Inspection on 20/04/05 for Laurel Dene

This inspection was carried out on 20th April 2005.

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

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

Other inspections for this house

Laurel Dene 05/07/06

Laurel Dene 21/09/04

Laurel Dene 26/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE LAUREL DENE 117 Hampton Road Hampton Hill Middlesex TW12 1JQ Lead Inspector Sandy Patrick Unannounced 20 & 21st April 2005 th 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 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 DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Laurel Dene Address 117 Hampton Road, Hampton Hill, Middlesex Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8977 1553 020 8943 5470 Care UK Community Partnerships Limited Ms Katherine Harman Care Home 99 Category(ies) of 69OP and 30DE(E) registration, with number of places LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1.Weekly staffing care hours are 558 hours for 35 service users, excluding laundry, cleaning and management tasks. This will provide 16.8 care hours per service user per day excluding night cover. 2. Night cover arrangement is a minimum of one waking night staff per unit. 3. The activities co-ordinator is employed full time and dedicates at least one third of his/her time towards providing Dementia related activities to the 15 service users with Dementia on a daily basis. 4. 20 beds to be used for nursing. Date of last inspection 21st & 22nd September 2004 Brief Description of the Service: Laurel Dene is a care home providing personal care and accommodation to up to ninety-nine service users. The home is registered to provide nursing care for up to twenty service users. The building is owned by the London Borough of Richmond and is leased to Care UK Partnership who manage and run the home. The home is located in Hampton Hill, close to shops, pubs, the post office, Bushey Park and other amenities. The home consists of a purpose built three storey building with six units. One unit provides specialist care for people requiring nursing input. Two units offer support to people with varying degrees of dementia. All bedrooms are for single occupancy and have en suite facilities. There is a passenger lift between all floors. The home has extensive, well kept and attractive grounds, which are easily accessible. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, the 20th and 21st April 2005, and was unannounced. The Inspection Team consisted of a Regulation (Lead) Inspector and a Pharmacy Inspector. The findings of the Pharmacy Inspector are recorded within Section 2, Health and Personal Care (Standard 9). The Manager was present throughout the inspection. The Inspection Team met with other staff on duty and many of the service users, speaking at length with over twenty service users. The Inspection Team was invited to join service users in one unit for their midday meal during the first day of the inspection. This was well prepared and tasty and was enjoyed by all. The Inspection Team observed positive interactions between staff and service users throughout the inspection and was made welcome by everyone at the home. The atmosphere at the home was calm and relaxed and service users were seen to pursue a wide range of activities both in groups and individually. The Inspection Team felt that staff support of service users was kind and demonstrated an understanding of individual needs. At the time of the inspection ninety-four service users were living at the home. One potential service user was visiting the home for an assessment. A large number of visitors were seen throughout the inspection. Although, the Inspection Team did not speak with any visitors at length, it was apparent that they were made welcome, felt comfortable at the home and had a good relationship with staff on duty. The Manager and staff spoke positively about service developments and staff were clearly proud of personal and group achievements. Service users who spoke with the team reported that they were happy and well cared for. Many staff members complimented particular staff members by name. Comments from service users included, ‘there is a nice atmosphere here and the people are nice’, ‘I have regular chiropody, see the hairdresser and staff do my nails’, ‘I cannot fault the home, the staff are very good and the food is good’, ‘there is a happy peaceful atmosphere’, ‘I am really happy here’, ‘the activities are wonderful’. One service user who spoke about their experiences prior to and since moving to the home reported that they felt the home was ‘wonderful’. They made an analogy to express the support that they had received stated that Laurel Dene had ‘helped them to fly again’. What the service does well: There is a good range of information for service users prior to and following a move to the home. Regular service user meetings are held and service users are consulted about areas of service delivery both informally and through LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 6 formal quality monitoring tools. Service users are able to make choices about their own lives and preferences and wishes are recorded within service user plans. Service user plans and related documents are well designed and appropriately maintained. These give a detailed account of individual needs. Staff have a good awareness of health care needs and liaise appropriately with health care professionals to ensure a holistic approach to care. The activity provision at the home is varied and offers a wide range of choices for service users. Throughout both days of the inspection, service users spoke positively about activity provision and the work of the Activities Officer. Service users spoke positively about the food that they receive. There is a comprehensive training programme for staff and staff are supported by a clear and suitable management structure. The building exceeds National Minimum Standard size requirements, is a pleasant design and has been well maintained. The building is set in attractive and extensive grounds. Systems for quality monitoring are thorough and recognise and highlight service deficits. There are planned programmes to ensure continued service development. What has improved since the last inspection? What they could do better: The service has demonstrated consistent improvements and developments over the past year. Work for the further development of the service, in consultation with service users, should continue. Attention should be given to LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 7 some medication practices and to ensure that monthly reviews of service user plans are recorded. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 5 All four standards are met (no shortfalls). One standard is not applicable. Service users are provided with comprehensive information about the service. There are appropriate procedures for the assessment and admission of service users, including trial stays. Service users are involved in the assessment process and are appropriately consulted. EVIDENCE: The home is registered to provide care to people who have dementia, nursing needs and physical and mental health needs. Service user plans appropriately reflect these needs. Daily care notes and reviews of service user plans indicate that these needs are being met. There is evidence that staff have a wide range of training and learning opportunities. The Manager stated that the home is well supported by health care professionals, who work closely with staff to ensure a holistic approach to care. Each service user is allocated a keyworker, who is responsible for overseeing care provision and is a contact for the service user and families. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 10 The Registered Person has produced a comprehensive Statement of Purpose and Service User Guide for the home. These documents are incorporated into a Welcome Pack, which is issued to service users and their representatives before they move to the home. Copies of both documents are available on request and can be accessed on notice boards and in the main entrance. There have been no changes to these documents since the last inspection, with the exception of minor amendments to staffing details. The Welcome Pack can be produced in a variety of different formats and languages upon request. There are appropriate procedures for the assessment and admission of service users. All potential service users are invited to spend a day at the home, sharing activities and meals with other service users. During this visit, Team Leaders conduct an assessment of need, in conjunction with the service user. Information from the service user’s representatives, health care professionals and placing authority social workers are incorporated into the assessment. The Nursing Manager conducts assessments on service users requiring nursing care, either at the home, or if this is not possible at the service user’s own home or hospital. All assessments are signed by the service user or their representative as a record of their agreement. On the day of the inspection, one potential service user was visiting the home. One of the Team Leaders explained the process for their assessment. The Inspector was able to examine documentation relating to the assessment made that day. The Nursing Manager also showed the Inspector the assessments made on two service users who would be moving to the nursing unit shortly after the inspection. These assessments were thorough and the Managers who spoke with the Inspector demonstrated a good understanding of the assessment process and how information would be used to formulate service user plans. Copies of assessments were seen to be in place within all service user files examined. These were highly detailed and focused on individual needs, wishes and preferences. Assessments of need had been appropriately translated into service user plans and were subject to regular review. There was evidence of reassessments following changes in need. All service users are admitted on a six week trail stay. At the end of this period a review meeting is held, where the service user, their representatives, the placing authority and representatives of the home make a decision about whether the service can continue to meet that person’s needs. Service users who spoke with the Inspector about their moves to the home confirmed that they were able to contribute to these review meetings and that their opinions about the suitability of the home had been sought. The home does not provide intermediate care. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 Four standards were met (no shortfalls). One standard was partly met (minor shortfalls). Service user needs are appropriately recorded and records are subject to regular review. Service users are consulted about their care and are able to make decisions about their lives. Personal and health care needs are met. Procedures are in place to ensure that service users are treated with dignity and respect. The home has good arrangements for the ordering, storage, recording and auditing of medication and has access to a pharmacist for advice. On the day of the visit errors in recording, and the use of medication outside of national guidance were found although they had had no effect on the health and welfare of service uses. EVIDENCE: Individual service user plans are in place for all service users. The Inspector examined twelve of these and related documents. Service user plans include information on personal and health care, social and emotional needs. Plans are based on individual wishes and needs and focus on choice. There is an emphasis on promoting independence where possible and on upholding choice LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 12 and dignity. All plans include regular assessments of health care, manual handling and mental health needs. Information was presented consistently and in an accessible manner. Multidisciplinary input is recorded. Night care plans are in place for all service users showing personal wishes and preferences. Service user plans include a social history completed by the service user or their representatives. Plans are reviewed monthly and where there is an identified change in need. In a small number of cases some monthly reviews had not