Inspection on 05/07/06 for Laurel Dene

This inspection was carried out on 5th July 2006.

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 20/04/05

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 Inspection 10:00 5th July 2006 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 Dene DS0000017378.V303929.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 Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurel Dene Address 117 Hampton Road Hampton Hill Middlesex TW12 1JQ 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) 020 8977 1553 020 8943 5470 manager.laureldene@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Limited Ms Katherine Harman Care Home 99 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (69) of places Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Weekly staffing care hours are 558 hours for 35 service users. 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. Night cover arrangement is a minimum of one waking night staff per unit The activities co-ordinator is employed full time. 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. 20 beds to be used for nursing The home can admit one named service user who has been diagnosed with mild dementia to the nursing unit within the home. 14th September 2005 2. 3. 4. 5. Date of last inspection 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. The majority of residents are placed by the London Borough of Richmond. The weekly charges range from £515 - £850. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, 5th and 7th July 2006, and was unannounced. The Inspection Team consisted of two Regulation Inspectors. The Inspectors met with some residents from each of the six units, staff on duty and Managers. The Inspectors were made welcome by everyone and spent most of their visit with residents and staff in the different units. The residents, staff and visitors who spoke with Inspectors were helpful and gave a range of useful information about their experiences. Their positive approach to the inspection has provided the Inspectors with a good overview of the outcomes for residents. The Inspectors also spent time observing staff interaction with residents and the support being offered. The Inspectors looked at a range of records and evidence including care plans, staff records, medication records and storage, health and safety and quality monitoring documentation. The CSCI sent surveys to the home to distribute to residents, their relatives and staff. Surveys were also sent to a number of professionals who work with the home. The aim of this was to gain information on the experiences of those who use and work within the service and whether they feel the needs of residents are being met. The response to the surveys was excellent and the CSCI thanks all those who returned surveys. Twenty one residents completed surveys. In general they were happy with the information they received when they moved to the home, the staff support, medical services, food and the control they had over their own lives. Some residents would like further improvement in activities and some mentioned that the staff were sometimes too busy to help them. Comments from residents included, ‘Laurel Dene was recommended as an excellent home and it is, the staff work very hard and all do their best to look after residents’, ‘I think the cook does a wonderful job’, ‘the cook make sure special birthday cakes for everyone’, ‘most of the staff are helpful and I think the home is a beautiful place’, ‘sometimes the staff are too busy to help’, ‘it is like a good hotel’, ‘the carers are kind and helpful’, ‘there is a choice of meals’, ‘sometimes the staff are too busy in the mornings’ and ‘I would like there to be more staff’. Twelve visitors completed surveys and they were mostly happy with the home. Some felt that activities could improve further. Visitors said that they were made welcome and were appropriately consulted about their relatives care. Some people raised concerns that hearing aids were not always checked. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 6 Some of the comments from visitors were, ‘The staff respect my mother’, ‘I think the residents are all well cared for and treated with respect’, ‘the home has a caring attitude’, ‘I have been impressed with the staff at Laurel Dene’, ‘the staff are always polite’, ‘the staff are a credit to their profession’, ‘I never see many staff they are always busy’, ‘more trips out are needed’, ‘excellent staff’ and ‘a peaceful atmosphere’. Nine members of staff completed surveys on the home. Seven staff were happy and said that they were well supported and training was good. Two members of staff were not happy and said that they did not feel supported. They raised concerns that they were bullied and not appreciated for their work. One person said that senior management did not give staff the opportunity to speak up. These staff did not identify themselves or give detail about their concerns. If staff feel unsupported or are concerned about bullying they should use the whistle blowing and grievance procedures to raise these concerns. Comments from other staff included, ‘staff training opportunities are excellent’, ‘the care residents receive is spot on – staff are dedicated’, ‘The Manager has given me the opportunity to further my career, her care and understanding of the service is more that what is expected of her’, ‘I am happy to be part of the team’, ‘team leaders are excellent and patient’, ‘the Manager gives support and supervision every day’ and ‘the residents are happy and well looked after’. Three professionals who work with the home completed surveys about it. They said that the staff communicated clearly and the Manager was approachable. They felt that specialist advice they gave was followed. Some of the comments from residents and visitors who spoke with the Inspectors were; ‘I can have a cooked breakfast if I want’, ‘food is very good but not much variety’, At the table we have water and you can help yourself’, ‘my husband visits nearly every day’, ‘everyone is pleasant and the staff are marvellous’, ‘I can’t complain about anything’, ‘the staff are so helpful’, ‘we never go on trips.’, ‘I am happy here’, ‘all the staff are kind’, ‘this is a wonderful home’, ‘the staff are nice’, ‘the garden is lovely’, ‘the cleanliness is ‘marvellous’, ‘jolly good home’, ‘I can have a TV in my room and watch what I like’, ‘everyone is so kind’, ‘the staff are very thoughtful’, ‘the food is very good’, ‘I am learning Polish and teaching them (the Polish staff) English’. Interactions between staff and residents were good and staff showed kindness and respect. There was a friendly atmosphere throughout the home and residents were able to ask for assistance at any time. What the service does well: Residents said that they are happy at the home and like the staff. Despite the size of the home, each unit has a homely atmosphere. