Inspection on 04/07/07 for Laurels EPH

This inspection was carried out on 4th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 Mr Ian Dunthorne Unannounced Inspection 4th July 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.V343354.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.V343354.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 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.V343354.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. 1st February 2007 Date of last inspection Brief Description of the Service: The Laurels was one of the 4 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. 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.V343354.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over nine hours during the morning, afternoon & early evening and it was unannounced. Prior to the inspection time was taken to review the information gathered since the last inspection and plan this inspection visit. This report also includes feedback from residents, relatives and visitors obtained from postal survey questionnaires. The inspection included a tour of the communal areas and several bedrooms, inspection of certain records, discussion with staff and the manager, discussion with residents, their relatives, visitors and observation of the routines of the home. The method of inspection was to track the lives of several residents. This was done by speaking to them about the service they receive, observing their life in the home, talking to staff and relatives and reviewing their records. Postal surveys had been sent to the home for the residents or their relatives on their behalf to complete prior to this inspection, however there was only one respondent. Therefore this information was limited as part of this inspection report. What the service does well: What has improved since the last inspection? The facilities for medication storage by introducing a dedicated room specifically for this purpose. Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 6 Maintaining infection control practices within the laundry procedures, demonstrated by introducing colour-coded bins. The menu format had been enlarged to make them easier for residents to read and make a choice. The provision of leisure activities for residents within the home had improved, due to the introduction of an Activities Organiser with fixed permanent hours dedicated to the home each weekday. More suitable flooring had been fitted on the first floor, which made the area appear clean & pleasant. What they could do better: Some of the things that the home could do better include: • Making sure that all residents or their representatives on their behalf are consulted and agree to information about how their care should be delivered and provided by staff. Making sure that there is enough information on the care plan to ensure that the needs of the residents can be met and then care provided by staff. Ensuring that medication is properly and safely looked after and that clear, accurate records are kept and that staff are assessed as competent. Making sure that residents are clear about the fee for their stay & anything they will have to pay for. Ensuring that the home is safe for residents and staff to live and work in. Asking for the views of others about what they think of the home and any suggested ideas for improvement. Then producing a plan, showing how they will act upon those views and carry the plan out. Keeping up to date the information about what the home does and what is provided. Reducing the risk to residents by making sure the risk is fully assessed and reviewed regularly and any actions to ensure residents safety, followed. Meeting the health and welfare needs of the residents in some areas. DS0000033128.V343354.R01.S.doc Version 5.2 Page 7 • • • • • • • • Laurels EPH 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.V343354.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.V343354.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): 1, 2, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided sufficient information for prospective residents, however it sometimes failed to identify the fees payable, which did not allow all residents to be aware of the fee and what they may need to pay. The information also needed to be updated at timely intervals, to ensure residents received the correct details. EVIDENCE: The homes ‘Statement of Purpose’ was displayed with a copy of the last inspection report in the homes entrance area. However the ‘Statement of Purpose’ was out of date in some areas and required updating, to ensure it provided the correct information and it was not always in a suitable format for the residents. This was a recommendation at the last inspection, although there was evidence that the manager was at the time of this inspection, in the process of updating this information. Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 10 There was evidence that the service users whose lives were tracked had written contracts with the home in the form of a statement of terms and conditions. The home failed to include the fees payable within the terms and conditions in some cases. This was a requirement at the last inspection. The residents’ representatives had signed them, indicating their agreement. There was evidence that the home had undertaken an assessment of the needs of residents on admission. They had also been provided with a summary assessment from the referring care management service, which they had used to form part of the information that contributed to their own needs assessment. The home did not admit residents for intermediate care. Laurels EPH DS0000033128.V343354.