Inspection on 01/05/07 for Laurels Nursing Home The

This inspection was carried out on 1st May 2007.

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

Other inspections for this house

Laurels Nursing Home The 23/02/06

Laurels Nursing Home The 02/09/05

Laurels Nursing Home The 15/03/05

Laurels Nursing Home The 03/09/04

Laurels Nursing Home The 03/02/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Laurels Nursing Home The High Street Norton Doncaster South Yorkshire DN6 9EU Lead Inspector Jayne White Key Unannounced Inspection 08:30 1st May 2007 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 Home The DS0000015864.V330739.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 Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurels Nursing Home The Address High Street Norton Doncaster South Yorkshire DN6 9EU 01302 709691 01302 708409 NONE 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) Mr Kenneth Swales Mrs Deborah Swales, Mrs Sheila Swales, Mr Andre Swales Ms Julie Riley Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (20) Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: The Laurels Nursing Home is situated in the village of Norton, which lies to the north of Doncaster. A conservatory reception area adjoins the Nursing Home to the Laurels Residential Care Home that is also owned by the Swales family. The two homes are registered and inspected as separate services. The Nursing Home is registered for up to 20 older people aged 65 years and over, who need nursing care and therefore has qualified nurses on duty 24 hours a day. Both homes have strong links with the local community. The residents’ accommodation is all on the ground floor and has access to pleasant, well-maintained gardens with seating areas that are shared with the adjacent home. All bedrooms are for single occupancy and have en-suite toilet facilities. The main kitchen and laundry are located in the adjacent care home. There is a large car park and additional parking near to the main entrance, which is accessible for wheelchairs via a ramp. The fees for the home range from £460.00 to £553.00. Additional charges were made for hairdressing, private chiropody, papers and magazines, aromatherapy and for residents who have a private telephone line in their own bedroom. This fee applied at the time of inspection and people may wish to obtain more up to date information from the care home. The home had a service user guide that provided information about the service for current and prospective residents. This was kept in the office, as was the CSCI report. A notice was on the notice board about how these could be accessed. Once resident, the resident had a copy of the service user guide in their bedroom. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced site visit carried out between the hours of 8:30 and 17:00. The home had provided comprehensive information to assist with the site visit. As part of the inspection process, 9 surveys were sent to residents to obtain their opinions on aspects of living at the home. Five were returned. Three surveys were sent to staff to obtain their opinions of the home, one was returned. Seven surveys were sent to health and social care professionals to obtain their opinions of the home, six were returned. The inspection process included a partial inspection of the premises, inspection of a sample of records, observation of care practices and speaking with residents, their representatives and staff. The inspector spoke in detail to two staff on duty about aspects of their knowledge, skills and experiences of working at the home, six residents about their opinions on aspects of living at the home and three relative’s representatives of their opinion of the home. Also taken into account was other information about the service since the last inspection. The inspector wishes to thank the residents, staff and owners for their time and co-operation throughout the inspection process. What the service does well: The Laurels was well managed with residents and/or their representatives expressing a high degree of satisfaction with the service. Prospective people who may use the service and/or their representatives had information they needed to choose a home, which would meet their needs. They had, had their needs assessed and on the whole contracts were in place that identified the fee that residents had to pay. Residents assessed needs were formulated into a plan of care where the health and personal care needs on the whole were very well documented. Residents praised the home for the way that the staff treated them with respect and upheld their dignity. Generally the homes procedures for handling medicines were good and helped to protect and maintain the health of residents. Comments from health and social care professionals about the home included “The Laurels is a lovely home, warm and friendly environment. Patients seem to receive a high standard of care. Carers attend training and link meetings that we offer on a regular basis” and “overall I haven’t experienced any Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 6 problems with this nursing home. They are very efficient with regards to feeding patients and weighing patients on request and as part of their weekly routine. They will also contact myself if they experience any problems”. People who used the service were able to make choices about their life style. The meals were of a good standard, with choices and alternatives provided. There is good contact with the local community and a range of activities and outings are provided. People who used the service were able to express their concerns and had access to a complaints procedure. The home was clean, comfortable, well presented and well maintained