CARE HOMES FOR OLDER PEOPLE
Laurel Villas 170/172 Tulketh Rd Ashton Preston Lancashire PR2 1ER Lead Inspector
Ms Susan Dale Key Unannounced Inspection 25th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Laurel Villas DS0000009834.V331096.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 Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Laurel Villas Address 170/172 Tulketh Rd Ashton Preston Lancashire PR2 1ER 01772 720609 01772 768908 laurel1702003@yahoo.co.uk 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) Laurel Villas Limited Mrs Susan Hall Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (22), Physical disability (2) of places Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Laurel Villas is registered as a care home that provides personal care and accommodation for up to 24 persons, both male and female over the age of 65 years. The home is located near to the centre of Preston in a residential area of Ashton close to shops and various local amenities. The home is not purpose built and arranged over two floors with access provided to all parts of the home via a lift. Accommodation is provided in single rooms and certain rooms are available for use as a double room if so required. The accommodation provides a homely atmosphere with plenty of communal space including a large lounge that overlooks a very attractive garden that can be easily accessed by service users. Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit was unannounced and focused on key standards. The inspector was able to speak to service users and staff and examine various records. Comment cards were provided to service users, relatives/friends and health professionals prior to the inspection. 1 comment card was returned from a service user and 4 comment cards were returned from relatives. All the responses were very positive and the results were taken into account as part of the inspection. What the service does well:
The home is well run with a family atmosphere and the staff work well together under the leadership of the registered manager who is well supported by the owner of the home. Staff are supported and encouraged to attend training courses and over 50 of care staff have an NVQ qualification. Staff are encouraged to work as part of a team and to participate in the running of the home. The manager is always looking for new ways to improve the home and has put in place a number of procedures to monitor the performance of the home. The large number of staff available ensures that staffing rotas are well maintained with ample staff to cover for absences. Every effort is made to ensure that service user whose health deteriorates are able to stay at the home with arrangements put in place to ensure appropriate care and attention are maintained. Service users spoken with were full of praise for the manager and staff and the general premises and facilities. All of them enjoyed the food and looked forward to meal times. Relatives made a number of positive comments about the care provided including: “Unrestricted visiting always welcomed, mum always ready if I want to take her out. If I telephone the home they will put mum on the phone to speak to me.” “There are a high proportion of mature staff at the home who show empathy and understanding. There are a few young staff who are delightful and who my mum responds to.” “If I have any concerns (usually minor) they are acted on promptly.” Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 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 Villas DS0000009834.V331096.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Each service user has a comprehensive assessment prior to admission to ensure that the services provided within the home meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New service users can be sure that the home is suitable for them by the decisions reached at the initial assessment and there ability to sample the services prior to permanent residency. All service users are able to sample the services for four weeks before agreeing to permanent residency. Specialist advice is sought as necessary and staff confirmed that they have received training to meet the needs of the service users. The assessment is generally carried out by the registered manager and her deputy; two senior staff have occasionally attended in order to learn the process.
Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 9 One service user recently admitted to hospital who then developed a pressure sore was assessed by the hospital as requiring Nursing Care. The family were concerned about her being moved and the manager carried out an assessment and asked to be allowed 10 days at Laurel Villas in order to improve her situation. The home was given a week only, but with constant care and frequent turning the pressure sore healed and she has been allowed to stay within the home and her family are delighted. Comments included: “Without input from the manager of Laurel Villas whilst my mother was in hospital, she would have probably ended up in a nursing home.” Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. A care plan is devised and delivered in a way that meets individual service users’ physical, health and emotional needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were examined; the initial assessment leads to an individual care plan that covers all physical health and emotional requirements. Any risks connected with the care of each individual are recognised and recorded. New service users and any person classed as vulnerable are provided with 2hour observations for as long as necessary. The daily recordings were up to date and clear with a review of the care plan carried out each month. A signature on the care plan had been obtained from the service user or a relative/advocate when possible. A record is kept of any input from health professionals there was clear evidence that advice had been sought appropriately and as frequently as
Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 11 necessary. A staff member spoken with confirmed that they had access to the care plans and they were easy to understand, at each change over of staff the details are exchanged over the care requirements and any concerns. The medication is stored appropriately and the medication record was examined and found to be up to date. Five staff have completed medication training – ‘Safe Handling of Medication’. Service users spoken to confirmed that staff are respectful and comment cards returned from service users confirmed that they feel well cared for and privacy is respected. Comments included: ”If there are any problems or situations that need medical assistance, they are very good and alert.” “Someone is always available when needed all the time.” “Very impressed with the care and attention my mum receives she looks better now than when she came in 2003.” “There are a high proportion of mature staff at the home who show empathy and understanding. There are a few young staff who are delightful and who my mum responds to.” Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Appropriate activities are in place according to the needs and capabilities of the service users. Meals meet the dietary requirements and choice of individual service users. Contact is maintained with family, friends and the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the initial assessment a recording is made of individual wishes with regard to hobbies and interests and any cultural or religious requirements. Activities include, Arts and Crafts once a week and relatives are encouraged to join in and able to have a glass of sherry with service users if they wish. The drinks trolley is also provided with chocolate biscuits every afternoon. Other activities include Dominoes, Bingo, Karaoke, Quizzes and playing cards. Special suppers are provided from time to time with the activities, the last one was at Christmas. Outings are to start in the summer with trips planned to the Guild Hall, Fairhaven Lake and an Ice cream Factory. Shopping trips are undertaken with the service user’s key worker and service users have trips to the pub accompanied by a member of staff. An entertainer has proved so successful; he attends the home once a month.
Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 13 Relatives confirmed that they are made to feel welcome at all times and service users spoken with confirmed that they are able to exercise control over their lives as much as possible and that all the staff are helpful and encourage them at all times. Menus are planned on a four weekly rota and cater for any service user on a specialised diet. Mealtimes were seen to be unhurried and assistance provided discreetly. The manager confirmed that in order to stimulate and encourage new menus, ‘themed’ days had been provided at which the menu was in keeping with the theme such as Chinese or Italian; a special menu was planned for Valentines Day. Service users spoken to confirmed that the food at the home was of a high standard and the menu offers variety and a choice of meals. Snacks and drinks are provided at regular intervals throughout the day. Comments include: “Meals are very good and a good selection.” “They often have activities to keep residents occupied and entertained to help them still enjoy life.” “The care home is very good, maybe more in the way of activities is needed on a daily basis for the residents who could participate. Some residents get very bored during the afternoon which leads to restlessness.” “Unrestricted visiting always welcomed, mum always ready if I want to take her out. If I telephone the home they will put mum on the phone to speak to me.” Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Policies and procedures are in place to ensure that service users are protected from abuse and any complaints/concerns are recognised and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a suitable complaints procedure and service users, relatives and any other interested parties are aware of how to raise any concerns. The registered manager has made improvements to how any concerns are recorded and the action taken following the complaint. There have been no complaints to the Commission for Social Care Inspection (CSCI). The home has suitable policies and procedure in place with regard to Adult Abuse and `whistle blowing’ and staff are provided with information at induction and foundation training. All staff are provided with training on Elder Abuse and also Empowerment and Diversity. Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. Service users live within comfortable safe surroundings that are well maintained and meet all their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bedrooms are re-furbished and decorated as rooms become vacant. The home has ample communal space, which provides a variety of recreational lounges and dining space. The home is now entirely non-smoking and the few service users who smoke have been provided with an area outside and staff accompanies them. The manager was advised that the Statement of Purpose should be updated to include the non-smoking details. The home has recently been checked by Fire Safety Officers and changes have been made to all doors to ensure they shut in the event of a fire.
Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 16 The dining room and lounge are due to be decorated and refurbished; there have been a couple of new chairs and a new computer, a new bath chair has been ordered for the upstairs bathroom. All areas of the home were clean pleasant and hygienic. Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. A suitable recruitment procedure is in operation that ensures the protection of vulnerable people and training is provided to staff that ensures they are competent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a suitable recruitment procedure and the records examined showed that appropriate references had been received including clearance by the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults Register (POVA). All staff receive a contract of employment and are expected to abide by the code of conduct set by the General Social Care Council. Staff confirmed that they had received induction training that includes the training requirements set by the National Training Organisation such as the principles of care and safe working practices. The induction training has been improved with a different programme for senior staff to complete to ensure their knowledge is according to their role. Staff also complete and experiences sheet prior to the induction. There has been a high turn over of staff and the reasons were discussed with the manager; a number of older staff have retired. The large number of staff
Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 18 available ensures that staffing rotas are well maintained with ample staff to cover for absences. There are 20 care staff and 13 staff have achieved a National Vocational Qualification (NVQ) and a further 2 staff are working towards the qualification. The number of trained staff means that the home has exceeded the requirement for 50 of all care staff to be trained to NVQ level 2. Foundation training is also provided and includes Moving and Handling, Health & Hygiene, Safe handling of Medicines etc. Further training planned is for Palliative Care and the 2 seniors are attending training on Fire Marshalling. Both seniors have been trained as First Aiders and one of them has been on a Dementia training course. Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. The service users and staff benefit from the competency and leadership of the manager and are given every opportunity to participate in the running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Laurel Villas has extensive experience in the management of care staff and obtained a qualification at NVQ level 4 and level 5 in Care and Management. The designated responsible individual and owner of the home who has also achieved an NVQ level 5 qualification supports the registered manager. The management and staff of the home have achieved the Investors in People Award on the 21st September 2005.
Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 20 As well as an annual appraisal, there was evidence that staff are provided with one to one supervision and are provided with a self assessment form to complete themselves prior to the annual appraisal. The individual supervision provides an opportunity for staff to discuss any issues they may have in the running of the home, service users or any training needs. Staff also complete a Colleague Appraisal form that helps in establishing an effective care team. Staff spoken with confirmed that they are well supported by the management of the home. Team meetings take place on a regular basis with minutes seen from the meeting held on the 2nd March 2007. Staff have been encouraged to become more involved in the running of the home by an Employee of the Month Award. Questionnaires are provided to service users every 6 months and there is also a suggestion box. A senior collates the details and the results fed back to staff at team meetings. Regular training opportunities are offered to staff on health and safety topics. Risk assessments have been carried out for all safe working practices; the health and safety of staff and service users is given careful consideration at Laurel Villas. The registered manager provided evidence in the pre inspection questionnaire of compliance with relevant health and safety legislation. An accident book is maintained and staff receive regular updates on health and safety topics. There is need for the registered responsible person to comply with Regulation 26 of the Care Standards Regulations that require a written report on the conduct of the home to be kept on file and be available to the Commission for Social Care Inspection by request. The report should also be made available to the registered manager. There is also a need for the registered manager to comply with Regulation 37 of the Care Homes Regulations that require notice to be sent to the Commission for Social Care Inspection of any death, illness or other event. Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 21 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 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1
2 3 4 5 6 X X 3 X X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 22 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 OP38 Regulation 26 Requirement The registered responsible person for the home must complete a written report once a month on the conduct of the home. The details should be kept on file and be made available to CSCI on request. The registered manager must give notice to CSCI of any death, illness or other significant event occurring within the home. Timescale for action 31/05/07 2 OP38 37 04/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Laurel Villas DS0000009834.V331096.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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