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 7 Staff are kind, polite and attentive. The residents are consulted about their care through surveys, formal monitoring and meetings. Managers are experienced and know the needs of the residents. The staff work well with other professionals. There are good procedures for staff recruitment, support and retention. In general the staff feel well supported and are happy in their work. Residents like the food at the home and the chef takes a pride in providing a varied and nutritious choice of food. Medication is generally well managed and there are good systems for medication auditing. What has improved since the last inspection? What they could do better: Some of the care plans are task orientated and the home should consider how they can work towards a more person centred approach. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 8 Further improvements to activities should be made to look at how the social needs of residents can be better met when they are not participating in the organised programme of activities. There needs to be improvements in the Nursing Unit in the assessment of residents, care planning, risk assessments, the formal support of staff, training and in some nursing practices. The Registered Manager and Nursing Manager should develop an action plan to look at how these areas can be improved. Some staff are signing for medication administered by others and this practice must cease. There needs to be better recording of staff training. In general there are systems in place to safeguard the health and safety of residents. However, the Inspectors saw two examples where residents were put at risk and the Manager must take steps to avoid reoccurrence of such incidents. 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 DS0000017378.V303929.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents are given information to help them make the decision about whether they would like to live there. Residents are able to visit the home and have a trial stay there. There are procedures to make sure residents needs are assessed to make sure the home can meet these. Residents have a written contract with terms and conditions of the home. EVIDENCE: A welcome pack for residents contains the Statement of Purpose, Service User Guide and aims and objectives of the home. The Manager said that all residents receive a copy of this. Copies of the pack are available in the home’s entrance hall. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 11 Most of the residents who completed surveys about the home said that they received enough information about the home to help them make a decision about moving there. Some residents could not remember and some felt that they would have liked more information. One resident said that they had requested a brochure but had not received one. The Manager must make sure the welcome pack and other information about the home is available for all potential residents. There is a thorough procedure of assessment and senior staff at the home meet with potential residents to assess their needs. The record of assessment includes their views and information from their representatives and professionals who work with them. Potential residents are able to visit the home and spend time with other residents before they decide whether to move there. There is a six week trial stay period for all residents to make sure the home can meet their needs and that they are happy. Pre admission assessments for most residents were seen and generally gave a range of information to help staff to put together a care plan. Some of the assessments on the Nursing Unit were not complete or were absent. The Manager must make sure detailed assessments are made to help determine whether individual residents needs can be met by the home. The Manager has started to attend the local authority allocation panel. She said that this helps her to have an overview of residential placements and is a positive working partnership with the local authority, who fund the majority of places at Laurel Dene. Residents are issued with contracts outlining the terms and conditions of residency. Some residents completing surveys could not remember receiving a contract. The Manager should make sure all residents are aware of the terms and conditions for living at the home. Laurel Dene DS0000017378.V303929.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents have their individual needs recorded within care plans. In most cases these are detailed and include input from other professionals and the resident’s consent. Work to develop these further would benefit residents. Most risks have been fully assessed and action taken to reduce risks. Further work is needed on risk assessment for some residents. Residents’ medical needs are met through a multidisciplinary team. Medication procedures and practices safeguard residents. EVIDENCE: Each resident has an individual care plan. The home started to use a new computerised system of care planning in 2005 and now all care plans are recorded on this system. The system is a good data base but is not accessible to residents and their families or temporary staff. Paper copies of care plans are in place for most residents, however one resident on the Nursing Unit did Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 13 not have a paper care plan. The Manager must make sure paper copies of care plans are in place for all residents. The quality of information in care plans varied. Some care