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Inspection on 11/08/08 for Laurels Nursing Care Centre

Also see our care home review for Laurels Nursing Care Centre for more information

This inspection was carried out on 11th August 2008.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Comments that the Commission received about the service include: " The staff are always very welcoming and helpful to visitors. They always answer any questions or queries I have had adequately. The staff always treat the patients with a positive and smiling attitude" " When I visit my friend the staff come to me and make a conversation to tell me if anything new has happened to my friend or to ask me what I think. My friend is looking much better" "The home does great work and they are always on their toes making sure everyone is feeling happy. They always friendly when we visit and always have a pleasant word" " I feel good because my friend has never had the opportunity to relate to other people but now she can communicate and chat with other residents" "My relative praises the food and enjoys the personal attention from staff". "Staff always appear happy to see us and are interested in the person he (my relative) used to be" "The staff are wonderful and always helpful. They do a hard job and always seemed happy to help with anything". "The level of care and attention provided to individuals is generally very good. Any issues I have raised have been dealt with without any fuss". A member of staff valued regular team meetings as an opportunity to discuss how the service can provide better care and any safety implications for staff. A health professional commented, " The home is well staffed with low staff turnover. They know their clients well. They are always welcoming and listen to the advice given. I have never had to raise concerns and the advice and recommendations I provide are followed" A visiting therapist said, "Staff always facilitate my work in the home which helps in giving the residents better care"

What has improved since the last inspection?

Building security has improved making it safer for residents and staff. Lighting has been improved and this makes it easier for residents to read in the communal areas. Areas of the home have been re-decorated and carpets replaced in some rooms.

What the care home could do better:

Specialist health advice must be incorporated into written care plans and staff must ensure that the advice is followed, for example providing correct nutrition. Staff must keep better records of how each person is each day and there must be more effective monitoring of health indicators such as a persons weight. Staff must keep a record of every time a medication is administered or refused (there are some gaps in the records) and the medication cabinets must be large enough to safely store all medication being used. The home manager must keep better records of how complaints have been dealt with and there must be a better understanding of what to do when a complaint has adult protection implications so that relevant authorities are notified and can provide assistance to ensure safety.

CARE HOMES FOR OLDER PEOPLE Laurels Nursing Care Centre The Laurels 70 Union Street Clapham London SW4 6JT Lead Inspector Sonia McKay Unannounced Inspection 09:30 11 August 2008 th 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 Nursing Care Centre DS0000007030.V368075.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 Nursing Care Centre DS0000007030.V368075.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 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) The Laurels Care Centre Limited Manager post vacant 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.V368075.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 13th June 2007 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. Privately funded care fees range from £600.00 to £800.00 per week depending on individual care needs. The service is also available to people funded by a local authority. Prospective residents are given a copy of the service users guide as part of the pre-admission process. A copy of the most recent Commission inspection report is available in the main reception area. Laurels Nursing Care Centre DS0000007030.V368075.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 1star. This means the people who use this service experience adequate quality outcomes. One inspector carried out this unannounced key inspection over two days. The methods used to assess the quality of service being provided include: • • • • • • • • • • • • • • • • Talking with the interim 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 eight of the current residents Joining residents for lunch A tour of the premises Looking at records about the care provided to five 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 Sending surveys to residents, relatives, staff and visiting professionals before the inspection Three members of care staff completed and returned surveys Two Residents completed, or were assisted to complete and return surveys Six relatives completed surveys and two gave their views during the inspection Two people who visit the service to provide healthcare completed surveys There was also discussion with psycho-geriatrician who visits the home on a regular basis to provide nursing staff with advice about medications commonly used for people with dementia In addition, findings of a thematic inspection carried out in September 2007 are also included in this report. A thematic inspection is a short, focused inspection that looks in detail at a specific theme. This inspection looked at the quality of care people with dementia experience when living in care homes, focussing on ‘dignity’ as an important part of people’s quality of life. The Commission would like to thank all who kindly contributed their time, views and experiences to this inspection process. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Building security has improved making it safer for residents and staff. Lighting has been improved and this makes it easier for residents to read in the communal areas. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 7 Areas of the home have been re-decorated and carpets replaced in some rooms. What they could do better: 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 Nursing Care Centre DS0000007030.V368075.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.V368075.