Inspection on 01/06/09 for Laurels Nursing Care Centre

This inspection was carried out on 1st June 2009.

CQC found this care home to be providing an Adequate service.

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 Nursing Care Centre 11/08/08

Laurels Nursing Care Centre 13/06/07

Laurels Nursing Care Centre 11/07/06

Laurels Nursing Care Centre 11/01/06

Laurels Nursing Care Centre 12/07/05

Laurels Nursing Care Centre 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Laurels Nursing Care Centre The Laurels 70 Union Street Clapham London SW4 6JT Lead Inspector Sonia McKay Unannounced Inspection 10:00 1 & 2nd June 2009 st DS0000007030.V374937.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurels Nursing Care Centre Address The Laurels 70 Union Street Clapham London SW4 6JT 020 7498 7500 020 7498 9833 laurelscare@yahoo.co.uk www.laurelscare.org.uk The Laurels Care Centre Limited 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) Urvasee Shersing Care Home 68 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0) Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. up to 21 frail, elderly patients aged 55 years and above up to 47 patients aged 55 years and above with dementia Date of last inspection 11th August 2008 Brief Description of the Service: The Laurels is a purpose built private nursing home for older people, some of whom may have a physical disability or mental health need. The home has three floors with the categories of need being grouped separately on each floor. The ground floor supports elderly people who may have a physical disability. The first and second floors support people with dementia or mental health needs. The home is located in a residential street in Clapham with good links to bus and underground train services. There is a small parade of shops within short walking distance of the home, with larger shops and supermarkets available in Stockwell and Clapham. Fees range from £600.00 to £800.00 per week and depend on individual needs. Prospective residents are given a copy of the service users guide as part of the pre-admission process. Copies of the most recent Commission inspection report are available in the main reception area. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors carried out this unannounced key inspection over two days. A pharmacy inspector attended for one day to look at how the home handles medication. The methods used to assess the quality of service being provided include: • • • • • • • • • • • Talking with the registered home manager Looking at the Annual Quality Assurance Audit document completed by the manager (this document is sometimes called an AQAA and it provides the Commission with information about the service) Talking to staff on duty during the inspection Talking to some of the current residents Talking with a visiting GP A tour of the premises Looking at records about the care provided to some of the residents Looking at records relating to recent staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled Getting feedback from the Local Authority, who place many residents in the home The Commission would like to thank all who gave their time, views and experiences to this inspection process. What the service does well: The home is purpose built and suitable for its stated purpose. All of the current residents have single bedrooms with en-suite bathrooms. The home is generally clean and tidy and warm enough. The healthcare needs of prospective residents are carefully assessed before they are admitted to the home, and a local GP visits the home each week to conduct surgery. The registered manager is experienced and qualified and the staff and residents find her approachable. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 6 There is a good mix of nurses and carers on duty at all times and there are a sufficient number of staff on duty. Staff are well trained and supervised often. Staff were observed to have a caring and warm attitude. There are two enthusiastic activities co-ordinators who provide a range of things for people to do in the home and in the community. Staff ensure that the correct medication is always available for people. What has improved since the last inspection? What they could do better: Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 7 More could be done to meet the environmental and communication needs of the people with dementia that the home is registered to accommodate, for example, signage and colour schemes. There is an informative guide and statement of purpose, although some additional information is needed to fully meet the current minimum standards required. The cultural and linguistic needs of prospective residents must be considered during pre-admission assessment so that the home can properly assess whether they can meet these needs. Cultural and linguistic needs must be identified in specific care plans so that staff know what to do to meet them. More could be done to make sure that the meals available meet the cultural needs of the current resident population. Prospective residents must be advised, in writing, of the outcome of any preadmission assessment. This letter will advise them of whether their assessed needs can be met at the home or not. There is also a need for more revision of plans when needs medical care needs change. Health care needs are generally well looked after and the home involves external professionals as required; however, more must be done to ensure that health issues are monitored properly and there should be better evaluation of care plans. More must be done to ensure the privacy and dignity of the residents, as confidential written information is on display in some areas. Staff have to turn the heating on and off and sometimes the building is too warm. More should be done to ensure that temperatures are comfortable, especially in warm weather when additional ventilation, like portable fans, are needed by many people. One ensuite bathroom has a blocked drain and this is causing a bad smell. There must be better records of peoples possessions so that ownership is clear. These records must be updated when new purchases are made. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Laurels Nursing Care Centre DS0000007030.V374937.