plans gave clear and detailed guidance while others needed needed to improve. Some of the recording in care plans is task orientated. The Manager should support staff to understand and have a more person centred approach to care planning which is based on outcomes for individual residents. Some of the terminology and language in care plans was inappropriate or confusing and some poor spelling and grammar made care plans difficult to understand. Whilst accurate spelling is not a priority it is important that care plans can be easily understood. Inaccurate or inappropriate terminology could be detrimental to the care of residents and staff should make sure care plans are clear and appropriate language and terms are used. Information on individual social needs and interests in care plans varied. In some care plans there was a range of information, however in others information on social interests was absent or very limited. For example in one care plan it stated, ‘prone to falls’ as the only information within social interests. In another care plan the information stated that the resident enjoyed watching TV and reading, when in fact the resident was blind and the staff said that they did not do either of these activities. There should be further work in this area to make sure individual interests and needs are accurately recorded and met. One of the members of staff has downloaded all the residents’ photographs onto the computer system and the Manager hopes to attach photographs to each of the computerised care plans. This is important and will help newer staff identify residents and all staff to check they are completing the correct care plans. The care plans on the residential unit were very detailed and gave clear guidance for staff on how to meet specific health care needs. Care plans included detailed risk assessments which showed that residents, their representatives and other professionals had been involved in the assessment. Risk assessments and care plans were reviewed regularly and new risk assessments had been developed following changes in need. Risk assessments on the Nursing Unit were very basic. Some residents were left in wheelchairs during the day and at mealtimes and the reason for this was not recorded. There must be a full risk assessment in place detailing the resident’s consent. Risk assessments for the use of adjustable bedrails on the Nursing Unit were basic and did not contain the necessary information. Nor did they evidence consultation with residents, their representatives or other professionals. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 14 The Manager has been supporting one of the Team Leaders to put together a falls management plan. The Team Leader spoke to the Inspector about this work. The Team Leader has worked closely with a team of other professionals and has been invited to spend time in the falls clinics at two local hospitals. She has undertaken training and has worked with the Primary Care Trust to put together a plan for the home which aims to reduce falls. All residents are risk assessed and action plans are put in place for residents who are most at risk of falling. Detailed plans record information on all factors which might lead to falls including the environment, medication, diet, health, clothing and vision. The plans look at ways in which the risks of falling can be reduced. The Team leader has also obtained leaflets on falling to share with residents and their families to help them have a better understanding. The Team Leader was able to talk about individual cases in detail and what action had been taken to support these residents. The work in this area is commendable and shows a commitment to working with other professionals to develop the service. Continued work in this area will have a direct benefit for residents. The care plans for some residents indicate that they have incontinence pads changed during the night. The Manager said that she has asked a senior member of staff to look at continence management at the home and how this can be improved. It is important that care interventions are as unobtrusive as possible. The review of continence management should include investigating whether it is possible to manage some people’s continence without disturbing them at night. Some staff who spoke to the Inspector said that they were not always able to offer residents baths each day but tried to support residents to have baths and showers as often as they wished. One resident said that they could not have a bath as often as they wanted. The Manager should make sure residents are able to have baths as often as they wish. All residents are registered with local GPs and the Managers reported that they worked closely with the local GP surgeries. Two surgeries visit the home for weekly clinics. Health care professionals completing surveys about the home said that staff communicated well with them and listened to their advice. In general residents said that they received the medical support and services they needed. One person raised a concern about the optician services in the survey they completed about the home. The Manager said that she felt the optician offered a good service and was generally helpful. Residents do not have to use the visiting optician, dental, chiropody or hairdressing services and can make their own arrangements if they want to. The Team Leader on one unit said that they had worked very closely with the local Mental Health Team who offered regular advice and support on how to meet the needs of the residents. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 15 One of the Inspectors spent a day on the Nursing Unit. The Nursing Manager was present throughout the inspection. Suitable equipment was in place to meet the needs of the residents. The Nursing Manager said that the staff worked closely with the GP and other health care professionals. The treatment recommended by a health care professional was not being followed for one resident and there was no treatment plan in place. The Inspector spoke to the Nursing Manager about this and felt that he should have been more proactive in researching best practice techniques. A treatment plan incorporating recommendations from health care professionals should be in place. The Inspector was concerned that the Nursing Manager was not always following current practices. He told the Inspector that he did not need to renew training. Best practice and medical interventions are regularly reviewed and unless he is aware of changes the residents will not be getting the best nursing care. The Nursing Manager offers training and holds lectures for nursing staff and carers at the home and it is essential that he has the most up to date information and knowledge or residents may be put at risk. The Nursing Manager must make sure he keeps his training and practice knowledge up to date and proactively seeks information about recommended changes in practice, through training, use of the internet and nursing journals. There is an appropriate medication procedure and staff administering medication are trained to do so. The medication is stored in dedicated rooms which are maintained at a cool temperature and are appropriately secured. The Inspectors looked at a sample of medication and records relating to this. In general procedures were being followed appropriately and there are good systems for internal checks. The Nursing Manager said that he is working with GPs to review medication and reduce the use of this where possible. Senior staff were able to speak about individual residents medication needs. The nurses on the Nursing Unit have been signing for medication which carers administered and this practice must cease. The person who administers medication must sign the record for this. There is a bereavement pack available for residents and their relatives. Residents’ individual wishes and preferred funeral arrangements are recorded. The home has a multi-faith room which residents, their families or staff can use for private prayer. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents are able to choose from a range of organised activities. work in this area would improve the quality of life for residents. Residents are able to see visitors when they want. Residents are involved in making choices about their own lives. The Manager is looking at ways in which they can be more involved with decision making in the home. Residents enjoy the food and have a choice from a varied and nutritionally balanced menu. EVIDENCE: Two Activity Officers are employed to work at the home throughout the week and at weekends. The Manager said that the employment of two Activity Officers had meant that more residents were able to go out for short walks and to use the local community. Further Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 17 There has been an improvement to activity provision and this is an area the home has focused on over the past year. However, improvements need to continue, in particular in supporting residents to meet their social needs outside of the planned activity programme. There is a programme of regular activities which are advertised on notice boards. On two of the units the staff and residents said that they did not know what the planned activities for the day were. The Activities Officers should make sure activities are well advertised do that residents can make an informed choice about whether they wish to participate. Entertainers and musicians visit the home on a regular basis for different music events, plays and shows. Regular church services are held at the home. A lot of the residents and their visitors who spoke with or contacted the CSCI said that they felt activities could be improved. In particular, people said they would like more opportunities for trips out, including short trips and longer day trips to the seaside and places of interest. Two different hairdressers visit the home four days a week. Observations made during the inspection were that some residents pursued their own individual social interests. However, for long periods of time some residents were not doing anything. In some units the TV was switched on and lots of the residents were sitting in the lounge, but some of them were not watching the TV. Many of the residents were sleeping. The Inspectors appreciate that the inspection took place on hot days and residents may not have wanted to be active, however staff on the units were generally occupied attending to tasks rather than spending time with residents. The staff were very kind, caring and attentive when residents approached them. However, in some units staff did not initiate conversations or spend time sitting and talking to residents. The Manager should consider how staff could be encouraged to spend more time with residents rather than attending to other tasks. The home has a good supply of craft material and games but this is generally located centrally. There were limited activity resources available on the units. The staff on units should consider what resources would be useful and meaningful to the residents on each unit, (such as colouring, craft materials, games, jigsaws etc) and start building a supply of these which residents and staff can access at any time for ad hoc activities and personal use. Some of the residents, friends and relatives who completed surveys about the home and some of those who spoke to the Inspectors said that they would like to have more variety for activities. Some said that they would like better opportunities for trips out of the home. Some people said that there had been improvements to activities. The Manager has been working with other local professionals to look at how the ethnic and cultural needs of residents could be better met. She has Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 18 obtained written information on different cultures and religions and contact details for local groups. The Manager said that she hopes staff will be able to use these resources to support residents to celebrate their culture and heritage. There is a multi faith room in the home which residents, their visitors or staff can use for private worship. The Manager has also been working with other professionals to investigate ways for residents to be more involved in the decision making at the home. Some of the staff have been on training around this. There are regular relative and resident meetings and the last