people living in the home. Programmes of training were in place in relation to abuse awareness. The home was introducing a new dietary assessment called `Nutmeg`. This helped to ensure the meals provided to residents promoted their health, gave a nutritional balanced diet and offered a more extensive choice.

What the care home could do better:

The home is advised to ensure that effective monitoring and review of care is conducted to ensure the care provided to people meets their assessed needs. Care plans required developing to evidence staff were able to provide consistent care that reflected people`s wishes, dignity and aspirations. The home is advised to move forward proposals relating to establishing a more person-centred care approach to care planning. Procedures relating to the management of medication on the residential unit were found to be in order, this standard needs to be developed and sustained on each of the three remaining units. Shortfalls in such procedures had the potential to compromise the health of people living in the home. 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 support the residents.

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 8 October 2007 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.V340624.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.V340624.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 Ashbourne Homes Limited 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.V340624.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. 27th February 2007 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.V340624.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.V340624.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of the home started on the 3 October 2007 and was unannounced. A further visit was made on the 8 October to conclude the inspection. Two inspectors conducted the visits. The inspection looked at requirements and recommendations made at the last inspection, social and nursing care programmes, examination of records required to be held and discussions with people living in the home. The opportunity was also taken to meet people visiting the home at the time of the inspection. A self-assessment form referred to as the Annual Quality Assurance Assessment, AQAA, had been completed by the home and received by the Commission prior to the inspection. A number of files, relating to care and support offered to people were examined. Records and procedures relating to health care and medication records were also examined to ensure procedures were in place to meet the assessed needs of people being cared for. A tour of the building was conducted and observations made during the course of the inspection on how people living in the home and staff supporting them interacted. Comment cards were left at the home to be distributed to people living at the home to gain their views about the service they received. The Commission received four completed comment cards. The home does not have a registered manager at present, however a person had been appointed and would be seeking registration with the Commission as registered manager. What the service does well: During discussions with people living in the home a number said they liked living there. Relatives of some people did compliment the home on the care and supported offered to them and that they were welcomed when visiting and were kept informed on personal and health care issues. People are provided with a contract relating to the care they receive. Staff confirmed that meetings and supervision sessions were provided on a regular basis. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 7 Policies and procedures are developed as corporate documents used within all Southern Cross health care homes. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Laurel Court Nursing Home DS0000021556.V340624.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.V340624.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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessment procedures were in place to assess people needs prior to admission. Information in the homes Statement of Purpose and Service Users Guide must be regularly updated to ensure they reflect the levels of support people should receive. EVIDENCE: Information in the homes Statement of Purpose and Service Users Guide should be regularly reviewed to ensure information is up to date and informs people of the care and support people should receive on each of the four units within the home. This related to information about staff on each of the units, aims and objectives of each unit and information relating to current fees and Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 10 who is responsible for payment. This should be clearly set out in contracts and statement of terms and conditions of placement. Information about the home is provided to people verbally and through literature about Southern Cross and in particular Laurel Court. Procedures were in place to carry out a pre-admission assessment of peoples needs at the time of referral to the home. This included use of a standard document by senior nurses from the home to assess people’s needs and receipt of the care manager’s assessment for the person being referred. The information gathered through these sources assisted the home to develop care plans and identify and plan for any areas of risk to each person. On the day the inspection started, 3 October, an admission was planned. The home had not received the care manager’s assessment for the person being admitted. The home is advised to ensure assessment information by the local authority is received by the home prior to an admission. The admission process does provide people with the opportunity to visit the home on a trial visit, take a meal and meet staff and people living there. Staff said that relatives would support or make such visits on behalf of the person being referred. There have been a number of changes in senior management and staff within the home, as a result the home is advised to review and ensure procedures for supporting people moving