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 Nursing Care Centre DS0000007030.V374937.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4. Standard 6 is not applicable. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an informative guide and statement of purpose, although some additional information must be added to meet current minimum standards. The health needs of prospective residents are assessed well but more must be done to ensure that all areas of a persons life are considered in the assessment. EVIDENCE: There are two documents that provide prospective residents and their families with information about the home and the services provided. The statement of purpose provides information about the home, the staff, and key policies and procedures. The service users guide provides information of use to people living in the home. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 10 Some additional information is needed in the guide. A copy of the most recent Commission inspection report is not added to the guide. This should be done to ensure that prospective residents and their families and friends have an independent view to consider when choosing a care home. The service users guide does not include service users views of the home. Their views should be added, as they would be of interest to prospective residents and their families and friends. There should also be contact information for the local social services and healthcare authorities. This information may be of use to residents and their families and friends. The majority of residents are placed by local authorities. There are a small number of placements funded privately. At the time of this inspection there are 53 people living in the home. Residents are admitted on the basis of an assessment of their needs. Full needs assessments are obtained from referring local authorities. This allows the home manager to make an initial assessment of the homes ability to meet the persons needs. The manager, or other senior nursing staff, then visit the prospective resident to conduct the homes own assessment of need. We looked at the records of some of the information obtained and the needs assessments undertaken by senior nursing staff. Copies of community care assessments of need are in place and if the resident is being admitted directly from the hospital, discharge notes are obtained. The manager said that if the discharge notes are not supplied by the hospital, senior staff are aware to follow this up with a telephone call to request them, as this has been an area of concern. Some of the information recorded in the homes pre-admission assessments is good and provides a sense of the individual. Other pre-admission assessments are less informative, for example, they do not cover cultural and linguistic needs, so it is hard to assess whether the service can meet these needs. The home manager also identifies a need to improve by concentrating more on the social, emotional and spiritual needs of the residents. There is also a need to send prospective residents a letter at the end of the assessment. The letter must confirm whether the home can meet the persons assessed needs, as this is not done at present. Additional fees are paid for private chiropody and hair dressing. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 11 There are also plans to encourage referring authorities to visit the home so that they have a better understanding of the services provided and the current resident population. Prospective residents and their representatives are encouraged to visit the home to see what it is like for them selves whenever possible. Review meetings are held six weeks after a resident moves into the home. This provides an opportunity for people to get together to discuss how things are going and to see whether the placement is suitable. The home does not provide intermediate care. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are adequate, but do not always provide sufficient information about cultural and linguistic needs. There is also a need for more revision of plans when medical care needs change. Health care needs are adequately met and the home involves external professionals as required, however, more must be done to ensure that health issues are monitored properly. Arrangements for the administration of medicines are adequate, with some areas that can be improved upon. Safe storage continued to be a problem, despite a previous requirement about this however this was addressed on the day of the inspection. More must be done to ensure that confidential information is not displayed in any way that compromises the privacy and dignity of any resident. EVIDENCE: We looked at the written plans for the care of residents on each of the three floors of the home. We looked at records relating to nine of the residents. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 13 The staff encourage the resident and their friends or family to assist in developing the written plans. It is noted that one first floor resident has his blood sugar levels tested at erratic intervals. They should be being done weekly, but were tested only once in March, twice in April and once in May. Blood glucose monitoring must be improved. A care plan around communication says that a resident should be approached in a ‘gentle, polite and kind’ way. This is positive advice. Monthly weight records are kept, as required in the previous inspection report. A resident on the second floor has a dietician’s letter in her file that says that she should have finger foods provided and a list of ideas is provided. The food records show that biscuits and cake are offered, with occasional finger foods also served at supper. Records for this person show a 2kg weight loss between April and May. A monthly evaluation of a nutritional care plan says that the resident is assisted with feeding and is eating and drinking well. Nutritional care plan evaluation should take note of the results of weight monitoring so that appropriate action can be taken if necessary. The resident is Greek although in the social needs care plan there is no reference to any cultural needs. It is noted that if staff see