Inspection on 09/11/05 for Laurence House

This inspection was carried out on 9th November 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 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 Ann Stoner Unannounced Inspection 9th November 2005 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.V264306.R01.S.doc Version 5.0 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.V264306.R01.S.doc Version 5.0 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 Care Home 29 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (29) of places Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The place for DE is specifically for the service user named in the application for variation dated 14 March 2004 5th July 2005 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. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 5th July 2005. There have been no further visits until this unannounced inspection. The registered manager’s post is vacant and as a short term measure the deputy manager has taken on the ‘acting manager’ role. This inspection was carried out between the hours of 10.30am and 4.30pm. During the inspection, I looked at records, saw care staff carrying out their work, made a tour of some parts of the building and spoke with service users, staff, visitors and the acting manager. Comment cards/questionnaires are left for service users, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection (CSCI). We discuss any comments received with the manager, without revealing the identity of those completing them. None have been returned. Copies of previous inspection reports are available via the Internet at www.csci.org.uk. What the service does well: The home is located next to Peel Park, which provides visitors with the opportunity to enjoy some fresh air with the service user. During the inspection one person went for a walk in the park with her relatives, and another visitor spoke of enjoying some time outside of the home with his mother. Staff are kind to service users. One person who was ill in bed looked very comfortable and staff explained how they do their best to make sure she is well cared for. Visitors are welcomed, and offered refreshments. One visitor spoke highly of the home and the service it provides. He was also full of praise about the carer’s group meetings, held in the home on a regular basis. He said that these meeting had been a valuable source of comfort and advice for him, and that the expertise of guest speakers such as representatives from the Alzheimer’s Disease Society was very much appreciated by the group. This person also said that staff at the home had gone out of their way to make sure that his mother was able to attend a family wedding, so much so that staff had given their own free time to make sure she had new clothes and her hair was washed and set. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this visit. EVIDENCE: Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9. Record keeping in the home is poor. Care plans provide the opportunity for needs to be overlooked and the lack of risk assessments fails to protect service users. EVIDENCE: The home is in the process of introducing a new format for care planning. Three care plans were sampled, one of which was in the new format. A service user, who was admitted to the home on the 5th September, had a new style care plan, but the plans for social and leisure, mental health, toileting, bathing, personal appearance, dressing and night care, had not been completed. When asked, staff said they relied on verbal information from other staff as to the level of care required. Other care plans failed to demonstrate the actual care that was given. One person’s plan stated that she could brush her own teeth, but needed reminding to do so. However, her relative said that she wore dentures, but these had been missing for some time. Her mobility care plan stated that she was mobile and that no moving and handling was required, despite the fact that she had suffered numerous falls, one of which resulted in a fractured pubic bone, making her immobile and needing to use a wheelchair. There was no falls risk assessment in place and no care plan for the prevention of falls. Records showed that she had lost 7lb in weight over recent months, which was confirmed by her relative, but there was no nutritional assessment Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 10 in place and her dietary care plan made no reference to any weight loss, nor did it give instructions for staff on ways of prevent further loss. There was an entry in her medical records of a bed and pressure relieving equipment being ordered by community nursing staff, but there was no pressure area care plan in place. One very frail service user, near to the end of life, was being cared for in bed. She was being re-positioned two hourly, there was a pressure relieving mattress in place, and the acting manager said community nursing staff were visiting twice a week to dress her heels. A large cushion was seen on the floor at the side of the bed, which staff said was to reduce the impact of a fall. None of this was in her care plan. The plan stated that her mobility was fine, that she was able to get in and out of bed unaided, that there were no problems with her general health, and that she could wash herself if prompted. Once again there was no pressure area care plan in place. The home specialises in providing a service for people with dementia, but none of the care plans had any information about the specialist needs of the service users. Numerous entries in daily records described one person as being ‘demanding’. Records of baths, weight, and other information, are still recorded in a book, rather than being held in individual care plans. Monthly reviews take place, but information from the reviews is not transferred to the care plan. MAR (Medication Administration Records) were sampled. Handwritten entries by staff were not signed by the person making the entry, and were not checked and countersigned by a second person. Some entries were not filled in, and staff did not know whether the medication had been given or not. Staff were unclear about the use of homely remedies, and had difficulty finding the home’s medication policy document. Checks on the temperature of the refrigerator, used for storing medication, are not made. Requirements and recommendations have been made to address these issues. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 13. The lack of stimulating activities provides the opportunity for service users to become restless. Visitors are welcomed and are offered support. EVIDENCE: The home employs an activity organiser, but this person has been sick for some time. There is an activity timetable displayed in the main lounge, but this was not followed on the day of inspection, and visitors said they had never seen the timetable followed. In the main lounge area the service users were clearly unable to occupy their time meaningfully without help and guidance from staff. During the inspection the only interaction that took place between staff and service users was when staff came to attend to their personal needs. One person in this lounge became restless and was disturbing other service users, which resulted in a physical attack where a service user fell onto the floor. Comments from visitors included, “People (service users) are left to their own devices, there is not enough stimulation”, “There is not a lot of activities, people (service users) tend to wander a lot.” Visitors said that they could visit at any time, and one person was offered a hot drink by staff, which he said was normal practice. One person said that the home had offered him lots of support and advice, and that he valued the support given at the regular carers’ meetings. A requirement has been made to address this issue. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 12 Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this visit. EVIDENCE: Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26. In general the environment is well maintained, but the lack of an accessible call system in all areas, could pose a potential risk to both staff and service users. Some practices increase the risk of cross infection within the home. EVIDENCE: Some refurbishment has taken place, and the home has recently purchased some small settees and new chairs, which give the main lounge a homely feel. Some areas need re-decorating where wallpaper has been torn from the wall, particularly in the main lounge and one corridor. There is no emergency call system in the toilet or bathroom areas, which has recently created a problem when a member of staff required assistance. It was noted that the locks fitted on bedroom doors, are 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, an immediate exit is available. 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. Some areas of the home had an offensive odour, which was more noticeable in the main lounge and along one corridor. Visitors commented on the offensive Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 15 smells. Residents’ clothing is washed at the home, but visitors expressed concern that their relatives are often wearing other people’s clothing. Staff were unsure when they last received training in infection control, and the home has no system of identifying when updates are required. When asked, a member of staff said although latex gloves are always worn when dealing with bodily fluids, protective aprons are not, despite these being readily available. A member of staff was seen collecting crockery from service users in the lounge, she was still wearing latex gloves. This creates a serious risk of cross infection. The laundry area was clean and tidy. Requirements and recommendations have been made to address these issues. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing levels are inappropriate for the layout of the building and the needs of the service user group. EVIDENCE: Service users were left unattended in the main lounge area for most of the day, other than at times when care was being given. This observation was confirmed by all of the visitors spoken with. The same issue was also identified in a quality assurance peer visit report. During this inspection a physical attack on a service user could have been prevented if staff had been available in the lounge area. Entries in the home’s accident book identified three service users being assaulted in the lounge area by another service user, within a short space of time on the same day. Although the situation was dealt with appropriately, the attacks may have been prevented by the presence of staff. One service user was being cared for in bed. There was the potential for her to be isolated because her bedroom door was permanently closed. Staff said that this was to safeguard her from other service users wandering into her room and disturbing her. Appropriate staffing levels should prevent such a situation arising. The home operates from three wings. During the night there are only two night staff on duty. Given the degree of care that some service users require and risk of falls during the night, this level is unacceptable. A requirement has been made to address this issue. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 17 Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. The home’s system of quality assurance could be improved by seeking the opinions of relatives and other professionals. The financial systems in place do not provide service users and/or their relatives with up to date information about transactions and the current balance of savings. Health & safety records do not provide all of the required information. EVIDENCE: The home is currently without a registered manager. As a short term measure the deputy manager has taken on additional responsibilities. A new manager has been appointed but had not taken up his appointment at the time of this inspection. The home sends out questionnaires to relatives of service users receiving a short stay or respite service, but there is no quality assurance system in place for permanent service users. A carers support group is firmly established within the home, and relatives said they valued the support from this group, but this is more of a support and advice mechanism rather than feedback on Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 19 the activity and service provided within the home. A self-assessment