to the home are regularly monitored to ensure that the home meets peoples’ assessed needs. The inspection included an assessment of a number of care files for people recently admitted and people who had lived at the home for some time. Care manager assessments of need had been obtained for these people and senior staff had completed in-house assessments of need prior to admission. The manager of unit 1, which provided personal care only, was asked about the admission process. She said that a person was being admitted to unit 1 that afternoon and that the home manager had conducted the assessment. The unit manager added that once the assessment has been completed the home manager decides if the person’s needs can be met. This is not put in writing to the individual. The unit manager had not been involved in this process and it was unclear to what extent the views of the prospective resident and their representative had been taken into consideration as these had not been recorded. Each person should receive confirmation that the care home is suitable for the purpose of meeting needs. This should be supported with evidence of appropriate consultation with the person and their representative in relation to preferences in how their care and support is to be provided. It is also advised that there is a more consultative approach with decisionmaking by discussing admissions with staff on each unit, particularly the unit manager who will have more knowledge of compatibility on the units. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 11 On the day of the inspection there were 80 people living in the home. There was little evidence that the needs and preferences of people from specific minority ethnic and cultural groups were being catered for. Care records generally failed to detail individuals’ diverse needs and how these were to be met. One person’s records stated that he was a non-practicing Muslim and that his first language was English. While this person may be communicating in English, the records failed to identify the mother tongue’ of his country of origin. It was encouraging to note that a copy of the Koran had been provided for this person. Conversations with staff highlighted a need for development of equality and diversity learning in this area. The conditions of registration on the homes certificate would be reviewed as part of the inspection process. The Commission received four comment cards and all indicated they had received information about the home, three confirmed they had received a contract and one person said they could not recall receiving a contract. The home did not provide an intermediate care service. Laurel Court Nursing Home DS0000021556.V340624.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 adequate. This judgement has been made using available evidence including a visit to this service. Care plans required reviewing and monitoring to ensure the assessed social, personal and health care needs of people were at all times being provided for. Medication procedures must be regularly audited and monitored to ensure people are protected. EVIDENCE: As part of the inspection the care plans of six people were examined to look at information gathered at the time of their admission, how this information was used to develop care plans and how staff report on the support offered to meet assessed needs. On examination of the files, discussions with staff, relatives and health professionals there were evident shortfalls in the way the home responded to and addressed assessed needs and plans of support. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 13 Of concern was the fact that relatives and health professionals had identified and raised concerns or set in place action plans to support people with little evidence that staff had responded to these concerns and action plans. Plans of care relating to manual handling and management of pressure care were not always adhered to and concerns were also identified that there was a short fall in staffing levels to ensure plans of support were adhered to. This resulted in identified risks not being appropriately addressed through records and staff intervention. During discussions with relatives there was contrasting feed back about how their relative were being cared for. This ranged from complete satisfaction with the care and support offered to dissatisfaction with how the home responded to assessed needs. Information at the time of the inspection identified a lack of immediate action by senior staff to follow through programmes of support. This was fed back to the current manager who stated that action would be taken to address any short falls and systems would be put in place to improve communication between each unit and herself as manager of the home. On examination of care plans, there were examples where changes in care and support needs had not been addressed in written plans of support and risk assessments. All written documents must be reviewed and monitored to ensure information is current, amended and informs staff of the level of support required by each person. Failure to address this had 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 had been consulted about how they wanted to be supported on health and social care needs. Each person has a named key worker and nurse assigned to support them. Some of the care plans inspected had not been updated to inform staff about strategies relating to management of pressure care, equipment to be used and the number of staff to support people on some care activities. The information relating to one person, requiring support in pressure care management, indicated the person spent prolonged periods in bed. A further plan of support for one other person failed to evidence that he was being supported in accordance with established plans set out by the Tissue Viability Nurse. Programmes of support for people on pressure care plans must be followed to ensure people’s needs are being met. Procedures were in place to carry out reviews on a three month and six month basis. This process must be monitored by senior staff to ensure information is current and understood by all staff. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 14 Medication administration procedures were assessed on each level. Procedures for the management of medication on the residential unit were managed well by senior staff. Procedures on the remaining three levels did identify some weaknesses. A discrepancy was noted in the management of Warfarin for two people on one unit. In one case medication was down and the second persons medication was in excess by the identified amount. This error possibly occurred by blister foils of Warfarin being transferred from prescribing packets. Prescribed liquid medications also required monitoring. The medication for one person required reordering as the remaining amount would not be sufficient for the reminder of the week when following prescribing directions. One other liquid medication had approximately 20 ml of medication dispensed when 40ml should have been dispensed according to prescribing directions. Medication is administered by senior staff on each unit. Prescribed medication and controlled medication is held securely and transferred on each unit using a medication trolley. Medication is stored in the office on each unit. The temperature in the office on the first floor required altering as it was excessive and required monitoring for safe storage of medication. All shortfalls in medication had the potential to compromise the health of people. Each person is registered with a General Practitioner and healthcare professionals to support their continuing care, however some people commented they had difficulty accessing appropriate dental care. Laurel Court Nursing Home DS0000021556.V340624.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. Care plans must evidence that the social care needs of people are being met. People were provided with choices at meal times and were consulted on their preferences. EVIDENCE: Details regarding activities were displayed in the main entrance and on each individual unit. At the time of the inspection visits, an activity organiser was seen to hold an activity session in one of the lounges to which people were invited to attend. One person commented that she was not always informed of the activities and had missed out on some activity sessions. Some people on the young disabled unit were observed to go out on planned trips using an adapted taxi service. There was however, a lack of evidence of social programmes for a number of people, especially on the young person’s unit. This is an area, which requires developing to ensure people are involved in activities of their choice and that programmes of activity ensure people are Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 16 involved and motivated through structured activity programmes. There was an evident absence of such programmes for a number of people. Each file contains a plan of activities undertaken by people, this is completed by staff using codes. The majority of codes referred to discussions, watching television and watching a video show. Religious needs were met through planned services and visits by ministers of various denominations to the home. Meal and menu plans are developed using a varied and balanced diet plan referred to as the ‘Nutmeg’ menu plan. The current manager said she was in regular contact with the head of catering to ensure the plan was used in consultation with people to ensure it met their preferences likes and dislikes. During discussions with people and their relatives, varying comments were received in relation to meals provided and the range of satisfaction with meal and menu arrangements from, “meals were cold”, to “not happy with the meals being provided”. The menu plan for each day does provide an alternative at each mealtime. Staff meet with people on a daily basis to inform them of the options to choose from. The information is recorded on a menu plan for each unit and forwarded to the main kitchen. Meals are transferred to each unit via a dumb waiter to each floor and served from a heated display area in each dining facility. Breakfasts were observed to be prepared on trays and brought to each person as they arrived in the dining area. During discussions with some residents they commented they would prefer the main meal of the day in the evening as opposed to the current mid day serving. Consultation should take place with people on this issue. People responding through the comment cards indicated usually, sometimes and never to the question ‘do you like the meals at the home’. One person said there was “no choice and not very tasty”. The minutes of a residents’ meeting held on the 19 September provided evidence that people were being consulted. Action had been taken in response to requests to provide cakes more often and to replace food supplements with nutritionally fortified food. 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.V340624.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 homes complaints procedure enabled people to raise concerns about the service they received. Procedures relating to protection ensure staff have the skills and knowledge to protect people from abuse. EVIDENCE: The procedure relating to complaints is detailed on notices around the home and in each persons Service Users’ Guide. A register is maintained by the home of complaints it may receive. The home is advised to insert an additional column in the homes register to evidence the complainant had been consulted to determine if they were happy with the outcome of the investigation and to record the outcome within the complaints register. Relatives commented that they were aware of who to speak to if they had a concern. Most indicated that they were confidant the current manager would address and investigate concerns on their behalf. People responding through comment cards said they knew who to speak to in raising a complaint; one person did say they were not aware of the homes complaints procedure. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 18 Procedures relating to protection and abuse awareness are established through the organisations internal procedures and training. This is supported by the home accessing and adhering to guidance established through Manchester’s Multi Agency procedure. The manager demonstrated a clear understanding of procedures and commitment to ensure all staff had the necessary information to deal with abuse issues. During discussion with staff they demonstrated a good understanding of protection procedures and what to do if they were to witness or be informed about an abuse issue. Staff also demonstrated a clear understanding of the homes whistle blowing policy. In the period since that last inspection two issues had been referred to the Safeguarding team. At the time of the inspection two incidents were under investigation. It is recommended that a copy of Manchester’s multi-agency procedure and relevant contact numbers be held on each of the four units. Laurel Court Nursing Home DS0000021556.V340624.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 very large and set out in four units each with a unit manager and designated staff team. Each unit has its own designated dining and lounge areas, bedrooms and toilet facilities. A small satellite kitchen is located in each unit. A reception area is located in the foyer and allows access to stairs and lift to all levels. This area is used by visitors and some people living in the home as they access the grounds. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 20 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. A tripping hazard was noted on the paved, seated area of the garden. A raised flagstone required levelling. The home employs a maintenance person to address maintenance and health and safety checks on the building. 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. All bedrooms are fitted with mortice style locks and in some cases people hold a key to their room. This style of lock is not appropriate and should be replaced as people could lock themselves in their room. The device should be replaced with, for example a turn thumb device located on the inside of the door, enabling the door to be opened in the event of an emergency/accident from the outside. The call point and or the extension cord to the call point were missing in at least four bedrooms inspected. This required attention to ensure people could access their call point if required. One person commented that the lighting was too bright as it shone in her face at mealtime and that the dining room was too warm. The laundry and kitchen area were suitably equipped and staff. 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. The exit doors in the staff rooms located on the ground floor required attention as they were secured shut with angle brackets. This must be addressed, as there was no designated exit route out other than back into the building to the most immediate exit route. Some ceiling tiles were also missing and needed replacing. Laurel Court Nursing Home DS0000021556.V340624.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 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 to register the current manager has been submitted to the Central Registration Team. On the day of the visit there was an evident need to review deployment of staff on the young disabled person’s unit to ensure people had the necessary support to meet their assessed personal and social care needs. Deployment of staff on the remaining units required regular monitoring also. Information relating to staff indicated some staff work excessive hours and required monitoring to ensure staff are able to carry out their duties effectively. During discussions with staff they spoke about the lack of time to sit and speak with people and having to work through their breaks because of the volume of work to be undertaken. Staff also commented that they would periodically be asked to work on different units. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 22 On meeting one of the residents and explaining the purpose of the inspection he commented, ‘I wondered why there were so many staff on duty today. If you come back tomorrow there will not be as many staff around. You sometimes have to wait a long time for assistance as the staff are too busy.’ Staff personnel files were examined and contained the required information relating to recruitment and selection procedures for staff. This included reference checks, application form, CRB clearance information, and training and supervision records. Any gaps in work histories had been explained. People responding through comment cards said staff listened to them and were available when needed. One person answered sometimes to the above indicating that this was “due to staff shortages. One person said, “Laurel Court is a wonderful place and staff could not be more helpful, caring and kind”. The home employs a head of catering, maintenance and housekeeping. The manager has set up meetings with each person to discuss issues relating to each section. It was not clear if training records had been kept up to date. One of the unit managers said that in the previous twelve months she had received training in medication management, dementia awareness, safeguarding adults and abuse awareness and was currently booked on training in moving and handling and fire awareness. She had completed a National Vocational Qualification at level II in care and was currently working towards achieving this qualification at level III. Two of the three care assistants had achieved NVQ level II in care and one of the four staff had received training in dementia. Additionally, there was evidence that only one of the four staff had received a formal induction following her appointment. However, in conversation with other members of staff it appeared that mandatory health and safety training was currently being brought up to date. It was also noted the of the four file examined, there was only evidence that the nurse had received supervision and appraisal. This was not evident in the three care assistants files. 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. The home is also advised to provide staff with training and development in equality and diversity. Laurel Court Nursing Home DS0000021556.V340624.