been recorded. Staff must ensure that they record monthly reviews. Service users or their representatives have signed individual plans. Daily care notes are made and records are maintained by the Activities Officer, regarding participation in organised activities. The standard of recording was good and information was clearly presented. Two of the Team Leaders discussed some new paperwork which has been introduced to support care planning. This new documentation is in relation to specific health care needs. The Team Leaders demonstrated a good understanding of how the new documents were included within the service user plans. One Team Leader was conducting training for staff on care planning and on the new documentation around the time of the inspection. Staff reported that they found the care planning documentation well designed and easy to use. Information on meeting personal and health care needs is included within service user plans. There is an emphasis on promotion of choice, dignity, privacy and independence. Preferences for same gender carers are recorded. Service users reported that they were able to rise and retire at a time of day of their choice, and service user plans reflected this. Mealtimes are flexible and hot drinks and snacks are available throughout the day and night. Service uses confirmed that they make choices about their personal toiletries. There is an appropriate record of all accidents and incidents at the home. All service users are registered with local GPs and access health care services as required. Multidisciplinary reviews and consultation with health care professionals are recorded in individual service user plans. A number of service users who spoke with the Inspector reported that they were able to access health care services as they required and that the home was visited by a chiropodist and dentist on a regular basis. The Manager reported that the home has a good relationship with GPs and visiting nurses. One of the GPs holds a weekly surgery at the home. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 13 The home is registered to accommodate up to twenty service users who have nursing needs, within a separate nursing unit. This unit is managed by a Registered Nurse and qualified staff are on duty twenty-four hours a day. The Nursing Manager is a qualified lecturer and has offered training and support to staff throughout the whole home. Training includes information on general and specific health care needs. Training takes place approximately once a week. The Nursing Manager also provides informal support and advice as required to all staff. Team Leaders, the Nursing Manager and the Registered Manager all demonstrated a good knowledge of individual service users’ health care needs and how these were met at the home. The Nursing Manager spoke positively about improvements in health for some of the service users within the nursing unit. He felt that this was a positive reflection of the dedication of the staff and the positive liaison with health care professionals to ensure a holistic approach. One of the Team Leaders reported that work had taken place to enhance understanding of continence issues. Some of the new paperwork within service user plans is related to this. The Team Leader reported that staff had worked closely with Continence Advisers to ensure that service users received the right support and products to meet individual needs. There are appropriate procedures regarding dying and death. Individual preferences and wishes are recorded within the service user plan. The Manager has designed a bereavement pack, which provides information and support to service users and their relatives. Individual religious needs are recorded in service user plans. Local places of worship, of different denominations, hold monthly services at the home. A small lounge on the second floor has been set aside for a multi-cultural room. Service users and their visitors may use this room for private worship. The written medication policies and procedures were found to be adequate on the last inspection and were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge was interviewed, the administration of medication on one unit observed and the audit records on three units reviewed. From these observations and discussions medication in twenty-seven instances the allergy section on the medication records had not been completed, one service user had been recorded as receiving the wrong strength of medication, one service user was recorded as not receiving their medication as it was out of stock when the medication had been discontinued by the doctor, large amounts of medication had been returned with no indication as to why and LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 14 medication had been prescribed to two service users outside of Guidance from the National Prescribing Centre on the use of this medication. All other records had been completed accurately and provided evidence that all medication had been administered correctly, changes were clearly identified, medication was stored and administered safely, regular audits had been performed and any necessary action taken. Refer to Requirements 1 –3. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Two standards were met (no short falls). The home exceeds two standards. Service users are supported to pursue a range of activities, which are appropriate and meet individual and group needs. Service users are able to maintain contact with family and friends. Service users are offered a choice of well prepared, wholesome food. Service users are supported to exercise choice and control over their lives. EVIDENCE: The home employs two full time Activity Officers and there is a planned programme of activities. The Inspector met with one of the Activity Officers and observed them supporting service users with a variety of activities throughout both days of the inspection. Activities included dominos, scrabble, a quiz, bingo, knitting and nail care. The programme of activities allows for time to be allocated for individual support as well as small and large groups. Evidence of this support was seen by the Inspector. Throughout the inspection a high number of the service users and staff praised the work and dedication of this Activity Officer. The Nursing Manager reported that the Activities Officer has consulted with him about the specific needs of service users within the unit, to ensure that activities were appropriate and did not have any detrimental effects on health. The Inspector saw that service users were enthusiastic about the support that they received and had a genuine fondness for the Activities Officer. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 16 At the time of the inspection, the second Activities Officer was not working at the home. The hard work of the Activities Officer on duty to ensure that this did not have a detrimental effect on activities provision is commended. The Activities Officer spoke about her work and demonstrated an in depth understanding of her role. She spoke about the way that she conducts activities and indicated that she had a flexible approach which accommodated different needs and feelings expressed by service users on a daily basis. The Inspector saw examples of this as the planned quiz lead to discussions and reminiscence between service users. Regular planned group activities include quizzes, bingo, singalongs, craft work, beauty club, keep fit and music sessions. The programme of activities also includes visits by entertainers and trips outside of the home. The staff on individual units were also seen to support activity provision. Service users confirmed that this was normal practice and that staff initiated and supported a range of activities on a daily basis. Service users spoke enthusiastically about parties and special celebrations at the home. A number of service users reported that the attended day centres outside of the home. One service user spoke enthusiastically about the weekly beauty club that was held at the home. Two hairdressers visit the home each week. Service users spoke positively about this service. One service user is a keen artist and they showed the Inspector their artwork, some of which was displayed within the home. Each unit is equipped with a small kitchenette. Service users are able to access this, according to risk assessment. The Inspector observed one service user being supported to make their own hot drinks. Team units. users There of the Leaders organise for service user meetings to be held within individual Minutes of these meetings were examined and indicated that service were able to contribute their ideas and that these were acted upon. is a process for service user consultation about service delivery as part quality assurance process, refer to Section 7 of this report. Service users are able to bring personal belongings and furniture (with the agreement of the Manager) when they move to the home. Service user plans record personal choices and preferences with regards to all aspects of care, including meal times and night time requirements. Information for staff states that they should not assume known preferences and should offer choices on a daily basis. Service users reported that they are able to rise, retire and eat when they wished to and that they had a choice of meals and activities. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 17 Throughout the day the Inspector observed staff offering service users choices Service users with disabilities were and giving appropriate information. appropriately supported to maintain independence where possible. Staff who spoke with the Inspector demonstrated a good knowledge of the communication needs of service users. The Inspector saw examples of staff using different communication techniques to converse with service users. The visitors procedure states that visitors are welcome at any time to the home, although those visiting during the evening and at night are asked to inform staff in advance, where possible, for security reasons. The Inspector saw service users receiving visitors throughout the inspection. There is a trolley telephone available on each unit and service users are able to equip their rooms with a private telephone line if they wish. There is a four week cyclical menu, which offers choices at each meal time. Meals are varied and offer nutritional balance. Service users are able to have drinks and snacks, including fresh fruit, throughout the day. Food is distributed to the units in heated trolleys. Service users reported that they enjoyed the food and that it was well prepared. Quality surveys on food indicated that the majority of service users found this satisfactory. The Inspection Team joined the service users on one unit for their midday meal. This was a pleasant and sociable occasion and food was attractively presented and tasty. The Inspector observed the cook meeting with service users on the units following a meal to ask individuals about their satisfaction. This is good practice. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 All three standards are met (no shortfalls). There is an appropriate complaints procedure, which is accessible to service users. Complaints are investigated in accordance with this procedure. Service users rights are protected. Systems are in place to protect service users from abuse. EVIDENCE: There is an appropriate complaints procedure, which is available to service users. The procedure includes timescales and information about the Commission for Social Care Inspection. There have been no complaints since the last inspection. At previous inspections, evidence was seen that complaints were investigated appropriately. The Manager reported that all service users have representatives external to the home. Information on local advocacy services is available for service users and their representatives. The Manager reported that all service users were registered to vote. The Inspector saw evidence of consultation with individual service users about whether they needed support to access the polling stations or wished to use a postal vote. The Manager reported that she had made contact with local political parties so that they could provide information for service users who wished for this service. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults procedure. Care UK has its own procedures on abuse and whistle blowing. All staff attend training in recognising and reporting abuse. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 19 The Inspector saw evidence of this in the staff training files which were examined. Care UK has sound recruitment and selection procedures and pre employment checks, including criminal record checks, are made on all staff prior to employment. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 34, 35 & 26 The home meets six standards (no shortfalls). Two standards were exceeded. The building is well maintained, welcoming, homely, attractive and meets the needs of the service. Private and communal areas are spacious and meet the needs of service users. The building is kept clean and procedures are in place to ensure cleanliness and infection control. EVIDENCE: Accommodation is provided on three floors, accessible through a passenger lift and stairways. The home is divided into six separate units, each with up to twenty bedrooms, a lounge, kitchenette and dining area. The home employs a maintenance worker who attends to minor repairs and decoration. The home was in good decorative order and repair throughout. The building is set in large grounds with an attractive and mature garden to the rear. The garden has level areas, patio and lawn. Pictures and plants throughout the building added to the general ambience. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 21 There is a lounge, dining area and kitchenette on each unit. There are also additional seating areas, lounges, a multi faith room and a smoking area throughout the home. These are attractively decorated and appropriately furnished and equipped. All bedrooms are for single occupancy and have en suite facilities. There are two bathrooms, equipped with specialist baths and showers on each unit. There is a call alarm system available in all rooms. The home is equipped with a passenger lift and hand rails in corridors. All service users are individually assessed for equipment needs and referrals to health care professionals are made as necessary. There are a number of hoists available at the home. There is evidence that these are regularly checked and serviced. Specialist nursing beds are available. All staff receive training in manual handling. Moving and handling risk assessments are in place for all service users. Examples of these were seen in all the service user plans examined. All bedrooms are appropriately equipped and furnished. Service users are able to personalise their rooms. Bedrooms are equipped with call alarm systems, television ariel points and thermostats. Service users are able to have a telephone line installed if they wish. All service users have been asked if and how they wish to identify their bedroom doors for the purposes of orientation. A variety of symbols, pictures, photographs, numbers and name plates have been used, according to individual wishes, which are recorded. The home is appropriately lit, ventilated, heated and was clean throughout on both days of the inspection. There are appropriate procedures for infection control, Control of Substances Hazardous to Health (COSHH) and laundering of clothes. A team of domestic and laundry staff are employed. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 All four standards were met (no shortfalls). Staff are employed in sufficient number to meet the needs of the service. Staff are aware of their roles and responsibilities and are appropriately trained and supported. Procedures for recruitment and selection of staff are designed to protect service users. EVIDENCE: The Management team includes the Registered Manager, Deputy Manager, Nursing Manager, Team Leaders and senior administrative staff. Teams of staff are allocated to each Team Leader. Since the last inspection the post of Deputy Manager and additional Team Leader posts have been created. In addition the general staffing levels for the home have been re-evaluated and increased. At the last inspection of the service, staffing was a key topic for discussion. Many of the staff had expressed concerns that staffing levels were not sufficient and that Team Leader support was stretched. At this inspection, staff who spoke with the Inspector reported that problems with staffing had been alleviated. Team Leaders spoke positively about the increase in senior staff support and how this had supported time management. From observations of practice and discussions with the Inspector, staff on duty demonstrated a good understanding of their roles and responsibilities and the needs of the service users. There is a planned programme of training for staff, which includes NVQ training. Twenty-five of the staff are currently undertaking NVQ qualifications. Many staff have already achieved these. The Inspector examined training records for six members of staff, including senior staff LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 23 members. Records were up to date and indicated that a range of training had been attended by individuals. Training profiles included course evaluations by the staff member. Examination of these revealed that staff generally found that training met course objectives and was relevant to their roles. The Nursing Manager and Team Leaders provide in house training for staff on health care needs, care planning and other key areas of service delivery. Staff who spoke with the Inspector about this training reported that it was very useful and interesting. All staff are trained in manual handling, basic first aid and health & safety, fire safety, food hygiene and abuse. All the training profiles examined highlighted additional training in areas relevant to the staff member’s role, including senior training and customer care. There is an appropriate procedure for the recruitment and selection of staff. The Inspector examined recruitment records for four members of staff who had been employed within the last few months. The files contained all the required information, including criminal record checks, references and checks on qualifications. A record of recruitment interviews is maintained. The Manager reported that over the past year