any injury they make a note and may take a photograph. A resident had a swollen eyelid, a photograph was taken and staff said that they monitored the eye and contacted relatives. Another residents notes say that she has a bruise on her hand. There are no notes to evidence any monitoring outcomes into the causes of these conditions. One new ground floor resident is Muslim and her first language is Urdu. She also speaks Punjabi, but does not speak any English. Relatives have provided good information about her likes and dislikes although the home’s admission assessment doesn’t refer to any cultural or linguistic needs. There is good information about her needs in relation to diet – arising from her religion and culture. The preferred gender for staff assisting with personal care is not identified, and some care plan entries are inaccurate, for example, saying the resident is bed bound when she is not. A first floor resident has a medical needs care plan that says that she is insulin dependent. Monthly evaluation records show that this is no longer the case, although the care plan has not been revised to show this change clearly. This must be done to ensure that care plans are up to date and reflect current need. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 14 The resident has vascular dementia and has difficulty sleeping at night. The GP has referred for input from psychiatric services and staff are keeping behavioural charts. Staff refer to aggression in records, although it is not clear what this actually means. Staff should keep better records of any aggression as this would be useful information to the other health professionals currently involved and would also better safeguard the resident (and staff) in case of any injuries, that may otherwise go unexplained. There is a brief personal history that says that the resident is from Jamaica. There is no planning information about how the residents cultural needs should be supported. The home manager looks at a selection of care plans each month as a way of monitoring the quality of the recordings, and each day a resident on each floor is selected in turn for care plan evaluation and review. All residents are registered with a local GP who visits the home each week for surgery. The GP was visiting during the inspection and gave us positive feedback about healthcare in the home. He said that the home is also trying to improve palliative care for those with a terminal illness, so that residents can stay at home when nearing the end of their lives, rather than being taken into hospital. Staff are being trained and negotiations are underway to involve a specialist community matron. A palliative care nurse visits the home regularly to advise staff on the care of those with terminal illness. In addition to care planning records there are also assessments of risk areas, such as falls, moving and handling, falling out of bed, tissue viability, nutrition, and any challenging behaviour. A member of staff on the first floor was observed to have a calming manner with residents, some of whom are agitated at times; holding their hands and being very soothing. We inspected medication records, and medication storage areas on all three floors, and observed staff giving medicines to residents. All prescribed medicines were available at the home, and medication records together with stock checks showed that residents are receiving their medicines on time and as prescribed. We observed staff giving medication and completing medication records accurately, providing evidence that staff are following the homes procedures, ensuring medicines are given safely. There is a comprehensive updated medicines policy dated January 2008, however there are some old copies of the policy dated August 2006 on two Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 15 floors, which contains some sections which are no longer applicable, for example, it mentions returning controlled drugs to the pharmacy instead of being destroyed at the home, and says that the medication charts should be signed by the prescriber which is not necessary. It is recommended that all medication record and policy folders are checked to ensure the updated version of the policy is available for staff to ensure correct practice. There are some good medication guidance documents in the medication folder on the First Floor. We talked to staff in charge of medication on all three floors. These staff are knowledgeable on medication issues and were able to explain any queries we had when reviewing the medication records. All controlled drugs are being stored securely, and recorded in a controlled drugs register according to the Misuse of Drugs Regulations. Stock checks are carried out regularly. Controlled Drugs should be destroyed at the home using a suitable destruction kit according to the clinical waste regulations, however unwanted controlled drugs had been returned to the supplying pharmacy the previous month. The Manager confirmed after the inspection that a denaturing kit was available. This should be used before controlled drugs are sent for disposal. Two prescribed medicines were not being used according to the prescribers’ instructions, an inhaler for breathing problems and a cream, although all other prescribed medicines were being given as prescribed. The home must ensure that all medicines are given as prescribed. There were a few instances where instructions have been changed on medication records, for example, from twice a day to once a day, however it was not clear who had made these changes and when. It is recommended that staff sign and date the medication record whenever changes are made to prescribed medicines. One resident is having a medicine mixed with food. Approvals have been obtained from the prescriber and the next of kin to add medicines to food. One of the medicines being crushed is a modified release tablet, and crushing may be unsafe. The home must seek the advice of the manufacturer or pharmacist to ensure that this method of administration does not alter the effectiveness of the medicine and cause unwanted side effects. Although all medicines are kept securely when not in use, in locked clinical rooms, the medication trolley on one floor is too small, so medicines are being stored unlocked underneath the trolley and attached to the side. When staff take the trolley out of the clinical room to give medicines to residents, these medicines are no longer secure, and residents and other people in the home could have access which poses a risk. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 16 This was the subject of a requirement in the previous inspection report and medicines storage had continued to be unsafe from the last inspection to the date of this inspection. A new larger trolley had been obtained for one of the floors and others were on order. We requested that medicines were made secure on the day of the inspection, and this was done. Daily temperature monitoring is carried out on medicines storage areas, and records show that on two of the three floors, the temperature has been above the recommended temperature of 25C for most of the past month. Medicines must be stored at the correct temperatures to avoid deterioration, so the home should look into the use of air conditioning units or relocating medicines to other areas which can be kept cooler. Personal care and treatment is carried out in the privacy of bathrooms and bedrooms. During a tour of the premises it was noted that a bedroom on the first floor has a notice about a resident’s continence pads which is visible from the corridor. This was pointed out to the service manager who agreed that this compromised the person’s dignity, and would be better placed somewhere more private. Similarly, another persons nutritional report is on display on the wall of the first floor lounge. More must be done to preserve dignity and privacy. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to maintain contact with family and friends whilst living in the home and they are assisted to exercise as much control as possible over their lives. There are a range of things for people to do and someone to help to co-ordinate activities seven days a week now. Meals are prepared safely and most are satisfied with the meals. More could be done to meet the cultural needs of residents in regards to meals and activities. EVIDENCE: There are two activities organisers and they are now available throughout the week not just Mondays to Fridays. This means that residents are now being supported with better weekend activities. Both organisers have worked in the home for many years and know most of the residents well. They attend external meetings to keep up to date about activities of benefit to this resident group. There are also a small team of volunteers who visit the home to spend time chatting with residents, and occasionally bring small dogs for residents to pet if they wish. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 18 Each floor has communal space where residents can spend time together, watching television and listening to music. Residents can choose to stay in their bedrooms if they wish, although staff encourage interaction to prevent isolation. Activities organisers spend one to one time with residents who prefer to stay in their bedrooms. In the reception area there is a display of photographs of each member of staff giving their name and role in the home. There is a quarterly newsletter about events and activities at the Laurels. Activities arranged include visits to a local community centre, shows, museums and daytrips to local parks and the seaside. Entertainers are also booked on occasion and family and friends are invited to attend. A theatre group has visited the home three times since the last inspection. Feedback from the local authority monitoring team is that they would like the home to offer a wider range of activities in the home. Residents are offered an increasing range of activities, and residents and relatives are encouraged to become involved and make suggestions. This is good practice. There is a small courtyard garden where residents can spend time or have meals. Outdoor space is very limited and care must be taken to ensure that residents on the first and second floors get regular opportunities to get outside into the fresh air if they wish. Televisions are available in the communal lounges and some residents enjoy having a radio or television in their bedrooms. There is also a library corner on the ground floor. During this inspection residents were observed to be mostly relaxing in armchairs, watching television or reading magazines and newspapers. Residents are able to make decisions about when to get up and when to go to bed. Preferences are recorded. Residents can maintain the friendships and family relationships whilst living in the home and can entertain their visitors in their bedrooms or in the communal areas. Some small meeting rooms are also available. Some residents are able to go out to local shops with a member of staff, and other residents go out with their relatives or friends. A local Church sends someone in to conduct regular Christian services and there is also a visiting library service. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 19 The manager aims to improve the service by working with staff to ensure that they understand the importance of social care. Residents are also being registered with local dial-a-ride services so that they can go out more often. Many people have elected to have private telephones installed in their rooms. The telephones used have large numbers for ease of use. There is also a cordless handset for residents to use if they wish to make or receive a call. The home employs two chefs and kitchen assistants who prepare a range of meals in a well-appointed catering style kitchen. Food hygiene inspection results are good. Meals were sampled over the course of the inspection. The fish pie served on the first day was dry, salty and unpleasant although lunch on the second day was better. Feedback about the quality of the food varied also, one resident said it was excellent and another was less complimentary. The records of the meals served show that a variety of meals are prepared, although cultural needs are not well addressed. The current Laurels residents are from culturally diverse backgrounds and there are plans to increase the range of options available. Breakfast and lunch are served in the communal lounges on each of the three units. Residents can opt for a sandwich if they prefer and can request snacks in between meals if they wish. Menus are posted on a wall and meals served were in accordance with menu plans. Menus may be more accessible if they were on the dining tables, like in a restaurant. Nutritional plans are sent to the kitchen, but the chef said that care staff serving the food on each floor are responsible for ensuring that nutritional advice is followed for each resident. There should be better records of the snacks and meals that are provided for an individual as a result of specialist advice. Residents needing assistance with eating their meal are helped by patient and respectful staff, who were observed to talk with residents and explain what they were doing. People who need a soft or puréed meal are served a puréed or mashed version of the menu available. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has got better a keeping records about what they do when they get a complaint, but care must be taken to record an outcome at the end of any investigation. The home is better at distinguishing complaints from safeguarding issues and staff are trained in safeguarding vulnerable adults. Care must be taken to keep an up to date record of peoples possessions so that ownership is clear and residents are protected. EVIDENCE: There is a complaints policy and procedure that meets the minimum standards and regulatory requirements. The complaints procedure is posted in the reception area of the home and it is in the written guide to the home. There is also a book stored in the reception area where relatives and visitors can record their concerns and compliments. The home manager checks the book regularly and follows up on the issues raised. The Annual Quality Assurance Audit (the document, sometimes called an AQAA, that the provider completes to provide the Commission with information about the service) states that the manager has an open door policy. Her office is located in the reception area of the home so that she is accessible. Concerns Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 21 are also discussed in review meetings with individual residents and their families and in group meetings for relatives. There are better records of the complaints that have been made and how they have been dealt with and the home is working more closely with the local authority to identify any safeguarding and deprivation of liberty issues. During the inspection we raised the issue of the outcome of complaints not being properly recorded, in terms of whether the complaint was substantiated or not. The home manager added the outcomes to the record during the inspection. The findings and outcome of any complaint should be recorded at the end of any investigation. Staff are being trained in the new Deprivation Of Liberty Safeguards. None of the current residents can go out alone and all need support from a member of staff, or friends or family members, to access the community. The home has applied for standard Authorisation under Deprivation Of Liberty safeguards for each person with dementia who may be vulnerable should they leave the premises alone. Residents are registered on the electoral role and are assisted to go and vote in elections if they wish. There is indication that the service has got better at distinguishing between safeguarding allegations and complaints. This is important because safeguarding allegations need investigation and the over view of other authorities (the local authority and possibly the police), and the manager and staff must recognise when this is required. The local authority procedure for safeguarding adults is available and is understood by the home manager and copies are available on each floor of the home. Staff receive training in adult abuse awareness and safeguarding vulnerable adults. Recruitment checks include verification that applicants are not on the register of people who are, because of previous concern, prohibited from working with vulnerable adults and an enhanced check for any criminal record. During case tracking it was noted that relatives had bought a television into the home for a resident in January 2009. This item had not been added to the residents inventory of possessions. This must be done to ensure that ownership is clear, and to protect the resident from abuse. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built and is generally clean and tidy. More could be done to meet the environmental and communication needs of the people with dementia that the home is registered to accommodate. More must be done to ensure that unpleasant odours are removed and to ensure that room temperatures and ventilation are good on warm days. EVIDENCE: The home is purpose built and provides residents with accommodation on three floors. The ground floor building surrounds a small central courtyard garden that is accessible from the ground floor lounge and hallway. Outdoor space is limited. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 23 Each floor of the home has its own communal lounge and dining area. The first and second floors have coded keypad access. There is a passenger lift. There are 62 bedrooms. All of the bedrooms are currently single occupancy as shared bedrooms have been phased out. The home is registered to accommodate sixty eight residents and discussion with management during this inspection indicates a need to maintain the registration at the higher number in case people specifically wish to share, for example, couples. The ground floor accommodates 20 people who are elderly and frail, and may also have mobility needs. The first floor accommodates 25 people who have dementia care needs and the second floor accommodates 18 people with dementia care needs. There are maintenance and domestic staff. A program of refurbishment and renewal is ongoing. At the time of this inspection the ground floor hallway is being redecorated. There are plans to redecorate four bedrooms and a groundfloor shower room in the coming months. The maintenance operative undertakes the majority of health and safety checks for the building, including periodic inspections