Inspection on 22/11/06 for The Laurels

This inspection was carried out on 22nd November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 37 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Laurels 14/07/08

The Laurels 02/07/07

The Laurels 06/06/06

The Laurels 15/02/06

The Laurels 23/09/05

The Laurels 31/01/05

The Laurels 27/10/04

The Laurels 23/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Laurels, The 65 Frederick Road Stechford Birmingham B33 8AE Lead Inspector Susan Scully Key Unannounced Inspection 22nd November 2006 08:00 Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 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, The DS0000033658.V320951.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 Adults 18-65. 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, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurels, The Address 65 Frederick Road Stechford Birmingham B33 8AE 0121 784 5222 0121 784 5232 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) Social Care and Health Warren Mark Powell Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. That the home is registered to accommodate 17 adults under the age of 65 for reasons of learning disability. That the home can continue to accommodate 3 named service users who are now over 65 years of age. That minimum staffing levels are 7.00am - 10.00pm 3 care assistants and a suitably qualified and competent designated shift leader. The Care Managers hours must be supernumerary to care hours. Service users are admitted to the home for respite care and not longterm care. Long-Those residents who have been at the home for a longer period will be found alternative appropriate places at the earliest opportunity. Maintenance schedule to progress at a pace, which is acceptable to CSCI to allow continuation of registration. Reprovision plans to progress at a pace, which is acceptable to CSCI to allow continuation of registration. 6th June 2006 6. 7. Date of last inspection Brief Description of the Service: The Laurels is a large two-storey purpose built Local Authority Home, accommodating up to 17 adults who have a learning disability on a respite basis. The Home has nine ground floor bedrooms and the remainder of the bedrooms are on the first floor, which can be accessed via a shaft lift. There are a number of communal areas on both floors. There are bathroom and toilet facilities on both floors. The Home does not meet the National Minimum Standards in terms of accommodation provided. All but two bedrooms are below minimum spatial standards. Five bedrooms are without wash hand basins. The number of toilets is not adequate for the number of service users accommodated. The home ensures a number of adaptations to the bathrooms and toilet if required by the service user these include assisted bathing facilities and toilet seat raisers. The Home is situated in a quiet cul-de-sac in Stechford, close to local shopping facilities, a train station and bus routes. To the front of the building is a car park area and to the rear is a garden. The fees payable at the Laurels depend on the length of stay, and range from £65 per week. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection took place over a one-day period by two inspectors. Records pertaining to residents were sampled and included: care plans, risk assessments, daily notes, fire Safety records, accident records, complaints, compliments, and staff rotas. Records pertaining to Health and Safety were also sampled, these include Gas Safety checks, electrical appliances testing, water temperatures, infection control, safe storage of Hazardous Substances, food hygiene and manual handling assessments. During the visit the inspectors were able to obtain an overview of the management of the Laurels and speak with service users and staff and observe the support offered to service users by staff. What the service does well: What has improved since the last inspection? Since the last inspection a new kitchen has been fitted to enable service users to have the facilities to prepare food and drinks. The manager said at present service users are not using the facilities it had only been complete a short time ago, but the intention was to introduce service users to use this kitchen as part of their daily living skills to enhance their skills in cooking and preparation of food. Decoration has been completed in some service users bedrooms and communal areas and this gives a fresh appearance to some areas of the home. The bedrooms do not have all the required furnishing but beds were clean and some items of furnishing had been purchased to make service users more comfortable. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 6 What they could do better: Most areas inspected require significant improvements to meet service users needs. Care plans, risk assessments and the management of The Laurels requires significant improvements. Health and welfare of service may be placed at risk through lack of information contained in service user files. The high number of requirement still outstanding pertaining to the care plans, risks assessments and the review of service users needs that have been poorly completed place service users at risk. Water temperatures in the shower room must be regulated. Pipes leading into showers must be boxed or measures taken to minimise the potential of the pipes becoming to hot when in use by service users, to reduce the potential of service users being scaled. The testing of the water supply for Legionella must be completed regularly and a record kept. The records show the last checks were completed in 2003. The cleanliness of the main kitchen has improved significantly in appearance. Staff monitor fridge