Inspection on 13/06/07 for Laurels Nursing Care Centre

This inspection was carried out on 13th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 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 Key Unannounced Inspection 13th June 2007 10.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Laurels Nursing Care Centre DS0000007030.V341031.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.V341031.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 Mrs Joyce Glenda Tendai Chengeta 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.V341031.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 17th January 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 CSCI inspection report is available in the main reception area. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in twelve hours over two days. It involved observation of the care provided and discussion with residents, visitors, the home manager, the area manager and nursing, care and ancillary staff on duty. The CSCI Pharmacist inspector completed an assessment of how well the home deals with medication issues. The findings of this inspection are included in this report. Survey forms were sent to the home before the inspection. Completed forms were received from: • Five residents • Seven relatives or friends The home manager completed a pre-inspection questionnaire to provide the Commission with information about the running of the home. The Commission thanks all who contributed their time, opinions and accounts of their experiences. Records relating to individual care arrangements, staff recruitment and training and health and safety were examined and there was a tour of the premises. The last key inspection of this service took place in July 2006. An additional inspection was carried out on 17th January 2007. The findings of this additional inspection are included in this report. What the service does well: The home manager and staff are trying to involve residents and family members and friends in the running of the service and there are regular meetings and newsletters. Feedback from relatives and friends is positive. Comments include: “I think they do a wonderful job, very patient with all. My husband gets quite aggressive, but they always manage to do things for him without showing any bad feelings”. “They are always friendly and kind when I am there, they offer help if I need any and give me information when needed”. “If there is a problem with my relative they always let me know straight away”. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 6 “They have made us welcome and we find the home to be homely and friendly” “The manageress always has time to explain things” “The staff seem well trained and genuinely interested in what they are doing”. “I think this care home does the very best it can. I visit daily and notice that the staff are kind and patient. The lady in charge is excellent –always keen to answer questions and to listen to and act on suggestions”. “I feel that I am lucky to have my husband in such a caring environment”. “I consider that in every area of care, the staff are exemplary in all they do. I cannot fault anything. Every need seems to be met, with kindness, courtesy and respect for the dignity of the residents”. “I applaud the imaginative way in which trips, outings, parties and ‘get togethers’ are organised by the management. This clearly gives a sense of well being to the residents and enables them to have something to look forward to”. “Totally satisfied!” “I think the staff are remarkably responsive and caring” “My friend prefers her own routine in her own room and this is accepted”. Feedback from residents includes: “The home was recommended by a friend. I know nothing about care homes, but I liked the atmosphere here and I took a room. I like being here”. “It is a good place and it is still good!” What has improved since the last inspection? Prospective residents have the information they need to make an informed decision about the service and whether to use it. Written plans detailing the type of care and support that each person needs are more ‘person-centred’ and provide staff with practical information about social care needs, in addition to the care required to maintain physical health. There is evidence that residents and family members or friends are consulted about the planned care arrangements. This is good practice. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 7 The home manager has developed specific plans for how residents are to be cared for during a heat wave. The records that are kept of the care provided to residents with pressure sores are more comprehensive. This enables the home manager and tissue viability nurse to have a clearer picture of what care is being provided. There are more specialist-trained nurses in the team now; this ensures that a nurse with specialist training in meeting the needs of people with dementia is always available. More of the care staff have attained a vocational qualification in providing care. Lighting in the communal areas of the home is improved; this is better for people whose eyesight may be failing. There are also more handrails. Bedroom doors can now be left open, because they have been fitted with a mechanism that will close if the fire alarm goes off. Residents often prefer to have their bedroom doors open, especially if they are spending the day in bed. 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.V341031.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.V341031.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed decision about the service and whether to use it. The home manager completes a comprehensive assessment of the care needs of all people referred. EVIDENCE: The information given to prospective residents has been revised in accordance with recent changes in legislation. There is now more information about fees and what they cover, as required in the previous inspection report. The pre-admission assessments of two residents who recently moved to the home provide evidence of comprehensive pre-admission assessment, and in both cases local authority and nursing care needs assessments are also available. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health, personal and social care needs are set out in individual plans for each persons care. Health care needs are fully met and residents are treated with respect and their rights to privacy is upheld. Residents are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Written plans detailing the type of care that each person needs are in place. The planning system has been revised and the plans are now more holistic and do not focus on health problems alone. There is good progress in introducing these more ‘person centred’ plans. There is more information about the social care needs of each person, how they like to spend their time and how best to engage and communicate with each person. Care plans provide staff with practical information about how to assist each person to maximise their independence and choice in addition to the steps needed to maintain physical health and mental well-being. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 11 The care plans identify each medical and personal care need and how these needs will be addressed and met. 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. Where possible, the initial written care plans are discussed with the resident and their relative/representative and their signatures are obtained as evidence of this. This is important to ensure that relatives and residents agree on the type of care and support that should be provided. There is good progress in retaining evidence of this involvement and a requirement made in this regard is therefore met. The daughter of one of the residents confirmed that the plans for care had been discussed with her and her father. There is one GPs practise to serve all residents. A GP visits once a week to see any person that has requested a consultation or who staff request one for. The GP can also make additional visits if required. An optician is contracted to visit the home each year to undertake eye examinations, additional consultations can be requested if needed. Residents are referred to the community based foot health clinic and can select their own dentist in the area. All other health disciplines are accessed via a referral made by the GP (such as dietician, speech therapist, occupational therapist or audiologist) The staff keep a log of residents who need to be seen and what the concern is. The log also details what action has been taken by the GP. The medical care of a minimum of fifteen residents is routinely reviewed during each GP visit. The home has input from the Care Homes Nursing Support Team who provide continence, tissue viability and falls prevention support and advice. 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. During the random inspection carried out in January 2007 it was noted that staff were recording wound dressing changes in two separate documents, neither providing an accurate and complete record of wound dressing and care. One of the records, the ‘wound and dressing audit chart’ was checked and on a regular basis by the home manager. The other record the ‘progress and evaluation’ log was not. All entries are now made on one record chart so that Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 12 the home manager can audit the complete record of wound care, as recommended in the previous inspection report. Tissue viability risk assessments are in place for all residents, and residents at high risk are reviewed frequently. Turning charts are in place when staff are required to assist residents to change position so that they do not develop pressure sores or to promote better healing of any sore already developed. General health issues are monitored well, and there is good follow-up with input from the appropriate health professionals, for example, the community mental health teams, dieticians and tissue viability nurses. Daily progress logs are detailed and meaningful, and give a good picture of the residents condition. There are an adequate number of air circulation fans for use in hot weather both in communal areas and in bedrooms. The home manager has obtained department of health guidance for action to be taken during heat waves as recommended in the previous inspection report. Staff were observed to knock on bedroom doors before entering and address residents by their preferred names. All personal care is provided in the privacy of bedrooms and staff were observed to be mindful of the dignity of people, by ensuring that doors were closed. Discussion with the home manager indicates that there is sometimes a difficult balance to be stuck when residents are keen to maintain their own personal care and do not recognise the need for staff support in the area. Some people may not be able to manage these tasks as well as they used to. Residents wear their own clothes, although staff have on occasion provided some of their own clothing to residents who may have temporarily run short. Steps were taken during this inspection to resolve financial matters preventing the purchase of new clothing. Feedback from some relatives and residents indicates that laundry sometimes gets mixed up or lost. It is recommended that laundry procedures be revised to ensure a better outcome. (See recommendation 1) There is a payphone available if residents wish to make a private telephone call. All bedrooms are currently single occupancy, although people can request to share a room if they wish. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 13 The CSCI Pharmacist inspected Standard 9, Medication. Quality in this area outcome is good. Evidence The CSCI Pharmacist left 4 requirements and 2 recommendations on medication at the last inspection in July 2006. At this inspection all requirements except one have been met. Medication management has improved significantly. The Registered Manager has been conducting regular audits on medication handling and staff interviewed had a good understanding of medication issues. The supplying Pharmacy is going to be changed in August due to some supply issues. The GP visits regularly, there is also input from a psycho-geriatrician, facilities for medication storage are good, and the medication policy has been updated. Medication records were accurate. There were a small number of recording issues, mainly relating to night doses of medicines not signed for on one day only in the week before the inspection. This will be addressed by the Manager as a training issue. One prescribed item had the frequency changed from two to three times a day; staff had not dated and initialled the change. Receipt quantities were missing for 4 items received mid-month. One item was out of stock for a resident recently transferred this week from another home. The reason for this is that the previous home did not supply all of the residents prescribed items, so the home has arranged for the GP to see this new resident, and the medication will be available within 24 hours. A requirement has not been left for these issues, as the incidence is very small. Some residents are not taking their medicines regularly. There is evidence that the prescriber is aware. As mentioned at the last inspection the home should have a care plan on medication compliance for these residents, stating what action the home has taken e.g. contacting the prescriber, and how to manage their health conditions without medication (see requirement 4). Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are increasingly involved in choosing leisure activities to enrich the lifestyles of those living in the home and the range of activities is being gradually increased. Residents can maintain contact with family and friends and are able to exercise choice and control over their lives whilst they have capacity to do so. Residents receive a wholesome, appealing and balanced diet and mealtimes are pleasant and relaxed. 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. Care staff were also observed to engage in entertaining activities such as singing songs and dancing 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. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 15 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 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 relaxation if someone is particularly unsettled or noisy. Soothing aromatherapy hand massage has been introduced and is a good activity for people who are less able to engage in some of the other activities available. Observation on the first floor indicates that there is improvement in the quality of the environment in the communal lounge and in activities and opportunities for interaction and stimulation available to residents. There is a large display of photographs in the reception area. Photographs show staff and residents enjoying special events and daytrips together. There is also a display with photographs of each member of staff giving their name and role in the home. Activities that are currently available include: • Arts and Crafts • One to one sessions • Dominoes group • Gentle exercise • Reminiscence • Musical videos • Hand massage • Sing-a-long sessions • Cheese and Wine nights • Visiting entertainers • Seasonal parties (Christmas etc) • Purley King visits • Mobile library • Visits to a local community centre • Visits to parks and places of interest • Visits to shows • Residents meetings • Relatives and residents meetings • Visiting clothing shops • Sitting in the small courtyard garden There are charges for some of the activities, such as the local community centres, shows in the community and transport costs. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 16 Residents are offered an increasing range of activities, and residents and relatives are encouraged to become involved and make suggestions. This is good practice. 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. The home manager seeks information about the life histories of new residents from their family members; this enables staff to have an understanding of their interests and hobbies. This is good practice. Residents are able to make decisions about when to get up and when to go to bed. 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 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. 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. 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. 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.V341031.R01.S.doc Version 5.2 Page 17 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.V341031.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 good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident that their concerns and complaints will be listened to and acted upon and steps have been taken to protect residents from abuse. EVIDENCE: There is a complaints policy and procedure that meets the standards and regulations and the home manager has kept records of any complaint made. During the January 2007 inspection visit the home manager said that books to record verbal complaints and comments were available on each floor of the home, as recommended in the previous inspection report. Examination of these records indicates that the nurse in charge and manager review the books regularly and take appropriate action to address any concern raised. This is good practice and may reduce the need for people to make more ‘formal’ complaints. There have been four complaints in the last 12 months. One of which, in regard to lost items of clothing belonging to a resident, was substantiated. The home manager has kept detailed records of investigations undertaken to address any complaint made. A sample of these records indicates that the Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 19 home manager has looked at each issue properly, taken appropriate action as needed and given the complainant detailed feedback of her findings. There are policies and procedures to safeguard residents from abuse. Records of accidents and incidents and actions taken by staff indicate that the home manager has notified the Commission and local authorities of events in the service as required. The previous requirement to ensure that notifications are made in accordance with Regulation 37 is therefore met. All staff have attended ‘abuse awareness’ training, and refresher training is available. Local authority adult protection procedures have been obtained and are displayed in the home, as recommended in the previous inspection report. Laurels Nursing Care Centre DS0000007030.V341031.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the building is clean and reasonably well maintained on the inside premises security is a concern. There is also a shortage of accessible open-air communal space. 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. There is ramped access for people who use wheelchairs. The first and second floors have their own communal lounges and dining areas. Each floor of the home is separated by security keypad access. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 21 The home manager has increased the communal areas on the second floor by using an empty bedroom as a second communal lounge. This provides residents with more options. A requirement was made to seek advice about improving building security after the key inspection in July 2006, as a resident had complained of feeling unsafe on the ground floor. Tall hedges around the exterior of the building have been trimmed to improve building security in this area as a result. There has been a further breach of security, involving the discovery of an intruder, reported to the police and to the Commission earlier this year. During a tour of the exterior grounds the inspector noted two security lapses. An immediate requirement was issued for the registered provider and manager to take immediate action to ensure that the premises were more secure. The home manager confirmed that actions have been taken to better secure the ground floor windows and doors. (See requirement 1) The report detailing advice taken in regard to security was made available during this inspection. The report highlights a number of problems and advice that includes the installation of CCTV to the exterior of the building, lighting that is triggered by movement and better door locking systems. (See requirement 2) An occupational therapist assessed the premises in 2006 as a result of a requirement made by the Commission. The report makes a number of observations and recommendations on improving the building to meet the needs of current and future residents: • Lighting is poor in some area and bedroom door numbering is complex. Relatives and residents 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. There is a need for improved handrails and lighting in some communal areas and bathrooms and a need for chairs of different heights with suitable cushions in all areas of the home. • There is progress in improving the lighting and handrails, although door numbering is still confusing. (See recommendation 2) 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 Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 22 caller alarm system with a pendant call alarm option for service users who find wall mounted call alarms inaccessible. (See recommendation 3) Residents bedrooms are generally personalised and homely and relatives and friends are encouraged to assist by bringing things in. Staff are now also assisting residents to personalise bedrooms in the absence of assistance from relatives or friends. There are profiling beds and pressure relieving mattresses if required. Bedroom doors have locks of a type that can be opened in an emergency by staff, but these locks are not of a type that would allow the resident to lock the door when they left their room. This type of lock should be available unless a risk assessment suggests otherwise. (See recommendation 4) 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. The home has a passenger lift between floors. The lift is operated by keypad code. Odour control continues to prove challenging. The home manager said that during the early morning there is sometimes an unpleasant odour in some areas, because many people need support with using the toilet and are using continence aids. Early morning cleaning routines improve the air quality, and no unpleasant odours were noted during this inspection. Pest control continues to be a challenge. There have been complaints about sightings of mice and one relative, who is otherwise happy with the home, raised this issue during the inspection visit. There is a pest control contract in place and an environmental health inspection was also carried out at the time of this inspection. The report of this inspection indicates that measures in place are adequate. (See recommendation 5) Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 23 The registered persons should seek advise on/consider ways in which the perimeter forecourt and exterior garden can be made accessible to residents, including those who use wheelchairs, as a communal area with seating. These areas should be designed to meet the needs of all residents including those with physical, sensory and cognitive impairments. (See recommendation 6) Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team is continuing to improve in terms of skills mix and training. This ensures that the needs of the resid4ents are understood and addressed. Recruitment procedures ensure that adequate checks are undertaken of all staff and volunteers and staff training is ongoing and well attended. 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. During the January 2007 inspection it was noted that all three nurses on duty were RGN’s. There were no RMN’s on duty. This is not in accordance with the staffing proposal supplied to the Commission as part of action taken to meet the outstanding requirement to ensure that an RMN is on duty at all times. There are now 3 permanent and five ‘bank’ RMN nurses. The nurses have specialist training in meeting the nursing care needs of people with dementia and mental ill health. This means that there is now always an RMN on duty in the home. The home manager has 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. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 25 The current daytime staff ratio and skills mix for each unit is: • Ground floor: One trained nurse and three care assistants • 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. If necessary, additional staffing is provided by a local home run by the registered provider and many staff have worked in the home for many years. The recruitment records of staff 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. The pre-inspection questionnaire completed by the home manager states that 68 of the care staff have attained an NVQ (National Vocational Qualification) at level 2 or above. This is an improvement since the last inspection. There are now 21 registered nurses and five qualified first aiders. Domestic staff are also undertaking an appropriate NVQ qualification. Overall this shows continued improvement in staff training and qualification. Staff have access to internal training provided by the registered provider and to training offered by the Care Homes Support Team. All staff receive structured induction in accordance with ‘Skills for Care’ training targets and a wide range of service specific training is available. The • • • • • training plans for 2007 includes: Manual handling updates First Aid awareness Basic infection control Adult abuse awareness Food hygiene DS0000007030.V341031.R01.S.doc Version 5.2 Page 26 Laurels Nursing Care Centre • • • • Health and safety Managing challenging behaviour Person centred dementia care Training in the use of specialist equipment There are regular team meetings and staff receive regular and recorded supervision (one to one meetings with a line manager) and annual appraisal of their performance. One training target for this year is for better ‘end of life’ care training for staff. Laurels Nursing Care Centre