recruitment and retention of staff had been successful. A Care UK recruitment drive involving other local Registered Managers was taking place at a local job fair on the second day of the inspection. The Manager spoke positively about the hard work of the staff team, commending individual and group achievements. The Team Leaders and Nursing Manager also complimented the work of staff within their teams. Staff reported that they were well supported by their line managers and the Registered Manager. Individual supervision and team meetings are held on a regular basis. The Inspector examined minutes from team meetings. These indicated that staff were well informed and supported to contribute their ideas and opinions. Service users who spoke with the Inspector reported that staff were kind and supportive and that they fulfilled their duties. A number of staff were mentioned by name and two members of staff were commended by a high number of service users. This information was discussed with the Manager. Care UK has a system of internal awards to celebrate success and recognise achievements. Staff at Laurel Dene have received individual and team awards for a high standard of service delivery. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 24 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 37 & 38 Three standards were met (no shortfalls). The home exceeded two standards. The home is appropriately managed and the Manager is suitably experienced and qualified. There are appropriate procedures for quality assurance and monitoring. Records are well maintained and accurate. There are appropriate procedures in place to protect the health, safety and welfare of service users and staff. EVIDENCE: The Manager is suitably experienced and has managed other Care UK homes before taking up her role at Laurel Dene. She has undertaken a number of management and care qualifications, and completed her Registered Managers Award in 2004. The Manager has consistently demonstrated a good knowledge and commitment to the service at this and previous inspections. The home LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 25 experienced some difficulties within the first year of operation. The Manager and staff team have worked hard to over come these difficulties and have developed the service. The Manager is clearly very proud of the achievements of her team and her personal achievements. Throughout the inspection she demonstrated a personal enthusiasm for her role and for meeting the needs of the service. There is an appropriate system of quality assurance, whereby inspected by Care UK and by the London Borough of Richmond basis. Both organisations assess the service against a series of indicators. Objectives are made following quality inspections undertaken to meet these. the home is on a regular performance and work is A representative of Care UK conducts an unannounced visit to the home on a monthly basis. Reports of these visits are forwarded to the Commission for Social Care Inspection. These include recommended actions and commended practice. There is a system of in house monitoring, whereby all service users are asked for their opinions on a particular areas of service delivery. Recent surveys include quality, presentation and choice of food, the laundry service, rising and retiring times, bathing facilities and activities. Team Leaders talk to service users individually and record their opinions. It is aimed that these surveys are conducted monthly. The findings are appropriately recorded and used for developing individual services. Service users are expected to make their own arrangements for the management of their financial affairs. However, the home offers a service of holding small amounts of cash on behalf of individual service users. This money is used for the purchase of small items, personal shopping, the hairdresser and any additional expenditure. Service users and their representatives are able to access the records of these finances. The system used for managing these monies is appropriate. Records are highly organised and show a clear audit trail. Receipts for expenditure are kept. The Inspector examined records for money held on behalf of four service users. These were well maintained and accurate. The Manager reported that there had been no errors in recording service users’ money since the home opened. Records required by Regulation were seen to be in place and were appropriately maintained, accurate and accessible. There is a range of checks made to ensure health and safety within the environment. These include checks on water safety, fire safety, gas and electrical safety. Risk assessments for individual service users and in relation to the building are in place and are reviewed at regular intervals. The service LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 26 was recently inspected by the Environmental Health Officer who commended the standards within the kitchen. The organisation recently conducted a full health and safety audit for the home. Recommendations from this had been acted upon. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION 3 4 3 3 4 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 4 x 4 x 3 3 LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) The Registered Person must ensure that the allergy section on the medication records is completed for all service users. 2. OP9 13(2) The Registered Person must ensure that the administration/nonadministration of all medication is recorded accurately. 3. OP9 13(2) The Registered Person must ensure that doctor reviews the medication used outside the national guidance. 16/05/05 16/05/05 Requirement Timescale for action 16/05/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The Registered Person should ensure that all monthly LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 29 reviews of service user plans are recorded. 2. OP9 It is recommended that the reason for disposal be recorded when large amounts of medication are returned. LAUREL DENE G54-G04 S17378 Laurel Dene V213601 200405 Stage 4.doc Version 1.30 Page 30 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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