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): 7, 8, 9, 10 & 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home had failed to improve their procedures for administering medication sufficiently, placing residents at risk and of harm. EVIDENCE: Several of the residents care plans and supporting documentation; including risk assessments were sampled and found to contain insufficient information to help meet their daily needs; however residents care plans had been reviewed at intervals. The care plan of a resident recently admitted to the home did not relate directly to the needs assessment; the needs assessment identified that the resident was at risk from dehydration and from falling due to their mobility, yet neither of these areas had a care plan. The supporting records were also inadequate and had not been completed consistently, the resident whose needs assessment identified dehydration due to poor fluid intake had a chart in place to monitor their fluid intake, however this had not been completed regularly or when required. In addition there was no evidence for those residents whose lives were case tracked, that they or their representatives had Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 12 been consulted when the plans were drawn up. There was no evidence that the resident or their representative had been involved in the reviews, or consulted about any changes made to the residents care plan. Further development of the care plans were required to ensure that sufficient detail was included. These were requirements at the last inspection. Risk assessments with particular attention to the prevention of falls had been completed, but had not always been reviewed and therefore some information was out of date. Those risk assessments sampled had not been completed in full, with necessary information and the home failed to identify the level of risk in some areas, which limited the value of the risk assessment as a tool to safeguard and minimise risk to residents. The health care needs of the residents were not being adequately met by the home. Further development was needed to ensure tissue viability assessments were completed and practices improved when necessary for each resident. One resident had treatment applied to a pressure area which was identified on a daily record entry made by staff, however there was no care plan or risk assessment in place which identified this. Residents weight had been monitored, however this was not always being completed at regular intervals. One diet controlled diabetic resident described as having a ‘poor appetite’, had not been weighed for three months, despite recorded information that detailed considerable weight loss over a period. Evidence available supported the fact that residents were enabled by the home to access a variety of health care services, to meet their assessed needs, evidenced by various records. A specialist pharmacist inspector examined medication storage and records. Residents are protected by adequate security of medicines and the temperature of the storage facilities ensures the quality of medicines in use. The temperature of the storage room must be monitored and recorded regularly to show that medicines are constantly stored under suitable conditions. The temperatures of the refrigerators used to store medicines are recorded. However, it is of concern that the temperatures of the medicines refrigerator were recorded outside the recommended range without action taken to investigate the performance of the fridge or if the medicines stored there were still usable. The cupboard used for the storage of drugs controlled under the Misuse of Drugs Regulations does not comply with the requirements of the regulations and should be reconsidered. Stocks of medicines were at an acceptable level but one item was found in a cupboard used by district nurses, which carried a label bearing the name of a person who is no longer in the home. It is not acceptable for medicines to be retained after they are no longer prescribed, or for them to be used for the treatment of others. Staff must make sure that medicines that are no longer required are disposed of promptly. There is generally a good audit trail to account for all medicines received into the home and disposed of. Records of medicines prescribed and administered were examined and there were a worrying number of gaps in the administration records for medicines giving no clear indication of whether medicines had been administered or not. Where medicines were prescribed in Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 13 variable doses e.g. “one or two tablets” then the quantity of medicine given to the resident was not always clearly recorded. In some cases medicines prescribed on a “when required” basis for residents was given to them on a regular basis without any justifiable reason for this recorded in the care notes. Additionally, where medication is prescribed on a “when required” basis there were no details or guidance in care plans as to the circumstances such medication is to be used. This is needed to ensure that residents are not put at risk by being given medication when it is not necessary and other approaches can be used. For a few residents it is considered necessary to crush their medicines and disguise them in food. This must be done only under exceptional circumstances. Although there is permission from the resident’s GP that this is permissible there needs to be full agreements with the resident themselves, if possible, or the resident’s next of kin and agreement from a pharmacist that the crushing and mixing and medication with food will not affect the treatment that the resident receives. This must be clearly documented in the care plan. Only trained staff are allowed to give medicines to residents and observation of this showed that residents choice and dignity was respected. The training of care staff on the safe use of medicines is evidenced by attendance on relevant courses but there is no assessment of competence that staff can put this knowledge into practice. This is, however, planned for the future. The evidence from speaking with some residents and relatives was that the residents were treated with respect and their rights to privacy were generally upheld and this was consistent with observations made during the inspection. Some comments made by relatives during the inspection were “the staff are all so friendly and good with all the residents and they are all so approachable” and “the staff have built up good relationships with my mum”. Staff were observed knocking on residents bedroom doors, bathrooms and toilets before they entered. The home had a death and dying policy and there was evidence that residents wishes, that in the event of terminal illness or death were recorded. However resident’s wishes with regard to resuscitation required evidence of consultation with the resident and their representative which had not been obtained on one residents record. Those wishes then required regular consultation and review, which there was also no evidence of and subsequently some records were old and their wishes may have changed since they were originally documented. Laurels EPH DS0000033128.V343354.