CARE HOMES FOR OLDER PEOPLE
Laurels Nursing Home The High Street Norton Doncaster South Yorkshire DN6 9EU Lead Inspector
Ms Stephanie Kenning Unannounced Inspection 23rd February 2006 2:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 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.V282975.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Laurels Nursing Home The Address High Street Norton Doncaster South Yorkshire DN6 9EU 01302 709691 01302 708409 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.V282975.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd September 2005 Brief Description of the Service: The Laurels nursing home is situated in the village of Norton near Doncaster. It is attached to the Laurels residential home that is also owned by the Swales family. It is registered for up to 20 older people who need nursing care and therefore has qualified nurses on duty 24 hours a day. The recent extension and alterations has created all single bedrooms with en-suite toilets and washbasins. A shower room has also been installed giving further choice to service users. Rooms are larger and some have patio doors giving access to the grounds. The service user accommodation is all on the ground floor with access to the gardens that are shared with the adjacent home. The main kitchen and laundry are located in the adjacent home. There is a large car park and additional parking near to the main entrance, which is accessible for wheelchairs via a ramp. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over a period of about four hours and was combined with an inspection of the adjoining care home. The manager was present for part of the inspection, and other employees assisted with the inspection on her behalf. The inspection comprised of a partial tour of the building, discussions with some service users and staff members, examination of records and other documentation. This was the second inspection since April 2005 and the majority of the key standards had already been assessed previously, therefore this inspection covered the remaining few key standards and other issues raised. The home was well managed and met all the standards. What the service does well: What has improved since the last inspection?
The two requirements and five recommendations from the previous inspection have been addressed. One requirement was the shower room that was not finished, and was finished and working at this inspection. The other requirement was to secure the medicine trolley to the wall of the new storage room that was done straight away. The care staff now complete the charts in the service user care plan recording system giving a clearer picture of the care given. The wishes of service users regarding activities are documented in the care plans and service users were happy with the activities they were doing. Consultation regarding the deployment of care staff has resulted in more people being around during the evening time, and the laundry is being covered by a joint team effort from the two adjoining homes. A notice in the hallway explains how the previous inspection reports can be accessed and it was also raised at a service user and relatives meeting. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 6 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. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4, and 5 were assessed and met at the previous inspection. Standard 6 was not assessed, as the home does not offer intermediate care. EVIDENCE: Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, and 10. The Laurels ensures that all service users have a plan of care that meets their assessed health, personal and social needs. Service users praised the home for the way they were treated and assisted. EVIDENCE: All the standards 7 to 11 were assessed and met at the previous inspection. The requirement regarding fixing the medicine trolley to the wall of the new store- room was done straight away. Care plan documentation was examined and care workers were recording care given on charts and in the daily records. Case tracking was done on two people, one who was very dependent and the other who was awaiting transfer to another home. Both had clear plans of care, such as nutrition, pressure area care, medication, management of behaviour, and the records showed the action taken, and reviews as necessary. Additional support through GPs and hospital services was evident showing that service users were accessing health care as required. Service users appeared comfortable and relaxed, and several were in their own rooms, Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 10 resting or watching television, or with visitors. Care workers were observed in conversation with service users in the lounge and were friendly and respectful in their manner. Service users stated that they were treated well by staff, and felt well cared for. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed and met at the previous inspection, and service users continue to be satisfied with them. EVIDENCE: Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed and met at the previous inspection and no complaints have been received, or referrals to adult protection since then. EVIDENCE: Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21, and 26 The home provides a good standard of accommodation and service users were particularly pleased with their rooms and with the cleanliness of the home. The completion of the building work included an additional shower room to offer more choice to service users. EVIDENCE: The key standards were assessed and met at the previous inspection, and the building work / alterations have now finished giving all the 20 ground floor bedrooms en-suite facilities, some with patio doors to the gardens, and a new shower room offering a choice to those who do not want a bath. Some redecoration has also been done and some new carpets are on order. The home has been continually upgrading the facilities for service users, and service users who liked their rooms very much appreciated this. The home was Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 14 clean, tidy, free of obvious hazards and odours, and was a pleasant and safe environment for service users. Service users and relatives felt that the cleanliness was very important to their daily lives, and made them more comfortable. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Service users are protected by the by the homes’ recruitment procedures and the competence of the staff. The only requirement is because they have not met the target of 50 of staff trained in NVQ, although they are working towards this. EVIDENCE: Standards 27 and 28 were assessed and met at the previous inspection. A recommendation to consult with relatives regarding comments made about staffing led to a change in the way care workers were deployed so that there are more around in the evenings. Another consultation regarding the staffing of the laundry has led to the two homes working together more to get the work done. The homes recruitment procedures remain the same and all the relevant checks are carried out prior to employment in order to safeguard the service users. One Registered Nurse vacancy was in the process of being filled and other nurses were covering the shifts to ensure that service users needs were being met. Some additional relief nurses were also being employed to help cover holidays and other absences. Service users were happy with the staff team and found them helpful and kind. The manner in which workers assisted service users was noted to be sensitive and offered choices. The Laurels has recently joined a new training provider to help care workers to achieve NVQ, and had 6 in training, with more starting in April, and 7 already
Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 16 have an NVQ. The target of 50 is likely to be achieved in September and will be a requirement until it is met. Some other training has been taking place at the home including Protection of Vulnerable adults, fire safety, moving and handling, and first aid. A plan of training has been made using topics identified by care workers, such as diabetes and dementia, and updates due such as food hygiene and health and safety, to improve the safety and wellbeing of service users. Registered nurses have all done several training courses in the past year to update their knowledge and skills, and to improve the service offered. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 37 and 38. The Laurels was well managed with a high degree of satisfaction of the service users. The health and safety of service users is protected by the practices at the home, and records are well kept. EVIDENCE: Standards 31, 32 and 33 were assessed and met at the previous inspection, with standard 31 exceeding the standard due to the team approach of the managers of the two homes and the high level of input from the owners. A previous recommendation regarding assisting relatives to access the inspection reports has been addressed by a notice explaining how to access them and raising it at a service user and relatives meeting. Service users have a lockable facility within their lockable rooms in which to keep valuables if they wish, and facilities were also available for safekeeping
Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 18 with the owner. Where the home looks after monies written records are maintained for individuals with receipts kept. All of the records kept by the home that were seen were up to date and accurate and held securely to maintain confidentiality for service users. It was also noted that records are well organised and simple in their design making information retrieval easy, and this should be commended. Records of equipment servicing, fire checks, accidents, fire officer visits, and environmental health officer visits were up to date and clear. There are clear policies and procedures regarding safe working practices including the training to be offered at induction and ongoing. Storage facilities are adequate and it is recommended that a copy of the COSHH data be held in the cleaners’ storeroom so that they have better access to the information whilst they are using the equipment and chemicals. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 19 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 X X X X X N/a 3 X 3 X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X 3 3 Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 20 No Are there any outstanding requirements from the last inspection? 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 OP30 Regulation 19 (5b) Requirement At least 50 of staff to have an NVQ by 2005. Timescale for action 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP38 Good Practice Recommendations Keep the COSHH data in the cleaners’ cupboard in order to promote better access to it. Laurels Nursing Home The DS0000015864.V282975.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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