CARE HOMES FOR OLDER PEOPLE
Laureston House Residential Home Laureston Place Dover Kent CT16 1QU Lead Inspector
Julie Sumner Announced Inspection 1st November 2005 10:00 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 Laureston House Residential Home DS0000023472.V251747.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. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Laureston House Residential Home Address Laureston Place Dover Kent CT16 1QU 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) 01304 204283 Mr Leslie Charles Roberts Mrs Gillian Mary Roberts Mrs Ann Clare Lott Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One Service User DE(E) whose date of birth is 29/12/1934. Date of last inspection 17th June 2005 Brief Description of the Service: Laureston House provides care and support for up to 21 frail elderly people. The building is on 3 levels with both staircase and passenger lift connecting the floors. The home comprises of a large lounge and a dining room on the ground floor and a smaller lounge in the basement. There is a rear terraced garden with a suitable patio area adjacent to the dining room accessible for wheelchair users. The home is located in a secluded area on top of a hill in a side road overlooking the town of Dover. Public transport services are approximately five mintues walking distance. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by Julie Sumner during one day in November. The home has been able to continue to provide a high quality standard of care to residents. All requirements and recommendations have been fully or partly addressed and the manager is working hard to complete them to meet all national minimum standards. The following methods of inspection and information gathering were used: One-to-one and group discussion with service users and staff, including having lunch with residents, observing activity in the home, touring the home and reading and discussing policies, plans and records including individual care/support plans, medication charts, complaints logs, quality assurance reports, some staff records including training records and duty rota. The manager completed a pre-inspection questionnaire and feedback surveys were sent to residents, relatives and health care professionals. What the service does well:
All the residents spoken to during the inspection were full of praise for the staff and their life in the home. A resident said “the reason they chose this home is because they liked the owners and staff’s attitudes. During a visit prior to moving in “they were sitting with residents chatting, there was such a good atmosphere, so warm and welcoming” and “actually living here they could not wish for better”. From the feedback questionnaires that were sent to relatives, health care professionals and residents, many were received and all contained very positive comments about the care in the home. Examples: “the carers demonstrate a high standard of care and dedication to the residents in their care…the standards are of the highest calibre”; “the staff are a delight, always cheerful no matter how busy”; “the lunch time meal always smells delicious”; “…the housekeeping is always neat, clean and ‘smell free’…”, “if I have any worries, I can always talk to the carers and manager…I am very satisfied with the care”. Resident care/support plans are very well written and provide a wealth of information, relevant to each individual resident, which in turn ensures that care staff deliver individual care and are aware of the risks for each resident in the home. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 6 There are opportunities for entertainment and pursuing individual interests. Residents spoke about the fun they had had at the recent Halloween party held in the home. They said that they enjoyed living here and had plenty to do. Residents also said that they were able to be by themselves in their rooms if they preferred. There are clear medication storage and administration procedures in the home that meet the standards of the Royal Pharmaceutical Society and NMS. There is a well designed quality assurance system in the home, designed by the registered manager and staff team. This covers environmental, social, personal care and forward planning. What has improved since the last inspection? What they could do better:
Residents said that they could think of nothing that could be better in the home as it was just right as it is. The home need to continue providing NVQ training to meet the workforce target of 50 of the team achieving NVQ level 2 and above. Infection control training needs to continue to be provided so that all the team have attended. Please contact the provider for advice of actions taken in response to this
Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 8 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 Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 9 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): 1 Residents are given a good range of information prior to moving into the home. EVIDENCE: The statement of purpose has been reviewed and contains all required and relevant information. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 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 the following standard(s): 7, 9 Clearly written and informative care plans have been designed and are effective in providing guidelines for care to meet individually assessed needs and reflect support given. The systems for medication administration are good with clear and comprehensive arrangements being in place to ensure the residents medication needs are met. EVIDENCE: The care planning system is very well designed and implemented. Staff have completed the sections with clear information and all viewed were up to date and all relevant information was easily accessible. The medication cupboard is bolted to the wall for security. Storage of controlled medication was viewed and records also viewed and were completed accurately with two signatures and routine tablet counting. There is a dedicated medication storage fridge which was kept and the correct temperature containing stores of insulin. 6 staff have attended updated
Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 11 training for the administration of insulin and 5 staff have attended updated safe handling of medication training. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 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 the following standard(s): 12, 15 The residents are offered choices in regard to their social activities, and their choices are listened to and acted upon. The residents are able to maintain contact with family and friends. The meals in the home are good offering choice and variety and cater for any specialised diets required by the residents. EVIDENCE: Residents said they talk to the staff about what they want to do and how they want to be supported and they are listened to. Weekly residents’ meetings are held at lunchtime as it has been found that at this time it encourages participation. Events are organised in the home to mark festivals and special occasions. The recent Halloween party was a great success. Plans were being made for Christmas events. Residents spoke about what they like to do and are encouraged to pursue interests, like crafts which were seen. Residents spoke about their families and said they visited when they wanted to. Feedback also indicated that many relatives are regular visitors and that their positive experiences of the home are consistent. One resident has visits from the Priest and takes holy communion regularly.
Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 13 A menu is designed providing residents with varied choices for meals. Residents said that the food was always good and they could have what they want. There are no vegetarians living in the home at present. Residents are given appropriate seating and support so that they can sit and enjoy their meal based on assessed needs. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 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 the following standard(s): 18 There are effective systems in place to protect service users. EVIDENCE: Following advice to review the CRB disclosures of existing staff every three years, the manager has designed a declaration form that staff need to complete. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 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 the following standard(s): 19, 25 Modifications have been made to the home and grounds to make sure service users are safe. EVIDENCE: Tour of the home undertaken. The home was clean and odour free throughout. The home has been decorated and there is an ongoing programme of maintenance and refurbishment. Two bathrooms have had nonslip flooring laid. An occupational therapist has assessed the home and provided a report with advice that the manager is incorporating into the development of the home. The home has been awarded the clean food award at the last EHO inspection of 13th January 2005. A fence has been erected around the raised seating area just outside the dining room, to make sure that service users can relax out there safely. Service users said they liked sitting out there is warm weather.
Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 16 Covers have been installed on all radiators. The hot water temperatures have been adjusted to make sure they are no hotter than 43 degrees. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 17 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): 28, 30 Staff morale, is high resulting in an enthusiastic workforce that works positively with the residents to improve their whole quality of life. EVIDENCE: NVQ training has been provided by the home and is ongoing. 2 staff are studying NVQ 4, 1 member of staff is studying NVQ 3 and 2 staff are planned to start studying NVQ 2. A recommendation has been made to continue providing this training and achieve the workforce target of 50 of the team to hold an NVQ. At present out of the staff team of 16 carers, 6 staff hold the NVQ. Induction training in line with ‘Skills for Care’ (formally TOPSS) is provided. There is a sample of the training pack in the quality assurance file for information. The process of induction was discussed. Records of training completed and planned are kept in a staff training file, which was viewed. Some training is provided in house. In discussion, staff confirmed that they had taken part in a variety of training which was relevant to meeting the needs of the residents in the home. A sample of certificates was viewed. Infection control training is being attended a few staff at a time and in the interim, until all staff have attended, the home are providing in-house training. The records of training provided were viewed and the training was thorough
Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 18 and practical. A recommendation has been made to continue providing infection control training. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 19 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, 34, 35, 36, 38 The registered manager has a clear development plan and vision for the home, which is supported by the whole staff team, and is clearly communicated to the residents, their relatives and friends. The home reviews all aspects of its performance through a good programme of self review and consultations, which include the views of the residents, staff and visitors. The home is financially viable and there are clear financial procedures in place to safeguard residents. The home is well maintained. Residents’ health, safety and wellbeing are of prime importance. EVIDENCE: The registered manager has achieved the NVQ level 4 and RMA.
Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 20 The home has a business and development plan. One of the owners manages the business finances in the home. Insurance certificates are on display and cover both loss and damage to the building and legal responsibilities to employees, residents and third parties. The majority of service users living in Laureston House are able to manage their own personal allowance. Each person has a fixed, lockable box for their valuables and money. Where support is needed to manage finances, relatives and legal representatives carry this out. Records of transactions made on behalf of residents are recorded with receipts kept. Samples of records were viewed. Supervision and appraisal is ongoing. The manager has designed a format which is currently being used. The manager utilises individual staff skills and one of the staff has attended supervision and appraisal training and assists with keeping the records. This makes it possible to keep to the timescales for regular one-to-one supervision. The quality assurance file was viewed and discussed. Part of the process is to have a diary of usual events, recording what has happened in the home as another form of information gathering through the year. The file had feedback given from service users, relatives and staff that were all very positive. The registered manager keeps regular checks of all health and safety aspects in the home and these records are easily accessible and state clearly the date and time of the checks. Maintenance certificates for all appliances in the home were in date. Gas servicing certificate was viewed. Mandatory training is provided and is ongoing. Records and certificates were viewed. All staff have received updated fire training. The fire safety officer has reinspected the home and stated that all existing measures were being maintained to a satisfactory standard. The manager is organising staff so that a designated and trained fire warden is on duty each day. There was a notice in large print of where water, gas, electricity supplies are. The registered manager has devised an evacuation procedure with the fire safety officer. Arrangements have also been made in the event of an emergency for somewhere to go if residents have to be evacuated from the home to prevent them having to hang around outside in the cold. Allocated staff cars will be used for transport. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 21 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 x x x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x 3 x STAFFING Standard No Score 27 x 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x 3 3 3 x 3 Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP28 OP30 Good Practice Recommendations To continue to provide NVQ training to meet the target of 50 of the workforce achieving this qualification. To continue to provide infection control training so that the whole staff team have attended. Laureston House Residential Home DS0000023472.V251747.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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