Inspection on 11/12/07 for Laurels EPH

This inspection was carried out on 11th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Laurels EPH 27/01/09

Laurels EPH 04/07/07

Laurels EPH 01/02/07

Laurels EPH 17/11/05

Laurels EPH 26/05/05

Laurels EPH 06/01/05

Laurels EPH 17/08/04

Laurels EPH 26/02/04

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

CARE HOMES FOR OLDER PEOPLE Laurels EPH Ely Way Luton Bedfordshire LU4 9QN Lead Inspector Andrea James Unannounced Inspection 11th December 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 Laurels EPH DS0000033128.V355933.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. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurels EPH Address Ely Way Luton Bedfordshire LU4 9QN 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) 01582 576877 01582 847244 maria.watkins@luton.gov.uk Luton Borough Council Maria Watkins Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No of residents; 35 Gender: Male and female Categories: Older people with Dementia DE(E) Provision for one named male under the age of 65 years, for respite care only; this condition refers only to the service user named on the variation application and for no other. The conditions of registration will revert to those that had been approved prior to the date of this certificate, when the service user attains the age of 65 years, or no longer requires the service. 11th October 2007 Date of last inspection Brief Description of the Service: The Laurels was one of 4 elderly persons home owned by Luton Borough Council. It provided care for up to 35 older people with a diagnosis of a dementia type illness. All the places at The Laurels were admitted through Social Services. The accommodation at The Laurels was on two levels with the main communal areas on the ground floor. The upper floor could be accessed via stairs or a passenger lift. The home had an enclosed garden to the rear of the building and a parking area to the front. The Laurels was situated in a residential area of Leagrave, a suburb of Luton, close to a range of amenities and public transport links. Information provided regarding the home’s range of fees stated that the weekly fee was circa £630. These fees did not include newspapers, hairdressers, personal telephone, toiletries or private chiropodist; these services would incur an additional charge. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Inspection carried out by Andrea James on the 11th of December 2007. The inspection lasted for 8 hours and the registered manager was present for the duration of the inspection. The inspection followed a case tracking methodology where a sample of people using the service was randomly selected. 5 users files were inspected and several staff and users spoken to. The communication skills for some of the users were limited due to their dementia type illnesses. The inspection also consists of views from relatives and a tour of the building undertaken by the inspector on the day of the site visit. The reason for the site visit was to undertake a key inspection, check compliance with the last inspection report and inspect key standards to ensure users safety. The inspector would like to thank the manager, care staff, users of the service and the relatives for their support and cooperation in the inspection process. What the service does well: The home provided a safe and homely environment for the users that met with their needs. Relatives spoken to said, “ it’s a lovely home, staff are good and friendly”. The home showed that they were effective in listening to the views of people using the service. The residents meetings held was published in the main hall and it showed that the home provided both in house and outdoor activities for the users. In recent months some users had been to Woburn Safari and to South end. They also had had a bon fire night. The photographic images of these events were also displayed on the walls in the communal areas of the home. The home was good at ensuring relatives were kept informed of any events of changes that affected their relative in the home. One relative whose mother was receiving palliative care was kept informed at all stages and was invited in to have an informal talk about the illness by the manager. The service also offered a satisfactory diet to users and choices were offered. Users who had to have soft diets received this in an attractive and welcoming way. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Since the last inspection there was evidence to suggest the manager and staff had worked hard in order to ensure compliance for requirements made in the last inspection. As a result the following areas had improved: • • The home ensured all users had a contractual agreement with the amount to be paid included in the document. Appropriate risk assessments and manual handling assessments had been implemented for users in areas that could pose harm to their lives. The care plans for users showed specific instructions on how best to meet the needs of users, these were reviewed and updated monthly. Several records showed that procedures for promoting the health and welfare needs of the users were effectively implemented. The storage, administration and stock control measures for medication was in place and care staff received competency checks to ensure this is adhered to. The percentage of users having crushed medication had also decreased. People using the service had suitable bathing facilities that was safe and in good working conditions. Good systems were in place to ensure the views of users and their relatives were obtained in regards to quality assurance. • • • • • What they could do better: The home should ensure that: • • Sufficient numbers of staff are available at all times to meet with the needs of people using the service. Manual handling assessments clearly identify the risk to the users and the carer. DS0000033128.V355933.R01.S.doc Version 5.2 Page 7 Laurels EPH • • • Where PRN medication is to be administered that clear guidelines are written to ensure transparency and consistency. All Medication Administration Record Sheets (MARS) are signed when administration of medication occurs or is refused or omitted. Satisfactory Infection control measures should be in place to protect users of the service. All areas of the home protect users privacy and dignity. All carer’s individual training programmes are updated to reflect current needs and achievements. It provides an environment that is dementia friendly. • • • 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. