CARE HOMES FOR OLDER PEOPLE
Laurel Mount Woodville Road Keighley West Yorkshire BD20 6HP Lead Inspector
Gillian Sangster Unannounced Inspection 19th October 2005 13.40p 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 Mount DS0000019880.V258346.R01.S.doc Version 5.0 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 Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Laurel Mount Address Woodville Road Keighley West Yorkshire BD20 6HP 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) 01353 667482 01535 604366 Mr Christopher Bolland Mrs Catherine Bolland Care Home 34 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (34), Physical disability (1) of places Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The places for DE are specifically for the service users identified on 2.4.4 The category of PD is specifically for the service user named in the variation application dated 21 May 2004. 21st April 2005 Date of last inspection Brief Description of the Service: Laurel Mount is a converted property in a residential area in Keighley, close to public transport routes. The home is registered to provide nursing care for up to 35 older people. Accommodation is provided in single and double rooms, two of the single rooms have en suite facilities. Residents have a choice of several lounges, one of which is used by smokers, and a small dining room. The home is situated in extensive and attractive gardens to which there is level access from the home. There is a car park to the front of the building. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector between 1.40pm and 5.45pm.The manager was present during the visit and was joined by the provider for the feedback session at the end. The purpose of the visit was to review the requirements made at the last inspection and look at the core standards which had not been reviewed previously. During the visit time was spent talking with residents, a relative and some staff as well as observing practice. Some records were examined including care plans, assessments, medication records, duty rotas, recruitment records, residents/relatives surveys and financial records. The home has made a number of improvements since the last visit and the majority of the requirements had been dealt with. What the service does well: What has improved since the last inspection?
The statement of purpose and service user guide, which provide information about the home, have been update to reflect the changes in management. Pre-admission assessments are more detailed which makes sure that the home has sufficient information to judged whether it can met the resident’s needs. Care plans have also improved and contain more detail for staff about the action they need to take to meet the resident’s needs.
Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 6 Some bedrooms have been fully refurbished to a good standard. An upstairs bathroom has been refitted and upgraded to provide assisted bathing and toilet facilities. More staff have been recruited to strengthen the staff team. Nine care staff have started NVQ training. The manager has submitted an application to register with CSCI and has started the Registered Managers’ Award. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 7 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 Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 8 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): Standards 1, 3 and 6. The home provides good information about the home so that residents are able to make an informed choice about moving in. Residents’ needs are assessed before admission to make sure that the home can meet their needs. EVIDENCE: The statement of purpose and service user guide, which give detailed information about the home, have been updated as required to reflect the changes in management. One visitor, whose relative had been admitted in the last twelve months, said that he had been given good information about the home when he came to look round. The manager or deputy carry out pre-admission assessments on all residents before they are admitted to make sure that their needs can be met. Detailed assessments were seen for two recently admitted residents. The home does not provide intermediate care. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 9 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): Standards 7, 8, 9 and 10. Care planning is satisfactory but records should be signed by staff and the resident to show that the care planned has been agreed by both parties. Health care needs are met. Safe systems are in place for managing medications. Residents are treated with respect and their privacy is respected. EVIDENCE: Three residents were case tracked, which involved looking at their care records, speaking to the residents and looking at their rooms. The care plans provide detailed information showing what action staff need to take to ensure that needs are met. The care plans had been reviewed monthly. Two of the care plans had not been signed by the nurse completing them or the resident or their representative. One of the residents was in for respite care and said that he had been coming to the home for over two years. He said that he thought the care was very good and praised the nursing staff for their expertise in managing his PEG feed. He said the care staff were kind and caring and was pleased that staff consulted him about how he liked things done.
Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 10 The other two residents said that they felt well looked after and praised the staff for their kind and caring attitude. Arrangements are in place to make sure that health care needs are met and specialist advice can be obtained if needed. One of the residents had been admitted with a pressure ulcer, which has now healed. The home has a variety of pressure relieving equipment including specialist mattresses and cushions. The home has good systems in place for managing medication. An individual sheet is kept for each resident, which shows what medication has been ordered and received from the chemist. The home has made contractual arrangements for the disposal of medicines and keeps a list of the medicines sent for disposal. Some medication administration charts were inspected and were well completed with individual photographs to aid identification. Storage arrangements are satisfactory. Residents said that they were treated with respect by the staff. One resident said “even the night staff knock on my door before coming in, even if I’m asleep”. Residents said that staff made sure their dignity and privacy was protected when they were carrying out personal care. Staff were seen to approach residents discreetly when asking about using the toilet or other personal care tasks. Residents were well dressed although some people’s hair looked unkempt. The manager advised that the hairdresser had not visited for almost three weeks and they were looking for a replacement. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 11 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): Standards 12 and 14. The range and frequency of social activities could be improved to offer the residents more opportunities for stimulation and fulfilment. Residents are encouraged and supported to maintain as much control and choice as possible over their lives. EVIDENCE: Since the last inspection there has been little change in activity provision. Entertainers visit the home regularly and weekly exercise sessions are held. Several of the residents said that they enjoyed the exercise sessions. Some residents who are avid readers have formed an informal book group. Several others enjoy reading the daily paper. There are a small number of residents who have dementia and consideration should be given to providing activities that will meet their specialist needs. Discussions with staff showed that this was an area in which they felt the home could improve. The manager stated that one of the care staff has previously worked as an activity organiser elsewhere and it is hoped will start to co-ordinate activities in the home. Staff were seen to give residents as much choice as possible. Residents said that they were able to make choices about their daily lives including what time they get up and go to bed. Staff interactions with the residents were warm and friendly.
Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 12 Standard 15 was not fully reviewed at this visit. However since the last inspection the cook now goes round to ask each resident individually what they would like for each meal offering them alternatives if they do not like the main meal. Staff were seen to do this at tea time asking each resident what they would like before serving the food. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 13 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): These standards were not inspected at this visit. EVIDENCE: Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 14 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): Standards 19, 24 and 26. The home is well maintained and provides a comfortable environment. Residents’ bedrooms are personalised and homely. The home is kept clean and odour free. EVIDENCE: The home is well maintained and provides a comfortable and homelike environment. Several of the bedrooms have been redecorated and refurbished since the last inspection. The roof has been retiled and an upstairs bathroom has been upgraded to provide assisted bathing and toilet facilities. There is an ongoing programme of redecoration and refurbishment. Residents’ rooms seen during the visit were comfortably furnished and personalised. One resident requires an armchair in her room and another needs lockable facilities. All bedrooms have door locks and residents are given keys to their own rooms. Residents said that they liked their rooms and were pleased to have their own things around them. All areas of the home seen were clean and free from malodours.
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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): Standards 27 and 29. Staffing levels must be reviewed to make sure that they are sufficient to fully meet the needs of the residents. Recruitment procedures are robust in making sure that staff are suitable before they start working in the home. EVIDENCE: Duty rotas are maintained. Some new staff have been recruited for both days and nights which has strengthened the staff team. Staffing levels are at a minimum level and it is difficult to see how the residents’ social and recreational needs can be met fully unless staffing levels are increased. Therefore staffing levels must be reviewed. Recruitment records for two staff were inspected, one who has started work at the home and another who is due to start. The records show that a thorough recruitment process is followed and references and criminal record bureau (CRB) checks are received back before the employee starts in post. Staff training records were not inspected at this visit. However the manager advised that nine of the care staff have started NVQ training and one of the domestics is doing NVQ level 3 in housekeeping. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 17 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): Standards 31, 33 and 35. The home is well managed. Quality assurance systems are limited and must be improved. Residents’ personal monies are safeguarded. EVIDENCE: The manager has submitted her application for registration with the CSCI and has started the Registered Managers’ Award. Staff said that they felt the home was well organised and that communication was good at all levels. They said that they were able to take any suggestions or concerns to the senior staff and were confident they would be dealt with appropriately. Records show that questionairres were sent out to residents and relatives in January 2005. Thirteen were returned with a number of comments but there was no information to show what action had been taken in response or how people would be informed of the action that had been taken. Some concerns had been raised in surveys sent out by the Local Authority about staffing levels at the weekend and late evenings and a lack of social activities. These concerns had been passed onto the home but there was no evidence to show
Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 18 how these matters have been addressed. However the surveys also identified that relatives were more than satisfied with the care and praised the loving, caring and professional approach of staff. The home must have suitable systems in place to be able to review the quality of care and provide feedback to all parties. As stated at the previous inspection, regular formal meetings for residents, relatives and staff would provide an opportunity for these matters to be discussed and feedback provided. Small amounts of residents’ personal monies are kept securely in the home on the resident’s behalf. The deputy manager advised that this is usually no more than £25 per person. Individual sheets are maintained for each resident showing all transactions and a running balance. Receipts are kept but need to be matched with the transactions recorded on the individual records. Two signatures were recorded for some entries but not others. It is recommended that two signatures are recorded for all transactions. The home does not act as appointee for any residents. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 19 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X X Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op7 Regulation 7 Requirement All residents must have a care plan, which is drawn up in consultation with them or their representative and, where possible, signed by them and the nurse completing the record. A choice of daily activities must be provided tailored to meet the needs of the resident as well as providing opportunities to go out. Staffing levels must be reviewed to ensure that they are sufficient to meet the needs of the residents. Systems must be in place to review the quality of care, show what action has been taken in response to feedback received and how this is communicated back to all parties. Timescale for action 31/12/05 2. op12 16 31/12/05 3. OP27 18 31/12/05 4. OP33 24 31/01/06 Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 21 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. 2. 3. 4. Refer to Standard op7 OP10 op32 OP35 Good Practice Recommendations All staff should be encouraged to contribute to the care records. Arrangements should be so that residents can have regular access to a hairdresser. Formal meetings should be introduced for residents, relatives and staff to promote and open and inclusive management approach. Two signatures should be recorded for all transactions relating to residents’ personal monies. Receipts should be matched to transactions recorded on individual sheets. Laurel Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Mount DS0000019880.V258346.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
