Inspection on 26/05/05 for Laurels EPH

This inspection was carried out on 26th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 11/12/07

Laurels EPH 04/07/07

Laurels EPH 01/02/07

Laurels EPH 17/11/05

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 Beds LU4 Lead Inspector Andrea James Unannounced 26th May 2005 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 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 I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Laurels EPH Address Ely Way Luton Beds LU4 01582 576877 01582 847227 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Luton Borough Council Maria Watkins Care Home 35 Category(ies) of DE(E) Dementia over 65 - 35 registration, with number of places Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 No of residents; 35 2 Gender: Male and female 3 Categories: Older people with Dementia DE(E) 4 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. Date of last inspection 6/01/05 Brief Description of the Service: The laurels was one of the 5 elderly person’s 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 I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Inspection carried out 5 months after the last inspection. The manager was available for the duration of the inspection. The inspection was carried out on the 26th of May 2005 and lasted for 6 hours and 10 minutes. The inspection process followed a case tracking methodology where samples of the service users files were selected at random to inspect. The inspector was able to speak to relatives, visitors, external professionals, staff, service users and management on the day of the inspection. What the service does well: The home provided care for 35 service users with varied degrees of dementia type illnesses and manages to offer a satisfactory standard of care. Service users spoken to expressed the amount of choices they were able to exercise, for example when to have their meals, when they wanted to get up in the mornings and when they went to bed. One service user said he was an early riser and wanted to get up between 5am and 6am. He said it was a nice home but did not like the idea of being locked in. This was because all the main doors were locked for the safety of the service users. The care staff offered satisfactory standards of personal care and on observation the staff appeared dedicated and caring. The service users were treated with a degree of individuality. External professionals spoken to said the home treated the service users as individuals and were acquainted with all their needs. The inspector was informed that the home had a proactive approach to the health care needs and mental state of service users and did not over medicate service users but always chose to use behaviour management at the onset of disruptive behaviour and medication as a last resort. The records examined suggested that the care staff received regular 1:1 sessions with a senior member of staff and all staff expressed that the standard of training provided was of a high standard. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 6 The home had satisfactory recruitment procedures in place and was fully staffed, which resulted in better levels of care being provided to the service users. The home was equipped with a satisfactory number of ancillary staff that complimented the care staff team. The catering team spoken to showed evidence that they were aware of the various dietary requirements of the service users and the meals provided offered choice and tasted nutritious. The home had a recent environmental health inspection and it was apparent that satisfactory procedures to ensure the welfare of the service users were being maintained. What has improved since the last inspection? What they could do better: Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 7 On arrival to the home some service users were seen undressing in the communal areas of the home. This was concerning because staff were seen to walk by oblivious to the fact that service users dignity was compromised. Although some improvements were seen for some care plans there was a need for further development to be made to the majority of them. This was to ensure service users needs are identified and met in accordance to the provision of care provided by the home. There was also a lack of risk assessments available and there was no evidence that service users were consulted about the care they received. It was evident from case tracking that the home was proactive in identifying and addressing the mental state of the service users but this was not recorded in the service users plans. The homes medication procedures needed further development to ensure the medication administration record sheets are correctly completed at the end of all administration of medication. Some medication sheets also failed to show correct receipt of medication. The activities the service users were offered were not always their choice, or specific to their wants and needs. The inspector observed staff taking individual service users for walks around the gardens and others receiving nail care. The home had an activity programme but there was no evidence that this was adhered to and that choices were offered. The records inspected suggested that some service users were able to visit the local pub but this was not on a regular basis. Visitors to the home commented that more activities were needed in order to stimulate the service users. The staff spoken to felt that they did not always have the time to carry out activities as the personal care needs of the service users took priority. The inspector would like to thank the service users, relatives, visitors, care staff, ancillary staff and the manager for their co-operation during the inspection process. 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 I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 standard(s) 3,4 and 5. The home created an environment where service users were able to make a choice regarding admission to the home. EVIDENCE: The home carried out a pre- admission assessment prior to all service users arrival in the home. The manager said some service users were allowed to have respite care before permanent placement was taken up. Relatives spoken to said they were allowed to view the home prior to the admission of their relative. The manager was not always able to make the final choice of admissions but had an opportunity to review the service users on admission to ensure their needs were being met. The inspector was able to see service users removed from the home if the staff team could not meet the needs of the service users. External professionals spoken to said the care staff were competent in meeting the needs of the service users on an individual basis. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11 The care planning procedures in the home had improved for some service users but others remained undeveloped. The health care needs of the service users were satisfactorily met and produced a good outcome for the service users. Further development was required for maintaining service users dignity. EVIDENCE: The manager informed the inspector that she had delegated the responsibility of the care plans to the team leaders. On inspection of the care plans some of them appeared to have almost met the requirements of the standards while other needed further development. The inspector identified that various needs identified in the service users documents were not clarified in the care plan documentation. There was also a need for further risk assessments where service users may pose a risk to themselves and others through challenging behaviours. The health care needs appeared to have been met. The home was proactive in identifying the changing needs of the service users. External professional spoken to said the home made appropriate referrals at the correct time which prevents service users further deterioration of health. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 11 The medication procedures within the home were satisfactorily maintained however the Medication Administration records Sheets showed that the care staff were not consistent in recording when medication was administered. The external medical professionals spoken to said the care staff were competent in administering medication and felt that they did not over medicate but used behavioural management programmes to maintain service users. It was said that medication was only used as a last resort for service users with challenging needs on PRN medications. Service users were observed to mostly be treated with dignity but, due to the nature of the client group, this was compromised at times. The inspector observed on two occasions service users undressing in communal areas. On one occasion a staff member walked by oblivious to the service users exposure. The arrangements for service users once deceased were available for some service users but the home needed to ensure all service users wishes were documented on file. In previous inspections the home managed the death of service users in a sensitive and professional manner. One deceased service users care plan was inspected and the documents suggested that the home acted in a professional manner. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 The service users appeared to have a limited choice due to the nature of the client group but lived in accordance with their expectations. The home encouraged family contact and the meals provided catered for various dietary requirements. This resulted in meal times being a very enjoyable time for the service users. EVIDENCE: The service users experience some activities that help to provide a fulfilled life style, however there was a lack of choice of activities and the programme implemented was not always adhered to due to the lack of allocated staff. Service users wanting to leave the home were only allowed to do so when sufficient staffing was available. One service user was enabled to walk around the grounds of the home with a staff member and the activities book showed that some service users were allowed to visit pubs. It was difficult to establish whether religious and cultural needs were met, due to insufficient information in the care plans. Family contact was encouraged within the home and relatives spoken to said they were always made to feel welcome. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 13 The meals provided for the service users were varied and offered choice. A 4 week menu was on display and the catering staff explained the dietary needs of the service users which demonstrated a knowledge of the service users needs. The inspector was able to taste one of the choices available on the day, which was nutritious and attractively presented. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 standard(s) 19,25 and 26 The environmental standards of the home were satisfactory in meeting the needs of the service users and the home had future plans for further development. EVIDENCE: The home had made improvements to the environmental standards since the last inspection. The inspector was informed that some furnishings had been replaced in some service users bedrooms to maintain high standards of hygiene. The home appeared satisfactorily decorated and continuous maintenance was evident throughout the building. On the day before the inspection the blinds to the conservatory were being replaced due to their unsuitability. No evidence of offensive odours was identified except for those expected when toileting and accidents occurred. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The home was fully staffed but there was a need for better allocation of staff during peak times. EVIDENCE: The home was fully staffed and the manager reported that all her vacancies were filled. This was a great achievement for the home. The inspector spoke to some care staff who felt that the numbers of staff allocated to the shifts were insufficient in meeting the needs of the service users at peak times during the day. One staff said she felt the home was still short staffed especially with 11 service users needing all personal care to be delivered by two carers. The rotas showed that 5 staff were available on the shift and the team leader was in addition to this. The manager felt that, when needed, the team leader would also perform care duties and felt the numbers were sufficient in meeting the needs of the service users. The home’s recruitment procedures were satisfactorily maintained and new staff were benefiting from the corporate induction programme. Staff at the home were experienced in meeting the needs of the service users including staff being recruited from different cultural backgrounds to break down cultural and language barriers for some service users. The training programme was detailed and the evidence inspected showed that various mandatory training was scheduled along with additional training to meet the needs of the service users. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36 and 38 The manager of the home created a positive image where relatives, service users and staff were able to communicate in an effective manner. EVIDENCE: The manager had several years experience in care and appeared knowledgeable about the needs of the service users. The records inspected showed that staff received regular supervision and staff meetings were held on a regular basis. The manager operated an open door policy. Relatives spoken to said they were able to speak to the manager if they had a problem. During the inspection several service users came to speak to the manager who was always courteous and warm in answering their requests. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 18 The home’s health and safety policy was satisfactory. The staff had health and safety training and regular training in manual handling was provided. The staff spoken to said they were aware of health and safety. Ancillary staff had recently been trained in Infection Control, Fire and Food and Hygiene. Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x x x 3 x 3 Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? 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 15 (1) (b) Requirement Arrangements must be made to 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. Arrangements must be made for all care plans to be reviewed on a monthly basis. Timescale for action original date: 30.02.05. new date: 30.07.05 original date:30.02 .05. new date:30.07 .05 30.07.05 2. op7 15 91) ( c) 3. op7 15 (1) (b) 4. OP7 15 (1) Arrangments must be made for consultation to be gained where possible from the service users about the care intervention intended for them at the home. All service users safety must be assessed and appropriate risk assessments implemented to ensure the welfare of the service users. All medications administered to the service users must be signed for by the staff administering the medication Arrangements must be made for service users to be stimulated by offering them a wider variety of activities on a daily basis. 5. op9 13 (2) original date: 30.02.05 new date:30.07 .05 30.07.05 6. op12 16 (2) (n) 30.07.05 Laurels EPH I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 21 7. op12 16 (2) (n) the home must ensure that service users are enabled by the care staff to participate in the actvities of their choice. 30.07.05 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 op10 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 should be made to implement a privacy and dignity policy within the home. 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 I51 S33128 Laurels V230146 260505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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