Inspection on 24/10/06 for Laurels Retirement Home

This inspection was carried out on 24th October 2006.

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 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 Retirement Home 27/08/09

Laurels Retirement Home 22/08/07

Laurels Retirement Home 27/01/06

Laurels Retirement Home 02/08/05

Laurels Retirement Home 14/03/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Laurels Retirement Home 195 Barrack Road Christchurch Dorset BH23 2AR Lead Inspector Martin Bayne Key Unannounced Inspection 09:00 24th October 2006 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 DS0000061915.V317411.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. DS0000061915.V317411.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurels Retirement Home Address 195 Barrack Road Christchurch Dorset BH23 2AR 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) 01202 470179 01202 485200 info@laurels.uk.net Mr Richard Kitchen Mrs Elizabeth Kitchen Mrs Tarina Ruth Price Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places DS0000061915.V317411.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users should only be admitted to the home who have low to medium dependency needs i.e. have mild to moderate dementia and intermittently need interventions that require reassessment, there is some likelihood of specialist referral. Physical or mental health is sometimes fluctuating, erratic or unstable, sometimes requiring intensive or unpredictable interventions. Service users must not be admitted to the home who present aggressive, violent or wandering behaviour. 27th January 2006 Date of last inspection Brief Description of the Service: Laurels Retirement Home is a residential care home registered for twenty places under the category of OP (Old Age) and DE(E). It is an older style property, with a more recent extension, situated on one of the main roads into Christchurch town centre. Mr and Mrs Kitchen took over as proprietors of the home in September 2004. Mrs Price who was formally employed as Head of Care by the previous owners became the registered manager in June 2005 and has worked in the home for many years. The majority of bedrooms are for single occupancy with two providing en-suite facilities. One of the four double rooms is also en-suite. The home has a lounge and a dining room, which also has a small seating area that looks out onto the patio. There are stair lifts to the upper floors. To the rear of the property is a secure, private patio area with seating where service users can entertain visitors. The fees for the home range from £345 to £550 per week. There are additional charges for things such as chiropody services. This information is detailed within the Service User Guide. Further information about fair terms within contracts can be found at: www.oft.gov.uk DS0000061915.V317411.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the findings of a key inspection to The Laurels that took place between 9am and 1pm. The aim of the inspection was to evaluate the home against the key standards for older people and to follow up on the two requirements that were made at the last inspection. Comment cards that were returned from five residents of the home, ten relatives of residents, three healthcare professionals, one care manager and two GPs. The views contained within these were also used to help form the judgements on the service. During the inspection eight residents were spoken with about their experience of living at the home. A tour of the premises was made, staff spoken with and time spent with the manager. The inspector was also able to briefly meet Mr Kitchen, one of the registered providers, who was visiting the home that day. What the service does well: What has improved since the last inspection? The two requirements made at the last inspection had been addressed. Newly appointed staff now do not start working at the home until a POVAFirst check, (a check against the register of people deemed unfit to work with vulnerable adults), has been received. The provider has been sending reports of unannounced visits to CSCI in line with Regulation 26. As agreed at the last inspection the office door is kept locked when medication is stored in the office awaiting collection to be returned to the pharmacist. As agreed at the last inspection care plans and reviews are signed and dated. DS0000061915.V317411.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. DS0000061915.V317411.R01.S.doc Version 5.2 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 DS0000061915.V317411.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 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 home carrying a full assessment of their needs prior to their being offered a place at the home. This ensures that their needs can be met should they choose to move to the home. EVIDENCE: The files for the two residents most recently admitted to the home were used to track the required paperwork that the home must maintain their behalf. One person had been admitted to the home from outside the area. In this case the manager had obtained a copy of the care management assessment and had held conversations with hospital staff over the phone as part of the home’s assessment process to determine that they could meet the person’s need. In the case of the other resident, the manager had visited them and carried out an assessment using the home’s assessment form. This covered all of the areas set out in the Standards for Older People that are required to be assessed before a decision can be made as to whether the home can meet a person’s needs. Copies of the assessments were seen for both residents. The home does not provide an intermediate care service. DS0000061915.V317411.R01.S.doc Version 5.2 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. 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. Residents benefit from care plans being developed through the assessment process, their health needs being met and a kind respectful staff team. Medication is administered in line with best practice. EVIDENCE: For both residents tracked through the inspection a plan of how the care needs of the particular resident were to be met was in place. These were typed, concisely written and found to reflect the needs as identified through the assessment process. A summary care plan is also written that can be given to agency staff who need a quick overall summary of the care needs of all the residents. The care plans were dated and signed as agreed at the last inspection. There were also copies of monthly reviews of care plans. Practice is for residents to be involved in preparing care plans, however in cases where the person’s mental or physical health preclude this, relatives are invited to help draw up the plans and sign on their behalf. DS0000061915.V317411.R01.S.doc Version 5.2 Page 10 The personal files for the two residents also contained key information, personal details and a photo of each resident. The care plans were also found