temperatures and labelled all food stock to minimise cross infection. However staff constantly uses the kitchen instead of their own kitchen that has been provided for their purpose. This means staff provide personal care to service users then enter the main kitchen in the same clothes. On the day of the inspection staff were seen entering the kitchen without protective aprons on a number of occasions. This may place service user at risk from cross infection. The kitchen staff must only use the main kitchen and the manager must make provisions and ensure only kitchen staff enter the main kitchen to ensure cross infection is minimised. Accident records sampled could not be audited. The manager said he audited all records such as accidents, records, medication, record and Health and Safety on a monthly basis. The inspectors were unable to verify this with the records that were presented. Mediation records show regular audits are completed. However on the day of the inspection the inspector identified a drug error and requested the staff member to inform the doctor to ensure the error would not have an adverse effect on the service user. Medication was missing and could not be traced. Robust procedures must be in place for the safe handling and recording of medication to ensure the safety of service users. The Laurels has no quality assurance systems in place and the views of service users are not recorded in enough detail to demonstrate their views are fully taken into account, this may place service users in a difficulty position when Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 7 their views go unheard in particular if service users have difficulty with communication. The manager confirmed there was no health action plans for service users all information pertaining to service users health is recorded in CR8. This is a document Birmingham City Council use to record information about the service user. The ones sampled gave very little information to the reader. This may lead to appointments being missed or doctors not contacted when service user health deteriorate. The monitoring of the service users health care such as pressure care or contacting other professionals as indicated on one service user file sampled. This had been missed and the referral was not made. The management of the Laurels requires significant improvement to ensure the safety and wellbeing of service users. 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, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service provided does not demonstrate how the service provided will meet service user individual needs in respect of their health and welfare. EVIDENCE: Since the last inspection there has been no progress made with regards to assessments being completed before a service user is admitted to The Laurels. For many service users they receive ongoing respite care. No update of their needs is undertaken prior to each period of care. The assessment tool available for use did not cover all basis areas of need to those set in the National Minimum Standard. This does not ensure service users needs are all known and planned for. The manager did not produce evidence that an assessment is completed if a service user has not been a resident at The Laurels for a period of time. This may place service users at risk if new needs are not identified. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The needs, preference, and personal wishes of service users are not respected. Service users do not receive a consistent service. This may lead to the needs of service users going unmet and is a potential risk to their health and welfare. EVIDENCE: The manager informed the inspectors that 21 care reviews had taken place; the inspector sampled three care plans. One care plan showed a review had been completed on the 3 July 2006 and referred to a profile. The manager said this was the care plan. The profile said the service user used a wheel chair and cannot weight bear. There was no risk assessment for manual handling to ensure the safety of the service users when staff assisted with personal care. The profile also said help is required at meal times, the guidance to staff said “ food needs chop’’. The service user uses bed rails; there was no risk assessment in place. There was an entry to say the service user could no longer communicate with staff. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 11 There was no information to say how the service user will communicate or what measures had been taken to ensure the wellbeing of the service user. For example how will this service user let staff know if he became unwell?. A risk assessment for one service user had been completed for epilepsy seizures and said if the seizures last more then 3 minutes to call the emergency services. There was no other information. For example, there were no control measures, no safety measures, no monitoring of the service user, and no regular checks being completed. There was no plan of care for this service user who has epilepsy. An entry in the daily records for this service user on 15 October 2006 said “ Skin around pressure areas are really badly and broken down’’. “All his chest and back area is very red and scaly, placed on left side with pillow behind his back’’. This person was then discharged home on 16 October 2006. There was no further mention of any action taken or whether the doctor was called. There was no mention whether a District nurse was called or if the family had been informed. The lack of information, or concern, regarding an entry such as this places the service user at risk. When the service user returned for respite on 17 November an entry in daily records (CR8) said “2x pressure areas’’. The