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): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided satisfactory opportunities for residents to engage in social and leisure activities within the home, which satisfied a variety of their social, religious and recreational interests and needs; the meals in the home were satisfactory offering both choice and variety and catering for special dietary needs. However further development was required to ensure suitable and sufficient information regarding nutritional needs, were included within the residents care plans. EVIDENCE: During the inspection some residents downstairs were observed in the morning and afternoon participating in planned activities. An allocated activities organiser was providing the activities on the day of the inspection, although staff spoken with also said they provided activities regularly in the evenings. An activity plan was available to examine and detailed some events and themed activities. The activities organiser spoke of a survey she had conducted recently with the residents, to establish what activities they wished to participate in. There had been no planned trips or outings recently, although there was evidence that a planned trip and summer outing was being Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 15 organised with another local authority home. The role of the Activities Organiser had begun recently within the home and already there were visibly clear benefits expressed by both resident’s, relatives and staff alike. Resident’s interests and activities were recorded individually. Some planned events were arranged by a care team leader, who had recently organised and held a cake stall event, which had proved to be successful and enjoyable. The home observed resident’s religious needs satisfactorily; several residents attended a service delivered at the home during the inspection. Resident’s interests and activities were recorded individually. Evidence suggested that residents were able to maintain regular contact with their relatives and friends without restrictions and were supported to maintain contact if they wished, by the home. Relatives who were spoken to during the inspection also supported the evidence and said they felt welcomed by the home when visiting and knew that they could visit at any time. Facilities were available to enable residents to receive visitors in private. The home was able to demonstrate that they supported residents to maintain as much choice and control over their lives as possible in most areas. Residents’ bedrooms were individualised with personal possessions and one resident’s relative said that they were encouraged to bring in the residents personal effects. There was evidence that an advocacy service visited the home on an ‘as required’ basis. Some observations were made over the lunch; afternoon tea and teatime periods during this inspection and residents appeared unhurried by staff during this time. Resident’s were observed being offered a choice of meals and beverages and those with dietary or cultural needs were being accommodated for, although there was limited evidence and information regarding nutritional needs included within residents care plans see ‘Health & Personal Care’ section of this report. Menus examined generally offered choice and a nutritious and wholesome diet to the resident’s, with a balanced and varied selection of foods. The format of the menu’s had been improved to suit the needs of some residents by enabling more residents to read them and subsequently support them to make an informed choice of menu. The home offered suitable food portions that were well presented. Staff were observed assisting resident’s who required support to enjoy their meals appropriately and sensitively. Residents spoken with said they enjoyed the meals at the home and one said, “the food is very good here”. Laurels EPH DS0000033128.V343354.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had satisfactory complaints and adult protection procedures in place, which ensured that complaints were listened to and residents were safeguarded from abuse. However some staff had not received Safeguarding Adults training for a long time, which could place residents at possible risk of harm or abuse. EVIDENCE: The home had documented five recorded complaints since the last inspection. One complaint was still under investigation at the time of the inspection. There was evidence that all documented complaints had been recorded and managed in accordance with their complaints procedure and timescales. Residents & relatives spoken with were aware how to complain and who to and they said they felt comfortable and confident to complain. The home had satisfactory procedures in place to safeguard residents from abuse. The majority of care staff had received Safeguarding Adults training, however several staff had received training a long time ago and therefore may require refresher training to update their knowledge. Most care staff spoken to knew what to do in the event of witnessing an alleged case of abuse occurring. Since the last inspection there had been five notifiable incidents in accordance with the Safeguarding Adults policy and guidance, which was reported to CSCI Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 17 at the time. Evidence examined, supported a process that had been followed to safeguard and protect residents. There was evidence that some staff had received training to support them to understand and deal with any aggression demonstrated by a resident appropriately. Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 18 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, 21, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home was satisfactory. However there were some identified risks, which need to be addressed, to minimize potential risk to residents and safeguard their health and physical well being. EVIDENCE: The home had a part time maintenance person based at the home who followed a maintenance program. The grounds of the home were tidy, well maintained and allowed access to residents. There was evidence during the inspection that a rolling program of maintenance and improvement would soon begin at the home in the form of a zoned refurbishment program. It was evident that some improvements had been made since the last inspection, one example being that all the commode chairs in residents bedrooms had been replaced, however some areas of the home still required attention to be addressed during the planned refurbishment Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 19 program such as some areas of boxed in pipe work that had ‘blown’ for example and one toilet which had exposed pipe work which had a hot surface temperature. One specialist shower room remained unsafe for residents and for staff to provide assistance. This was a requirement at the last inspection. The door panels into the shower area caused a potential hazard to staff when trying to provide assistance to residents, this in turn caused a hazard to the safety of the residents, in addition there was no grab rail in the shower other than the door itself which was unsafe for this purpose. Talking to staff & the manager supported this evidence, although the manager did explain that she has made several attempts to rectify this and spoke of a potential necessary re-design. However, the home had failed to risk assess the hazard and no control measures had been put in place to minimise the risk to residents and staff in the interim, see ‘Management & Administration’ section of this report. In another bathroom upstairs, the side of a bath panel had been removed and was observed to be stood up against the wall, exposing a protruding piece of metal, there was no indication why this was and the bathroom had remained in use. Several bedrooms were inspected during the inspection and were all found to suit the needs of the residents. The décor was suitable and some re-decoration in places had been done. A program of regular redecoration of resident’s bedrooms was evident. Residents were given the opportunity to personalise their room with various furnishings, which the home had supported them to do. A requirement had been made at the last inspection to repair or replace the bedroom sinks that had ‘blown’ due to broken seals, allowing water to seep into the wood. This caused effective infection control measure to be compromised. The home had failed to comply with this requirement within the given timescale. However, these works were planned to be completed within the impending refurbishment program that was evident. All commode chairs within resident’s bedrooms had been replaced since the last inspection. The home appeared suitably clean and free from offensive odours, more suitable flooring had been fitted on the first floor since the last inspection, which made the area appear clean & pleasant. Training records identified some staff that had undertaken infection control training. The infection control practises within the laundry had improved, demonstrated by colour-coded bins that had been introduced. Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staff recruitment were satisfactory. However further development was needed to ensure that a recent photograph of each staff member as proof of their identity was maintained, to safeguard residents as part of this verification process. EVIDENCE: The home provided sufficient numbers of staff to meet the ratio of residents in the home. On the day of the inspection seven care staff were available from 7.30am time to meet the needs of twenty-seven residents decreasing to six staff at 10.30am and reduced during the afternoon and evening to five staff these staff ratio’s excluded the duty senior. The home had recently begun the integration of re-deployed staff from two local authority homes as a result of their planned closures, which had previously prevented them from recruiting their own staff as the posts were ‘frozen’ in anticipation of the re-deployed staff. However there were still vacant care hours, which the manager explained, amounted to approximately one hundred and twelve hours. The home’s vacant hours were met by the use of agency staff and existing staff working additional hours; this provided the home with generally a consistent level of service and carers. The manager said the vacant hours were about to be externally advertised following internal advertisement, due to the previous Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 21 redeployment status and job freezes which prevented her from advertising before. In addition the home had several staff that were absent due to longterm illness and planned maternity leave that impacted upon the home’s level of agency use and staff cover arrangements. Training records detailed evidence that 51 of care staff had achieved NVQ level 2 or above. The homes recruitment procedures were satisfactory. However the home failed to ensure that each staff file contained a recent photograph as proof of the person’s identity. The training provided was varied and relevant, which helped to enable staff to be competent to do their jobs. Staff members spoken with reported various training which they attended, including some recently. Not all staff had received regular Safeguarding Adults refresher training see ‘Complaints & Protection’ section of this report. There was evidence that the home provides staff with ‘Skills for Care’ induction & foundation training, although these are not always completed within the ‘National Training Organisations’ (NTO) specified targets. This was in addition to and supported the home’s own induction training, which also included the local authorities corporate induction day. The home provided a training & development plan for each individual staff member, which formed part of their annual appraisal process and records. A training matrix was in place which identified all staff’s training records and consequently any deficits or refreshers due. Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ views were sought from time to time, but there was limited evidence that their views had much effect in changing how the home was run, & some aspects of the homes health & safety and safe working practice procedures needed further development to ensure residents & staff would be protected from the risk of harm. EVIDENCE: The manager Maria Watkins was present for the duration of the inspection. The manager said that she had NVQ level 4 in both care and management and has completed her Registered Managers Award. A part time administrator supported the manager administratively for the day-to-day operation of the home. However the manager had requested the part time hours of the Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 23 administrative support be increased to full time, as she felt this was necessary to enable her to meet the requirements of her role satisfactorily. Developing and maintaining an effective quality assurance system within the home, was set as a requirement at the last inspection and had still not been complied with fully. There was evidence that the manager had made some progress since the last inspection but had yet to complete the full quality monitoring cycle, which could then be maintained systematically. Residents’ financial records and secure safekeeping of money and valuables, were being maintained satisfactorily on behalf of the residents by the home. The residents financial interests were safeguarded by the home, this protected the interests of the resident. Staff spoken with said that they received supervision and appraisals, although it wasn’t always regular and structured. There were no supervision records available to examine to verify they were undertaken, as arrangements at the home for storage of the records meant that staff stored them at their own homes. There was no record of a signed agreement between the supervisor and supervisee, or evidence to support this practise with regard to data protection or confidentiality good practise guidelines and protocols. Team meetings were held at intervals for both day and night staff. There was evidence that the home maintained general risk assessments, including health & safety and fire which had been reviewed at regular and timely intervals. However the home had failed to risk assess a specialist shower room as detailed in ‘Environment’ section of this report. Some aspects of the homes health & safety safe working practices, required some improvements to protect residents from potential risk or harm. See ‘Environment’ section of this report and in conjunction with the planned associated maintenance program refurbishment works. It was of concern that the arrangements for the maintenance of the home’s call bell system were previously inadequate, as this was on a ‘when required’ basis if the system failed. However the manager said that the service contract had recently been reviewed by the local authority and improved to include a maintenance and service contractual agreement. There was no evidence to support or substantiate this during the inspection. Various records were examined to support adequate compliance with safe working practices, regarding health & safety. Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 24 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 1 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 X X 1 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 2 X 2 Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 25 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 OP2 Regulation 5 (1) (b) Requirement All resident’s contracts must include the amount and method of payment of fees. Previous timescale: 30/04/07 not met. Appropriate risk assessments must be implemented and reviewed to ensure the welfare and safety of the residents. The residents care plan must detail the action and objectives that need to be taken by care staff to ensure that all aspects of the health, social and personal care needs of the resident are met. Residents care plans must be completed with each resident or their representative and kept under review in consultation with the resident or their representative. Previous timescale: 30/04/07 not met. The home must ensure that their policies, procedures, practices DS0000033128.V343354.R01.S.doc Timescale for action 31/08/07 2. OP7 13 (4) (b) & (c) 31/08/07 3. OP7 15 (1) (2) (c) & (d) 31/08/07 4. OP8 12 (1) (a) & (b) 31/07/07 Laurels EPH Version 5.2 Page 26 and supporting records are adhered to & maintained, to meet, promote and benefit the health and welfare needs of residents. Including monitoring and recording nutrition and weight loss or gain. 5. OP9 13(2) Suitable arrangements must be in place for the safe storage of medicines including adequate temperature monitoring, stock control and storage of controlled drugs. Clear records must be kept of medicines administered (or not administered) to service users. All staff who are authorised to administer medicines must be assessed that they are competent to do so. Safe and suitable bathing facilities must be provided to meet the needs of the residents. Previous timescale: 30/04/07 not met. 31/08/07 6. OP9 13 (2) 31/07/07 7. OP9 13(6), 18 (1) (a) 31/08/07 8. OP21 23 (2) (j) 31/08/07 9. OP24 23 (2) (b) & (c) Repair or replacement of 30/09/07 bedroom sink units, which are no longer sealed and have ‘blown’, rendering them unsafe and not fit for purpose, must be arranged and completed. Previous timescale: 30/05/07 not met. An effective quality assurance system must be introduced as specified by this standard. Previous timescale: 30/06/07 met in part. Arrangements must be made to ensure the safety of the residents and staff are DS0000033128.V343354.R01.S.doc 10. OP33 24 (1) (a) (b) 30/09/07 11. OP38 13 (4) (a) & (c) 31/07/07 Laurels EPH Version 5.2 Page 27 maintained and the risk identified and minimised whenever possible by assessing & monitoring the potential hazard, including bathing facilities. 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. A record should be kept for all residents detailing their wishes in the event of their death and this record should be reviewed at regular intervals with the resident and their representative on their behalf and evidence of this consultation should be recorded. Staff should receive refresher Safeguarding Adults training at suitable intervals, to enable them to update and refresh their knowledge and understanding. A recent photograph of each person working at the care home should be maintained to verify the person’s identity. Suitable evidence should be made available to demonstrate that staff receive supervision and arrangements for storage of such records should comply with data protection and confidentiality guidelines, with evidence of both the supervisor’s and supervisee’s agreements for these arrangements. 2. OP11 3. OP18 4. 5. OP29 OP36 Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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. Extracts may not be used or reproduced without the express permission of CSCI Laurels EPH DS0000033128.V343354.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!