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, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is adequate information for people to make an informed choice to live or place a relative in the home. Qualified nurses assess the needs of any prospective residents although sufficiently detailed records have not been kept in some cases. EVIDENCE: The written guide, that is available to prospective residents and their friends or family, provides adequate information about the home to enable them to make an informed decision to move to the home. Relatives are encouraged to visit if the person referred themselves is unable to, as is often the case. During the inspection relatives of a prospective resident were looking around and they said that it had been useful to see the home and talk to staff. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 10 A resident who had moved in recently said that he did not have a copy of the guide. (See recommendation 1) During the thematic inspection of the dementia care in the home the statement of purpose was found to be good, but did not set out an understanding of the special needs of people who have dementia and how this client group will be supported. This information has been added to the statement of purpose and a requirement made in this regard is therefore met. The pre-admission assessments of two residents who recently moved to the home provide evidence of a comprehensive pre-admission assessment, although it is recommended that all areas of the assessment are completed as one assessment looked at had many gaps. In both cases local authority and nursing care needs assessments and initial care plans are also available. (See recommendation 2) Laurels Nursing Care Centre DS0000007030.V368075.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. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans have improved but could be more person centred. Care plans are not always updated when a persons needs and this has resulted in failure to provide adequate healthcare/nutrition. There must be better monitoring and recording of people’s weights. Medication trolleys are too small to store prescribed medications needed on rounds and this could lead to accidents. There are gaps in recording when a medication is administered or not administered. This could lead to overdose. EVIDENCE: Each resident has a set of written care plans and ongoing assessment records. The care plans identify each medical and personal care need and how these needs will be addressed and met. A hairdresser visits the service twice a month and carers assist some residents to maintain their hair-care. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 12 There is also a record of the health care and advice provided by relevant outpatient or visiting health specialists. Health consultations are conducted in the privacy of bedrooms. Nutritional screening is undertaken on admission and there are falls, moving and handling and tissue viability risk assessments in place. Care plans and risk assessments are reviewed regularly and the home manager also monitors the plans and the frequency of the reviews. Two Care Plans were examined in detail during the thematic inspection and were found to be adequate, they did contain some of the persons background and some preferences but they did not capture a sense of the of the person and would benefit from being made more Person Centred so that they fully reflect the person’s personality, history and the way their individual needs could best be meet. It is recommended that the Home move towards using a more Person Centred approach with their Care Plans that would include a biography, personality, communication support, strengths and wishes of the person as best known through observation and advocacy. In a good Care Plan the sense of the person would really come through. (See recommendation 3) During this inspection care plans for three people were examined. Care plans are generally comprehensive and reviewed regularly. There could be more personal information. Nutritional advice provided for one resident has not been developed into a care plan in the home and the resident is not receiving the advised nutrition. For example, the nutritionist had advised that meal supplement drinks be stopped and replaced by milkshakes and fresh fruit juices. The resident was observed to be given meal supplement drinks and fruit squash diluted with water. Staff were unaware that this was not in accordance with the advice provided. (See requirement 2) Additionally, the resident was of low body weight. Changes in weight were not easy to track. Some monthly records were in the personal record and others were in a communal weight book used by staff at the time of weighing for convenience. These entries are not dated and simply give the month weighed. This way of recording does not provide the individual record required for each person and will not allow staff to easily monitor and respond appropriately to changes in weight. This could lead to delay in providing any necessary healthcare. (See requirement 3) Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 13 Daily progress and evaluation notes were missing for another resident. This does not provide a record of care given. A requirement is made about this further on this report. This also is evidence of poor monitoring and recording. (See requirement 4) The home has a new GP and is using a new pharmacy. The GP conducts weekly surgery in the home and residents or nurses can request a consultation. Records are kept of GP advice given. Systems are in place for the safe disposal of medications and controlled drugs. Although there are no controlled drugs in use at the time of this inspection, each floor of the home has a controlled drugs cabinet and a safe system for administration and recording. There are also medication refrigerators and records of regular temperature monitoring. Medication is stored in clinical rooms on each unit. Medication administration is from a steel trolley stored in the clinical room. Observation of an administration round showed that the trolleys are not big enough to keep all prescribed medications in and many items are being stored on a shelf underneath the trolley or in an open container on the side. Blister pack racks are also being dismantled so that they fit in the trolley. This is unsafe and could lead to accidental overdose. (See requirement 