Inspection on 27/01/09 for Laurels EPH

This inspection was carried out on 27th January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Laurels EPH 11/12/07

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 08/06/2011.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Laurels EPH Ely Way Luton Bedfordshire LU4 9QN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrea James     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Laurels EPH Ely Way Luton Bedfordshire LU4 9QN 01582576877 01582847244 maria.watkins@luton.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Luton Borough Council Name of registered manager (if applicable) Maria Watkins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Laurels provides 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. Care Homes for Older People Page 4 of 27 care home 35 Over 65 35 0 Brief description of the care home Information provided regarding the homes range of fees stated that the weekly fee was £630. These fees did not include newspapers, hairdressers, personal telephone, toiletries or private chiropodist; these services would incur an additional charge. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection undertaken on the 27th of January 2009 by the Commission. The manager was present for most of the inspection process and the area manager was also available for feedback. The inspection process lasted for 7 hours. The inspection followed a case tracking methodology where a sample of people using the service were selected and where possible they were interviewed along with their key workers and relatives. Their files in terms of care plans and other records were also inspected. On this inspection a further methodology was used where an expert by experience spent 3 hours speaking to people to find out what is was like for them living at the home. He spoke to 9 people to include 5 more needy people and 5 members of staff. Care Homes for Older People Page 6 of 27 The report will therefore reflect both methodologies used. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 27 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available to people was of a good standard, as a result they were able to make an informed choice of whether or not to use the service. Evidence: The home provided sufficient information for people to be able to make an informed choice about using the service. The Statement of Purpose and Service User Guide were reviewed and updated in 2008. The Statement of Purpose detailed 35 different policies and procedures relating to the functioning of the service. The Service User Guide was renamed and called welcome to your new home. This document detailed the key worker system, services available to people, facilities and the qualifications of the staff. We also saw evidence of the aims and objectives of the home and the policies and procedures to protect people from abuse and ensure complaints can be heard was also Care Homes for Older People Page 11 of 27 Evidence: implemented. These documents were made available to visitors and people use the service and copies were seen on display in the communal areas of the home. A sample of care plans inspected showed that initial needs assessments and comprehensive assessments were undertaken for people prior to admission and upon admission to the service. We case tracked one person who had only been in the home for five days. This person received a pre-admission assessment. The contractual agreements for people use the service or implemented and kept on record. Those expected showed that people were able to sign and date these contracts along with a placing authorities and the cost of the placement was clearly recorded. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs were being met in regards to the care interventions recorded and the systems in place to ensure people are treated with respect. Evidence: A sample of three care plans were inspected in detail to ensure the health and personal care needs of people were being met. Of these care plans one was a new admission to the service another of a person with high needs while the other was randomly selected due to medication intake. In general the care plans were of a good standard we saw evidence to suggest comprehensive care plans were undertaken and kept under review and covered areas such as general health, physical health, communication, harm, diets, skin, mental health, personal care etc. Care plans were detailed and suggested that they were reviewed on a regular basis. There was also evidence to suggest peoples signatures were sought to ensure they agreed with the care plan prior to implementation. The home also identified where peoples needs could no longer be met within the home and had been proactive in finding alternative placements where peoples needs would be best met. Care Homes for Older People Page 13 of 27 Evidence: Risk assessments are also in place for several areas and again these are kept under review. However some care plans implemented were not necessary as they failed to have any intervention for staff to follow for example one person who had no personal care needs intervention such as combing hair and brushing teeth had a care plan for staff to follow. In two of the three care plans we failed to identify any interventions to ensure people were stimulated through appropriate activities. Policies and procedures for the safe Administration, storage and recording of medication were being maintained. We saw satisfactory audit trails undertaken by the manager on a regular basis to ensure this procedure safeguards people. All staff administering medication were also subjected to competency tests in recent months and medication audits were undertaking in 2008 in an in-depth manner. A new medication policy brief was also implemented. We observed the staff to competently administer medication in a safe way. The home was able to maintain medication for 30 people currently using the service and all medication administration record sheets were satisfactorily maintained. However two people receiving controlled drugs signatures were missing for one date. This was the night before the inspection and up on identifying that the controlled drug book was not signed we were informed that this was merely down to human error. The team leader explained that at the end of administering the medication the night before two members of staff had a disagreement and as a result she was distracted from signing the controlled drug book with one of the staff involved. We were satisfied that the outcome for people who took controlled drugs was satisfactory and this has never