Inspection on 03/10/06 for Laurieston House

This inspection was carried out on 3rd October 2006.

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

Laurieston House 09/09/09

Laurieston House 22/10/08

Laurieston House 03/10/07

Laurieston House 15/11/05

Laurieston House 13/07/05

Laurieston House 13/12/04

Laurieston House 06/05/04

Laurieston House 14/10/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Laurieston House 78 Bristol Road Chippenham Wiltshire SN15 1NS Lead Inspector Alison Duffy Key Unannounced Inspection 09:30 4th October 2006 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 Laurieston House DS0000028410.V302192.R02.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. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurieston House Address 78 Bristol Road Chippenham Wiltshire SN15 1NS 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) 01249 444722 Jennifer Jobbins Jennifer Jobbins Care Home 10 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (7) Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Not more than 3 service users over the age of 65 years with a mental disorder 15th November 2005 Date of last inspection Brief Description of the Service: Laurieston House is a home registered to care for ten older people, three of whom may have a mental disorder. The home is located on the outskirts of Chippenham giving good access to all local amenities. Laurieston House is privately owned by Mrs Jobbins. Mrs Jobbins is the Registered Provider and the Registered Manager. Mrs Jobbins works closely with residents and staff by undertaking various shifts within the working roster. Staffing levels are maintained at two or sometimes three members of staff throughout the waking day. At night a member of staff undertakes a waking night and another provides sleeping in provision. Residents’ private accommodation consists of four twin and two single rooms, all of which are comfortably furnished. The rooms are located on the ground and first floor although the home does not have a stair or passenger lift. The communal areas of the home consist of a homely lounge and a spacious dining room. To the rear of the property are large well-maintained gardens giving various seating areas. The home does not provide nursing or intermediate care. The fees for the home are between £395.00 and £440.00 a week. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on initially on the 4th October 2006 between the hours of 9.30am and 4.00pm. The inspection was concluded on the 20th November 2006 between 9.30am and 1pm. On the first day of the inspection Mrs Jobbins, the Registered Manager, was on holiday. The deputy manager, Mrs Carol Wallace assisted throughout the inspection. The second day was arranged with Mrs Jobbins so that access to staffing information was available. Full feedback was given during this time. At the start of the inspection, discussion took place with Mrs Wallace regarding current care provision. Mrs Wallace confirmed that nine residents were in the home and there was one vacancy. All residents are female. It was reported that there had been no changes to care provision and there had not been any new staff. There had been a number of changes to the environment, which are detailed within the main text of this report. The inspector viewed care-planning information, daily records, staffing rosters and the fire log book. A tour of the accommodation was made and the medication systems were examined. The inspector spoke with residents in the lounge and one resident was in her bedroom. Residents did not appear to want to fully engage in detailed discussion with the inspector. Feedback therefore involved general satisfaction such as ‘it’s nice here,’ ‘the food is good’ and ‘I’m alright.’ One resident said ‘I don’t do much’ while another confirmed she enjoyed looking at her newspaper. Residents’ surveys were sent to the home so that residents could have assistance with completing the forms. Comments cards were also sent to each resident’s primary relative and their GP. Many positive comments were received. Relatives stated, ‘the standard of consultation and care XX receives is exceptional. Whenever I ‘phone ad hoc and ask ‘how she is’, who ever is on duty is able to give me an in depth answer. We constantly talk re what is best for XX and often they guide and help me in how to deal/cope with XX’s condition. Really pleased with the home - I cannot thank them enough. XX’s always happy to go back.’ Also, ‘the family is very happy with the care that XX receives. She always has clean clothes on and her hair is always clean’ and ‘the care that my XX receives at Laurieston is excellent. All of XX’s practical and emotional needs are met. The staff are efficient, friendly and caring. My XX agrees she could not be better cared for. It is such a relief for the family to know that XX is treated with expertise, care and respect’ and ‘I have no complaints whatsoever about the home or the staff and I feel that my XX has received excellent care while she has been a resident there.’ Further comments are located within the main text of the report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 6 standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? What they could do better: Care plans contain a range of information, yet greater detail with preferred routines and how care is provided would ensure individual needs are met. Further consideration must be given to the risk assessment process with particular attention given to the use of the stairs. While in many areas, residents’ rights are promoted; attention must be given to issuing toilet paper to some residents on their way into a particular toilet. While it is acknowledged, that the toilet could be blocked through the misuse of the toilet paper, this practice significantly compromises residents’ dignity. Staffing levels vary from two staff to possibly three or four on duty during the waking day. However, leisurely personal routines and individual time are restricted when there are only two staff on duty. A review is required to ensure consistency and sufficient staff are available at key times of the day. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 7 While Mrs Jobbins confirmed in house and external activity takes place, this is restricted when staffing levels are minimal. Some relative feedback confirmed that more activity and stimulation would be of benefit to some residents. Further consideration needs to be given regarding how staff manage specific behaviours, which some residents portray. This includes behaviours that challenge and also disorientation within the home. Any possible restrictions on residents must be discussed and agreed with the resident and their representative. Such information needs to be documented within individual plans of care. The current process of gaining information through verbal means when recruiting staff, does not demonstrate a robust procedure. Mrs Jobbins is therefore required to formalise the process with clear, written documentation in order to evidence her reported criteria. Staff need to ensure that they check the balance of residents’ personal money held for safe-keeping, within each transaction. This will minimise the risk of error. While Mrs Jobbins confirmed that adult protection training has taken place, consideration should be given to an external trainer who will also focus on local reporting procedures. Other training such as the prevention and management of a pressure sore must be undertaken by a qualified, health care professional. 