next entry was not till the 20 November 2006 and this said “positioning and applying Cream’’. No review or full plan of care had been completed so the changing needs of service user are not protected or identified. The manager confirmed service users do not have health action plans and all information is recorded in CR8. This may lead to missed appointments and in contacting other Health Care Professional. For example: One service user that had been recently admitted. The initial assessment did not detail any disabilities, there was no information pertaining to sensory aids, such as did the person wear glasses, hearing aid, or any information pertaining to other professionals that may be involved. There was no information to show if the service user had been registered with a GP. Entries in daily records showed a telephone call from the social worker regarding the service user requiring support with aspergers. There was no further information to evidence the staff had contacted a nurse / psychiatrist. The file on this service user did not contain information pertaining to a referral to a GP; there was no plan of care. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 12 There was no independent travel training, as the service users went out each day un escorted, and it could not be confirmed if the service user would be safe. The inspectors were informed by staff that “they think he works with his dad’’. There was no information showing staff had liaised with the community nurse or psychiatrist pertaining to his aspergers, as requested by the social worker. One relative spoken to said “ It is ok now, but you have to keep on the ball with the staff and let them know when there are problems, I have wrote many a time to the manager and the director, they do listen to my concerns’’. One service user file contained no care plan, an assessment had been completed on 11 July 2006 from SALT, (Speech and language Therapist) this stated “ Staff need basic training in signing’’. “ Use symbols to assist in communication’’. “Behaviour strategies are needed’’. The issue raised in the SALT assessment were not in any format or plan of care, both the inspectors sampled this file and the manager said this had not been done. This could place this service user at risk if communication and issued raised by other professionals are not planned for or provisions made to incorporate them into plans of care. An ISS (Individual Service User Statement) completed on 19 September 2006 was very poor. For example there was one need identified and said, “ To interact with staff’’. “ Staff are to encourage interaction with others’’. “ How will the service user know this has been achieved’’. “ When the service user interacts with other’’. It was not evident in the file sampled how staff would know or the service user would know he had achieved this goal as the need identified was not monitored. There was no evidence to show how service users make decisions in their daily lives. The service users aspirations and gaols set are not reviewed when they leave The Laurels or when they return to The Laurels. This may lead to service users becoming frustrated at never achieving what they want to do. The lack of information in service user plans of care, risk assessments, and daily records could result in care needs not being identified and met. The manager confirmed there were no health action plans for service users this could result in service users not being registered with a GP as sited above or receiving health care support. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records do not demonstrate choice and personal development for service users. This may lead to service users needs not being met. EVIDENCE: The manager showed the inspectors an activity book that recorded information pertaining to the participation of activities in the home. There was very limited information in the activity book to show service users have a variety of different activities in the home or local community and paid no reference to individual choice. The inspectors were informed that service users regular play pool in the activity room and there was evidence of computers, and games. There was no evidence to confirm this is what service users wanted as records used to record what service users wanted and activities they participated in was poor. The inspector spoke with a relative who confirmed. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 14 The Laurels does have various functions and activities going on in the home, but not as often as she would like. In the entrance to the building there were a number of pictures of service users and staff when such functions have taken place. There was also information to say about forth coming events such as Christmas. The Laurel is a respite unit and some service users attend college, work and educational activity while at home. During the inspection service users were seen accessing transport to take them to day centres. One service user was attending work. The inspectors were informed that activities are planned on a day-to-day basis depending on who was there during the day as service users go out. There was an activity programme on the door of the lounge but there was no documented evidence to suggest this was undertaken. There needed to be some consultation with the residents about their preferred leisure time activities and actions taken to offer some stimulating pastimes. Records are not in detail to ensure all the activities; likes and dislikes of service users are met. Menus showed positive information pertaining to the different cultural foods available. Menus also showed service user were given a choice. There were various pictures available showing