Inspection on 11/01/06 for Laurels Nursing Care Centre

This inspection was carried out on 11th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Laurels Nursing Care Centre 01/06/09

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 12/07/05

Laurels Nursing Care Centre 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Laurels Nursing Care Centre The Laurels 70 Union Street Clapham London SW4 6JT Lead Inspector Sonia McKay Unannounced Inspection 11th January 2006 09:30 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.V271767.R01.S.doc Version 5.0 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.V271767.R01.S.doc Version 5.0 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 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 Mr Teeluckdharry Ramparsad 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.V271767.R01.S.doc Version 5.0 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 12th July 2005 Brief Description of the Service: The Laurels is a purpose built 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. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit began at 9.30am and was conducted over ten hours. There was a tour of the premises, discussion and a meal (lunch) with service users, discussion with staff, observation of activities and examination of care and home records. What the service does well: What has improved since the last inspection? What they could do better: Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 6 There is a need to recruit more specialist nursing staff that are trained to meet the needs of service users who have dementia. Assessment and care planning must be improved to ensure that staff know what to do for each service user and to ensure that the home is suitable to meet the needs of new service users. The outcomes of GP consultations must be recorded to ensure that service users health needs are met. The home environment must be assessed by an occupational therapist, so that changes can be made that will assist service users to move around the building more confidently. Verbal complaints must be looked into properly so that the person making the complaint feels they have been listened to. The management of health and safety must be improved. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 7 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.V271767.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 Prospective service users have the written information they need to make an informed choice about where to live, but should be offered an opportunity to visit where possible. Service users needs are assessed prior to admission. The lack of a sufficient number of suitably qualified nurses means that there is no assurance that dementia nursing care needs are adequately or consistently met. EVIDENCE: The statement of purpose and service users guide had been revised in September 2005. They now contain sufficient information. There is an admissions procedure that involves extensive pre admission assessment by the home manager, who visits prospective service users and obtains specialist assessments as required. Prospective service users are not routinely offered the opportunity of visiting the home before moving in for a trial placement, although relatives often visit the home before making the decision for their relative to be placed there. In some cases this may be sufficient. However, if a person is able to Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 9 communicate their views, they should be offered the opportunity to look around them selves before commencing the trial placement. (See recommendation 1). Long-term residential nursing care is provided. The home does not offer respite or intermediate care. Each of the three floors has a qualified nurse leading a team of care assistants at all times. Service users living on the first and second floors have dementia. The home manager said that recruiting specially trained nurses (RMNs) is still proving difficult and the home does not have enough RMNs to provide 24-hour cover. General nurses and care assistants have undertaken on-the-job training in the care and support of service users with dementia. This does not negate the need to have an RMN on duty at all times on the first and second floors. This is essential to ensure that service users receive the specialised services for people with dementia offered by the Laurels. (See requirement 1) Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Service users health and personal care needs are set out in individual plans of care. Social care needs are not fully addressed. Whilst healthcare needs are adequately documented and there is good access to input from specialist teams, failure to provide a sufficient number of specialist nurses means that mental healthcare needs may not be adequately met at all times. Although medication handling is generally good, there is insufficient information available to ensure maximum safety/benefit for service users. EVIDENCE: Care planning systems have been revised recently and are now more individualised. The care plans identify each medical and personal care need and how these needs will be addressed. There is also a record of the health care provided by relevant outpatient or visiting specialists that are conducted in the privacy of bedrooms. Care plans examined identified social needs but did not specify how these needs are to be met. (See requirement 2) Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 11 Nutritional