Inspection on 05/07/07 for Laurence House

This inspection was carried out on 5th July 2007.

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

The inspector 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 25/07/06

Laurence House 09/11/05

Laurence House 05/07/05

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 Pamela Cunningham Key Unannounced Inspection 5th July 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Laurence House DS0000033600.V336364.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. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurence House Address 5 Cliffe Road Bradford West Yorkshire BD3 0JP 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) 01274 641367 01274 627147 City of Bradford Metropolitan District Council Department of Social Services Christine Harrison Care Home 29 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (29) of places Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are Dementia - Code DE and Code DE(E). The maximum number of service users who can be accommodated is 29. The place for DE is specifically for the service user named in the application for variation dated 14 March 2004 25th July 2006 2. 3. Date of last inspection Brief Description of the Service: Laurence House is a single storey, purpose built 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 provided. 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 At the time of the visit weekly fees for care provided are between from £98.63p and £435.68 per night. These charges do not include hairdressing or chiropody. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One visit was made to the home on 5th July 2007. The home did not know that this was going to happen. Feedback was given to the manager and one of the wing managers at the end of the visit. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents. Providers are now required to carry out an annual quality self assessment of their service (AQAA) which identifies what the home does to make sure the service is run in the best interest of the people living there. It also gives them an opportunity to say what they do best, how they do it, and how they can improve the service they provide. It also gives them chance to tell what their plans for future improvement are and if there are any barriers to improvement. The AQAA was returned to the Commission before the inspection and was used as an aid to planning the visit. Before the inspection 18 service user and 18 relative/visitors comment cards were sent to the home to be given to residents, their relatives and other visitors to find out what their views of the home were. Unfortunately these do not appear to have been received by the home, and therefore the residents and relatives view on how good/poor the service performs could not be identified. Other records in the home were looked at such as staff files, training records and accident records. A sample of the homes polices and procedures were also looked at. In order to find out how well staff knew residents, care plans were looked at during the visit and residents and staff were spoken to. Relatives spoken to said they were always made to feel welcome when they visit and were kept informed of any changes in the health of their relative. One lady said she was very satisfied with the service, had visited the home at Christmas and had had a ‘lovely meal’. She said the previous cook had been involved with the relatives about meal planning and hoped the new cook would have the same ideas. She said the staff were very good with all the residents, not just her relative, and that the place is beautifully clean and doesn’t smell. She also said she had been supported through her recent illness. One gentleman who was visiting said ‘if anywhere could be better than here I would be amazed, I can’t fault the place and am always made to feel welcome’. He said he had had a meal at the home and thought it was good. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 6 Unfortunately non of the residents I spoke to were able to tell me how well they were cared for or even if they liked living at the home, but there was nothing to suggest they were unhappy or not well cared for in any way. I also spoke to two district nurses who were visiting the home. They indicated the home was delivering an acceptable standard of care to the people who live there and said they were always called on promptly for advice if the senior staff identified any problems. What the service does well: The home is attempting to plan person centred care, and there was evidence in the care plans to evidence this. Care plans are reviewed on a regular basis and care plan reviews that include the relatives also take place. The senior staff are quick to obtain advice from other health professionals such as the Community Nursing Services if they are concerned about the health or any aspect of any particular residents care. The district nurses said that this usually happens very promptly. Pre admission assessments carried out identify the needs of the people who use the service and good attempts have been made to make sure all their care needs are met. The home also obtains social worker assessments that help them in planning the care. The home hosts a social evening every Saturday where the people who receive a service are treated to an informal meal where different types of food are served, including alcohol if the residents want it. Visitors are made to feel welcome when they visit and are invited to take meals with their relatives if they want. The senior staff also provides support for relatives where a need id identified, and one visitor confirmed this. Training is seen as a high priority, and training records evidenced mandatory training was up to date, with other more specialised training provided such as dementia care of people with epilepsy and diabetes. When the staff in the home who are currently working towards NVQ level 2 have completed the training, the home will have achieved 100 of the staff team as trained carers. This is good practice. Recruitment procedures are robust and protect the people who live at the home. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 7 All Health and Safety in the home is fully addressed. The manager is very keen to point out any shortfalls in the home and identify ways of making any improvements. She is making improvements in the right direction, but still has a way to go. What has improved since the last inspection? What they could do better: The staff could sit down with those people who receive a service and who are able to make in formed choices, and ask them about their past lives, and what if any special interests they have, or used to have, as currently these are missing from the care plan documentation. This would then help to make sure person centred care is planned. Care documentation could also have included in them an activity care plan. Risk assessments should be reviewed on a regular basis to identify any deterioration/improvement so that further planning can take place if necessary. More information could be supplied in the ‘brochure’ given to prospective service users and their relatives so that they have enough written information to help them make up their minds whether or not to live at the home. Instructions regarding pressure area care must be in a care plan in the care documentation and not just written in the district nurses’ notes kept at the home. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 8 More in depth training should be provided to all staff involved in the dispensing of certain medications that have to have a procedure to be followed to identify if the medication is needed or not. Information regarding interest on service users money should be made available to them. Practices could be reviewed regarding the locks on service users bedroom doors, as presently they can’t go to their rooms unless a relative or member of staff is with them, and this restricts their freedom of movement and choice. There could also be better notices provided to help the people who live at the home, and who are confused, to recognise where they are and where they want to be. Footstools could be provided as an aid to comfort when the people who receive a service are sitting in the main lounge area, and occasional tables could be provided so that there is a place to put a drink down, it would also make the lounge look more homely. The dining area on the wings could be made more homely looking. The manager must continue to make sure staffing levels on night duty remain at least at the current level for service user safety. 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. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 9 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 Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4, 5. Standard 6 does not apply to the home People who use the services experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People who wish to use the service have access to information about the home, but the service user guide could be in more detail so that potential users of the service have more information of the services they can expect the home to provide. EVIDENCE: The Statement of Purpose and Function for the home, which sets out in detail what the home provides, and the experience of the staff, has been sent to the BMDC (Bradford Metropolitan District Council) for approval. When this has been accepted a copy will be forwarded to the Commission. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 11 All prospective service users have a pre admission assessment of needs done either before they move in to the home or on the day of admission. The information in the AQAA (Annual Quality Assurance Assessment) completed by the manager and forwarded to the Commission said this document is available in various languages and designs. It also made reference in the plans for improvement for contracts of residency to be in place for the people who are receiving respite and short stay, as currently these people are not provided with one. The manager showed me a copy of a leaflet that is given to potential residents families and to those people who might want to live at the home. This is an information leaflet and does not provide the prospective service users and their families with enough information for them to make an informed choice whether or not to live at the home. This was discussed with the manager during the inspection and advice given what information the document should contain. People who use the service who are permanent residents are provided with the contact of residency, however those people who are admitted for respite care are not. This was a requirement at the last inspection. The information in the AQAA identified this was one was area in which the service could improve. The contracts of residency seen for the permanent residents also did not contain any information about what the person has to pay for that is not included in the fees. There was also no reference made to the room to be occupied. The service does not provide intermediate managed care. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 12 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 and 10 People who use the services experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The home provides satisfactory health and personal care service taking into account residents dignity and privacy; however, the way medicines are controlled in the home, and missing information about health care needs could place them at risk. EVIDENCE: Three care plans were looked at and the key workers for those residents spoken to. Allergies and information about special needs were clearly identified on the front of the care plans. There is a key worker system in place, and it is intended that a photograph of the key worker will be included in the documentation. Documentation looked at was complete with a pre admission assessment, including a social worker assessment. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 13 Risk assessments for nutrition and skin care were seen. If any concerns are recognised by the staff team these are identified to the district nurses providing the nursing care, and recommendations are made by them regarding action and preventative measures to be taken. However, a risk assessment seen relating to falls had not been reviewed or updated for almost a year. This could lead to the persons’ health care needs not being met. The manager said details of the person in question had been referred to the district nursing services for action to be taken, however any decision made by the district nursing team should be documented in the care plan and not just in the district nursing notes kept at the home. Although there was evidence of health care needs being met, i.e. optical, chiropody and dental care, there were no plans in place to address day to day hygiene needs such as mouth care or foot care. The home is attempting to make the care needs person centred, and certain evidence seen in the care planning evidenced this, however there was very little written information in the file about the past lives of any of the people receiving a service. For person centred care to be effectively planned, relatives should be asked to provide information about the persons’ life history, and this should be documented. The medication system was inspected. None of the residents manage their medication and the home has a policy and procedure in place to deal with this. The home uses a monitored dosage style of medicine control. Each person who receives a service receives their medication from individual heat sealed blister packs prepared by the pharmacist and delivered to the home monthly. I checked the system on one of the wings. The medicine trolley is stored in one of the satellite kitchens when not in use and secured to the wall. The door to the kitchen is locked when not in use. The correct procedure for handling medication was seen in the folder containing the medicine administration record sheets. On case tracking one persons’ medication it was noted she was being given a certain medication that had special instructions attached to it. When discussed with the manager it was apparent that neither her nor her staff knew of the procedure that had to be carried out before the medication could be given. This has identified a training need for all the staff who are authorised to dispense the medication to the people receiving a service. The manager immediately spoke to one of the district nurses at the time of the inspection who said she would attend the home and give the necessary instructions to the senior care staff, but this should be in addition to the essential training in safe handling of medication that is in place. Antibiotics were also being stored in the domestic fridge in the kitchen. This is acceptable, however at the time of the visit there was no evidence of the fridge temperature being monitored daily. As good practice it is also advised the prescribed medication should be kept in a sealed container. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 14 On looking at the MAR (Medication Administration record) charts it was seen there were omissions where medications had not been given, and the reason for omission not documented. It was also identified on three occasions certain medications were ‘unavailable’. The managing of the system should be robust and identify when supplies are running out and need re ordering. The people receiving a service looked well cared for. Staff spoken to said they had induction training that covered treating the people they care for with respect and making sure their dignity was respected, and said this was also mentioned at any staff meetings. Certain staff spoken to had a good knowledge of people who use the service and their individual care needs. They were able to provide details about how they looked after them. This was particularly evident when speaking to the carer from an agency that was providing one to one care for one person with very specific needs. None of the people receiving care I spoke to during the visit were able to tell me anything about the care they were receiving or how the staff treated them. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 15 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 and 15. People who use the services experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The people who use the service are helped to exercise choice and control over their lives, however more effort could be made to provide a more person centred approach to individually planned activities. EVIDENCE: On the day of the visit there was an agency cook employed. The permanent cook who has recently been recruited was attending another home to work with their cook as part of the induction process. This is good practice. Menus were inspected. These are five weekly rotational menus and were varied and with a choice identified. Cooked breakfasts are provided twice a week, and the residents go to the day centre at this time. The manager said the meals were taken in a ‘café style’ setting and appeared to be enjoyed by the people who receive a service. Records are kept of all food served. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 16 The manager said every Saturday night is a social evening where pizza’s, hot dogs and alcohol is provided to those residents who would like some. The kitchen was clean, tidy and well ordered. Records of cleaning schedules, food delivery and serving temperatures and fridge and freezer temperatures are kept, but it was evident the agency cook had not been keeping records, as core food and fridge and freezer temperature recordings had not been kept during the time that cook had been present at the home. The fans in the main kitchen also looked as if they needed cleaning. The manager said this had identified before the inspection and arrangements had been made to have them cleaned. It is also recommended the dried food in containers in the dry food stores are labelled when they are refilled from catering packs. This will help to identify how long the dried foods have been decanted and also identify if any are out of date. The routines in the home appear to be flexible and relaxed, however there was nothing documented in the care plans to tell the staff what times the residents preferred to get up or go to bed. This information would be better obtained from the relatives, due to the residents having been diagnosed with dementia and many of them being unable to make their own choices. It was evident that the people who use the service are helped to maintain contact with family and friends with the amount of activity in the home with relatives visiting. Two relatives spoken to said they were always made to feel welcome when they visit and were kept informed of any changes in the health of their relative. One lady said she was very satisfied with the service, had visited the home at Christmas and had had a ‘lovely meal’. She said the previous cook had been involved with the relatives about meal planning and hoped the new cook would have the same ideas. She said the staff were very good with all the