different cultural foods that enable service users to choose what they wanted. The meal on the day of the visit did not include an English choice of food, which means service users who only eat English meals would not have a choice. One relative said she regular attends any functions and she was encouraged by staff to participate in activities when functions are held. The laurels is a respite unit so service user have regular contact with family and friends The rapport between service users and staff was relaxed and friendly. One inspector sat with service users in the lounge speaking about the home. Comments from service users include: “Staff and people who live here are good’’. “Sometimes we go to the cinema and shops’’. “I have a nice room and comfy bed’’. “ I like the food but not too spicy’’. Service users appeared happy. Staff was seen giving choice to service user and support. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Laurels does not ensure the health and wellbeing of service users by ensuring all the relevant information and the changing needs of service users are closely monitored and reviewed. This may place service users at risk. EVIDENCE: Care plans and risk assessments sampled did not show how service users needs and health care needs are met. Documentation was not completed in full, for example pressure care. In daily records on the 15 October 2006 staff had identified one service user as having very bad pressures areas around chest and back. There was no entry in daily records or care plan to say what action had been taken. There was a statement that said, “discharged home on 16 October 2006’’. The manager confirmed there were no health action plans for service users. In one-service users records the need area identified personal hygiene was a concern as this service users was at risk of self-neglect. There was no plan of care for this service user and on the day of the visit the inspectors observed the service user going out, and clearly by presentation and appearance of the service user the need areas had not been addressed. There were no instructions to staff to monitor the service users personal appearance or hygiene. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 16 The same service user had been admitted recently and there was no evidence of the service user being referred to a GP as was identified at the time of admission, or action taken in respect of a request from a social worker to refer/support the service user to a Community nurse or psychiatrist for aspergers. The lack of information contained in service users plans of care and the monitoring of ongoing health issues seriously places service users at risk. The inspector completed an audit of medication. Records showed the manager or duty manager completes an audit on a monthly basis. When the inspector sampled service users MAR Charts (medication administration records) for one service user recorded showed there should have been 6 tablets remaining. These could not be found or traced. The member of staff said “she must of taken them home with her’’. This was of particular concern as the medication was a controlled drug. In the control drugs register tippex had been used so an audit could not be completed with accuracy for one service user. On one MAR chart there were two tablets with the same name but different doses to be administered morning and night. The dosage for the morning was 25mg and the evening dose was 100mg. When auditing this medication the inspector identified that the staff had administered more of the 100mg tablets then the 25mg tablets, indicating that the medication administered was wrong. The inspector requested the member of staff to contact the GP to ensure no harm would come to the service user having received the wrong dose. The GP was contacted and advice sought. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information contained in care plans and risk assessment do not protect service users from harm. Training records do not demonstrate staff have the relevant skills to ensure service users are not placed at risk. EVIDENCE: One complaint had been received since the last inspection, which had been investigated appropriately by the team manager. The CSCI have received no complaints about The Laurels since the last inspection. A member of staff commented that service users were unlikely to raise complaints, due to their communication needs, however she went on to say that staff take account of individual’s behaviour and body language as an indicator that they are unhappy and offer 1:1 support in private to attempt to establish an appropriate response and gave examples of this taking place. One service user had been supported to make a complaint to social service about his finances. Accident records do not show how accidents are audited to ensure the manager is able to monitor and take action if the same accident re occurs. The manager said he audits all accident on a monthly basis but could not provide the evidence to support this. Risk assessments completed do not protect service users from harm. They do not give enough detail to the reader to prevent or minimise risks such as manual handling. Adult protection training for staff in the protection of vulnerable adults remains outstanding. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 18 The manager said some staff had completed this training and others have been nominated. Staff training records were not up to date so an adequate audit could not be completed to ensure staff have the relevant skills to ensure service users are not placed at risk. The risk assessments completed for service users were not detailed and did not give staff instructions to ensure the safety of service users with manual handling or other risks identified. Lack of information in care plans and risk assessments places service users at risk. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements are generally adequate to ensure service user live in a homely, comfortable environment. EVIDENCE: Since the last inspection the smoke room has been adapted into a small kitchen for service users to use. The manager said they were encouraging service users to use this kitchen to assist with cooking skills. The new kitchen was clean and facilities for tea and coffee were available to introduce service users to the new facilities. One service user said “this is great’’. A tour of the building revealed a number of repairs that must be completed and include: • The shower in the down stairs bathroom when turned to maximum was too hot. When the inspectors sampled the running water, both inspectors could not leave their hand under the shower for a period of time, as the water was very hot. DS0000033658.V320951.R01.S.doc Version 5.2 Page 20 Laurels, The • • • The manager must ensure service users are not placed at risk from scalds and ensure measures are taken to reduce the risk. The bath mat was mouldy and must be removed. Bedroom 9 when the water was run in the sink the water was too hot. The manager must ensure service users are not placed at risks from scalds and take appropriate action. The bathroom up stairs that is being refurbished, there are hot pipes leading from the shower and when the shower is turned on the pipes become too hot and places service users at risk from scalds. The shower must be regulated to prevent risk to service user of scalds. The quiet lounge upstairs 1st floor the lampshade needs replacing to ensure service user have adequate lighting. The laundry walls are damaged and require plastering. The extractor fan requires cleaning to ensure ventilation. • • • • • Service users bedrooms varied from some service users having limited personal belonging to service users having bedrooms that appeared more comfortable and more personalised depending on the length of stay of the service user. The main kitchen has improved significantly since the kitchen has been refurbished. The kitchen was clean, regular food audits were completed, temperatures of fridge and freezer were recorded Hazard Cleaning Products were stored securely. Staff continue to use the kitchen freely for storage of their own food and beverages along side service user food this could pose a risk to infection control. Staff food is mixed with service users food and stored in the same fridges and dried food area this could present a risk of cross contamination. This means staff are frequently in the main kitchen and prevents effective measures to control infection. The manager said he had told staff not to store food with service users food on a number of occasions and would speak with staff. The manager must ensure staff adheres to safe working practices to ensure service users are not placed at risk. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Adequate arrangements are in place to ensure service users are protected by the organisations recruitment practises. Training records do not demonstrate all staff have the relevant skills and competencies to ensure service users are not placed at risk. EVIDENCE: Service users spoken with were aware that Warren Powell was the manager. Staff spoken with said the management team were supportive. The manager told the inspectors that supervision had commenced and he had delegated some of this responsibility to other senior staff. Two staff files were sampled that contained supervision and personal development plans. Training records were not up to date and an adequate audit could not be completed to identify if all staff had the relevant skills to ensure service users needs were met and not placed at risk. Recruitment records sampled demonstrated adequate measure are taken to ensure staff who are employed have had all the necessary checks completed such as two references, Criminal Records Bureau Check and appropriate employment history to ensure staff are suitable to work with vulnerable adults. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38, 39, 42,43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not benefit from a well-planned and consistent service. Service users health and welfare is not protected by polices and procedures through lack of implementation from the management. EVIDENCE: The Laurels continues to require significant improvements in all areas assessed. This service is of serious concern to CSCI. In discussion with the manager 17 requirements pertaining to service users health and welfare were still outstanding from the last three inspections and mainly referred to care plans risk assessment activities, health action plans, monitoring of service user health, and the lack of continuing to evaluate service users needs. The manager said he had completed 21 reviews with service users since the last inspection. An example of a review completed said. • Service user “what I want to achieve’’. DS0000033658.V320951.R01.S.doc Version 5.2 Page 23 Laurels, The Personal care to be encouraged to participate in personal tasks. • How will staff help? By supporting me through the task. • Who will carry out the service? Staff . • How will I know I have achieved this. When I am able to do the task. • By when will this be done? No entry • Service user comments. No entry This consisted of a review completed for one service user. When this was discussed with the manager he said “ I know they need to be in more detail’’ and gave an example to the inspectors from another home that he intended to implement at The Laurels. The reviews did not