to link to risk assessments that had been carried out to minimise potential harm to residents. At the time of inspection there were no residents with pressure sores and the home has specialist mattresses that can be used should these be required. The home has good links with district nurses and the GP surgeries where the residents are registered. Comment cards from two GPs informed that high standards are maintained at the home and health needs met. In the case of one of the residents tracked there was evidence that the home was working with CPNs (community psychiatric nurses) to meet their needs. Within the personal files for the residents were recorded visits from GPs, district nurses, opticians, dentist and chiropodists. Since the last inspection the home has purchased a new medication cabinet that allows better storage of the unit dosage system that is supplied by the pharmacist. The manager informed that following a drug administration error that had occurred, the procedures for the home have been reviewed and all the staff who administer medication, retrained through the pharmacist. A photo of each resident is now attached to each unit dosage system container so as to minimise any errors in the future. The procedure is to administer to each resident individually from the medication administration record. The medication administration records for all of the residents were seen and these had been completed correctly with no gaps in the records and allergies of residents recorded. It was agreed that in cases where staff have to enter medications by hand, such as when a person is discharged from hospital with medication, one staff member should enter onto the medication record and another person sign that they have checked that the information is correct. At the last inspection it was agreed that on the days when medication is being stored in the office waiting to be returned to the pharmacist, the door be kept locked to ensure safety. The manager informed that this practice was now adopted. The residents spoken with all spoke highly of the staff and observations of the interaction between staff and residents demonstrated that there were good relationships between the staff and residents. They also informed that they were treated with respect and dignity. This was also corroborated through the returned comment cards. DS0000061915.V317411.R01.S.doc Version 5.2 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. 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. Through the assessment process the home tries to meet the expectations of residents and their preferred lifestyle. Residents benefit from the home encouraging visits from families and friends with residents being in a much control of their lives as is possible. The home provides a varied and wholesome diet for the residents. EVIDENCE: Part of the assessment process is to involve each resident in discussing their lives and what is important to them. This information is then used to draw into the care plan. The home employs a retired CPN who provides training to the staff on person centred planning for the staff and she also runs a weekly activity group for the residents. An ‘Extend’ exercise group is run for residents each fortnight and there is also a weekly craft afternoon. Once a month singers or entertainers visit the home for the benefit of residents. The staff are also encouraged to spend individual time with residents when they are able. Spiritual needs of residents are assessed and there is currently a Holy Communion service conducted by a visiting Church of England clergy member. DS0000061915.V317411.R01.S.doc Version 5.2 Page 12 The manager informed that should a resident from another faith be admitted they would work with the resident to meet their spiritual needs. Residents spoken with informed that visits from their families and friends were welcomed. Information to this effect was also received through the returned comment cards. Residents can get up and go to bed when they choose and are supported to make choices as far as their mental capacity allows. The residents spoken with informed that the food provided at the home was of a good standard. Copies of the menus seen supported that residents are provided with a wholesome and varied diet. Residents are involved in the menu planning and new menus are drawn up every four weeks. There is a choice of two meals for the main meal of the day at midday and a choice of at least five alternatives for the evening meal. The likes and dislikes of residents are noted as part of the assessment process. Part of the assessment process is to involve each resident in discussing their lives and what is important to them. This information is then used to draw into the care plan. The home employs a retired CPN who provides training to the staff on person centred planning for the staff and she also runs a weekly activity group for the residents. An ‘Extend’ exercise group is run for residents each fortnight and there is also a weekly craft afternoon. Once a month singers or entertainers visit the home for the benefit of residents. The staff are also encouraged to spend individual time with residents when they are able. Spiritual needs of residents are assessed and there is currently a Holy Communion service conducted by a visiting Church of England clergy member. The manager informed that should a resident from another faith be admitted they would work with the resident to meet their spiritual needs. Residents spoken with informed that visits from their families and friends were welcomed. Information to this effect was also received through the returned comment cards. Residents can get up and go to bed when they choose and are supported to make choices as far as their mental capacity allows. The residents spoken with informed that the food provided at the home was of a good standard. Copies of the menus seen supported that residents are provided with a wholesome and varied diet. Residents are involved in the menu planning and new menus are drawn up every four weeks. There is a choice of two meals for the main meal of the day at midday and a choice of at least five alternatives for the evening meal. The likes and dislikes of residents are noted as part of the assessment process. DS0000061915.V317411.R01.S.doc Version 5.2 Page 13 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 have access to a full complaints procedure with complaints being investigated seriously. Residents are protected from abuse through staff training and all relevant policies and procedures for adult protection. EVIDENCE: Since the last inspection there has been one concern raised with CSCI and it was agreed that this be investigated through the manager. This related to disturbances when the kitchen was refurbished earlier in the year. The manager took steps to minimise disruption to residents and it was clear that the concern had been investigated and taken seriously. The complaints procedure is detailed within the Service User Guide that is available to the residents, within the terms and conditions of residence and also displayed within the reception area of the home. Residents and relatives are therefore fully informed of how to make a complaint. The home has a copy of the local “No Secrets” document and also has its own policies and procedures that link into this main procedure. The home has policies and procedures on confidentiality, abuse and how to report on suspected incidents and whistle blowing. It was reported that all of the staff have received training in adult protection through internal training and also from an outside trainer as part of the dementia training undertaken by all of the staff. DS0000061915.V317411.