Inspection on 29/05/07 for Laureston House Residential Home

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Laureston House Residential Home 01/11/05

Laureston House Residential Home 26/01/05

Laureston House Residential Home 14/09/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Laureston House Residential Home Laureston Place Dover Kent CT16 1QU Lead Inspector Julie Sumner Key Unannounced Inspection 29th May 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 Laureston House Residential Home DS0000023472.V336905.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. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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.V336905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with dementia DE(E) are restricted to two (2) whose DOB`s are 29/12/1934 and 07/10/1920. 1st November 2005 Date of last inspection Brief Description of the Service: Laureston House provides care and support for up to 21 frail elderly people. 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 minutes walking distance. 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 current fees for the service at the time of the visit are £303.25 to £360.00 per week, this fee can be increased to the assessed needs of service users. There are additional charges for chiropidy, hairdressing, newspapers and toiletries. Information on the homes services and the CSCI reports for prospective residents/relatives will be referred to in the statement of purpose and service user guide. This information is also included with quality assurance questionnaires which are forwarded to residents, relatives and other stakeholders. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The inspector visited the home to talk to residents and staff and view records and practices. Information was gathered for this inspection in a variety of ways both prior to and during this visit to the home. Surveys have been sent out and completed by relatives and visiting professionals. Their feedback was incorporated into the inspection and this report. People living in Laureston House were able to participate in the inspection by having conversations about their lifestyle and completing the surveys prior to the visit. The home has been able to continue to provide a high quality standard of care to the residents. There were no outstanding requirements or recommendations from the previous inspection and none were made from this visit. What the service does well: All the residents spoke positively about life in the home. Residents said they are well looked after and do what they want to do within reason. A visiting professional commented: “There is always a good atmosphere, it’s a happy family orientated home” 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: “home provides a safe and secure and pleasant environment for my mother to live in”, “It is a relatively small residential home with motivated and knowledgeable staff who do their best for all residents” and “any attention I need is given as required”. 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. There are opportunities for entertainment and pursuing individual interests. Residents spoke about recent activities including the Easter tea 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. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 6 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 and effective 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: 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. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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 Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are treated as individuals, with dignity and respect for the life changing decisions they need to make. EVIDENCE: The service user (resident) guide and statement of purpose have just been reviewed. A sample of care plans were viewed which have the assessment as the basis. They contain clear information and all relevant aspects of care are included to support each individual. The assessments are updated as individual needs change. The district nurse also makes an assessment when her services are needed and this is included. Residents spoke about how they have been made to feel at home and relatives spoke of the welcome they received and the good information when making a choice to move in. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 9 Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff make sure that the health care and personal care is person led, flexible and consistent with the assistance of visiting professionals. The home is highly efficient when caring for residents who are in pain, distress or are dying. EVIDENCE: Samples of care plans were viewed. They continue to be well maintained. Staff have completed the sections with clear information and all viewed were up to date and all relevant information was easily accessible. The manager explained that if a person’s needs change they continue to care for them utilising the support of all community services. They then obtain additional training for staff rather than individuals having to move unless they need full nursing care. The staff have recently trained in palliative care to support individuals and the district nurse visits twice a week. Staff have very clear guidelines reviewed by the district nurses on how to support individuals Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 11 who are becoming frailer or dying. The district nurse was in the home and commented that the home was very well organised with good communication, so that it does not matter who is on duty all staff are up to date with current care plans and information when they visit. Parts of the lunchtime medication administration were observed and some records viewed. There were risk assessments for people who want to administer some of their own medication, which included prescribed creams. All records viewed were clear and up to date. There is a quick reference for short term prescriptions like anti-biotics. The GP makes a prescription ready for individuals when it is needed as part of the palliative care plan organised by the district nurse. All staff have received medication training. Medication is audited monthly. All staff are observed monthly for competency as a spot check. Night staff do not currently give out medication because there are no prescriptions for that time. They have been trained and are checked for competency by giving verbal account of the procedure. Residents spoken to said they are well looked after. Care plans indicated personal preferences. All personal care and treatment, for example, from district nurses is carried out in private. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sought the views of the residents. They have considered their varied interests when planning the routines of daily living and arranging activities both in the home and outside. Meals are well balanced and individual nutritional needs are taken account and supported well. EVIDENCE: The manager explained that activities are organised in the home and mark special events. There are photo collages and albums to remember them. The most recent event was the Easter tea and bonnet making. There was a music session held during the visit and posters of forthcoming armchair aerobics on Thursdays for those that want to join in. Some of the feedback suggested that an increase in activities would be beneficial. Residents spoken to said they were quite happy with their lifestyle in the home. In answer to the question in the survey completed by 5 residents ‘Are there enough activities arranged by the home?’ they all responded “always”. Records indicated that there are various activities including special bingo, arts and crafts and some trips out. Meetings are still held at lunch times as this is the time when most residents Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 13 are together and is a sociable time when events and activities are planned and ideas and issues discussed. Residents spoke of their experiences and said that there are no restrictions to visitors. Some visiting relatives said that they visit regularly and always come unannounced at different times and the home is always welcoming and the atmosphere is happy. One person explained how her health has deteriorated and she can no longer go out independently but has the support of the local Age Concern and her friends who visit her regularly and also take her out. Residents who are able to make their own decisions independently get up and go to bed when they want to. Residents who are less able to make day-to-day spontaneous decisions have their preferences recorded in their care plan. Some residents said they prefer to get up early and go to bed early. Mealtimes are flexible and residents choose where they prefer to eat. The main meal is at lunchtime and residents are encouraged to eat in the dining room as a more communal, social time. Residents spoke about their experiences during lunch and the atmosphere was relaxed and food well presented. A sample of records were viewed including nutrition plans to support any eating or appetite difficulties and any health concerns. A resident commented in a survey: “meals are always well cooked and enjoyable”. A part time cook is employed and worked during the afternoon at time of visit preparing afternoon tea, including making cakes. The manager and assistant managers carry out some of the meal preparation as a means to working away from the office and being with residents and staff. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Individuals and others associated with the home say that they are extremely satisfied with the service, feel safe and well supported. EVIDENCE: The complaints procedure is on the notice board and there are forms to complete if needed. There is a complaints log. There are no complaints that have been made officially or written down. The manager said that residents talk to her or the staff and make occasional complaints about day-to-day issues that have all been resolved at the time. Residents confirmed this in conversation. Visitors were very complimentary of the home, saying they could visit any time and the atmosphere was always open and friendly. The staff’s approach is consistent and approachable. Adult protection training is provided through the induction and NVQ programme. The manager has completed an adult protection paper, as part of her NVQ 4, that has been incorporated into the home’s policy. There is a folder with all relevant information and contact details that was viewed. The relevant part of the induction training pack was also viewed. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. It is a clean and pleasant place to live. EVIDENCE: There was a tour of parts of the home with the manager. All areas of home clean and smell fresh. There is an ongoing programme of maintenance and refurbishment. The plans for this are written in the homes business plan. Home smelt of toast at the beginning of the inspection because breakfast was just coming to an end. The communal parts of the home look homely. The tables in the dining room have sufficient space around them for easy access with mobility support equipment. Where there have been difficulties with incontinence, some of the bedroom floor coverings have been changed to washable surfaces. The vinyl that has Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 16 been laid has a wood look and actually does not detract from the homeliness. New vinyl has also been laid in the toilet on the first floor and is ready to be laid on the first floor bathroom. Infection control measures like paper towels, liquid soap, flip top bins are in place. Infection control training in-house ongoing and staff spoken to aware and have done training. A relative commented in a survey received that “my mother is always saying it’s spotless and she always has a nice clean bed”. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff demonstrate a thorough understanding of the particular needs of the residents and give highly effective person centred care. EVIDENCE: The duty rota in the home and observation during the visit showed that there are sufficient staff on duty to meet the assessed needs of the residents at the present time. At peak times and when required the registered manager works hands on with the staff. The manager said that she likes to do this to keep in touch with everyone in the home. There is a part time cook and a house cleaner. A GP wrote in one of the comment cards received: “Staff always encourage residents to express their wishes and needs and my observation during home visits to the place is that ‘patients’ are comfortable and have enough support from management and staff.” There is a running programme of NVQ training. More than half of the team have NVQ level 2 or above. A new member of staff started in September, has just commenced NVQ 2 and spoke about this and her induction positively. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 18 Parts of the recruitment process have been reviewed and the procedure file was viewed and discussed with the manager. All staff are not employed until they have had POVA clearance, a CRB is being processed and they have satisfactory references. As part of the selection process the prospective members of staff are invited to visit the home after they have successfully been interviewed, and introduced to residents. Afterwards the manger asks residents what they think and this influences the final decision to employ. The records of training completed and a sample of certificates were viewed. All essential training to provide care and support is provided. Infection control training is delivered in the home. One resident developed diabetes and the staff had training to continue to support him. Care plan viewed. The district nurse explained about the staff being trained in palliative care and how training is also given as each person’s needs change so that the staff can carry out good practice with regard to health care needs and personal care. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager communicates a clear sense of direction and is able to evidence a sound understanding and application of best practice. This is particularly in relation to continuous improvement and responding to what residents, relatives and staff say. There is effective implementation of risk assessments and good maintenance to provide a safe environment for residents to live in and staff to work in. EVIDENCE: The registered manager has achieved the NVQ level 4 and RMA. She keeps up to date with training including participating in the new training delivered in Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 20 conjunction with the district nursing services. All written information needed during the visit was accessible and clearly written. The assistant manager who is responsible for carrying out quality monitoring was handing out questionnaires to residents and visitors at the beginning of the visit. Relatives spoken to said they had been requested to give feedback periodically and are very happy with the home. The system in the home was discussed with the assistant manager and the folder containing the current information gathered and reports was viewed. The assistant manager is auditing all aspects of the home and care by going through all the standards to make sure they have covered everything. The service user guide has been updated as a result. The home has a development plan based on the outcomes of the audit. 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. How each person needs to be supported and a list of belongings is recorded in the care plan. Samples of relevant records were viewed. Residents and relatives commented positively on the homes management and support of finances. A sample of risk assessments were viewed which were contained in the care plan. There are clear guidelines for staff to minimise risk. Various areas of risk were identified depending on individual need, for example: diet, falls, medication and pressure areas. The procedures for fire safety were discussed with the manager. The fire risk assessment was up to date. All staff have received training at the required times and fire safety is also discussed as part of their appraisal. A sample of certificates and questionnaires were viewed. Kevin owners’ son carries out maintenance and budgeting in the home and visited during the inspection and also discussed his role. A sample of maintenance and servicing certificates were viewed and discussed. Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 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 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 4 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 3 Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 22 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. 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.V336905.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Laureston House Residential Home DS0000023472.V336905.R01.S.doc Version 5.2 Page 24 - 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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