5) All prescribed medications are in stock at the time of this inspection. Stock checking of a course of anti-biotics indicated correct administration and recording. Examination of MAR charts (Medication Administration Records) showed that on four occasions (during one month) an evening administration of a prescribed cream had not been signed for. As it is a cream it is difficult to tell whether the cream was actually applied. (See requirement 6) The home has input from the Care Homes Nursing Support Team who provide continence, tissue viability and falls prevention support and advice. There was discussion with psycho-geriatrician who visits the home on a regular basis to how medications commonly used for people with dementia are being prescribed. A nurse attending the meeting said that this is useful. Feedback from the psycho-geriatrician indicates that there are no urgent concerns. The incidence of pressure sores, their treatment and outcome, are recorded. Pressure relieving equipment is available. Photographs of individual wound sites are taken every two weeks to monitor and record wound healing. The Dignity and Privacy policies are good; they are detailed and set out the expectations of staff and give examples of how privacy and dignity can be Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 14 protected. They would benefit from including more details about the difficulties of supporting people to preserve dignity and privacy when they have a dementia type illness. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to continue with the lifestyle of their choosing to some degree and they can maintain contact with family and friends. There are a range of activities available and standards of lighting have improved opportunities for people to read. The meals are good but more must be done to ensure that individual nutritional needs are catered for. EVIDENCE: There are two activities organisers who provide activities between Monday and Friday. There is also a small team of volunteers who visit to spend time chatting with residents. A written programme of activities is available and distributed to residents. There is also involvement and training from the Care Homes Support team. Residents on the first and second floors are supported to spend time with others in the communal areas, thus increasing their access to social interaction and activity. This is important for some residents who can exhibit quite challenging behaviour at times, so that they do not become isolated in their Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 16 bedrooms. Residents can choose to stay in their bedrooms if they wish. There are also additional communal spaces on the first and second floors. One room is used to encourage sensory relaxation if someone is particularly unsettled or noisy. There is a large display of photographs in the reception area. Photographs show staff and residents enjoying special events and daytrips together. The acting home manager recognizes the need for an increase in outdoor and community-based activities. There is also a display with photographs of each member of staff giving their name and role in the home. There is a quarterly newsletter about events in the Laurels and it is now published in colour. There are charges for some of the activities, such as the local community centres, shows in the community and transport costs. Entertainment is bought into the home and family and friends are invited to attend. 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. A television is available in the communal lounge 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 watching relaxing in armchairs, watching television or reading magazines and newspapers. Staff said that they noticed that people in the ground floor lounge were reading more now that the lighting has been improved. 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. Meeting rooms are 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. There is a portable payphone available that can be wheeled to bedrooms as required. In addition to the payphone, many people who use a telephone have elected to have private telephones installed in their rooms. The telephones used also have large numbers for ease of use. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 17 The home employs two chefs and kitchen assistants who prepare a range of wholesome meals in a well-appointed catering style kitchen. The records of the meals served show that a variety of meals are prepared. Menus include options suitable to meet the individual and cultural preferences of residents. The chefs also meet with residents who have particular requests and meal preferences and individual meals can be prepared if a resident does not fancy something from the main menu for the day. Individual nutritional needs were not being met on this inspection in one case. (See requirement 2) 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. 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. Staff eat the same meals as the residents are served, but eat their meals during breaks in the staff room. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 18 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. All residents of this home are vulnerable and must be better protected by the homes response to serious complaints and allegations. This is insufficient multi-agency contact when allegations are made against members of staff. This does not provide residents with adequate protection from abuse and must be improved. There must also be a better record of how complaints have been handled. EVIDENCE: There is a complaints policy and procedure that meets the standards and regulations. The complaints procedure is posted in the reception area of the home. It is also in the written guide to the home. One resident did not think the home had a procedure. Most residents spend little time in the reception and as some residents are reading more now it is recommended that guides are distributed. There is a book for relatives and visitors to record concerns and complements in the reception area. Information supplied in the AQAA was hard to track in the record of complaints. This may be because the Registered Manager resigned earlier this Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 19 year and interim management arrangements are in place until a new manager is appointed. Examination of records and discussion with the interim home manager