with pleasant communal areas and provided a good standard of accommodation for residents. All residents said the home was always fresh and clean and residents’ commented, “by far one of the best in the locality, it’s kept beautiful” and “it’s very welcoming place”. There was an experienced and stable team of staff, including a mix of carers, nurses and ancillary staff in sufficient numbers to support the people who used the service and to support the smooth running of the service. What has improved since the last inspection? What they could do better: Include all the detail required in the service user guide, in particular, the range of fees to be charged, all the terms and conditions in regard to their stay and the CSCI inspection report. Ensure on admission all residents’ contracts, identify the fee to be paid and the method of payment of the fees and the person or persons by whom the fees are payable. Where the breakdown of who will pay the different parts of the fee has not been received by the placing authority this should be acknowledged in the contract and that information will be provided as soon as the provider knows that information. Ensure residents’ wishes for end of life are obtained and recorded and a record is made of valuables they bring to the home, so that appropriate information is available when required. Complete daily records to demonstrate the actual care provided during that day. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 7 Review the policy/procedure for protecting vulnerable adults from harm and/or abuse, provide training for all staff on the protection of vulnerable adults and ensure staff commencing employment have satisfactory CRB clearance, so that residents are sufficiently protected from abuse/harm. Document the reasons for gaps in employment where necessary, to demonstrate these have been explored, so that a full recruitment procedure is followed in order to protect residents. Provide liquid soap and paper towels in all toilet and bathroom areas to further support the control measures in place for the spread of infection. Review the training provided to ensure it is sufficient to ensure the knowledge and skills of carers remain up to date and meets all statutory requirements. Further safeguards in record keeping were required to ensure the financial interests of residents are safeguarded. Ensure certificates are in place and up to date for the servicing of all equipment and services at the care home, including fixed electrical wiring. 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 Home The DS0000015864.V330739.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 Home The DS0000015864.V330739.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): The outcomes for standards, 2, 3 & 6 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective people who may use the service and/or their representatives had information they needed to choose a home, which would meet their needs. Additional information in the service user guide and contract would improve this. People admitted to the home had, had their needs assessed. EVIDENCE: The service user guide included the terms and conditions of the services and facilities to be provided. An individual contract identified the fee to be charged and the arrangements for paying that fee. The standard contract/terms and conditions did not contain all the information required for residents to be sufficiently informed about the terms and conditions of their stay. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 10 Out of the five surveys returned by residents, three said they had a contract with the home, one said they didn’t and one didn’t know. The contracts for two residents were requested. Both had a contract with a breakdown of the fee to be paid to the home, including the nursing element. Some people had taken the opportunity to visit the home before making a decision, others had asked a relative or other representative to visit on their behalf and sometimes someone had visited from the home to answer their questions and assess their needs. Residents and relatives stated that they were made very welcome at the home when they came to view. Assessments were seen on file in three residents’ files inspected that were undertaken prior to admission to determine if the home could meet the needs of the resident. The assessment included the opportunity for prospective residents to state any particular needs they felt they had, including likes and dislikes, so that an individual plan of care to meet their needs could be formulated. Laurels Nursing Home The DS0000015864.V330739.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): The outcomes for standards 7, 8, 9 & 10 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents assessed needs were formulated into a plan of care where the health and personal care needs on the whole were very well documented. Residents praised the home for the way that the staff treated them with respect and upheld their dignity. Generally the homes procedures for handling medicines were good and helped to protect and maintain the health of residents. EVIDENCE: Residents spoken with spoke positively about their personal care needs being met. The five surveys returned identified two residents always felt they received the care and support they required, two usually and one sometimes. All said they received the medical support they required. All of the six surveys returned from health and social care professionals said the home communicated and worked in partnership with them, they were able Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 12 to see residents in private when they visited, staff had a clear understanding of residents’ needs, the managers and staff took