residents, not just her relative, and that the place is beautifully clean and doesn’t smell. She also said she had been supported through her recent illness. One gentleman who was visiting said ‘if anywhere could be better than here I would be amazed, I can’t fault the place and am always made to feel welcome’. He said he had had a meal at the home and thought it was good. There are no social care plans present in the care documentation which gives the impression social care is not provided. The activity organiser keeps a record of individual activities the people who receive a service take part in, however these is very little evidence how the leisure time is arranged, when provided, either in house or on a one to one basis. Certain comments written in the individual records read ‘had fish and chips’ ‘put some hand cream on’ and ‘had toe nails cut’ etc. These are basic care needs and not planned activities. The person filling this role would obviously benefit from some formal instruction on identifying and arranging appropriate activities that will suit the needs of the people living at the home. The manager said other entertainment is arranged and includes trips out in the mini bus, outside entertainers and reminiscence therapy. She also said some Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 17 of the people who receive a service were taken out for walks in the nearby park by staff and relatives, weather permitting. There is an activity timetable displayed in the main lounge, however on the day of the visit there was no indication this was being followed. During the inspection the only interaction that appeared to take place between staff and service users was when staff came to attend to their personal needs. Two people in the main lounge appeared restless, and staff tried to orientate them and help them to go where they wanted to. There are no restrictions on visiting and some relatives visit every day. Residents are able to see family in the privacy of their room. The manager said most residents relatives have keys for their relatives bedrooms, however there was no evidence in the care records looked at to indicate this. Some visitors use communal sitting areas when they visit. The manager said residents also have the opportunity to take part in the day centre activities and it also gives them the opportunity to mix with people from the community. The manager said relatives had been made aware of the opportunity to have access with their relatives to care files, and that they are also encouraged to have involvement in the care planning process, however there was only evidence of relative involvement in one resident’s care file. Apart from the two relatives comments I obtained by speaking to them, no other relatives, comments were available as none of the comments cards forwarded to the home before the inspection had been returned to the Commission. When this was mentioned to the manager she said she did not recall any comments cards arriving at the home by post, and if she had she would have certainly distributed them to any visit relatives. Although the people who use the service have their religious preferences identified, there is very little evidence in the care documentation to say this happens. However on speaking to one of the wing managers she said certain people are taken to visit the local church, and during the 6 weekly reviews, residents and their relatives are asked of they want any support in this way. Information in the AQAA in the section that identifies what they could do better, the manager has said they could develop community contacts, observe religious rights and preferences and encourage attendance from local priest and mosque etc. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 18 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 and 18 People who use the services experience good outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The home takes complaints seriously and has systems in place to successfully deal with allegations of abuse. EVIDENCE: The organisations complaints procedure is in place. It is on display in the foyer of the home and is clear and easy to follow. A notice on how to get in touch with advocacy services is also displayed. The home has investigated four complaints since the last visit. One was about members of staff sitting outside and not supervising residents in the home. This was dealt with adequately and an acknowledgement sent to the complainant. Another complaint was made by a relative and was regarding hospital escorts. The manager dealt this with appropriately. A third complaint was made via the Alzheimer’s Society. The complaint was not supported. The manager said if complaints are serious or complex, the Bradford Metropolitan District Council complaints panel deals these with. From information received since the manager came into post it is clear that any concerns raised and identified are taken seriously, investigated and dealt with appropriately. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 19 Copies of the organisations adult protection procedures and the local authority adult protection procedures are kept in the manager’s office, and also on each of the wings in the home. The training matrix seen at the time of the visit identified all staff have had instruction on safeguarding adults as part of their mandatory training. The manager told me she has attended the 2-day manager course on the subject. Staff spoken to during the visit (one of whom was an agency carer) were certainly aware of the action they should take if abuse was suspected or witnessed, and said they would report any incidences to the person in charge, and said they had had training in safeguarding adults. As part of the recruitment and selection by the Local Authority all staff have a Criminal Records Bureau (CRB) and POVA (Protection of Vulnerable Adults) check before being offered employment. Copies of the organisations adult protection procedures and the local authority adult protection procedures are kept in the manager’s office. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 20 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, 24, 25 and 26. People who use the services experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The home provides a safe and comfortable environment for the people who live there, but it could be more suitably adapted for people with dementia. EVIDENCE: During the tour of the building I got the impression that more needs to be done on the environment to make it easier for the people who use the service to identify where they are and where they want to be. For example, the main lounge is the central area and corridors access the three wings where the bedrooms, satellite kitchens and dining areas are. However none of the wings have any identification near them that will help the people who use the service to know where they are. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 21 Since the last inspection new carpets have been provided in the main lounge and wing corridors, and as these are quite plain carpets will not have a detrimental effect on the people who live their who are confused. Locks fitted on bedroom doors are still of a type that when the bedroom door is closed, entry can only be gained with a key, although by turning the handle from inside the room, people can easily get out. The manager said all staff and relatives have keys to the residents’ bedrooms, however practices should be reviewed to make sure that this does not restrict the choice of those service users wishing to return to their room at any time during the day with or without the help from staff or relatives. I talked to the manager regarding the suitability of the environment for residents with dementia. She acknowledged that the environment could be more suitably adapted to assist the resident group with dementia, like replacing the existing wallpaper in the main lounge with a style ‘less busy’. More footstools could also be obtained so that the people who use the service will be able to put their feet up and relax. There are also very few occasional tables in the main lounge for residents to put drinks on. Since the last inspection a new emergency call system has been commissioned, and staff and relatives are now able to call for assistance easily when needed. The manager said there were plans to replace bedroom furniture and provide new dining furniture for all three wings. I observed a teatime meal in one of the wing dining areas. Residents appeared to be enjoying their food, and were being cared for and supervised by a carer who appeared sensitive to their needs. However the dining area looked more like a café than a dining room in someone’s home. With this in mind maybe the providers could look at ways to make this area more homely looking. All areas were clean and free from offensive smells. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 22 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 and 30. People who use the services experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Staff are recruited and trained to provide good levels of care to the people receiving a service. EVIDENCE: One the day of the visit care staff were present in such numbers to meet the needs of the people living there. Up to date duty rotas were obtained. These identified staffing has increased on night duty, and that there are now three waking night staff on seven nights per week. However concern was expressed to the manager when reading the minutes of one of the staff meetings where it was documented, ‘in an emergency on of the night staff could be expected to work at another service’. Due to the layout of the home, and the dependency of the people who use the service, especially the one person who is currently receiving one to one care during the day, night staff numbers must not fall below three waking staff. Looking at the duty rotas for the ancillary staff, in particular the cooks rota, it would appear, for the weekend of 16th and 17th June 07, Sunday 24th June 07 and the weekend of 30th June and 1st `July 07, there was no cook present in Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 23 the home. If anyone had been rostered to perform cooking duties this was not identified on the rota. Information on duty rotas also indicates there are five vacancies on day duty and five on night duty. The manager said agency and her own care staff fill the vacancies. It is also not documented when agency staff are used and which agency supplies the people. The manager said regular staff meetings for the management team at the home and all staff still take place, and written minutes are kept of these meetings, which gives the manager the opportunity to discuss management issues, and for staff to discuss matters relating to the residents and their work issues. Staff training continues. A training Matrix made available identified all mandatory training such as manual handling and fire safety training was either up to date or courses arranged for those staff needing updates. Staff induction training is linked to skills for care and records evidenced this. Four staff are currently in the process of completing NVQ (National Vocational Training) at Level 2, which when completed will mean 100 of the staff team are trained in care. This exceeds the ratio recommended by the National Minimum Standards, which is 50 . Dementia Care training has been provided for six of the staff with more training arranged for others. Staff have also been given instruction on catheter care and Diabetes, and training is being arranged to teach the staff about Epilepsy. The community epilepsy nurse specialist is providing this. All staff involved in the dispensing of medication were given training by Boots Chemist before the monitored dosage system they provide started to be used in January 07, and certain staff have done an accredited training course on the safe administration of medication provided by Park Lane College. The staff files looked at showed that the required pre-employment checks had been carried out before new staff started work in the home. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 24 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, 36, 37, 38 and 39 People who use the services experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The manager has the experience and the qualification to carry out her role, which should provide staff and the people who receive a service with clear leadership and stability. EVIDENCE: The manager has recently made a successful application to the Commission to become the Registered Manager. She is experienced and has a certificate in Management Studies, which she gained in 1996 and has completed the NVQ level 4 and the Registered Managers Award. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 25 One of the” wing managers “ has also Registered Manager Award (RMA) and NVQ 4 all senior care workers has attained NVQ 3. The providers are currently recruiting a deputy service manager to support her in her role. On speaking to the staff it is quite evident the manager is popular with them, and has knowledge of individual residents. Staff spoken to also said she was very approachable. There are clear lines of responsibility in the home, and the manager said senior officers are identified to be in charge of the home on a rota basis when she is on annual, leave. The manager said she operates an open door policy and is accessible to residents, relative and staff. Information from relatives spoken to said that they thought the home was well managed and run. Staff meetings are held every regularly to discuss any issues, training and to introduce new staff to the team. Individual wing meetings are also held to discuss matters relating to individual residents. Full staff meetings are held periodically, and meetings with the domestic staff are held twice a year, although the manager said she intends to hole these meetings on a more regular basis. A record was seen for the health and safety checks carried out in the home. These were up to date. The fire alarm is tested on a weekly basis, and the manager said she intends to make sure monthly evacuations are carried out as at present they are done three monthly. A new emergency call system has recently been installed throughout the building. All of the home’s management team, which also include night staff, have completed a First Aid course. Supervision records were seen in staff files and staff said they found the sessions helpful. One member of staff said she was encouraged to read the care documentation by the manager and that helped her to get to know the residents she is key worker for. The manager said twice yearly appraisals also take place. This is also identified in the AQAA. The manager said quality assurance surveys are done on an annual basis and the information audited by the BMDC. It was however identified that Regulation 26 visits (Quality Assurance) have not been made to the home since 13/03/07 as is required. A high percentage of residents’ relatives continue to handle their financial affairs. For those residents who do not have any relative or cannot handle their own affairs, this is carried out by BMDC. Records were seen of individual Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 26 account made available to individuals as was required at the last inspection. However there is still no indication of any interest paid on any savings. (Information in the AQAA said this was one area the home could improve on.) Individual records and home records are secure, up to date and in good order in accordance with the Data Protection Act 1998. Communication in the home is good and staff said they learned about the residents’ immediate needs at handover times. One member of the care staff team said she was encouraged to read the care documentation by the manager. This is good practice. Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 3 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 2 X 3 3 3 3 Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5(1) 5(band c) Requirement The registered provider must: a . Make sure prospective service users are provided with enough information to help them to make up their minds whether of not to live at the home, and b. Provide all service users including those who are receiving either short stay or respite care with a contract of residency that clearly sets out what care they can expect to receive. The service user guide must include the contract. b. is unmet from the inspection on 5th July 2005, 31 March 2006 and 31st October 06 Timescale for action 30/10/07 2. OP7 15 The registered provider must 31/08/07 make sure all service users a. Have a 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, and DS0000033600.V336364.R01.S.doc Version 5.2 Page 29 Laurence House b. 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, and a record of the person’s condition and treatment. b. Unmet from previous visits of 5/705, 31/106 and 31/10/06 3. OP8 15 The registered provider must make sure all risk assessment are regularly reviewed to identify any deterioration or improvement. This is particularly with reference to risk assessments for falls. 31/08/07 4. OP9 13 (2) 5 OP12 16(2) The registered provider must 31/08/07 make sure there are arrangements in the home for the safe administration of medication. This is with particular reference to one medication that must not be given before a certain procedure has been carried out. 30/09/07 All service users must have access to activities to suit their individual needs and preferences. Unmet from the inspection on 31 January 2006 and 31st October 06 The registered provider must make sure that staffing levels meet the needs of the service user. This is with particular regard to night duty, and the expectation that care staff can DS0000033600.V336364.R01.S.doc 6. OP27 18 (1) (a) 31/08/07 Laurence House Version 5.2 Page 30 be moved to another service in an emergency. 7 OP33 24 (1) (b) 26 The registered provider must 30/09/07 a. make sure out come of information from quality assurance questionnaires sent to relatives, are made available to families and others who had an input in the survey and a copy forwarded to the CSCI local office. b. Make sure monthly quality monitoring visits are made to the service to and forward copies of such visits to the Commission a. Unmet from previous inspection of 31/11/06. Although individual accounts are now provided for service users, the registered provider must still demonstrate how each individual service user will receive any interest applicable to their individual savings. Unmet from previous inspections of 31/03/06 and 30/11/06 8. OP35 20 30/09/07 Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP7 OP38 Good Practice Recommendations The manager should continue to encourage residents/relatives to be involved in the care planning process. Daily records should be kept of care food temperatures and fridge and freezer temperatures Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Laurence House DS0000033600.V336364.R01.S.doc Version 5.2 Page 33 - 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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