indicates that although some complaints have been addressed appropriately there is a lack of evidence of the outcomes of substantiated complaints and action taken as a result. (See requirements 7 & 8) There is also lack of clarity between complaints and safeguarding issues. For example, a family member made an allegation against a member of staff. This was handled as a complaint, which was substantiated and the member of staff subsequently resigned. This situation should have been referred to the Local Authority Safeguarding Team. The Commission was not notified. (See requirement 9) There is a need for better implementation of the local authority safeguarding vulnerable adults policy and procedures. All residents of this home are vulnerable and must be better protected by the homes response to serious complaints and allegations. This is because some complaints may be serious and warrant investigation by other authorities, such as the police or social services. Additionally information requested in the AQAA indicates that two referrals have been made to the POVA list (The list of people who should not be allowed to work with vulnerable adults). Querying this on the inspection indicated that the home has not made two referrals to the list. (See requirement 10) Advocacy services can be provided by ‘Help the Aged’. . Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 20 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, 22 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This purpose built home is reasonably clean, well maintained and decorated. There are sufficient communal spaces for people to spend their time but outdoor space is limited. There is an ongoing programme for improvement and additional lighting has been of benefit to residents. Building security has improved. 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 very limited. There is ramped access for people who use wheelchairs. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 21 The first and second floors have their own communal lounges and dining areas. Each floor of the home is separated by security keypad access. There is a passenger lift between floors. During the last key inspection there were concerns about the security of the premises. Checks are now in place to ensure that ground floor windows are not left open and a security keypad entry system and automatic door closure has been fitted to the front door. There have been no further breaches of security reported. During the thematic inspection it was noted that a resident was racially verbally abusing another resident in a communal lounge. A requirement was issued for staff to consider the seating arrangements so that this was less likely to happen. During this inspection the residents were seated so that they did not have direct eye contact. There is a full time maintenance operative who is responsible for routine environmental safety checks. All hot water outlets accessible to residents have hot water temperatures that are restricted to within safe limits to prevent scalding. Domestic staff are employed to maintain building cleanliness and all staff are trained in infection control. There were no unpleasant odours noted on a partial tour of the premises. The home is generally clean and tidy and well decorated. Bedrooms and bathrooms are fitted with fixed cord call-alarm for residents who may need emergency assistance. 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. (See recommendation 4) Call alarms are available in all rooms. Although there was a fault with the system that meant an alarm was sounding continually throughout the inspection. Staff said there is a fault with the system. This must be disturbing for residents, staff and visitors and should be repaired. (See recommendation 5) A programme of refurbishment and renewal is slowly ongoing. Improved lighting makes the home look brighter. There are plans for further carpets to be replaced. Carpet in a small lounge on the second floor is badly creased and presents a trip hazard. This should be replaced as soon as possible (See requirement 11) Room door numbering is still confusing. This was commented upon in a recent OT report of the home and by relatives on previous inspections. (See recommendation 6) Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 22 Each of the bedrooms has a small en-suite bathroom facility consisting of a W.C and a hand-basin. Some bedrooms have an en-suite shower facility also. Communal bathrooms have been refurbished recently and a programme of redecoration is in place for bedrooms and communal areas. Bedrooms are usually re-decorated when a room becomes vacant. Aids, slings, hoists and assisted toilets are installed. There are records of professional tests of hoists and slings in use. Pest control continues to be a challenge but a pest control contract is in place and there are regular checks. A resident reported finding mice dropping in her bathroom during the inspection. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 23 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. There are a sufficient number of staff on duty, and residents are protected by the checks made during recruitment. Training is going on but is not well coordinated. This means that staff may be overdue for refresher courses. 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 staff have worked in the home. 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 o the second and third floors. 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 previous registered manager assessed that the needs of the residents are best met by a combination of RGN and RMN nursing, as some of the people with dementia care needs also have other physical healthcare needs as well. The current daytime staff ratio and skills mix for each unit is: • Ground floor: One trained nurse and three care assistants Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 24 • • First floor: One trained nurse and five care assistants Second floor: One trained nurse and three care assistants The current nighttime staff ratio and skills mix is: • • • Ground floor: One trained nurse and one care assistant First floor: One trained nurse and two care assistants Second floor: One trained nurse and one care assistant 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. 