screening is undertaken on admission and there are falls and tissue viability risk assessments in place. Care plans are reviewed each month. Where possible the initial written care plans are discussed with the service user and their relative/representative and their signature obtained as evidence of this. A GP visits the home on a weekly basis. Records of these visits and the outcomes of these consultations had not been kept on all occasions. (See recommendation 2) The home has input from the Care Homes Nursing Support Team who provide continence, tissue viability and falls prevention support. Comments received from other health professionals during the July 2005 inspection were generally good, although they did note an apparent shortage of adequately trained nursing staff. This shortage is still a concern. (See requirement 1) The incidence of pressure sores, their treatment and outcome, are recorded in the service users individual plan of care. Pressure relieving equipment is available. The home manager involves families and friends in planning for and dealing with increasing infirmity, terminal illness and death, if that is what the service user wishes. The specialist Infection Control team offers MRSA awareness training to all staff. The home is also taking part in a study of MRSA and depression in nursing homes. The outcomes of which will be examined during the next inspection. Staff were observed to use the terms of address preferred by the service users and to listen to a service users wishes in regard to his personal care. There is a portable payphone available that can be wheeled to bedrooms as required. Service users wear their own clothes at all times. The CSCI Pharmacist made one requirement in the July 2005 inspection report about the use of creams. Instructions are not always given by the GP, leaving it up to the staff to decide how and when to apply. The GP is required to add instructions for all prescribed medication, and prescriptions should be returned to the surgery if they do not contain instructions for use. This requirement has not been met. (See requirement 3) Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 12 MAR charts examined did not contain information about allergies (for example, allergic reaction to penicillin) (See requirement 4) The Medication policy has recently been reviewed. It contains good information on most aspects on medication handling. The following additions/changes are recommended at the next review: • Due to recent changes in environmental legislation, which now do not allow unused medication from nursing homes to be returned to retail pharmacies, the home will have to make arrangements with their clinical waste management contractor to remove unused medication • The drug recall section states that medication must be withdrawn by the home. Good practice would be to speak to the GP and arrange for a review as an alternative item may need to be prescribed before withdrawing treatment as this could be detrimental to the service users health • Verbal orders by a GP cannot be accepted to initiate treatment, only to make changes to an item already prescribed • Leave medication should be considered for all periods of absence from the home for example, attendance at day centres and leave with relatives, as the home must ensure continuity of medication • For emergency admissions to hospital, consideration should be given to supplying the service users medication as out of normal working hours it may not be possible for the hospital to obtain certain medications. Guidance has been written by the PCT and a copy has been provided to the home. • The when required (PRN) section should be made more detailed. There should be written protocols for PRN antipsychotic medication, as staff need to have clear guidelines from the GP as to when this medication should be given, the frequency of administration and the maximum dose in 24 hours. This relates to medications that are prescribed to be administered only on occasions when specific symptoms are noted (See recommendation 3) Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 There has been improvement in the range of activities available and more service users have opportunity for socialising. As activities are closely linked with social care plans, which are not in place in all cases, there is still a need for improvement. Service users receive a wholesome appealing and balanced diet. EVIDENCE: There are now two activities organisers who provide activities between Monday and Friday. A written programme of activities is available and distributed to service users. There is also involvement and training from the Care Homes Support team. Service users, who had been noted to be socially isolated in annexe suites on the first and second floors during the July inspection, are now supported to spend time with others in the communal areas, thus increasing their access to social interaction and activities. Aromatherapy hand massage has been introduced with encouraging results. Service users were observed to be enjoying a variety of leisure activities including television, singing gospel tunes and spending time with their visitors. The home manager is introducing life story work to enable staff to have a greater understanding of each service users interests and hobbies. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 14 Progress with developing the range of activities available will be examined during the next inspection. One service users said, I had the best Christmas ever, I really enjoyed it, the nurses even danced for us! (See recommendations 4 & 5) The home employs two chefs and kitchen assistants who prepare a range of wholesome meals in a well-appointed catering style kitchen. Records of meals served show that a variety of meals have been prepared. Menus include options suitable to meet the cultural preferences of service users in residence. Lunch was served in the communal lounge and consisted of lamb chops, chips or mashed potato, and broccoli and cauliflower or a pasta dish with banana cream pie and fresh cream or fresh fruit for dessert. The meal was well cooked. Portion size was adequate and the meals were served hot. Service users needing assistance with eating a meal were helped by staff that were patient and respectful. Service users who needed a soft or puréed meal were served a puréed or mashed version of the menu available. One service user said We had three Christmas dinners, they were lovely and the tables looked beautiful, another service user, who is unable to communicate verbally, gave a thumbs up sign when asked what he thought of the food. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17. Service users and their relatives/friends are not all confident that their complaints will be listened to, taken seriously and acted upon. There is a need for better staff communication to address this. Service users would benefit from access to independent advocacy to ensure that their legal rights are fully protected. EVIDENCE: There is a satisfactory complaints policy and procedure. However, it is essential that staff respond appropriately to verbal complaints made by service users and their relatives/representatives. There is a need for a system of recording the issues raised so that responsible staff have the opportunity to take any necessary action and respond to the complainant accordingly. This will ensure that service users and their relatives feel that their concerns are listened to and acted upon. (See recommendation 6). There has been one complaint made since the last inspection visit. This is in regard to the handling of a service users clothes and laundry. The home manager has taken appropriate action and is revising the laundry procedure. Service users do not have access to independent advocacy services. Where service users lack capacity, the registered persons should facilitate this access. (See recommendation 7). Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. The home is reasonably well maintained and decorated. However, adequate checks are not in place to ensure environmental health and safety. Service users do not have the specialist equipment and environment that they require to maximise their independence. EVIDENCE: The home is purpose-built and provides service users with accommodation on three floors. The ground floor has a central courtyard garden accessible from the ground floor lounge and hallway. The first and second floors have their own separate communal lounges and dining areas. Each floor of the home is separated by security keypad access. The new home manager has recently increased the communal areas on the second floor by converting one of the bedrooms into a second communal lounge. This provides service users with options. On the day of the inspection one service user was enjoying singing in one room whilst another service user enjoyed some quiet time in the other lounge. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 17 There is an outstanding requirement from the previous three inspection reports for the home to obtain a full occupational therapy assessment of the premises. This would be of benefit to service users, some of who have difficulty finding their way around the building. Lighting is poor in areas where down lighting creates excessive floor shadows. Bedroom door numbering is complex. Service users and relatives have said that they often get lost in the building. This is not ideal for a home offering services for elderly people who may be confused or have dementia or sensory impairment. More could be done to plan decoration/colour schemes to assist service users to move around the building confidently. (See requirement 5). The home is generally clean and tidy and well decorated. Bedrooms and bathrooms are fitted with fixed cord call-alarm for service users who need emergency assistance. A test call was placed from a toilet and a member of staff responded by attending the room within two minutes. However, some service users may not be able to easily use the call alarm system. A preferable system would have the option of a pendant alarm call as an alternative method for service users unable to access the wall mounted cords. (See recommendation 8). Service users bedrooms range from personalised and homely (relatives said they assisted by bringing things in) to bare. More must be done to ensure that each service user has a bedroom personalised to their own taste. Some of the bedrooms did not have overhead and bedside lighting or comfortable seating for two people. Minimum requirements for furniture and fittings in individual accommodation must be provided for each service user. (See requirement 6 and recommendation 9). Service users had profiling beds, pressure relieving mattresses and bed rails if they needed them. Pipe work and radiators are fitted with guards to prevent contact burns. Each room is centrally heated with individually controlled thermostats. Bedroom doors have locks, but these locks are not of a type that would allow the service user to lock the door when they left their room. This type of lock should be available unless a risk assessment suggests otherwise. (See recommendation 10). Each of the bedrooms has a small en-suite bathroom facility consisting of a W.C and a hand-basin. There has been refurbishment of the communal bathrooms and redecoration in some en-suite facilities. One service user is still awaiting adaptations to ensure independent use of his bathroom. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 18 Aids, slings, hoists and assisted toilets are installed. However, a recently admitted service user is unable to use his toilet facilities, as the aids in place are not appropriate. Hot water temperatures are thermostatically regulated at each hot water and outlet to prevent scalding. Records of hot water temperature testing indicate that hot water temperatures are too low. This must be addressed. (See requirement 7). Air cooling fans are not available in all communal areas and some bedrooms. This is recommended to ensure that service users are protected in hot weather. (See recommendation 11). The home has a passenger lift between floors. The lift has been out of action since September 2005 whilst a new lift is installed. The home manager said that the installation would be complete by mid-January 2006. There are no records of routine environmental health and safety checks conducted by an appropriately trained member of staff. (See requirement 8). The London Fire and Emergency Planning Authority (L.F.E.P.A) inspected the home in June 2004. Their report indicates a number of areas require attention. (See requirement 9). The Health and Safety Executive (H.S.E.) inspected the home in February 2005. Their report indicates a number of areas require attention. (See requirement 10) The local authority environmental health department inspected the food handling areas in June 2005 and made a number of requirements and recommendations. A pest control contract is in place. Staff reported that mice have been seen recently in the home. (See requirement 11) Water utility authorities inspected the premises in October 2004 and confirmed that the home complies with the Water Supply (Water Fittings) Regulations 1999. A drain cover is loose in one en-suite bathroom in the first floor annexe. There is also a blockage in the drain and foul smelling water is close to the surface. (See requirement 12) Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 There are sufficient numbers of staff on duty at all times, although the skills mix is inadequate. There is a shortage of specialist dementia care nurses. There has been progress in identifying training packages. EVIDENCE: Staff duty rotas record that a qualified nurse is on duty on each floor at all times. Two care assistants are also on duty on each floor. The home manager is an RMN. There is a shortage in mental health qualified nurses in the home. This must be addressed. (See requirement 1). The home employs an administrator, a nursing sister in charge, RGNs and carers. There are also domestic operatives, chefs, kitchen assistants, laundry assistants and a maintenance person. The manager said that the home is making progress in attaining the required 50 trained members of care staff (National Vocational Qualification level 2 or equivalent), although there is still a need for improvement. (See requirement 13). Staff have access to internal training provided by the registered provider and to training offered by the Care Homes Support Team. The new home manager is developing a training plan for 2006. This must be supplied to the CSCI. (See requirement 14) Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 & 38. An experienced and qualified home manger has been appointed. Staff are adequately supervised on a day-to-day basis, but not all benefit from regular individual supervision meetings with their line manager. More must be done to ensure that health and safety is managed effectively. EVIDENCE: A new home manager has recently joined the team. The manager is an RMN/RGN and also has the RMA and extensive experience in nursing care. The inspection was well facilitated by the home manager, the director of nursing and all staff on duty. All staff presented as keen to develop and improve the services provided at the Laurels. The home manager has yet to register with the CSCI. (See requirement 15) The deputy manager post is also recently vacant. This has therefore been a period of great change for staff and service users. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 21 The director of nursing, who visits the home each week, supervises the home manager and conducts inspections in accordance with Regulation 26 on behalf of the registered provider. Reports of these monthly inspections are maintained in the home and supplied to the CSCI. Staff said that they felt adequately supported in their roles but had found recent changes in management difficult at times. Some staff are supervised individually and others are supervised in groups. Each member of care staff must have individual supervision meetings with their line manager on a regular basis. (See requirement 16) The management of health and safety issues have not yet been fully addressed. (See requirements 8, 9, 10 & 11) Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 22 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 3 2 2 N/A 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 2 13 2 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 