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 2 and 3. People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. The home does not provide intermediate care. Satisfactory systems were in place that ensured users received a preadmission assessment and a comprehensive assessment on admission along with a contractual agreement signed and dated by both parties, as a result users assessed needs were met. EVIDENCE: The home ensured that all users received a contractual agreement upon admission to the service. Those inspected showed that the cost of the placement was recorded in the contract and it was signed by the council’s representative and the user or their representative which was also dated and kept on file. The manager said the users were also issued with a copy. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 10 The home had assessment records for all users in the form of a tick chart, which was satisfactory in identifying the immediate needs of users. This could however be developed by having further assessments included to identify levels of dementia. The home also carried out a full comprehensive assessment, which was undertaken in a six-week period to gain a better understanding of the needs of the users. There was evidence that the user or their representative was consulted in this process and it also formed the basis for developing their care plans. The contents of the assessment included personal care, diet, communication, sight, hearing, medical, oral, foot care, mobility, continence, medication, mental state, falls, social, risks and family. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 7,8,9,10 and 11. People who use the service experience an adequate quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. Systems were in place to ensure users were treated with respect and the health care needs were identified and met in regards to personal care and medication, however further development was needed to ensure all procedures for administration of medication is recorded in line with procedures, as a result errors could occur and users could be put at risk. EVIDENCE: Five of the users care plans were inspected and all showed that they reflected the current needs of people using the service. There was evidence that they had been reviewed and where identified relevant risk assessment and manual Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 12 handling assessments were undertaken. There was a need however to ensure the severity of the risk in regards to manual handling was clearly identified. The inspector was also informed and shown evidence to suggest that all care staff received care planning and risk assessment training in recent months. There was also evidence to suggest users and their relatives were consulted when the care plans were implemented. Night care plans was implemented to identify specific needs and some care plans also had the photographic image of the user in order to reduce errors. The daily recording of users activities such as daily notes, meals eaten, accident forms and GP’s notes were held separately and as a result could create inconsistency in recording as it may not reflect the needs of the users. This was of particular importance that all records are held collectively as the home used several hours of agency cover and these staff may not be aware of the day-to-day procedures. The inspector was informed that it was the lack of storage space that created this procedure but she was hoping to resolve the problem in the near future and all records would be stored together. There was evidence to suggest users needs were fully met and where the home identified needs that were outside their remit then external professionals were called. The users spoken to said they felt confident that the home was able to meet their needs. Relatives spoken to also said that the home was meeting the needs of the users and was happy with the care staff. Records seen suggested that care staff received specialist training in meeting the users needs. In recent months the care staff embarked on dementia awareness training and two care staff spoken to said they were due to embark on the training in January 2008. The home had new medication policies and procedures that ensured the safety of the people using the service. The policy showed various guidelines to follow for ordering, receiving and disposing of medication. Records inspected showed that 20 staff received medication training. The medication room was airconditioned to ensure satisfactory temperatures were maintained and all medication including controlled drugs were safely stored and accurately audited. The home used the MDS system and as a result the likely hood of errors occurring was minimised. The inspector was also informed that the number of users needing medication crushed had reduced to just one user. There was however further development needed to ensure all medications administered or omitted is signed for in accordance with the policies and procedures. There was evidence to suggest users were treated with privacy and dignity and although most users cognitive abilities were impaired and could not say how they were being treated, from observation care staff appeared friendly and warm to users. Care staff were observed to attend to users with tenderness and a warm caring nature was displayed. Relatives spoken to said the carers Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 13 were very nice and would do anything for the users. The users were seen to freely wonder around the home. The home ensured that the end of life care provided for users was handled in a sensitive manner. One user was receiving palliative care on the day of the inspection and the manager explained that she took time to meet with the relative and explain the illness and what to expect. The care plan for this user showed that regular checks were to be undertaken and relatives were to be kept informed both day and night of any changes. There was also evidence that equality and diversity would be addressed. All care plans recorded the wishes of the users in the event of their death. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. 12,13,&15. People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. People’s lifestyle in the home suggested that they had good social activities and daily living; as a result their interests were being maintained. EVIDENCE: The home produced evidence to suggest the people using the service enjoyed a lifestyle that met with their expectations. Records including resident meeting suggested that their views were being listened to and where possible they were carried out. The inspector saw that “age concern” was able to assist in some of the areas of need identified for some users. The users had recent trips to Woburn Safari Park, South end and had in-house activities such as bonfire parties. The home had recently employed an activities coordinator who spoke passionately about the plans she had to engage the users. The relatives had recently formed a family support group that met quarterly to discuss common issues that would benefit the people using the service. The inspector was also informed that the relatives were involved in choosing the colours for their relatives’ rooms that had recently been refurbished. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 15 The home encouraged users to maintain contact with their families. One user was able to maintain contact with his wife on a daily basis and provisions were made to ensure privacy was provided for them. Relatives spoken to said they were always made to feel welcome and could take their relative out if they wanted to. One relative spoken to said his mother was happy at the home and couldn’t change anything about how his mother was cared for. People who use the service were encouraged where possible to exercise choice and make decisions about their lives. Users bedrooms were individualised with personal possessions and one user’s relative said they were encouraged to bring in residents personal belongings. Relatives were also encouraged to choose the colours of the bedrooms. Age concern also visited the home on a regular basis in order to advocate for the users. The inspector spoke at length with the catering staff that spoke knowledgeably about the menu and the various needs they catered for. The menu was available in the dining room and on the day of the inspection an alternative was made to one of the main course but users were able to make a choice of what they wanted to eat. The home also catered for users requiring soft diets and diabetics. The inspector observed that tea ad coffees were provided periodically throughout the day. The nutritional intake for the day was also recorded on individual users records and where users failed to eat this was monitored. Care staff were observed assisting users to eat their meals and consume beverages. This was carried out in a respectful and sensitive manner. People who use the service spoken to said the meals were “nice” and relatives also said they felt the home provided nutritious meals. One relative said his mother had gained weight since she arrived at the home and she looks better for it. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 16 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. People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. The home had satisfactory complaints and safeguarding procedures and procedures were in place that suggested alerts were made to the appropriate authorities when required, as a result users were protected. EVIDENCE: The home had not received any complaints since the last key inspection but relatives spoken to said they knew how to complain should they need to do so. There was evidence to suggest any complaint received would be documented and recording in line with the council’s complaints procedures. The home alerted CSCI and local authorities of two issues under safeguarding procedures which were dealt with satisfactorily. Where users were at risk satisfactory risk assessments and preventative methods were implemented to protect both the perpetrators and the victims. Training records seen suggested that 8 staff received safeguarding training and a further 13 were due to commence the training in February 2008. Most care staff spoken to were aware of the procedures to follow in the event of a suspected abuse Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 17 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): 19,20,23,24,25 26. People who use this service experience an adequate quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. The environmental standards of the home met with the needs of people using the service, however further development was needed to ensure all areas of the home are user friendly and safe, as a result some users could find the home unsatisfactory. EVIDENCE: The home was undergoing major refurbishment and as a result had six rolling rooms (vacancies). This enabled six bedrooms to be refurbished at once and to cause as little disruption to users as possible. The inspector have seen great improvements in the work carried out to date of the site visit and it showed that users were consulted in the processes to ensure choice was given. The inspector was informed about the work planned for the future to refurbish the home in its entirety. This for example included the blinds in the lounge that Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 