one in February 2006 was very well attended. An advocacy consultant who works for Care UK has been looking at resident involvement and is setting up a resident focus group which will begin in September. Resident meetings are held on each unit. The Inspectors examined the minutes of some of these. Residents were informed about activities, laundry services, menus and staffing and were able to contribute and ask questions. Minutes indicated that questions had been answered and suggestions made by residents had been acted upon. Residents told the Inspectors that they were able to be independent in some areas if they wanted. One resident said that they helped clear the tables after lunch, another resident said that they were involved in some of their own room cleaning and the Inspectors saw residents helping themselves to drinks and breakfast. The majority of friends and relatives who completed surveys about the home said that they were made welcome and that the staff were happy, caring and polite. There is an open visiting procedure and visitors who completed surveys and those who spoke to Inspectors said that they were made welcome at the home. Relatives can continue to be involved in the care of the residents if this is what they both want. There is plenty of communal space where residents can entertain visitors. Most of the people completing surveys about the home said that they liked the choice, variety and quality of the food. Some people felt that there could be a better variety of food at supper time. The Inspectors observed serving at mealtimes. Residents were offered choices and staff supporting them sat with them. The staff were polite and helpful and residents said that they were able to make individual choices at mealtimes. Some residents were given blue plastic aprons to wear. These look institutional and alternatives should be given where possible. Staff supporting Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 19 residents did so appropriately. The food looked well prepared and was presented to the residents in an attractive way. The majority of residents said that they liked the food. There is a varied menu and the cook meets with residents to gain their views on changes to this. There is a choice at each mealtime. The inspection took place on two hot summer days. Staff were seen offering drinks and refreshments to residents throughout the inspection. The staff showed a good awareness of the dangers of fluid loss and dehydration on hot days. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents are protected by sound complaints and protection of vulnerable adults procedures. EVIDENCE: There is an appropriate complaints procedure which details timescales and information on how to contact the Commission for Social Care Inspection. Copies of the complaints procedure are available in the welcome pack and are displayed throughout the home. Residents and relatives completing surveys said that they knew who to speak to if they were unhappy about their care. There had been one complaint made since the last inspection. The Manager was able to evidence what action had been taken to investigate this. An advocacy worker and consultant to Care UK has helped facilitate resident and relative meetings. She also aims to visit the home regularly and offer individual support to residents who wish for this. The Manager said that all residents were registered to vote. 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 are required to attend training in this area. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 21 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 DS0000017378.V303929.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The environment is safe, well maintained and comfortable. Although some parts of the building are excessively hot on hot days. Residents have unrestricted access to communal areas and are generally happy with the environment. EVIDENCE: Laurel Dene has 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 building is set in large grounds with an attractive garden to the rear. The garden has level areas, patio and lawn. Pictures and plants throughout the building add to the general ambience. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 23 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. The home is equipped with a passenger lift and hand rails in corridors. All residents 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 residents. Examples of these were seen in all the care plans examined. All bedrooms are appropriately equipped and furnished. Residents are able to personalise their rooms. Bedrooms are equipped with call alarm systems, television aerial points and thermostats. All residents 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. A team of domestic and laundry staff are employed. During the inspection a member of staff started vacuuming in lounges where residents were reading, sleeping and watching the television. The member of staff did not ask the residents if it was alright for them to vacuum the room. This was discussed with the Manager who agreed this was not acceptable practice. All staff must be aware that this is the residents’ home and they should not intrude on their peace and relaxation without asking permission. The home is well maintained and decorated. There is no air conditioning in the home. The inspection was carried out on two very hot days and parts of the building were uncomfortably hot. Some rooms had been equipped with fans but these did not always sufficiently cool the air. Rooms on the upper floors had limited ventilation and many of the residents, visitors and staff commented on the uncomfortable temperatures. The organisation should consider how best to address this problem. Residents who completed surveys and those who spoke to the Inspectors said that they liked the environment although some felt that the building was too hot and would benefit from air conditioning. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents are safeguarded by thorough recruitment procedures. The staff are well supported and are offered the training they need to do their job well and to protect residents. EVIDENCE: The majority of residents who completed surveys about the home said that found the staff kind and caring. Some of the staff on the nursing unit said that they had not had enough staff at times and this made it difficult to do their duties. One staff member had worked for nine days in a row without a break at the time of the inspection; this included some long days (up to 12 hour shifts). The Manager must make sure that staff are given sufficient time off and that working long hours does not have a detrimental effect on the care of residents. The Manager said that she felt that staff had improved practice and were taking more responsibility for their own work. She said that the Team Leaders worked alongside their teams and were involved in direct care. The Inspectors saw examples of this. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 25 Some of the friends and relatives who completed surveys about the home said that communication could be improved at times and sometimes other professionals had not been given the information which they needed about particular residents. The majority of staff who completed surveys said that they felt supported and listened to. Some of the staff said that they felt training was very good. One member of staff said that the Manager had helped them to develop in their career. Team Leaders who spoke to the Inspectors demonstrated a good knowledge of the residents who lived on the units they managed. They said that they were well supported by the Manager and felt they had good advice and support from other professionals. The Manager said that all staff participated in regular supervision meetings with their line manager. Generally staff completing questionnaires and those who spoke to Inspectors agreed with this. However, staff on the Nursing Unit said that they did not have regular individual supervision meetings. The organisation employs a Training Manager who oversees staff training for the home. There is a good package of induction training for all staff. Twenty staff are currently undertaking NVQ Level 2 and seven staff have just completed this. Ten staff will be starting this qualification later in the year. Not all staff have had training in dementia care and it is important that they have a good understanding of this condition and how they can support people affected by this. One of the Team Leaders offers accredited training in dementia over a period of ten weeks. There is an exam at the end of this training. She has been qualified and is approved to offer this training to staff and this has been a useful resource for the home. Some of the staff said that they had attended lectures from the Nursing Manager about various health care conditions. They said that they had found these useful. Not all staff have attended these training sessions. The Nursing Manager must make sure he is giving the most up to date advice and guidance to staff in these training sessions. Three members of staff who spoke to the Inspectors said that they had not attended training in Protection of Vulnerable Adults and one member of staff did not understand what this term meant or why this training was essential for them to attend. A sample of staff training records were examined. Training records for one member of staff could not be located. The records seen varied and some staff did not appear to have had training in food hygiene, first aid, dementia, abuse or manual handling. All staff must be trained in these areas by qualified Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 26 trainers. Some residents have behaviour which can be challenging and training on how best to support these people and manage their behaviours should take place. Training records should be maintained and must accurately reflect all training attended and where training needs are identified. There is an appropriate procedure for the recruitment and selection of staff including thorough checks and a formal interview. Jobs are advertised locally in papers, job centres and on the internet. There has been a successful recruitment campaign and twenty two new staff have been employed since April. Staff files are well organised and clearly show where checks on staff have been made. They contain all required information. The Managers responsible for staff recruitment checks have a good knowledge of the procedures around this and have developed links with external agencies. They have also attended training in employment law. Regular staff meetings are held for individual teams and these are minuted. The minutes evidence good consultation and support for staff. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The service is well managed and residents, staff, visitors and other professionals are involved in the continuous development of the service. The systems for quality monitoring and seeking residents views are excellent. In general residents are safeguarded by good health and safety procedures. However, two serious incidents where residents were put at risk were identified. EVIDENCE: Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 28 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, including the Registered Managers Award. The Manager has consistently demonstrated a good commitment to the service at this and previous inspections. Staff reported that they feel well supported by the Manager. The Manager felt that it had been a positive year for the home and that many good things had been achieved for residents. She spoke about the recruitment and retention of staff, improvements to activities, improvements to contact with relatives and improvements to health and safety. There are excellent systems for monitoring the quality of the service. Representatives undertake monthly visits to the home and a full annual audit of the service. Managers at the home conduct regular monitoring of different areas, such as food, staff, choice, activities and laundry services and ask each resident for their opinions. There is evidence that comments and concerns raised by residents are acted upon. The Manager told the Inspectors that she makes sure she spends time on each unit every day speaking with residents and staff. The staff confirmed this. In June 2006 a quality monitoring survey was given to all residents. This asked them