evidence staff had any specialist skills, or had an understanding of the process or length of time the person may need to learn a new skill or ensure the service users independence was encouraged. The manager has an excellent rapport with service users and demonstrates his ability to interact well with staff. However it is not apparent he has the skills necessary to lead this service. It is essential that the registered manager has sufficient insight knowledge and understanding of specific needs of the service users in ordered that they can lead and direct staff to ensure that service users needs are met. Requirement for care plans, adequate risk assessment and monitoring of health care continue to be requirements and have been outstanding since 2003. The manager clearly has difficulty in directing staff and monitoring their performance when tasks have been delegated, as tasks set had not been completed. For example risk assessments for service users, updating training records for staff, staff not entering the kitchen, inadequate daily records such as “food needs chop”, completing assessments at the point of admission, reviews outstanding, service users care plans not being updated and referrals to other professional when required. This brings in to question the manager understanding of being able to lead and direct staff in order to ensure the health and welfare of service users. While it is appreciated the manager delegates tasks to other staff members he does not monitor whether the tasks have been completed. Care plans do not provide instructions to staff on how the needs of service users are to be met this place service users health and welfare at risk. Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 24 The manager did not demonstrate an understanding into the potential risks to service users when information is not recorded and care plans are not completed adequately. The manager has received extended support from the team manager over a long period of time. The inspectors were concerned when sampling care plans and risk assessment the lack of information places service user at significant risk. The manager said that he delegates tasks to other staff member with an expectation that they will complete these. However the manager must ensure that he takes full responsibilities for the running of the home and ensuring service user are safe. During the inspection the inspectors requested the servicing certificates for lifting equipment in the home for example the passenger lift and hoist that comply with LOLER (6 monthly thorough Examination) that all lifting equipment must have to ensure the safety of service users when using such equipment. At the time of the visit this could not be produced. An immediate requirement was left for the manager to forward these certificates with in 48 hours. The water temperatures in the two shower rooms was very hot to touch these must be regulated to minimise the risk of scalding to service users. The manager must ensure cross infection is kept to a minimum by ensure only kitchen staff use the main kitchen. Accident records must be audited on a regular basis to ensure service users are not placed at risk from reoccurrence of the same accident happening. The manager must ensure the testing of the water supply for legionella is completed regularly to prevent the risk of cross infection. A quality assurance system must be in place to ensure service users views are incorporated in to the running of the home. Health action plans must be introduced to ensure service users health and welfare is monitored evaluated and reviewed. At the time of writing this report certificates had been received at the Commission that showed the passenger lift and hoist had received a 6 monthly thorough examination Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 1 1 1 1 1 X Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 26 Yes 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 YA6 Regulation 15(1) Requirement The registered person must ensure that the service user plan is reviewed at least on a six monthly basis and any changes recorded and action taken. Previous time scales unmet 01 May 2005 and 01 February 2006 & May 2006. September 2006. The Registered Person must ensure that each service user has an individual service user plan that identifies the needs of the service user and how these needs are to be met by staff. This must be within one week of admission when admitting service users in an emergency. Previous time scales unmet 01 May 2005, 01 February 2006 & May 2006. 01 September 2006 Timescale for action 01/01/07 2 YA6 15(2)(b) 01/01/07 Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 27 3 YA6 15(2)(b) 4 YA6 15(2)&15(2)(a, b, c, d) 5 YA2 14(2)(1)14(2)(a,b) 6 YA3 14(2)(1) 7 YA3 12(1)(a) Health Action plans must be introduced to ensure service users health and welfare is monitored and reviewed. The changing needs of service user must be identified and action taken to incorporate into plans of care A full assessment must be completed and a care plan developed from the initial assessment. The Registered Person must keep the care plan under review and revise the care plan when necessary. Previous time scales unmet May 2005. 01 September 2006 The Registered Person must demonstrate the home’s capacity to meet the assessed needs of residents, by ensuring care plans are reviewed in full consultation with the residents. Previous time scales unmet 01 March 2006 & May 2006. 01 September 2006 The Registered Person must ensure that the service users who have been in the home on a long-term basis are found alternative placements. Previous time scales unmet 01 May 2005 and 01 April 2006 & May 2006. 