happened before. This book was audited on a weekly basis by the home manager who was surprised at this discovery. All other areas in regards to medication were of a good standard. People who use the service said there are treated with respect and their rights and privileges were being maintained. Staff were seen to treat people in a respectful way. One relative said The girls treat my mother very well, I have no problems. The expert by experience reported that that people spoken to said Its lovely, very nice. Staff are great.. when I want something, they do their best. They talk to me with respect. In the care plans inspected there was evidence to suggest peoples wishes of in the event of their death was recorded through a consultation process and where possible relatives were a part of this consultation. Care Homes for Older People Page 14 of 27 Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home received an adequate standard of activities but further development could be made to ensure choices offered are more personalised to meet individual needs. Evidence: The lifestyle experiences of people in the home needed further development in this area was inspected by an expert by experience who spent an average of three hours with people who use the service he commented that this is an area in need of development. His report stated that the home is in the process of recruiting another activities coordinator, A member of staff with previous experience of undertaking activities explained that at present an agency staff undertakes activities 4 hours a day, 5 days per week. These activities included bingo once per week,singing/karaoke and playing the Wii games which appears to be very popular. The agency activity person was observed spending time with people on a 1 to 1 basis. The expert by experience went on to say that in his view the home had maintained a basic level of activity but they were over reliant on the activities organiser and as a result there seemed to be a lack of an overall strategy that fully assessed and planned an approach that involves a range of group activities and 1 to 1 activities that would involve all the key staff. For Care Homes for Older People Page 16 of 27 Evidence: example some people when asked said they would welcome sedentary exercises. One person saidcant see very well..they dont talk to me about activities another said I am not interested. Another said exercises? yes I was a physical exerciser in the army and a Bantamweight boxing champion. Another said Exercises? yes I would..., shoulder very painful so exercises would help. These examples are an indication of choice not being fully explored or met. The service ensured people were able to maintain family contact where possible. We saw relatives visiting the home on the day of the inspection. One relative spoken to said I have been coming to the home for 2 years and the staff are friendly, mom receives a good standard of care. The expert by experience reported that much more could be done to offer a personal/needs based service to people who use the service. The experience people have during meal times was also explored by the expert by experience who reported that in this area again he felt that a more comprehensive attempt could be made to ensure people are offered choices. From observations the expert by experience said he observed 2 residents being assisted to eat in a recliner chair. The liquidised main meal was nicely presented in terms of color and texture. Both carers were feeding the people in a caring and sensitive way and at a pace suitable to the peoples needs. At 12:35PM 17 people were seated in a pleasantly refurbished room with nice table cloths.Their were no menus on the table but a 4 weekly menu was displayed by the kitchen staff. There were 1 carer and 1 kitchen staff serving and helping at 12:45PM the team leader and 4 carers entered the room. This level was satisfactory and should have been in place from the onset of the dinner time. In the main only orange juice was available when asked was told that other beverages are available. There was a choice of main meal and sweet. Two people who spilled their drink were treated in a sympathetic and understanding way. Another person asked to change their sweet and an alternative was offered. People said they liked the food one person said Food? Very good. Another person said I ate all my dinner and I thoroughly enjoyed it one person summed up the meal by saying Its first class. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected and there are policies and procedures in place to ensure complaints will be dealt with satisfactorily. Evidence: Since the last inspection the home have received no formal complaints. Records inspected suggested peoples concerns would be dealt with satisfactorily should they have the need to complain. People spoken to said I am completely satisfied with the service and if I should have any complaints I would speak to the people above. Another said when asked if they felt safe replied, absolutely. The home had made some safeguarding referrals which were client to client incidences. Training records seen suggested staff received Safeguarding training and those spoken to were able to confirm this information. The manager had also implemented a weekly monitoring tool for complaints and safeguarding issues to ensure staff are following procedures satisfactorily. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a safe, well maintained and clean environment in which to live. Evidence: The environmental standards of the home was very impressive. Since the last inspection major refurbishment was undertaken which resulted in people having a warm, welcoming and clean environment in which to live. All bedrooms , halls and main communal areas had been redecorated and refurbished imaginatively. The manager said 6 different colour schemes were used and theses were personalised to ensure individuality was maintained. The bedroom doors were no longer locked but had been fitted with stay put doors which were connected to the fire alarm systems. All call systems were removed and placed in closer reach of people. The furnishings were of a good quality and appeared to be modern and steady. One person had received a high/ low bed which ensured the persons risk of falling from a high bed was minimised. The manager was also proud to show us the new shower room, the new bounce resistant grab rails and skirting boards.The special coverings for the skirting boards helps to prevent chipping. The communal toilets were also fitted with raised and tilted seats to ensure people are able to use the facilities