of hoists and testing of hot water temperatures. Records are kept of the outcomes of these checks. Bedrooms and bathrooms are all fitted with a fixed cord call alarm system for residents who may need emergency assistance from staff. During the last inspection it was noted that a fault in the system was causing a constant beeping noise that was disturbing. A requirement was issued and the fault has been rectified. The registered persons should consider installing a call alarm system with a pendant option for residents who find the current system hard to use. Bedroom door numbering is still confusing. This has been commented upon in an occupational therapy report of the home premises and by relatives visiting the home on previous inspections. The report indicates that more could and should be done to create a more communicative environment for people with dementia. Individual bedrooms and bathrooms could be made easier to identify. The building is centrally heated and there is emergency lighting. The heating is controlled centrally and residents are not able to regulate their bedroom temperatures. During the inspection it was noted that the heating was on even though it was a warm day. Maintenance staff turn the heating on and off depending on the weather, and the heating was turned off later in the morning. A member of staff said that there were not enough fans available at times. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 24 The lighting is being improved at the time of the inspection, with new fittings being installed to make hallways and communal areas brighter. During a tour of the premises it was noted that the home is generally clean and tidy, although there is an unpleasant odour of stale water in one en suite bathroom, where floor drainage appears to be a problem. There is a small laundry on the ground floor. Space is very limited for laundry staff. There is no space to hang clothes or to iron properly. Feedback from recent internal quality assurance auditing suggests that laundry services could be improved. 30 of people surveyed thought the laundry service was poor. Some waste bins did not have lids. This is poor infection control. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a sufficient number of appropriately trained staff available and a training programme is in place. Staff are supervised properly and feedback from residents and relatives is positive. EVIDENCE: Staff duty rotas record that a qualified nurse is on duty on each unit at all times and there is a record of when each member of staff has been on duty in the home. There are also carers on duty both day and night. There are qualified nurses and carers on each shift on each floor of the home. Nurses are RGN on the ground floor and RGN or RMN on the second and third floors. Over 50 of the carers have attained a vocational qualification in care at level 2 or above (NVQ). The nurses on the second and third floors have specialist training in meeting the nursing care needs of people with dementia and mental ill health. The home will support one of the RGN nurses to complete RMN training. This will increase the numbers of mental health qualified nurses that the home is short of and is having trouble recruiting. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 26 The home employs an administrator, a nursing sister in charge, RGNs, RMNs, senior carers and carers. There are two activities co-ordinators, domestic operatives, chefs, kitchen assistants, laundry assistants and a maintenance person. Feedback from recent internal quality assurance auditing indicates that the people who completed the surveys are happy with the staff. The recruitment records examined during the inspection suggest that adequate checks are made on all staff. Checks include obtaining work histories, evidence of training and nursing qualification, identity checks, POVA first and enhanced CRB (Criminal records) check and satisfactory references. Carers enrol to undertake an NVQ qualification and domestic staff also undertake an appropriate NVQ qualification. The home has a good training program that includes both Dementia Care and Privacy and Dignity training sessions that are scheduled on a rolling basis so that no staff members miss the training. The Person Centred Dementia Care Workshop includes an assessment and homework and covers areas such as the person centred theory of dementia, effective communication, engaging with people with dementia and keeping people safe. The new manager is putting together a training plan, as required in the previous inspection report. Copies of certificates for training attended are being added to individual staff files and the manager has a matrix of training attended so that she can see what training individual staff need. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People using the 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 registered manager is experienced and qualified and feedback about her management style is positive. There is some surveying for views but more could be done in regards to quality assurance and planning for service development and improvement. Steps are taken to ensure that staff are aware of health and safety issues and to ensure a safe environment. EVIDENCE: The home manager has been in post since August 2008 and registered with the Commission in March 2009. She is experienced and qualified. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 28 Feedback from staff is positive and they find the new manager approachable and accessible. During the last key inspection a requirement was issued for the home to develop a quality assurance system. Satisfaction surveys were distributed and the results collated. This gives the home feedback from residents and their relatives. Discussion with the area manager indicates that quality assurance systems differ in each of the homes and are designed by each home manager. There is no annual development plan in place in the home at this time, although the home manager has tried to address any issues identified in individual comments received. There are plans to increase the range of people surveyed for their views to health professionals involved in the care of the residents. The company produces a monthly joint statement of benefit monies held at the head office for residents. This can be printed and anonomised for residents and relatives on request. There is a small cash float available in the home so that residents can get their money easily. Records of all transactions are kept by the homes administrator who requires proof of any purchase made on a residents behalf and two staff signatures. Examination of a sample of receipts and records were correct. Relatives who manage finances on behalf of a resident can deposit money with the administrator and inspect any related expenditure record. The home manager is responsible for health and safety and there are associated in house policies and procedures and a range of mandatory staff training. There are numerous in house checks and external examination of equipment in use at the home. Environmental and fire risk assessments and evacuation procedures are in place. The home sends notifications of any incidents talking place, as required and a representative of the provider visits the home each month to do a miniinspection. The reports on the outcomes of these visits are available to the manager and are stored in the home. There are a number of requirements that have not been fully addressed from the last inspection visit. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 29 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 2 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X 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 3 18 2 2 X X 2 X X 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 14(1)(d) Requirement Timescale for action 31/10/09 2 OP7 12(3) 3 OP7 15(2) The home must confirm that it can meet the needs of any prospective resident by sending them a letter indicating the outcome of the pre-admissions assessment. The home must review care 31/10/09 plans to ensure each persons culture, language and religion can be fully supported. Care plans must be reviewed and 31/10/09 revised when a persons needs change. Although there is some progress this requirement is not fully met. The timescale of 17/10/08 for completion is extended until The blood glucose levels of 30/09/09 people with diabetes must be monitored at the required intervals. The home must seek advice from 30/09/09 a pharmacist in regards to crushing modified release tablets to ensure that this method of administration doesn’t alter the DS0000007030.V374937.R01.S.doc Version 5.2 4 OP8 12 5 OP9 13(2) Laurels Nursing Care Centre Page 31 6 OP10 12(4) 7 8 OP18 OP26 17 16 effectiveness of the medicine as this may be unsafe. Steps must be taken to ensure that the care home is conducted in a manner that respects the privacy and dignity of residents. Every resident must have an up to date inventory of possessions The home must be free of offensive odours, (there is a bad smell coming from a drain in an en-suite bathroom in the annexe on the first floor) 30/09/09 31/10/09 31/10/09 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 Refer to Standard OP1 OP1 OP3 Good Practice Recommendations The service users guide should include the views of the current residents and a copy of the most recent Commission inspection report. The service users guide should include contact information for social services and the local health authority. Pre-admission assessments completed by qualified nurses should be sufficiently detailed to provide an accurate and comprehensive record of a persons assessed needs at the time of referral for placement in the home. Staff should keep better records of any incidence of aggression so that health professionals have a better understanding of a persons behaviour. The staff should provide a wider range of suitable finger foods for residents, in accordance with any advice provided by nutritional teams involved. Any evaluation and review of a care plan around nutrition needs should take into account the results of weight monitoring. There should be better records kept of the meals and snacks provided as a result of advice and menu plans from dieticians. Staff should keep better records of any investigations they make into unexplained injuries. DS0000007030.V374937.R01.S.doc Version 5.2 Page 32 4 5 6 7 8 OP8 OP8 OP8 OP8 OP8 Laurels Nursing Care Centre 9 10 11 12 13 14 15 16 17 18 OP9 OP9 OP9 OP9 OP12 OP15 OP15 OP16 OP19 OP25 19 20 21 22 OP25 OP22 OP26 OP26 Medication records and policy folders should be checked to ensure the updated version of the medication policy is available for staff to ensure correct practice. Staff should sign and date the medication record whenever changes are made to prescribed medicines. The service should look into the use of air conditioning units or relocating medicines to areas that can be kept cooler. The home should ensure that all controlled drugs are denatured before being collected for disposal. Cultural needs and linguistic preferences should be better considered when planning suitable activities for individual residents. Cultural needs should be better considered in menu planning. Menus would be more accessible if they were on the dining tables rather than on the walls. The outcome of any complaint must be recorded at the end of any investigation. The registered person should seek advice about how to redecorate in a way that will make the environment better and more communicative for people with dementia. Care should be taken to ensure suitable temperatures in the building, as the heating cannot be regulated in individual bedrooms. Maintenance staff have to turn the heating on and off. There should be a sufficient number of fans available to help residents cool down on hot days and to ensure good ventilation. The registered persons should consider installing a caller alarm system with a pendant call alarm option for service users who find wall mounted call alarms inaccessible. Waste bins should have lids to prevent infection from spreading. Laundry facilities should be of an adequate size for the laundry to be done properly. Laurels Nursing Care Centre DS0000007030.V374937.R01.S.doc Version 5.2 Page 33 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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. 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