about their impressions of the service and included information on their involvement in care planning, the cleanliness of the home, consultation, food, dignity, activities and choice. The overwhelming response was positive in particular about staff, cleanliness and external services, although some residents said that they did not understand their care plan. Comments included, ‘staff excellent’ ‘wouldn’t change a thing’, ‘like staff to sit and chat a bit more’, ‘wonderful staff’, ‘more variety at lunch time’ The home has demonstrated a commitment to continuous improvement based on consultation with residents. The Manager has designed a business plan and mission statement for the service which looks at strengths and weaknesses. There is an appropriate financial plan. knowledge and Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 29 Residents 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 residents. This money is used for the purchase of small items, personal shopping, the hairdresser and any additional expenditure. Residents 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 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. A health and safety audit of the home is conducted annually and maintenance staff make regular checks on safety, including fire safety and water temperatures. The home recently received a standard of excellence for food hygiene from the Environmental Health Officer. One window one the second floor had been taken off its restricting device and was wide open. The Inspectors appreciate that the staff were trying to create better ventilation. However, there should have been a recorded risk assessment and there was not. A cupboard on the first floor which held steredant tablets was left unlocked. Staff looking for the keys to this cupboard commented that one particular resident often had the keys in their pocket. Steredant tablets could be fatal if swallowed and residents are put at risk if they are not stored securely. The residents on the unit where this occurred are confused and some of them would not be able to make a safe judgement about these dangers. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 30 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 3 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 4 3 3 4 3 3 3 STAFFING Standard No Score 27 3 28 3 29 4 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 4 3 2 3 2 Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement Timescale for action The Registered Person must 31/08/06 make sure the Nursing Manager carries out comprehensive assessments on potential residents to determine whether their needs can be met by the home. Copies of these must be held within the resident’s care record. The Registered Person must 31/08/06 make sure that detailed care plans and risk assessments, with the residents’ consent are in place wherever residents remain in wheelchairs. The Registered Person must make sure risk assessment for adjustable bed rails include multidisciplinary guidance and the resident’s consent. 2. OP7 12(1) (2) (3) 13(4) 3. OP8 12(1) The Registered Person must 31/08/06 make sure a treatment plan incorporating recommendations from health care professionals is DS0000017378.V303929.R01.S.doc Version 5.2 Page 32 Laurel Dene in place to manage individual health care needs. 4. OP8 OP30 12 18 19 The Registered Person must 30/09/06 make sure the Nursing Manager keeps his training and practice knowledge up to date and proactively seeks information about recommended changes in practice, through training, use of the internet and nursing journals. The Registered Person must 31/07/06 make sure that staff administering medication sign for this. The Registered Person must 31/08/06 make sure all staff have the opportunity to participate in regular individual supervision meetings with their line manager. The Registered make sure: 1. Person must 30/09/06 5. OP9 13(2) 6. OP36 18(2) 7. OP30 18(1) 13(6) Staff training records are completed and are up to date. All staff have attended training in Protection of Vulnerable Adults and have a good understanding of this. 31/07/06 2. 8. OP38 13(4) (6) The Registered Person must make sure: 1. Risk assessments are made and recorded where Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 33 any windows are taken off their restricting devices. 2. Steredant tablets must be locked securely and residents must not have access to the keys where these are stored. 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 make sure: 1. Paper copies of care plans are in place for all residents. 2. A more person centred approach to care is adopted. 3. More detailed and accurate information on individual social needs is recorded within care plans. 4. Language and terms used in care plans are clear, accurate and appropriate. 2. OP12 The Registered Person should: 1. Look at ways to improve organised activities further, in particular organising more opportunities for trips outside of the home. 2. Find out from residents what activity and craft resources they would like available on the units so that they can help themselves whenever they wish. 3. Encourage staff to spend more time with residents when they are not attending to essential tasks. Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 34 3. OP15 The Registered Person should consider alternatives to the blue plastic aprons used at mealtimes. The Registered Person should consider how best to address the problem of excessive heat and lack of ventilation in the house during the summer. 4. OP25 5. OP27 The Registered Person should make sure that staff are given sufficient time off and that working long hours does not have a detrimental effect on the care of residents. The Registered Person should organise for staff to have training in challenging behaviour where they are working with people who challenge the service. 6. OP30 Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London 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. Extracts may not be used or reproduced without the express permission of CSCI Laurel Dene DS0000017378.V303929.R01.S.doc Version 5.2 Page 36 - 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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