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. Training records are difficult to track. Copies of certificates for training attended are not in individual staff files. The interim manager has focussed attention on the day-to-day operation of the home and meeting with heads of departments to resolve any ongoing issues or concerns. There is a need for current training needs to be analysed and an appropriate training and development plan formulated for the coming year. This will ensure that staff are kept up to date with training. (See requirement 12) Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 25 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, 37 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is no registered manager in post at this time, although a new manager has been recruited. Interim management arrangements are in place. More should be done to monitor the quality of service being provided and record keeping must be improved to ensure that there is a clear record of the well being of all residents. Systems are in place to check and promote environmental safety. EVIDENCE: The registered home manager resigned in March 2008. An interim home manager has focussed attention on the day-to-day operation of the home and meeting with heads of departments to resolve any ongoing issues or concerns. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 26 A new manager was being appointed at the time of this inspection and is due to start in post shortly. The new manager has not yet applied to be registered with the Commission as a fit person to manage the service. A progress and evaluation log for recording the daily care given to another resident had a missing entry. There is no record of his well being or of care provided during the day. Some entries are brief and do not provide much information, for example, ‘All care given as required’. (See requirement 4) During the last key inspection a requirement was issued for the home to develop a quality assurance system. Satisfaction surveys were distributed in May 2008 and the interim home manager has tried to address any issues that arose as a result, for example improving laundry procedures so that fewer items of clothing go missing. The surveys that have been sent back will be fully evaluated by the new home manager. 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. (See recommendation 7) 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 float available in the home. Records are kept by the homes administrator who requires proof of purchase, two staff signatures and receipts for any money spent by or on a residents behalf in the home (hairdressing and shopping) or in the community. Examination of receipts and records for three sample people were correct. Relatives who manage finances on behalf of a resident can deposit money with the administrator and inspect expenditure records. Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 2 17 X 18 2 2 2 X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 3 Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. 2. 3. Standard OP7 Regulation 15(2) 16(2) 13(1) 17 Timescale for action Care plans must be reviewed and 17/10/08 revised when a persons needs change. Residents must receive meals 17/10/08 and drinks in accordance with any specialist nutritional advice There must be an effective 17/10/08 system for monitoring residents weight and for maintaining an individual record. There must be a record of all 17/10/08 care given to residents. There must be no gaps in recording in the daily and nightly progress and evaluation records. Prescribed medications must be 17/10/08 stored in a secure medication trolley during administration. Lockable medication trolleys must be large enough to safely store medication. There must be a record of all 17/10/08 medication administrations by staff. If a medication is not administered for any reason there must be a record as to why. A statement containing a 17/10/08 summary of the complaints DS0000007030.V368075.R01.S.doc Version 5.2 Page 29 Requirement OP8 OP8 4. OP37 17 5 OP9 13(2) 6. OP9 13(2) 7. YA16 22(8) Laurels Nursing Care Centre 8. YA16 17(2) Sch 4(11) 9. OP18 37(1)(g) 10. OP18 12 13 11. OP19 23 12. OP30 18 made during the preceding twelve months and the action that was taken as a response must be supplied to the Commission. The registered person must keep a record of all complaints made by service users or representatives or relatives of service users or by persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint. The Commission must be notified of any allegation of misconduct by any registered person or person who works at the home. Procedures for responding to allegations of abuse must be reviewed to ensure that local authority guidelines for safeguarding vulnerable adults are followed and all appropriate authorities notified. A crease in the carpet that is causing a trip hazard in a second floor communal lounge must be removed to provide a level walking area. The registered person must ensure that there is a staff training and development programme which meets national workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 17/10/08 17/10/08 17/10/08 17/10/08 17/11/08 Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 30 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. Refer to Standard OP1 OP3 Good Practice Recommendations Residents should be given a copy of the residents guide to the home. 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. It is recommended that the Home move towards using a more Person Centred approach with their Care Plans that would include a biography, personality, communication support, strengths and wishes of the person as best known through observation and advocacy. In a good Care Plan the sense of the person would really come through. 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. The constant beeping caused by a reported fault with the emergency call alarm system should be rectified to prevent continued disturbance to residents. The registered person should make bedroom door numbering easier to understand, so that residents and visitors are better able to locate bedrooms. The home should introduce effective quality assurance and quality monitoring systems, based on seeking the views of service users, to measure success in meeting the aims, objectives and the statement of purpose of the home. 3. OP7 4. 5. 6. 7. OP22 OP22 OP19 OP33 Laurels Nursing Care Centre DS0000007030.V368075.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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