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well suited in terms of layout and position to meet its aims and objectives. Residents benefit from good infection control procedures within the home. EVIDENCE: Since the last inspection much has been done to both maintain the building and to improve services to residents. This includes, completion of the paving of the car parking to the front and side of the home, refurbishment of the kitchen and provision of new appliances, installation of a new hoist in one of the bathrooms, replacement of all the beds, new carpets laid in nine of the bedrooms, new bedding provided for all of the residents, new boilers fitted and a new sign at the front of the home. As part of the inspection a tour of the premises was made. The home was found to be clean and in good decorative throughout. Two residents were DS0000061915.V317411.R01.S.doc Version 5.2 Page 15 spoken with in their rooms and it was evident that they are able to bring their own possessions to personalise their rooms. Rooms were furnished adequately. The home has low surface temperature radiators fitted in order to protect residents from burns. Thermostatic mixer valves are fitted to the hot water outlets to protect resident from scalding water and these are checked in rotation of one per month. The home has a well-maintained garden to the side and rear of the home with a paved patio area. The home was found to have taken appropriate steps in maintaining infection control. In the hallway is a gel disinfector dispenser that people entering the home are encouraged to use. The home has a sluice room and there were procedures in place for the staff on how to use this facility. Protective clothing is supplied to staff in carrying out their duties and all of the staff receive infection control training. The home has a copy of the latest guidance issued by the Department of Health on infection control in residential care homes and is in the process of developing a procedure in the case of a pandemic outbreak. DS0000061915.V317411.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from staff being recruited in line with best practice, being trained in core areas and by suitable staffing levels. EVIDENCE: At the last inspection a requirement was made as it had been found that staff had started work at the home before a POVAFirst check had been obtained. At this inspection a sample of two staff files were seen for staff recruited since the last inspection. It was found that the required checks had been completed before they started work in the home. All other checks and procedures had been carried out. New staff complete an application form and notes are kept of interviews for new staff. It was agreed that the application would be reviewed to seek a reference from the applicant’s last place of work with vulnerable adults or children and to request information on gaps with a person’s employment history. It was also agreed that the home would obtain an up to date copy of the Care Homes Regulations 2001. There is low staff turnover and staff spoken with seemed committed to providing a quality service to residents. The manager informed that by the end of this year there will be a level of 85 of staff trained to NVQ level 2. One member of staff is also studying NVQ level 3. DS0000061915.V317411.R01.S.doc Version 5.2 Page 17 All staff receive induction training and a record of this was seen for the two staff tracked through the inspection. Staff also receive core training in basic food hygiene, infection control, medication administration, first aid, fire safety, moving and handling, person centred working for people with dementia and adult protection. There are three staff on duty between 8am and 1pm and then two staff from 1pm to 8am the following morning. The two night staff carry out awake duties. In addition the manager works at the home during the weekdays and there is a cook and cleaner each day of the week. Staff duty rosters were seen that reflected the above staffing. The manager informed that the staffing levels met the needs of the residents. Information returned via the comment cards supported this judgement. DS0000061915.V317411.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the interests of the residents. Where assistance is given with finances, good records and best practice observed. Health and safety is promoted in the home to protect both staff and residents. EVIDENCE: The registered manager has completed NVQ level 4 in management and care. Comments cards returned informed of her good management of the home. At the last inspection a requirement was made with regards to reports of unannounced visits that Registered Providers must make to the home. These have been submitted as required since that time and the requirement therefore met. DS0000061915.V317411.R01.S.doc Version 5.2 Page 19 The manager safe keeps small sums of money on behalf of some residents. The records for one person were seen. The records were detailed recording money deposited, withdrawn and the balance held. Receipts of all expenditure are also kept. The money held was checked and found to tally with the balance. The manager periodically carries out satisfaction surveys as part of the quality assurance programme for the home that involves residents their relatives and relevant others. This is carried out by a volunteer so as to be objective and the results are used to develop the service in line with residents and others wishes. There were no hazards identified during the inspection. Information regarding checks and servicing of equipment and the fire safety system were sent as part of the pre-inspection questionnaire. DS0000061915.V317411.R01.S.doc Version 5.2 Page 20 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 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 3 X X X X X X 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 X 3 X 3 X X 3 DS0000061915.V317411.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP29 Good Practice Recommendations It that the application would be reviewed to seek a reference from the applicant’s last place of work with vulnerable adults or children and to request information on gaps with a person’s employment history. 1 DS0000061915.V317411.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000061915.V317411.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!