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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management and administration procedures must be regularly monitored to ensure the home is run in the best interest of people living and working at the home. EVIDENCE: The manager holds the necessary qualifications and experience to manage the home and is currently seeking registration as manager. The manager demonstrated a clear commitment to developing systems to ensure the home achieved its stated aims and objectives, involves and consults with people and their relatives and that training and development plans for all staff are implemented. Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 24 Since starting the manager had sent a letter to each person and their representative introducing herself as manager, had developed a newsletter, held a residents’ meeting and a social evening to which relatives were invited. The manager proposed to hold residents meetings on a monthly basis. Regular questionnaires were distributed to people and their representatives to establish their views on life in the home. The survey findings were not routinely brought together and published including what changes the home would make as a result of the findings. Procedures relating to managing and supporting people with their finances were overseen by administrative staff and the manager who will periodically audit records. Secure arrangements were in place for any money or valuables held on behalf of people. Relatives are encouraged to retain responsibility for the finances of people. 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 fire sounder is tested on a weekly basis and was sounded during the course of this inspection. Discussions were held with the manager regarding compliance with Regulation 37 requirements. This regulation requires the home to notify the Commission within 24 hours of an occurrence affecting the wellbeing of a person being cared for. A number of notifications forwarded to the Commission (6) did not contain sufficient information about the incident and all were received 10 to 24 days after the incident occurred. Procedures in relation to compliance must be reviewed to ensure such information is forwarded in accordance with this regulation. 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. Fire extinguishers were last serviced in August 2006 and were over due. The manager was advised to ensure this had been addressed and to forward confirmation by fax that this work had been done. Appropriate insurance liability cover was on place, dated to February 2008. 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.V340624.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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 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.V340624.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 14 Requirement All written documents and care plans must be reviewed and monitored to ensure information is current, amended and informs staff of the level of support required by each person. Failure to address this has the potential to place residents at risk. Arrangements for the recording, handling, safekeeping and safe administration of medicines as detailed below; must be made to ensure the health of people. All medication records must be accurate. (not met in previous time scale 30/12/06 and still applies) 3 OP12 15 Social care arrangements require 03/12/07 developing to ensure people are involved in activities of their choice and that programmes of activity ensure people are involved and motivated through structured activity programmes. Timescale for action 03/12/07 2 OP9 13 08/10/07 Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 27 4 OP19 23 Action must be taken to address issues relating to the premises identified in the Environment section of this report to ensure the safety of residents. 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. Evidence must be retained that all staff have received supervision and appraisal on a regular basis. Procedures relating to compliance with Regulation 37 notifications must be reviewed to ensure the information is forwarded to the Commission within 25 hours, so that the Commission is aware f the action taken to keep people safe. 03/12/07 5 OP27 18 03/12/07 6 OP27 18 03/12/07 7 OP31 37 03/12/07 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 OP1 Good Practice Recommendations Information in the homes Statement of Purpose and Service Users Guide should be regularly reviewed to ensure information is up to date and informs people of the care and support people should receive on each of the four units within the home Local Authority care plan and assessment information should be received prior to an admission. The home is also DS0000021556.V340624.R01.S.doc Version 5.2 Page 28 2 OP7 Laurel Court Nursing Home 3 OP9 advised to conduct a more consultative approach with decision-making by discussing admissions with staff on each unit, particularly the unit manager who will have more knowledge of compatibility on the units. It is recommended that more details about meeting the diverse needs of residents including culture and religious needs are included in the care plan. It is recommended that continued development of care plans in a more person centred way. Evidence should be retained that people are regularly consulted on their preferences at mealtime and their preferred time to take meals. It is recommended that a copy of the Manchester multiagency procedure and relevant contact numbers be held on each of the four units. It is recommended that more training be provided in areas associated with the conditions relevant to older age and equality and diversity. 4 5 6 OP9 OP15 OP18 7 OP27 Laurel Court Nursing Home DS0000021556.V340624.R01.S.doc Version 5.2 Page 29 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.V340624.R01.S.doc Version 5.2 Page 30 - 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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