appropriate decisions when they could no longer meet the care needs of residents and were satisfied with the overall care provided. Their comments included “The Laurels is a lovely home, warm and friendly environment. Patients seem to receive a high standard of care. Carers attend training and link meetings that we offer on a regular basis” and “overall I haven’t experienced any problems with this nursing home. They are very efficient with regards to feeding patients and weighing patients on request and as part of their weekly routine. They will also contact myself if they experience any problems”. Three residents’ care plans were inspected. All had clear plans of care that were informative and demonstrated how their health and personal care needs were to be met including nutrition, pressure area care, medication, falls, moving and handling and the management of behaviour to enable staff to carry out their jobs. Additional support through GPs and hospital services was evident, showing that residents were accessing health care as required. The plans were reviewed monthly and amended when a change of circumstance had occurred, showing that staff were identifying health needs and attending to them. The recording system had charts for staff to complete as they carry out personal care and activities each day with individuals. Although there was a record to record end of life wishes and an inventory of items the resident had at the care home these were not completed consistently. Daily records were not completed. Discussions with staff identified a daily report was only completed if the staff carried out tasks not identified in the plan of care. The inspector, however, draws attention to the following legislation and guidance: Care home regulations 2001, regulation 17 (Schedule 3, k) “Staff must keep up to date records of any nursing provided to the service user, including a record of his condition and any treatment.” Nursing Midwifery Council, Guidelines for records and record keeping “your record keeping should be able to demonstrate: a full account of your assessment and the care you have planned and provided”. The guidelines also add “the approach to record keeping that courts of law adopt tends to be that “ if it is not recorded, it has not been done””. Medicines held by the home on behalf of residents were administered through a monitored dose system, where possible. Medication was stored securely and safely, including controlled drugs. Records were kept of medication being received into the home and appropriate arrangements were in place for the return of medicines to the pharmacy. Records were organised and completed as required, although the printed medication administration record did not aid this process. Until scrutinised closely and discussed with staff the printed data did not correlate with the columns on the sheet and had resulted in the incorrect dosage of medication being recorded for particular days and therefore administered incorrectly. Fortunately, over the month, this was correct. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 13 Residents commented that they were well cared for by helpful and kind staff who treated them well and respected their privacy. There was clear and respectful communication between staff and residents, for example, at mealtimes and appropriate assistance was given. Residents were able to spend time in their room if they wished. Staff were able to describe how they care for people in a respectful and sensitive manner. They could describe how they respected the privacy and dignity of residents, for example, knocking on residents’ doors before entering and these were observed being put into practice. All personal care was carried out in the residents’ rooms and/or toilet/bathroom areas ensuring their privacy. Laurels Nursing Home The DS0000015864.V330739.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): The outcomes for 12, 13, 14 & 15 were inspected. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who used the service were able to make choices about their life style. The meals were of a good standard, with choices and alternatives provided. There is good contact with the local community and a range of activities and outings are provided. EVIDENCE: Of the five surveys returned, one said the home always arranged activities they could take part in, two said usually and two said sometimes. One resident commented, “there are various activities to suit all tastes”. A number of activities were provided, such as, communion and church services monthly, a craft and bingo session each week, coffee mornings with fundraising and a number of outings. Some residents chose not to join in these activities, preferring to spend time doing what they wished to do. All enjoyed the contact with the local community. Interests were recorded on the case file. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 15 Residents’ spoken with described how they could choose to spend their day and confirmed that they could choose what time to get up and go to bed within reason, accepting the constraints as part of group living. Residents were able to personalise their rooms with their own belongings, including some items of furniture. Relatives felt welcome at the home, a drink always being offered and staff having time to talk with them about the care their relative was receiving/needed. There were areas that could be used if a resident wished to see someone in private without going to their bedroom. There is regular support from the local community at fundraising events and also at the weekly coffee mornings when residents spend time talking to the visitors and catching up on local news. Residents confirmed their family and friends could visit “at anytime”. Of the five surveys returned, three residents identified the meals were always good, two usually good. Residents’ comments about the meals included “there is a good variety of fresh foods” and “diabetic desserts are less varied”. The pre inspection questionnaire said breakfast was served at 9:00, lunch 12:30 – 13:00, tea 16:30 – 17:00 and supper 19:30 – 20:00. The menu was displayed on the notice board in the main corridor and residents knew this was where they could find out what was for dinner. The board identified choices available at the lunchtime meal. The meals were presented attractively, at nicely set tables and were hot, well cooked and of good quality that residents found satisfying. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 16 & 18 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who used the service were able to express their concerns and had access to a complaints procedure. Residents were not sufficiently protected from abuse as the policy/procedure for protecting vulnerable adults needed to be reviewed. Staff needed training on the reporting of any allegations of abuse so that all allegations of abuse are reported. EVIDENCE: Of the five resident surveys returned, three residents knew how to complain, one usually knew how to complain and one sometimes. Four of them identified residents always knew who to speak to if they weren’t happy, one said usually. Residents spoken with knew who to talk to if they had a concern, but all spoken with said they had no concerns. Staff members and the owners were said to be approachable and well liked. There was a record of complaints. The complaints procedure did not include the correct details of the CSCI, so that complainants who wished to raise their concerns in this way knew how to do so. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 17 There was a policy/procedure in place for the protection of vulnerable adults to be followed by the home should an allegation of abuse be made. This needed reviewing as it identified an allegation would not be reported to the appropriate authorities if the resident did not wish to do so, which may not ensure appropriate action is taken should an allegation of abuse be made. A copy of the Doncaster multi agency protection of vulnerable adults policy and procedure was in place, but there were residents living at the home from other areas, so the policy/procedure may not be appropriate for them. Staff spoken with had undertaken training in the protection of vulnerable adults as part of their NVQ Level 2 in Care. Three staff files were inspected for training they had attended and this did not include the protection of vulnerable adults. Discussion with the manager at the home identified that all allegations of abuse would be reported to her and if she was absent, the manager of the adjoining care home. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 19 & 26 were inspected. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable, well presented and well maintained with pleasant communal areas. A good standard of accommodation was provided. EVIDENCE: All of the five resident surveys returned said the home was always fresh and clean and residents’ commented, “by far one of the best in the locality, it’s kept beautiful” and “it’s very welcoming place”. All residents spoken with said that they were happy with their living environment, their bedrooms were comfortable and on the whole that they had Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 19 everything they needed. Where they needed anything they spoke with the owners and/or manager and it seemed to be addressed. The building was well maintained and there were no obvious hazards to residents’ safety. Access around the home was good due to all the facilities being on the ground floor. The communal areas were comfortable and offered sufficient space for the number of people that use them. Access to the grounds was through the adjoining entrance hall and a range of garden seating and tables were provided for residents. Some bedroom areas had patio doors leading to the grounds of the home. All the bedrooms had en-suite toilets and wash- hand basins. Residents were able to personalise their rooms with pictures, photographs, ornaments and some furniture and all seemed very pleased with their rooms. The home was clean and free of offensive odours throughout and representatives of residents particularly appreciated this. The laundry facilities for both this and the adjoining home were located in the adjoining care home and therefore it catered for 50 people. Laundry facilities were sited away from food preparation and storage areas. Hand washing facilities were provided. Residents spoken with were satisfied with the laundry service. Inspection of toilets and bathrooms and discussions with staff identified there was not liquid soap and paper towels provided in these areas. Provision of these would add to the control measures in place to reduce the spread of infection. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 27, 28, 29 & 30 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was an experienced and stable team of staff, including a mix of carers and ancillary staff in sufficient numbers to support the people who used the service and to support the smooth running of the service, but staff recruitment was insufficient to protect residents from risk abuse. Staff had received training so that they were competent to meet residents’ needs, but this needed reviewing to ensure their knowledge and skills remained up to date. EVIDENCE: All of the resident surveys returned confirmed staff listened and acted on what the residents said, two of the surveys said staff were always available when they were needed, three said usually. Their comments included “friendly staff”, “staff listen and act on what you say where possible”, “if staff are attending others they come as soon as they can” and “staff mostly listen and act on what you say, but often it depends on their experience”. Residents spoken with gave praise regarding the helpfulness and friendliness of staff and liked the care workers and other staff very much. They also found them respectful of their privacy. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 21 The manager said during the day there was a nurse and three care staff on duty, with another member of care staff 7:00 – 9:00. At night there was a nurse and one carer on duty. On the whole, the staff rota confirmed this appeared to be met, but this was difficult to confirm in parts. There appeared to be sufficient on duty. The pre-inspection questionnaire identified 60 care staff held NVQ Level 2 in Care and ten staff held a first aid certificate. Staff stated they had opportunity for training and this had included infection control, moving and handling, health and safety, NVQ level 2 in Care and fire. They had not received training in food hygiene, but served meals at lunchtime. The three staff files inspected identified staff had received training in moving and handling, fire safety, hoist, syringe driver and skills for care induction. This was recorded in their personal training record and certificates to demonstrate qualifications and training of staff were also in place. The pre-inspection questionnaire identified staff training during the last 12 months as NVQ Level 2 & 3 in Care, manual handling, use of hoist, keyworker role, communication skills, fire lectures and drills, foot care course, continence course, catheter course, syringe driver updates, MacMillan nurse modules and training for aggression and violence. Future training is to include NVQ level 2 & 3 in Care, first aid, manual handling, use of hoist, fire lectures/drills, dementia care, infection control, nutrition, catheter updates, lymphoedema day, wound care, train the trainer courses, continence courses and syringe driver updates The homes recruitment procedure did not ensure all relevant checks were carried out before staff commenced employment in order to safeguard residents. Three staff files were inspected. One member of staff had commenced employment without a CRB being applied for, therefore without satisfactory clearance of a POVA first check to verify they can work with vulnerable adults, one file demonstrated a CRB from previous employment had been used and in the other, the CRB was not issued until after the member of staff had commenced employment, again without POVA first clearance. The owner stated all CRB’s were destroyed on guidance form CRB, but the retained record kept on computer did not include all the information required to demonstrate requirements had been met, including the date the CRB was applied for, the date of application for and receipt of a POVA first check if necessary and whether the CRB was satisfactory or not. The owner was told to apply for a further CRB for the member of staff with a CRB from previous employment and until a satisfactory CRB’s was received that they were supervised on shift. The owner was informed of the requirements in regard to supervision of those staff and the CSCI requirements re retention of CRB documentation. Satisfactory written explanation of gaps in employment were not documented, although the manager did say these were checked at interview. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 31, 33, 35 & 38 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Laurels was well managed with residents and/or their representatives expressing a high degree of satisfaction with the service. Residents were encouraged to control their own money, but further safeguards in record keeping were required to ensure their financial interests are safeguarded. On the whole the health, safety and welfare of residents and staff were protected. EVIDENCE: The registered manager Julie Riley is a registered nurse with many years experience including managing care homes. She has completed NVQ level 4 in Management and has the Registered Managers Award. There was an excellent Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 23 team approach at the home with the manager working closely with the manager of the adjoining home and the high level of input from the owners. A nurse manages each shift and in the absence of the home manager, with support from the manager of the adjoining site if necessary. The manager, owners and staff are well liked and respected by everyone at the home and they have created an atmosphere of openness and consultation, which enables the residents, their representatives and staff to feel valued. Two of the owners work at the home on a daily basis, managing the financial and administrative work and the building maintenance. There are joint meetings with the managers of the two homes on site and the owners, in which planning and decisions are made. There are also resident and relative meetings and staff meetings where ideas are put forward and discussed, including the regulatory role of CSCI. Progress had been made on all requirements and recommendations made by previous CSCI inspections. A valid insurance certificate was in place. The owner dealt with all the finances of residents and there was only he who had access to these. Residents were encouraged to maintain control over their own finances unless they did not want to or lacked capacity. The owner stated they were responsible for the finances for one resident. The inspector checked the monies held by the owner for safekeeping on behalf of one of the residents. The monies held correlated with the record, but the