in a comfortable and safe way. Care Homes for Older People Page 19 of 27 Evidence: Where people needed commodes these were placed in their bedrooms and again they were of a very good standard and purchased with the client group in mind. The home was furnished throughout with bright colours in terms of wall paint and furnishings to meet the needs of people with dementia. The home had also purchased 4 flat screen televisions which were placed strategically around the sitting areas. Some people were also said to have their own DVD players. The home had purchased 6 new recliners which were suited to the needs of the people who use the service. The home employed a domestic cleaner and throughout the visit no offensive odours were identified. They also invested in the garden. We saw new furnishings in terms of chairs and tables colourful cushions and two raised beds at approximately 2 feet, for people to be able to plant seeds and grow their own vegetables.One person spoken to said I will be going out there soon. We were told that these flowers were edible flowers to ensure safety for people who use the service. The home had also invested in Gazebos that will be used in the summer to protect people from the extremities of the sun. The expert by experience said the environment allied to the skills of the staff and accounted for what he found in a snap shot visit to be overall a calm and pleasant atmosphere. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are protected by having a staff team that are skilled, trained and competent to do their job, as a result people are in safe hands. Evidence: The home had good recruitment procedures and on the day of the inspection 4 staff files were inspected. In general staff records held covered things such as passports, application forms, contracts, offer letters, references and Criminal Record Bureau checks. However on one staff file inspected evidence of a Criminal Record Bureau check was not available. This was presented at the end of the inspection as a fax from central personnel. The home had good training records and staff spoken to were able to confirm that they had training. The expert by experience spoke to new members of staff who confirmed that they had 7 hours of dementia training and it was very good. The training matrix inspected suggested staff were sent on courses relevant to their job roles and staff also receives individual training according to their needs. The home offered NVQ levels 1,2,3,5 and 6 to its 43 staff team. We were informed that more than 85 have achieved their NVQ level 2 in care and above and records seen was able to confirm this. We were also told that 75 of the agency staff used were also NVQ level 2 qualified. In addition to this staff also received mandatory training to include Manual Care Homes for Older People Page 21 of 27 Evidence: Handling and First Aid. Staff also achieved certificates in Life study, Induction , Medication, Equality and rights and Mental Capacity. We were told that the home had recruited to several posts and were still in the process of recruiting new carers to ensure people receive a consistent level of care. The home currently have 3 part time night vacancies and 3 part time day vacancies. The rotas inspected suggested that total of 6 staff at the minimum was rostered on per shift. The manager said she sometimes has 7 staff at busy times to ensure the home can run smoothly. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in place ensured the effective and smooth running of the home, as a result people receive a good service. Evidence: The management of the home was of a very good standard. The manager spoke confidently and knowledgeably about the needs of the home and although she was proud of her achievements was also aware that further development was required in some areas. The manager was supported by 4 team leaders who take responsibility for the leading of the shifts and supervising the staff team both in the presence and the absence of the manger. People spoken to said the home was run effectively. One relative said The staff are all very nice, it shows the home is well managed. The staff team received regular staff meetings and supervisions. The supervisions were separated between the 4 team leaders and the records seen suggested people Care Homes for Older People Page 23 of 27 Evidence: received this support on a regular basis. Care staff spoken to were able to confirm this. Team leaders said they offer supervision on average of 2 per month. The records also showed that 10 probationary reports have been undertaken since January 2009. One staff member said I feel supported I can tell my supervisor anything. Another staff said I have had a lot of support from the team leaders and the manager.We were also informed that staff receive regular staff meetings the last being the week prior to the inspection. The home had developed their quality assurance systems and could evidence this very well. We saw various auditing tools where the manager audits what the service does on a weekly, monthly, three quarterly and six monthly basis. The quality assurance audit was undertaken with the consultation of people who use the service, relatives and external professionals, the results of these were analysed and displayed in the communal area of the home. The residents meeting was also undertaken and the minuets was displayed in the home for all the people to see. The format was written in enlarged text to enable easy reading for people with visual impairment. The home had updated their policies and procedures and on the day of the inspection we viewed 35 different policies that had either been reviewed in recent months or implemented to better protect and safeguard people who use the service. These polices were also audited by the manager to ensure their effectiveness. The home had satisfactory health and safety policies and procedures and records such as fire checks were satisfactorily recorded. The home had visits from maintenance engineers for lifts, fire alarm systems and other aspects relating to peoples safety. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Opportunities must be presented to people to ensure they are offered activities that matches with their expectations and satisfies their personal needs. To ensure people are able to live a fulfilled and stimulating lifestyle. 30/03/2009 2 14 16 Arrangements must be made to ensure people are helped to exercise choice and control over their lives. To promote and maintain individual independence. 30/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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