18 have been missing for a considerable time and replacing other furnishings that was torn and worn. The inspector discussed with the manager the need to ensure the home was decorated with the users with dementia in mind, as this had not been achieved to date. The home appeared to be satisfactorily maintained and safe for users. The inspector observed that users were able to access most areas of the home but some doors were locked to ensure safety. The outdoor facilities were restricted, again this was due to the level of dementia users had and so would not be able to access outside activities unsupervised. The inspector had a tour of the building and was able to view a sample of the users bedrooms. All seen were clean and satisfactorily decorated with pastel colours with furnishing to blend in with the decorations. The users spoken to said they liked their bedrooms and where users required they were able to have personal music centres and television sets. The communal areas of the home appeared safe and comfortable and users were able to sit in different areas of the home. The home also appeared clean and was free from offensive odours. There were several domiciliary staff that ensured the hygienic standards of the home were maintained. The manager addressed the identified hazard in the specialist shower room and purchased an equipment to accommodate the user needing two carers to manual handle but this equipment was deemed to be too cumbersome for the shower room and will be taken away to be used at a different site. This will result in the shower room not suited to be used for user requiring manual handling but the manager was aware of this and had risk assessments in place to ensure only able bodied users are encouraged to use that room. There was however a need to ensure grab rails are placed in the room for extra safety for users, as the room can be a hazard when wet. The bath panel identified in another bathroom have been repaired and made safe for the users. Repairs have also been made to the bedroom sinks and in most cases have been replaced under the current refurbishment work being undertaken. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 19 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. People using the service experience a poor quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. Satisfactory recruitment systems were in place to protect people using the service but further development was needed to ensure sufficient numbers of trained and competent staff are available at all times in the home, as a result users are at risk. EVIDENCE: The home had robust recruitment procedures and the files inspected suggested satisfactory clearances were obtained prior to employment. One new member of staff’s file was also inspected which showed that he received satisfactory training and induction. The inspector was also able to speak to this member of staff who said that he was happy with his induction and the level of training he had undertaken so far. The records seen also suggested that he was due to embark on several training courses in the near future. The inspector spoke to several members of staff and most of them complained that they felt that there was insufficient numbers of staff to satisfactorily meet the needs of the users. The home had 29 users (6 vacant beds due to the refurbishment). 11 of these needed two carers to cater for their personal needs due to manual handling risks. The rota should have a minimum of 5 carers to meet the needs of the users in regards basic residential care but as the needs of the users were higher there is a need to ensure more carers are available. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 20 The rotas seen suggested that at times only 4 carers had worked a shift. Some care staff said they have had to work with as little as 3 staff per shift at times. The manager explained that she had been recruiting but this has not been as successful as she had hoped. The home used on average of 4 agency staff to cover shifts per day and sometimes the agency cover failed to turn up. The impact of this resulted in a staff team that explained to the inspector that they were stressed because they have been working long hours. Some staff explained that the situation was also worsened by the lack of dedication from other staff members, which results in some staff working harder to ensure consistency for the people using the service. The manager said she was aware of the problem and was doing all she could to address the issues. The inspector was informed that they had been onto the agency to ensure they send reliable care staff and had 6 staff on standby over the Christmas and New Year period. The manager had also re-advertised the posts, which currently stands at 5 part time vacancies. The home provided satisfactory standards of training and all care staff spoken to said they received training. The records however were not transparent to reflect the level of training offered. The care staff individual training records were outdated and did not reflect current-training needs had been identified. Some were outdated as mush as 2002 to 2005. The inspector was reassured that some training had been provided. The inspector spoke with one of the in-house trainers who provided evidence to suggest all the carers received care planning and risk assessment training in recent months. Some information received showed this was undertaken on the 31st of October 2007. Another letter seen suggested 7 staff undertook Mental Capacity Act training level 1 on the 23rd of October 2007. Health and Safety in the workplace in August 2007, Safeguarding on the 8th of October 2007. Dementia November 2007 and 20 staff received medication competency training that was accredited by a reputable organisation. The records seen did not demonstrate how many carers had achieved their NVQ level 2 or above in care. Some carers spoken to said they had obtained this qualification, while others said they did not have this qualification. The last report suggested 51 of the staff had achieved their NVQ level 2 in care. There was evidence to suggest the home provided staff with “Skills for Care” induction and foundation training. This was in addition to and supported the home’s own induction training which also included the local authorities corporate induction day. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 21 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): 31,32,33,35,36 & 38. People who use the service experience an adequate quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. Systems were in place to ensure effective management structure were in place and users views were satisfactorily monitored, however further development was needed to ensure all aspects of health and safety was maintained, and effective quality assurance policies were implemented, as a result some users could be at risk. EVIDENCE: The management of the home remained consistent and the manager was dedicated to ensuring the home was compliant with the regulations. Users, relatives and some care staff spoken to said the home was managed effectively. The manager had team leaders who also ensured the smooth Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 22 running of the home. However some care staff felt that the manager did not understand the pressures that they faced and felt that better communications could improve the situations that they currently faced. There was evidence to suggest the care home was run in the best interest of the people using the service, through their quality assurance systems seen. Although the quality assurance policy had not been implemented several monitoring procedures were seen that demonstrated the views of users were sought and the home was committed to listening to users and their relatives. These included regular residents meetings, advocacy meetings, the homes quality audit that had been revised that looked at all the regulations and how the home was able to meet them, quality monitoring forms for complaints and concerns. The 2007 audit also showed that 88.8 of relatives and friends were greeted in a welcoming manner, 22.2 felt users were treated with privacy and dignity and 44.4 thought the service offered to users was excellent. Staff spoken to said they received supervision and appraisals. They commented that they received quarterly supervisions from the team leaders. There was evidence to suggest that these took place, however there was no recorded evidence to suggest a supervision agreement was made. Some files inspected showed that a copy of supervision and disciplinary actions were held on file. These however were not inspected due to confidentiality. The care staff said they received regular team meetings and records seen suggested that both day and night staff received team meetings. There was evidence to suggest the home had a health and safety policy and most procedures were adhered to. The inspector saw satisfactory fire procedures to include evacuation, fire drills, fire risk assessments and fire training for all care staff. There was however a need to ensure Infection control measures are reviewed to reflect the procedures as one carer informed the inspector that the flannels used for users faces were also used for carrying out other personal care which was unhygienic and did not reflect users dignity. There was also a need to ensure carers do not work excessive hours, as this could be a risk to both the users and the carers’ health. Care staff spoken to said they felt a need to work extra hours because they did not want to leave the users un attended. The manager said no carer worked over 48 hours per week but found out that some had taken extra bank hours at other places within the council. There was evidence to suggest that lifts and electrical appliances received their annual checks and records seen suggested they were safe for use. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 x X X 3 2 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 X 2 Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 24 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 13 (4) Requirement Arrangements must be made to ensure all manual handling assessments identify the level of risk to the user. Previous timescale 30/11/07 Arrangements must be made to ensure signatures are obtained for all administration of medication. Arrangements must be made to ensure the home provides privacy to users at all times. Arrangements must be made to ensure the environmental standards meets the needs for users with dementia. Arrangements must be made to ensure sufficient numbers of staff are available to meet the needs of people using the service. Arrangements must be made to ensure individual training programmes are implemented and up to date to reflect current training courses undertaken. Arrangements must be made to ensure quality assurance policies DS0000033128.V355933.R01.S.doc Timescale for action 30/01/08 2. OP9 13(2) 15 30/01/08 3 4 OP19 OP19 23 (2) (e) 23 (1) (a) (b) 18 (1) (a) 30/03/08 30/03/08 5 OP27 30/01/08 6 OP30 18 (1) (c) (i) 20/02/08 7 OP33 24 (1) (a) (b) 09/03/08 Laurels EPH Version 5.2 Page 25 8 OP38 12 (3) and procedures are satisfactorily implemented within the home. Previous timescale 30/06/07. 30/09/07 and 30/11/07. Arrangements must be made to ensure satisfactory Infection Control measures are in place to protect people using the service. 30/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The home should keep under review and where appropriate revise the statement of purpose and the service user guide. Information about the home including residents’ contracts & the service user’s guide should be made available in formats suitable for each resident. Not inspected at this site visit. 2 OP7 Arrangements should be made to ensure the records of all users are stored collectively. Laurels EPH DS0000033128.V355933.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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