Inspection on 05/07/05 for Laurence House

This inspection was carried out on 5th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Laurence House 05/07/07

Laurence House 25/07/06

Laurence House 09/11/05

Laurence House 16/12/04

Laurence House 13/08/04

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

CARE HOMES FOR OLDER PEOPLE Laurence House 5 Cliffe Road Bradford West Yorkshire BD3 0JP Lead Inspector Ann Stoner Unannounced 10.00 am: 5th July 2005. 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 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. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Laurence House Address 5 Cliffe Road Bradford BD3 0JP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 641367 01274 627147 City of Bradford Metropolitan District Council Dept of Social Services Mrs Jean Perkins Care Home Only 29 Category(ies) of Dementia Over 65 (29) Dementia (1) registration, with number of places Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The place for DE is specifically for the service user named in the application for variation dated 14th March 2004. Date of last inspection 16 & 20th December 2004. Brief Description of the Service: Laurence House is a single storey, purpose build Local Authority residential and day care resource centre for older people with dementia. In addition to day care, the home provides residential and respite care, without nursing, for 29 people of both sexes. Day care is not regulated and therefore is not inspected. The residential part of the home functions from three different wings. Each wing has a lounge, dining and kitchen area, all leading to a central lounge. A multi-cultural lounge, is also available. The layout of the home makes it easy to get to all wings from the central lounge area. Digital locks are fitted around the home and on all exit routes making sure that service users are safe. Bus stops are nearby and there is a small car parking area at the front of the home. Nearby there are shops, chemists, pubs and a local park. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, regulated care homes have a minimum of two inspections a year; these may be announced or unannounced visits. The last inspection was unannounced and took place on the 16th & 20th December 2004. There have been no further visits until this unannounced inspection. During the inspection, I looked at records and saw some areas of the home, such as bedrooms, lounges, dining rooms, toilets and bathrooms. I saw care staff carrying out their work and spoke with visitors, staff and members of the management team. Due to their level of dementia, many service users were unable understand the purpose of the inspection, however I watched their body language and their interaction with staff and other service users. Comment cards/questionnaires are left for service users, visitors and other professionals at each inspection, thereby giving the opportunity for anonymous feedback. None have been returned since the last inspection. This inspection started at 10.00am and ended at 5.30pm, in addition to the time spent in the home, I spent time preparing for this inspection. What the service does well: What has improved since the last inspection? What they could do better: The main concerns from this inspection are, the lack of appropriate care plans and other necessary records, the current staffing levels, some medication practices that do not meet the required standards, and the lack of specialist input from a community dietician. Other improvements are needed to keep foul and soiled laundry separate during all stages of the laundering process, to Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 6 monitor any weight gain/or loss of service users, to make sure staff are aware of the relevant sections of the Mental Health Act and to make sure service users have a contract and copy of the home’s terms and conditions. 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. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4 & 5. Standard 6 does not apply to this home. People are able to make an informed decision about the home; however, the lack of a written contract and statement of terms and conditions of the home leaves relatives and/or service users unaware of the specific rights and responsibilities of both the home and the service user. EVIDENCE: Prospective service users are invited to visit before admission but the registered manager said that this visit is usually made by relatives rather than by the prospective service user. The registered manager said that the lack of specialist dementia care units potentially restricts choice. This was a view echoed by two visitors, who said that, they were given information about the home and had the option to visit, but were recommended to accept the offer by the placing social worker as this was the only dementia care bed available at that time. A statement of purpose is available in the home, but this needs a minor change. The statement of purpose is being combined with the service user guide; and although copies of inspection reports are in the home, a copy of the Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 9 most recent inspection report was not in the service user guide, or details of where to find the report. In the three care plans sampled a contract of residency was seen in only one and this did not have all the information listed in Standard 2. There were copies of assessments in all of the care plans. One service user had been admitted for aftercare under Section 117 of the Mental Health Act 1983, but the home did not have any information about the Act or a copy of the Mental Health Act 1983 Code of Practice. Staff have received training in dementia care and take a ‘person-centred’ approach when working with service users. By patience and encouragement they have achieved success with a service user who, on admission, refused to eat and sleep in a bed. However, this has been achieved through informal processes rather than a planned approach via the care plan. Requirements and recommendations have been made to address the above. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, & 10. Care plans are poor, and although health care needs are met, the lack of proper records can lead to needs being overlooked. Some medication practices create the opportunity for error. The privacy and dignity of service users is respected. EVIDENCE: A good care plan is one that gives precise and detailed information on how and when care should be delivered, both during the day and at night, paying particular attention to the likes and dislikes of the service user in all aspects of care. The care plans at the home did not give such detail, for example, information such as ‘provide minimal restraint when initiating personal care’, does not give staff information on the type of restraint, and when this should be considered. ‘Wears incontinent pads’, fails to give precise instructions as to the type of pad, and how often it should be changed. ‘Feet need creaming regularly’ does not give staff instructions about what kind of cream to use or when to use it. There was no information in any of the plans sampled about how often a service user is offered a bath, preferred time or of preferred toiletries. The home still uses a bath book, with records of all service users on one page. This is a specialist home for people with dementia, many of whom Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 11 have communication difficulties and some who at times, display challenging behaviour. There were no clear and specific instructions on how staff should communicate with service users and no care plans showing specific triggers to challenging behaviour or of how to manage and respond to individual behaviours. There were no risk assessments for managing challenging behaviour and a risk assessment for a service user at risk of falling did not show actions to prevent further falls. The relatives of a service user recently admitted to the home were unaware of the existence of the care plan. A requirement relating to care plans remains unmet from the last inspection and a further requirement has been made. Records showed that service users have chiropody, dental and optical treatment and a visitor said she was kept informed when her mother had treatment from her GP. A community nurse, who was visiting the home at the time of this inspection, was very complimentary about the home. One service user has a pressure sore, which is being treated by the community nursing services. There was no pressure area care plan for this person, no records kept of community nurses’ visits, or any record or update of this person’s condition and treatment. Although nutritional assessments were in place for two service users nutritionally at risk, there was no record within the care plans of these service users being weighed. The registered manager described the difficulty that staff have when trying to encourage service users to stand on bathrooms scales. A requirement and recommendation have been made. Staff were seen giving medication out on two wings. One person had not received any formal or accredited training, and was unsure how to administer 5mls of medicine from a 300ml bottle. Another person explained, how in order to save time, a senior staff member pre-dispenses medication for two service users into a dosette box. This unsafe practice was identified at the last inspection and has not been rectified. Some entries on MAR (Medication Administration Records) are handwritten. These entries were not signed, the amount of medication was not recorded and the entries were not checked or countersigned by another person. Requirements relating to these issues have been made. All new staff complete the Best Practice induction programme, which tells them about important aspects of privacy and dignity when delivering care. Care staff described how they protect the privacy and dignity of service users, and this was seen throughout this inspection. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12, 13, 14 & 15. Service users’ choice, culture and diversity are respected and visitors are welcomed. A nutritious diet is provided, but the lack of specialist dietetic advice has the potential to place some service users at risk. EVIDENCE: Staff described the choices available to service users, such as times for going to bed, and getting up in the morning, what to wear and when to eat. Service users are encouraged to bring their personal possessions with them on admission and one person brought her own small two-seater settee and a TV. The registered manager explained how various religious events such as Christmas, Eid, Deepavali and Vashaki are celebrated with traditional food and dancing. The home embraces diversity and has designated one lounge area as a multi-cultural lounge, which has Satellite TV so that channels in several languages can be viewed. Service users seemed to enjoy the lunchtime meal, and the atmosphere was calm and relaxed. Staff, whilst encouraging independence wherever possible, gave assistance when needed in a sensitive way. Daily records for one person, who was very underweight, showed that a community nurse had weighed her. Her records stated that she should be offered extra puddings, and butter on Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 13 her potatoes. Another person’s diet consisted, in the main, of milk and sweet things. This person’s key worker explained how she suggested adding Complan to the milk, and from GP involvement vitamins are prescribed. However, in both cases there has been no specialist dietetic involvement from the community dietician. Other underweight service users were seen who would also benefit from this service. A requirement has been made. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 16, 17, &18. Complaints are taken seriously, but the lack of staff training on adult abuse does not guarantee that service users will be protected abuse. EVIDENCE: The home keeps a record of all complaints, and staff were able to show how all complaints are taken seriously. Although staff were able to explain how they would deal with any suspicion of abuse, they have received no formal training. Senior staff were not confident on the use of the Multi-Agency Adult Protection procedures. The outstanding recommendation from the previous inspection remains unmet. A requirement has now been made. Information on advocacy is available in the home. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19 The layout of the home meets the needs of the service users. EVIDENCE: The layout of the home gives service users the freedom to walk safely inside and outside of the building, and the small lounge and dining areas on each wing create a more domestic style feel to the home. Colour coding of the wings helps service users recognise their individual area and digital locks keep service users, who like to walk around, safe. Toilets on the wings have two doors, one adjoining the adjacent bathroom. This could compromise privacy and dignity and some attention should be given to address this. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30. Staffing levels do not meet the needs of the service users. Recruitment is thorough and protects service users, but not all of the records are held within the home. Staff are expected to undertake training. EVIDENCE: The staffing levels within the home are inappropriate for the layout of the building and the service it provides. Service users are at most risk of having their needs overlooked at night, when there are only two workers on duty to cover the three wings. This is unacceptable. A requirement relating to this has been made. The recruitment file of a newly appointed member of the staff team was seen and the appropriate pre-employment checks were in place, however, the recruitment details of existing staff remain at head office. All new staff complete the organisations Best Practice training manual, which is based on the TOPSS (Training Organisation for Personal Social Services) induction and foundation standards. Of the 25 care staff employed within the home 60 have achieved NVQ (National Vocational Qualifications) Level 2 or 3, and a further 32 are currently being assessed. This exceeds the 2005 targets. Staff showed a good understanding of dementia, and explained about the recent training provided ‘in-house’ on a rare form of dementia that affects one service user. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff are appropriately supervised. EVIDENCE: One of the wing managers explained the system of staff supervision, and a member of staff confirmed that formal supervision takes place every 6 weeks. The registered manager said that appraisal and supervision records are kept in staff files. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 x x x x x 3 x x Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 19 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. 2. Standard 1 2 Regulation 4 (1) (c) 5 (b) (c) Requirement The statement of purpose must include the number and size of rooms in the home. The service user guide must include: The statement of terms and conditions of the home. The contract. A copy of the most recent inspection report. The registered person must give 31.12.05. service users a contract showing the arrangements made. All service users must have a 30.9.05. care plan that sets out in detail the action which needs to be taken by staff to make sure that all aspects of the health, personal and social care needs of the service user are met. Service users and/or their representatives should be invited to contribute to the care plan. Risk assessments, showing 1.9.05. actions taken to reduce risk must be in place when risk is identified. Version 1.40 Page 20 Timescale for action 31.8.05. 31.12.05. 3. 4. 2 7 5 (3) 15 5. 7 13 (4) Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc 6. 8 17 (1) (a) Schedule 3 (k) A pressure area care plan must be in place for all service users at risk of developing a pressure sore. A record must be kept, within the care plans of those service users who develop a pressure sore, noting: A record of all community nursing visits. A record of the persons condition and treatment. In order to make sure the administration of medication is safe, all handwritten MAR (Medication Administration Records) must be checked and countersigned by a second person. The practice of secondary dispensing must cease. This is unmet from the inspection on 16.12.04. All staff who give out medication must receive accredited training. This is unmet from the inspection on 16.12.04. 1.9.05. 7. 9 13 (2) 1.9.05. Immediate as advised. 30.9.05. 8. 15 12 (1) (a) 9. 10. 18 27 13 (6) 18 (1) (a) 11. 29 18,19 Wherever there are concerns about a service users nutrition, the services of dietician must be sought. Staff must receive training on adult abuse, and the use of the Multi-Agency Procedures. The registered provider must make sure that staffing levels meet the needs of the service user. Information on staff required by Schedules 2 & 4 must be available for inspection in the home. 31.8.05. 30.9.05. 30.9.05. 30.9.05. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 21 This is outstanding from inspections on 13.8.05 and 16.12.05. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 3 7 8 26 Good Practice Recommendations There home should have a copy of Mental Health Act 1983 Code of Conduct. The practice of using a bath book should cease, and be replaced with individual records kept in care plans. Due to the needs of the service user group,the home should consider obtaining a chair type weighing scale. The registered manager should implement the use of water soluble bags to keep foul and soiled linen separate during all stages of the laundering process. This is outstanding from the inspection on 16.12.04. Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 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 Laurence House J52 J03 S33600 Laurence House V236288 050705 Stage 4.doc Version 1.40 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!