record of monies received and spent was kept on the same envelope in which the monies were held, including receipts for purchases made on their behalf. The method of holding and recording monies, because they are all dealt with and held by one person and is not audited by another party and/or double signatories not consistently obtained when financial transactions take place is insufficient to protect residents from abuse/harm. When the building was inspected fire exits were free from obstruction. Discussions with staff and staff records identified they had received fire training. The fire risk assessment was dated 1 September 2005 and the owner was advised to review this. The pre-inspection identified servicing of the gas installations, central heating system, fire equipment, hoists and call systems. The owner said portable electrical appliances were due to be tested 04 May 2007. The last certificate for legionella compliance was September 2003, but on the inspection the person reviewing the compliance advised a further certificate of compliance would be granted. There was no servicing record for fixed electrical wiring and the owner said they had never been asked for this. This may place residents at risk if it is not safe. Notifiable incidents were being reported to the CSCI. The pre-inspection questionnaire identified water temperature checks were carried out and recorded on a monthly basis. Excellent moving and handling techniques were observed, which meant residents were being moved safely. Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 25 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. Standard OP1 Regulation 5 Requirement The service user guide must include all information required by the regulation, so that prospective residents have access to full and accurate information about the care home. That the contract provided at the point of moving into the home, includes all the information in the regulation, so that residents and/or their representatives know the conditions of their stay and what the fee will be. An inventory must be completed of furniture brought by the resident into the room occupied by them, so that there is no discrepancy at a later date about what this is. Daily entries made in care plans by the staff must be specific and relate to the actual care plan. The up to date name, address and telephone number of the CSCI must be included in the complaints procedure, so that complainants who wished to raise their concerns in this way DS0000015864.V330739.R01.S.doc Timescale for action 30/11/07 2. OP2 5A 30/06/07 3. OP7 17(2) 30/06/07 4. 5. OP7 OP16 17 Schedule 3 22 (7) (a) 30/06/07 30/06/07 Laurels Nursing Home The Version 5.2 Page 26 6. OP18 13 (6) 7. OP18 OP30 13 (6) 8. 9. OP29 OP18 OP29 OP18 19 (4) (b) (i) 19 (11) 10. OP29 19 (10) (a) & (b) 11. OP29 19 (11) 12. OP29 19 Schedule 2 17 (2) 13. OP35 knew how to do so. The policy/procedure for protection of vulnerable adults must be reviewed, so that all allegations are reported to the appropriate authorities. Staff must be trained in the protection of vulnerable adults, so that they have the knowledge to support the reporting of all allegations and what happens as a result of this. A CRB must be applied for, for the identified member of staff. The member of staff without a satisfactory CRB must be supervised by an appropriately qualified and experienced member of staff pending receipt of a full CRB. A member of staff must not commence work until a satisfactory POVA first check has been received and the date this was applied for and received is documented. Where a member of staff commences employment without a full CRB being issued, they must be supervised by an appropriately qualified and experienced member of staff, pending receipt of the full CRB and this must be demonstrated. Where there are gaps in employment, a written explanation of those gaps must be demonstrated. There must be a record of all monies deposited for safekeeping by a resident, including the date the money was deposited, returned and a record of the purpose for which the monies were used. This must include written acknowledgement of the return of the monies, so that residents’ DS0000015864.V330739.R01.S.doc 30/11/07 30/11/07 04/05/07 01/05/07 01/05/07 01/05/07 01/05/07 30/06/07 Laurels Nursing Home The Version 5.2 Page 27 finances are sufficiently safeguarded. 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 OP7 OP18 Good Practice Recommendations That the plan of care records the end of life wishes of residents so that this can be initiated at the appropriate time and their wishes adhered to. Multi-agency procedures for the protection of vulnerable adults should be obtained from social services departments from where residents are placed, so that the correct procedures for reporting any allegations are used. That liquid soap and paper towels are provided in toilets and bathroom areas to enhance the control measures in place to reduce the spread of infection. Review all staff training to ensure all mandatory training is provided and that training is up to date. The record for financial transactions should demonstrate two signatories to confirm the transactions have taken place, in order to safeguard residents’ finances. The record of financial transactions should be kept separately from the monies deposited as a safeguard to further protect residents’ financial interests. The servicing of fixed electrical wiring must be undertaken, to demonstrate there is no risk of harm to residents and staff. 3. 4. 5. 6. 7. OP26 OP30 OP35 OP35 OP38 Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laurels Nursing Home The DS0000015864.V330739.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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