quality audit is carried out annually. Service users who have savings with Bradford social services do not receive any interest for the first £500; this does not comply with the Care Homes Regulations or guidance published by the Commission for Social Care Inspection. Individual statements identifying transactions and balances were not seen in files, and the acting manager was unaware of any being received. The home’s system of accident recording does not comply with the requirements of the Data Protection Act. One page of the accident book had details about seven different service users. The home completes a quarterly audit of accidents, but this is for organisational purposes, rather than to identify and trends and patterns within the home. Where accidents are not witnessed by staff, there is no record kept of when the person was last seen and by whom. Fire drills are carried out at intervals of no more than six months, but there is no record kept of those staff taking part in the drill, and the home does not have a system in place to identify when any mandatory training updates are due. The last monthly test of the emergency lighting was conducted in July 2005. Staff were caring for one service user who was ill in bed. This person was repositioned 2 hourly, but her bed was against a wall, making staff access difficult. Requirements and recommendations to address these issues have been made. Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 21 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 OP2 Regulation 5 (b) (c) Requirement The service user guide must include: The contract. This is unmet from the inspection on 5th July 2005. The registered person must give service users a contract showing the arrangements made. Timescale for action 31/03/05 2. OP2 5 (3) 31/03/05 3. OP7 15 This is unmet from the inspection on 5th July 2005. 31/01/06 All service users must 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. Service users and/or their representatives should be invited to contribute to the care plan. This is unmet from inspections on 16th December 2004 and 5th July 2005. Risk assessments, showing DS0000033600.V264306.R01.S.doc 4. OP7 13 (4) 31/01/06 Page 22 Laurence House Version 5.0 actions taken to reduce risk must be in place when risk is identified. This is unmet from an inspection on 5th July 2005. 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. 5. OP8 15 (1) 17(1)(a) 31/01/06 This is unmet from an inspection on 5th July 2005. 6. OP9 13 (2) 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. This is unmet from an inspection on 5th July 2005. All medication record sheets must be fully completed in accordance with guidelines from the Royal Pharmaceutical Society of Great Britain. Nonadministration of medication must be explained. 7 OP12 16 (2) All service users must have access to activities to suit their individual needs and preferences. Staff must receive training on DS0000033600.V264306.R01.S.doc 31/12/05 31/01/06 8. OP18 13 (6) 31/03/06 Page 23 Laurence House Version 5.0 adult abuse, and the use of the Multi-Agency Procedures. This is unmet from an inspection on 5th July 2005. Torn wallpaper in the main lounge and one corridor must be replaced. There must be an emergency call system in all parts of the home, including all toilets and bathrooms. Care must be taken to make sure that service users are not wearing clothing that belongs to other people. The manager must make sure that all staff wear protective aprons and gloves when care is given and clinical waste is handled. The home must be free from offensive odours. The registered provider must make sure that staffing levels meet the needs of the service user. Quality assurance questionnaires should be developed and distributed to the family and friends of service users, other professionals and any other interested parties. Feedback from the questionnaires should be analysed and used to inform future planning and improvement of the home. The registered provider must demonstrate how each individual service user will receive any interest applicable to their individual savings. 9 10 OP19 OP22 23 (2) (d) 23 (2) (n) 31/03/06 31/03/06 11 OP26 12 (4) (a) 01/12/05 12 OP26 13 (3) 01/12/05 13 14. OP26 OP27 16 (2) (k) 18 (1) (a) 31/12/05 31/03/06 15 OP33 24 (1) (b) 31/03/06 16 OP35 20 31/03/06 Laurence House DS0000033600.V264306.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The practice of using a bath book should cease, and be replaced with individual records kept in care plans. This is unmet from an inspection on 5th July 2005. Terms in daily records, should as ‘demanding’ should be replaced with actual descriptions of behaviour. Due to the needs of the service user group the home should consider obtaining a chair type weighing scale. This is unmet from an inspection on 5th July 2005. Those staff with responsibility for administration of medication must be familiar with when and how to use homely remedies. The temperature of the refrigerator used for the cold storage of medication should be monitored daily when in use, with a normal range of between 2-8 degrees centigrade maintained. A daily record should be kept. All accident records should provide a clear and detailed record of how and when the accident happened, the name of any witness to the accident, and the outcome of the accident. If the accident was not witnessed a record should be made of when the person was last seen and by whom. A monthly analysis should take place and take into account where and when accidents occur in order to identify any patterns or trends. Accident recording should comply with the requirements of the Data Protection Act. A record should be kept of the names of all staff attending fire drills and fire training. The emergency lighting should be checked on a monthly basis. A training matrix should be developed so that it is easy to identify when mandatory training updates, including fire training, moving and handling, infection control and food hygiene are due. DS0000033600.V264306.R01.S.doc Version 5.0 Page 25 2 3. OP7 OP8 4 OP9 5 OP38 6 7 8 OP38 OP38 OP38 Laurence House 9 OP38 Risk assessments should be completed for staff when beds are placed against a wall. 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