CARE HOMES FOR OLDER PEOPLE
Laurels EPH Ely Way Luton Bedfordshire LU4 9Q Lead Inspector
Andrea James Unannounced Inspection 17th November 2005 09:30 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.V266864.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. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Laurels EPH Address Ely Way Luton Bedfordshire LU4 9Q 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 847227 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.V266864.R01.S.doc Version 5.0 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. 26th May 2005 Date of last inspection Brief Description of the Service: The laurels was one of the 5 elderly persons home owned by the 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. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out 6 months after the last inspection. The manager was not available for the entirety of the inspection as a result the team leader on shift assisted with the inspection process. The manager arrived at the home at the end of the inspection. The inspection was carried out on the 17th of November 2005,which lasted for 5 hours. The inspection process followed a case tracking methodology where samples of the service users and care staff’s files were randomly chosen to inspect. The report consists of the views of service users, relatives, care staff and the manager. This report should be read in conjunction with the previous report to gain a full understanding of the home’s performance throughout the year. What the service does well:
The home provides care for 33 service users with varied degrees of dementia type illnesses and manages to offer satisfactory standards of care to these categories of service users. On observation the service users appeared well groomed and were attended to by care staff that spoke to them with respect. The service users spoken to said they liked the home and spoke about the “Girls” being very nice to them. The relatives spoken to said the home was very good, the staff were good and felt that they interacted well with the service users. They described the home as presenting a happy environment. One relative explained how the staff made extra efforts to accommodate service users when they were not well. They commented that the care staff would go the extra mile. The home also had regular input from external professionals who appeared to visit the home on a regular basis. The home ensured that the care staff received regular training and that they were updated on a regular basis. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The home had 33 service users but 11 of the service users in the home had high needs and as a result did not fall under their category of registration. The care staff explained that these service users had varied degrees of illness ranging from mental health to nursing needs and in trying to meet their needs resulted in them not be able to meet the needs of the other service users in the home. The home should therefore ensure that only service users registered to live in the home are allowed to do so. The registered providers should ensure that they are proactive in their approach in ensuring the needs of all the service users are met. The home should also address the issues of staffing resources. Relatives spoken to said they felt that there were insufficient staff around in the communal areas and service users were often left alone. The care staff spoken to commented that there were not enough carers on shift to meet the needs of the service users. The home needs to ensure the identified needs of the service users are reflected in their care plans in order that care staff can be clear about what they are expected to do for each service user. The home should also ensure that the Medication Administration Records Sheets (MARS) are satisfactorily completed to avoid medication errors. The Commission would like to thank the service users, care staff, relatives, the team leader and the manager for their co-operation in the inspection process. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 7 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. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 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.V266864.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 4 The home had satisfactory processes in place to ensure service users have the information they need to make an informed choice about living in the home and improvements have been made to the assessment tool used for new admissions, but some service users were still being placed in the home inappropriately. As a result service users needs were not being met and the home was illegally caring for service users outside of their registration conditions. The processes in place to ensure the home was able to meet the needs of more dependent service users was poor, as a result service users were at risk of being attended by staff who lacked the appropriate skills to meet their complex or nursing needs. EVIDENCE: The home had satisfactory Statement of Purpose and Service Users Guide that identified the resources available, which would enable service users to know what the home had to offer. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 10 The home had a pre- admission assessment and had implemented an admission assessment since the last inspection, however some service users were still being admitted to the home that had needs the home could not meet. The manager explained that some information was withheld from them and that was the reason for one service user’s admission. The manager also explained that she was put under pressure by external professionals to take the service users. The home was in the process of reviewing some service users in the attempt to have them appropriately placed. The manager explained that even when it was identified that they were not suited for the home there was a shortage of beds in other homes and as a result the service users had to remain in the home. The care staff spoken to said their moral was very low because of the increased expectation put on them to care for these service users who required increased attention or personal care. There was no evidence that the registered providers were ensuring the needs of all the service users are met. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. The care planning, health care and medication processes in the home had improved for some service users but further development was required to ensure consistency for all service users in regards to the care planning and the medication procedures, as a result some service users needs were not being met satisfactorily. EVIDENCE: The care plan inspected showed evidence that identified needs were recorded and some care plans received regular reviews and where possible consultation was gained for some service users. It was disappointing to note that still some care plans had not been developed after such a long time. Some care plans still failed to show clarity in respect of staff intervention and there was no consistency in the care planning processes. The problems identified with some service users as causing challenges to the home were not recorded in the individual service users plans and as a result the home was not clear as to how they were attempting to meet the needs of these service users.
Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 12 The home needed to ensure that the Medication Administration record sheets are filled in at all times. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12. The activities offered to most service users were good and as a result service users lifestyles had improved since the last inspection. EVIDENCE: There was evidence to suggest service users received better choice of activities. The activities book seen showed that service users were allowed to visit Woburn safari park, have pub visits and there were plans for them to visit the London to see the lights in the Christmas season. The home also had a weekly activities programme that was rotated to offer choice. Staff were seen playing basketball with some of the service users while other were offered nail care and other forms of entertainment. The care staff said only the more able bodies service users were able to embark on these activities. On observation the service users with greater degrees of dementia were not stimulated, as a result they were left for most of the day to watch television. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home had satisfactory processes in place to ensure service users or their relatives were able to complain and their complaint would be dealt with appropriately, as a result service users welfare was being protected by the homes complaints policy and procedures. The home was aware of how to identify and report suspected abuse to service users and as a result service users were protected. EVIDENCE: The home had corporate policies and procedures that ensured services users and relatives could make complaints and they would be death with satisfactorily. The home had 4 minor complaints from relatives since the last inspection and all complaints were recorded and resolved satisfactorily. The relatives spoken to said they were aware of the complaints procedure and would feel comfortable in making a complaint either to the manager or one of the staff members. The ensured that all care staff received their Protection of Vulnerable adults training and as a result they were aware of the procedures to follow should an abuse occur in the home. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26. The home was poor at controlling offensive odours as a result the environmental standards of the home were compromised. EVIDENCE: On entrance to the building offensive odours were identified. The care staff were seen to be vigilant in taking service users to the toilet but the smells identified appeared to be in the carpeted areas of the home. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. Staff moral in the home was low because of insufficient resources available to satisfactorily meet the needs of the service users. The home provided good standards of training to all care staff that ensured they were able to meet the needs of the service users. EVIDENCE: On the day of the inspection 7 care staff were available for the 33 service users. One care staff was working as a one to one to a difficult service user. Staff spoken to said they felt that they had insufficient carers to satisfactorily meet the needs of the service users due to having 11 service users who requires nursing care and as a result two carers were needed to care for each of these service users. They explained that it took between 3-4 hours each morning to get service users ready for breakfast. This resulted in the needs of other service users being neglected. One example of this was a service users who was a diabetic was fed very late because of insufficient staff available. On observation service users were left alone to have their breakfast and staff were not available in the communal areas to assist service users with their meals. Staff said they need more staff in order to meet the needs of all the service users. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 17 The home ensured all care staff were trained and competent to do their jobs. The training files inspected suggested care staff received mandatory training and additional training to meet the needs of the service users. However, only 16 of the staff group had achieved their NVQ level 2 in care. The manager said another 2 staff were due to complete. All the team leaders had their NVQ level 3 in care. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 18 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): 33. The oversight by the registered provider was poor, resulting in service users whose needs exceeded those able to be managed by the care home remaining at the home for an indefinite period. Where assessments had identified a service user requirement for a more appropriate placement the registered provider was not proactive in making arrangements for their needs to be met, leaving all service users at risk. EVIDENCE: The home had regular regulation 26 visits and it appeared that there was an oversight by the registered provider to ensure the needs of al the service users were met. The manager said some of the service users were allowed to remain in the home because beds were not available in other homes. This resulted in the home effectively operating outside their conditions of registration.
Laurels EPH DS0000033128.V266864.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 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X X Laurels EPH DS0000033128.V266864.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 OP3 Regulation 14 (1) (d) Requirement Arrangements must be made to ensure the home is suitable for the purpose of meeting the service users needs in respect of health and welfare. Arrangements must be made to ensure all service users are satisfactorily assessed before they are admitted to the home. Timescale for action 30/12/05 2 OP3 14 (1) 30/12/05 3 OP4 18 (1) (3) 4 OP7 15 (1) (b) 5 OP7 15 91) (c) Arrangements must be made for 30/01/06 the home to apply to vary their registration to include the current service users or make arrangements to better facilitate the service users needs. Arrangements must be made to 30/02/06 develop the care plans for all service users to ensure they reflect the needs of the service users and the care intervention to be carried out by the home. Previous timescale: 30/02/05 and 30/07/05. Arrangements must be made for 30/02/06 all care plans to be reviewed on a monthly basis. Previous timescale: 30/02/05 and 30/07/05
DS0000033128.V266864.R01.S.doc Version 5.0 Page 21 Laurels EPH 6 OP9 13 (2) The staff administering the medication must sign for all medications administered to the service users and must also indicate where medications are not administered. Previous timescale: 30/07/05 Arrangements must be made to eradicate the offensive odours identified in specific areas of the home. Arrangements must be made to ensure sufficient numbers of staff are available to meet the assessed needs of all the service users. The registered provider must make arrangements to ensure the home is run in the best interest of the service users. 30/12/05 7 OP26 23 (2) (d) 30/02/06 8 OP27 18 (1) (a) 30/02/06 9 OP33 7, 12 30/01/06 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 OP4 OP12 OP10 OP27 Good Practice Recommendations The home should implement an admission assessment tool to ensure they are able to meet the changing needs of the service users on admission. Arrangements must be made to ensure opportunities are available for better stimulation for service users with severe dementia. The home should ensure the privacy and dignity of the service users at all times. Risk assessments should be carried out on the duties of the night staff to ensure they are able to meet the needs of the service users in regards to manual handling and safe working practises. Laurels EPH DS0000033128.V266864.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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