X 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 X 2 Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 23 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 OP27OP4 Regulation 18(3) (18(1)(a) Requirement The registered person must ensure that at all times a suitably qualified registered nurse is working at the care home (an RMN must be on duty at all times on the first and second floors). Previous timescale of 30/11/05 not met. The registered person must ensure that service users social care needs are set out in an individual plan of care. Previous timescale of 30/09/05 not met. The registered persons must ensure that all prescriptions have full instructions for use including those for external products. Previous timescale of 31/08/05 not met. The registered person must ensure that allergy information is detailed on all MAR charts. The registered persons must ensure that an assessment of the premises and facilities is conducted by a qualified Occupational Therapist. DS0000007030.V271767.R01.S.doc Timescale for action 28/04/06 2 OP7 15(1) 31/03/06 3 OP9 13(2) 03/03/06 4 5 OP9 OP22 13(2) 23(2)(a) 03/03/06 31/03/06 Laurels Nursing Care Centre Version 5.0 Page 24 6 OP24 23(2)(e) 7 OP25 23(2)(j) 8 OP38OP19 23(2)(b) &13(4)(a) 9 OP38OP19 13(4)(a) & 23(4) 10 OP38OP19 23(2)(b) 13(4)(a) 11 OP38OP19 23(2)(b) The report must be sent to the CSCI Southwark office. Previous timescales of 31/03/04, 31/08/04, 01/03/05 and 30/09/05 not met. The registered persons must ensure that furnishings and fittings for individual rooms are provided in accordance with National Minimum Standards for older people 24.2). Reasons to be documented where there are individual exceptions. The registered persons must ensure that hot water temperatures are thermostatically controlled to temperatures close to 43 oC (hot water temperatures are too low in some areas). The registered persons must ensure that an appropriately trained member of staff conducts regular environmental health and safety checks. Records of these checks must be maintained. Previous timescale of 16/09/05 not met. The registered person must ensure that action is taken to meet the requirements made in the London Fire and Emergency Planning Authority (L.F.E.P.A) report of June 2004. Confirmation that each of these requirements has been fully met must be sent to the CSCI Southwark office. The registered person must ensure that action is taken to meet the requirements made in the Health and Safety Executive (H.S.E) report of February 2005. Confirmation that each requirement has been fully met must be sent to the CSCI Southwark office. The registered person must DS0000007030.V271767.R01.S.doc 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 Page 25 Laurels Nursing Care Centre Version 5.0 13(4)(a) 12 OP21 13(4)(a) 13 OP28 18(1)(a) 14 OP30 18(1)(c) 15 OP31 9 16 OP36 18(2) ensure that requirements made in the Food Hygiene Inspection report of 03/06/05 have been addressed. The registered person must ensure that the drain cover in the en-suite bathroom of bedroom number 115 is secure and that the waste pipe is clear of stagnant water. The registered persons must provide the CSCI with an action plan for 2006 outlining how they intend to meet the ratio of 50 of staff trained to NVQ level 2. The registered person must ensure that a staff training and development plan for 2006 is developed and supplied to the CSCI Southwark office. The registered person must ensure that the home manager submits an application for registration as the home manager to the CSCI. The registered person must ensure that all care staff receive formal supervision at least six times each year. 24/02/06 31/03/06 31/03/06 03/03/06 03/03/06 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 OP5 OP8 OP9 Good Practice Recommendations The registered persons should encourage prospective service users to visit the home themselves before making the decision to move in to the home for a trial placement. The registered person should ensure that the outcomes of all GP consultations are recorded. The registered persons should consider the changes to the medication policy suggested under Section 7-11 of this DS0000007030.V271767.R01.S.doc Version 5.0 Page 26 Laurels Nursing Care Centre 4 5 6 OP12 OP13 OP16 7 8 9 10 11 OP17 OP22 OP24 OP24 OP25 report. The registered persons should extend the homes activities programs to include weekends. The registered persons should devise a strategy to facilitate community access for any service user who wishes. The registered persons should devise a system of noting verbal complaints/concerns raised by service users and their relatives/representatives. A log of these complaints/communications should be maintained on each floor of the home. The logs/communication book should be checked by the registered persons on a regular basis. The registered persons should facilitate access to advocacy services for any service user who lacks the capacity to do so themselves. 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 registered persons should assist service users to personalise their bedrooms. The registered persons should fit bedroom door locks that can be locked from the outside if a service user wishes. The registered persons should provide air-cooling fans in all communal areas and bedrooms. Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laurels Nursing Care Centre DS0000007030.V271767.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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