01 September 2006 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 28 8 YA3 14(1a,b,d) 23(2d) 9 YA5 5(1)(b,c) 10 YA5 12(2) 11 YA7 14(2) The Registered Person must complete a full assessment and inform the service user in writing that based on the assessment the home can meet the service user’s needs. Previous time scales unmet 01 May 2005 and 01 February 2006 & May 2006. 01 September 2006. The Registered Person must ensure that each service user is given a contract/statement of terms and conditions that includes the room to be occupied, terms and conditions of occupancy, the support, facilities and service to be provided, the fees charged and the rights and responsibilities of both parties. Previous time scales unmet 01 February 2006 & May 2006.01 September 2006. The Registered Person must ensure that service users are involved and are provided with the appropriate support when drawing up the contract. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006. Information must be available to show how residents are consulted in the drawing up of care plans and be reviewed. Previous time scales unmet May 2006. 01 September 2006 01/01/07 01/01/07 01/01/07 01/01/07 Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 29 12 YA42 YA9 13(4)(a-c) 13 YA12 14 YA13 15 YA16 The registered person must ensure that all risk assessments for service users are comprehensive, dated and regularly reviewed. Previous time scales unmet 01 January 2005, 01 February 2006 & May 2006. 01 September 2006. 16(2)18(1a)24(1a,b) Evening, weekend and recreational activities (in house and out of house) must be made available to residents in accordance with ordinary life and the homes stated aims and objectives. A record must be kept of any such activities to enable any person inspecting the records to verify the level and range of activities. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006. 16(m) Staff must support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 16(m) The daily routines and house rules must promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 01/01/07 01/01/07 01/01/07 01/01/07 Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 30 16 YA18 14(1)(a-c) 17 YA19 15(2)(a-c) 18 YA20 13(2) 19 20 YA23 YA42 YA23 13(2) 23(2)(b) 21 YA24 23(2)(b) Significant information must be available to show how the identified needs of residents are met. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006 The health and welfare of residents must be monitored and reviewed. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006 Medication records must be audited on a regular basis with a full tablet count. Previous time scales unmet May 2006. 01 September 2006 Accident records must be audited on a regular basis The Registered Person must ensure the protection of residents in all matter relating to health and welfare, Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006 All parts of the building must be in a good state of repair. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 31 22 YA24 23(2)(b) 23 YA26 4(1)5(1) 24 YA29 23(2)(n) 25 YA30 13(3) 26 YA32 18(1)(a-c) All bedrooms must be decorated to a satisfactory standard. Previous time scales unmet 01 February 2006 & May 2006. Not assessed. The Registered Person must ensure that the shortfalls in the furniture and fittings in bedrooms and bedroom sizes are reflected in the statement of purpose and service user guide. Previous time scales unmet 01 February 2006 & May 2006. The Registered Person must ensure that there is a system in place that enables service users and staff to summon assistance throughout the home. Previous time scales unmet 01 February 2006 & May 2006. Not assessed. The Registered Person must ensure that an alternative site for the laundry is identified. Previous time scales unmet 01 February 2006 & May 2006. All mandatory training must be completed and records available for inspection. Previous time scales unmet 01 February 2006 & May 2006 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 32 27 YA35 18(1)(i) 28 YA35 18(1)(i) 29 YA37 13(4)(c) 30 YA39 15(2)(c) 31 32 YA42 YA42 13(4)(c) 13(4) (c) 33 YA42 13(4) (c) Refresher course in all mandatory training must be provided. Previous time scales unmet 01 May 2005, 01 February 2006 & May 2006. All staff must receive training to the work they perform. Confirmation of completion must be available. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006 The Manager must ensure all polices and procedures are implemented to protect resident’s welfare and wellbeing. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006 The registered person must ensure that there is a quality monitoring system in place that seeks the views of those using the service. Previous time scales unmet 01 January 2005, 01 February 2006 & May 2006. 01 September 2006 The testing of the water supply must be tested regularly for legionella The registered person must protect service users against scalds and ensure the pipes in all shower rooms are boxed or insulated. All showers must be regulated. DS0000033658.V320951.R01.S.doc 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 Laurels, The Version 5.2 Page 33 34 35 YA42 13(4)(c) 13(4)(c) YA42 Provision must be in place to minimise cross infection All care plans risk assessments pertaining to residents must be reviewed. Previous time scales unmet 01 February 2006 & May 2006. 01 September 2006 01/01/07 01/01/07 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 Good Practice Recommendations Laurels, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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, The DS0000033658.V320951.R01.S.doc Version 5.2 Page 35 - 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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