DS0000007030.V341031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the ethos, leadership and management skills of the home manager, who is qualified and experienced. There is progress in developing the quality assurance systems and residents and relatives are involved in the evaluation and improvement of the services provided to ensure that it is run in the best interests of the residents. Systems are in place to protect residents from financial abuse and records are well kept. Systems and checks are also in place to promote good health and environmental safety, although security is of concern and must be improved. EVIDENCE: Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 28 The registered home manager is an RMN/RGN and also has the RMA (Registered Managers Award) and extensive experience in nursing care. The inspection was well facilitated by the home manager and all staff on duty, who presented as professional and keen to develop and improve the services provided at the Laurels. There is evidence of good leadership and organisation, and improvement in many areas. The manager has an open, positive and inclusive management style and she communicates a clear sense of direction and leadership. A deputy home manager is being recruited at this time. The home manager is keen to involve residents and relatives more and regular meetings and social events are proving popular. These are steps towards effective quality monitoring, and surveys have been sent to residents and family members or friends. The results of these surveys are currently being analysed and progress will be examined during the next inspection visit. There are also plans to survey the views of visiting professionals later this year. Systems are in place to provide feedback to residents in the form of a newsletter, a report and a meeting. (See requirement 3) 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. The home administrator manages the financial affairs of residents whose personal allowance is supplied by the registered provider or the relatives of the residents. All cash and financial records are stored securely and receipts are retained for items purchased on behalf of any resident. The cash balances and financial records for two residents examined were in good order. There are records of routine environmental health and safety checks conducted by a member of staff. A pest control contract is in place and operatives attend the home regularly to conduct checks and set traps. However, there is a recurrent problem with mice. Pipe work and radiators are fitted with guards to prevent contact burns. Each room is centrally heated with individually controlled thermostats. Hot water temperatures are thermostatically regulated at each hot water to prevent scalding. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 29 Water utility authorities inspected the premises in October 2004 and confirmed that the home complies with the Water Supply (Water Fittings) Regulations of 1999. The security of the exterior of the building should be reviewed to ensure that residents feel/are secure. (See requirements 1 & 2) The fire alarms, fire fighting equipment and emergency lighting are tested professionally on a regular basis. Fire drills are conducted on a regular basis. Lifts, electrical and gas-powered equipment are tested professionally on a regular basis and records of safety testing are retained. Environmental and fire risk assessments are conducted regularly, and incorporate risks posed by/to individual residents. There is a clinical waste contract in place. Hot and cold-water temperatures are tested regularly and the results recorded. There are also regular checks of the water systems for legionella. The home manager said that the LFEPA have been consulted about the revised fire evacuation procedures, which now involve staff remaining in the building with residents who are unable to be evacuated easily, until the fire brigade arrive. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 30 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 X 3 2 3 3 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 3 2 X 3 3 X 2 Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 31 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 OP38 OP19 Regulation 23 Requirement The registered persons must take immediate action to ensure that the home is sufficiently secure to prevent intruders. Details of the revised security measures must be sent to the Commission by Evidence that action has been taken to meet this requirement was supplied to the Commission on 21/06/07. The registered person must ensure that action is taken to improve the security of the exterior of the building. Timescale for action 14/06/07 2. OP38 OP19 23 27/07/07 3. OP33 24 A detailed action plan must be supplied to the Commission by 28/09/07 The registered person must ensure that effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. There is progress in meeting this previous requirement. DS0000007030.V341031.R01.S.doc Version 5.2 Page 32 Laurels Nursing Care Centre 4. OP9 13.1 The registered person must 28/09/07 ensure that a care plan on medication compliance is written for those residents who regularly refuse their medication stating the action the home has taken to ensure their health needs are met. 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. 4. 5. 6. Refer to Standard OP10 OP19 OP22 OP24 OP26 OP20 Good Practice Recommendations The registered persons should revise the laundry procedures to ensure that clothing is not lost or misplaced. The registered person should make bedroom door numbering easier to understand, so that residents and visitors are better able to locate bedrooms. 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 fit bedroom door locks that can be locked from the outside if a resident wishes. The registered persons should review the pest control measures to ensure that all necessary actions are taken to reduce the likelihood of vermin entering the building. The registered persons should seek advise on/consider ways in which the perimeter forecourt and exterior garden can be made accessible to residents, including those who use wheelchairs, as a communal area with seating. These areas should be designed to meet the needs of all residents including those with physical, sensory and cognitive impairments. Laurels Nursing Care Centre DS0000007030.V341031.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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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