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. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 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 Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 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): 3, Standard 6 is not applicable, as Laurieston House does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Sufficient information is given to prospective residents so that they are able to make an informed decision about their admission. Assessments form an integral part of the admission process, yet greater detail within documentation, ld d d l d f ll dd d EVIDENCE: Within comment cards six residents confirmed that they had received sufficient information about the home before their admission. One stated that they had received a letter outlining costs and general conditions. These residents also confirmed that they had a contract. There was also evidence of prospective residents being a guest for the day and/or having respite care. Though discussion it was evident that Mrs Jobbins is clear regarding residents’ needs that can be met within the home. Mrs Jobbins confirmed that she visits all prospective residents in their own surroundings before admission. Individuals also have the chance to visit Laurieston House as they wish. During Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 10 the initial visit, a resume of care is developed. This is added to, as staff begin to learn more about the resident’s needs. Within documentation, a summary of care needs is stated. Some terms such as ‘needs all care’ and ‘needs assistance’ is documented. Mrs Jobbins is advised to clarify what such terms actually mean. In some instances further detail would also be of benefit. In particular, this applies to statements such as ‘sore on foot’ or ‘depression.’ Within one discharge letter, poor appetite was highlighted. It was also stated that the resident took food supplements on a regular basis. There was no evidence of this within the resident’s plan of care. While a range of basic information is available, Mrs Jobbins was advised to ensure greater detail, so that individual needs are fully identified. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Health care and medication systems are well managed. Care planning contains a range of information yet greater clarity, with some areas would ensure individual needs are met. Health care and medication systems are well managed. Residents’ rights are promoted, yet one individual practise, severely compromises residents’ dignity. EVIDENCE: All residents have a plan of care that is regularly reviewed. Mrs Jobbins reported that she regularly meets with the resident and their family to discuss the content of the plan. In response to this, Mrs Jobbins then devises a summary, which the family member is asked to sign. The residents’ family are able to keep a copy and a copy is placed in the care plan. The care plan starts initially with a resume of care. This gives a brief summary of need. Later in the plan, specific needs are addressed. This may include risk areas such as the use of the stairs or ways to manage certain behaviours. Care plans contain a range of information. However due to the format of the plans, Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 12 some information is not clearly evident. For example, individual wishes of preferred daily routines and the management of some conditions, such as depression, were unclear. Mrs Jobbins was also advised to clarify some terms such as ‘needs help with all personal care’ and ‘needs the assistance of one carer.’ Further examples include ‘care required with XX’s diet and weight loss’ and ‘keep XX stimulated.’ Some aspects, such as managing a physical condition were well written. Discussion took place with Mrs Jobbins regarding a number of entries recorded within daily records. Due to the way the entries had been written, limited staff understanding was portrayed. This included ways in which staff managed situations such as a resident not wanting to get up and disorientation when needing the toilet. Mrs Jobbins believed it was a recording issue rather than a practice matter. However, investigation and regular monitoring is required. Within daily records there were some subjective terms including ‘snappy’ and ‘not very co-operative’ Mrs Jobbins is required to address this area with the staff team. Within some documentation, some decisions had been made about aspects of resident’s care. This included ‘XX has difficulty in dressing: help with some items then leave XX to do top garments. XX agreed to this procedure today’ and ‘do not repeat yourself more than twice when XX asks questions - get XX to remember. XX needs a lot of input but you must permit XX to keep some independence.’ Other statements included ‘family have been asked to take XX out for only short periods’ and ‘encourage XX out to toilet at 1.45am and 5am.’ Mrs Jobbins was informed of the need to demonstrate the rationale for each decision. Discussion with other stakeholders is also required. Mrs Jobbins confirmed that the majority of residents do not have care managers. She is therefore addressing such matters with family members. In one instance a resident’s hand washbasin in their room has been covered due to inappropriate usage. Mrs Jobbins confirmed that this has been agreed with the resident’s family and the family are pleased to note improvements are being made. Such documentation must form part of the care plan. Within the plans, manual handling and pressure care management risk assessments are in place. These generally identify when intervention is required. However in some instances, ‘manages stairs with assistance’ and copes well with the stairs’ is evident. Mrs Jobbins is advised to document how this assessment is reached. Within a daily record, a member of staff had also written ‘helped XX upstairs, she was a little unsteady.’ Any potential risks must be considered within the risk assessment process. Within one pressure care management risk assessment, it was highlighted that the resident was at risk. The assessment continued to state ‘any injuries or broken skin, inform the senior on duty, immediately.’ This information needs to be reviewed, as staff need to be notifying the senior member of staff, before such breakdown. Further detail, regarding pressure sore prevention is also required. Mrs Wallace reported that it is the home’s policy never to leave a resident alone in the bath Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 13 due to safety reasons. Mrs Wallace reported that this is not documented, due to the staff members’ responsibility of following procedures. A record of weight is maintained. Records also evidence procedures such as blood pressure checks. Within comment cards received from residents, five stated that they always received the care and support they required. One said ‘usually.’ Within both days of the inspection, all residents appeared well groomed, with manicured nails, clean hair and well-laundered, co-ordinated clothes. Within comment cards ten relatives were satisfied with the service provided. One did not identify their view. Mrs Jobbins confirmed that staff aim to make visitors welcome and communication is promoted. Eight relatives confirmed that they were kept informed of events yet three said they were not. Eight also said they were consulted about their relatives care. One said ‘yes and no’ and two relatives confirmed they are not consulted with. Specific comments included ‘my XX receives the highest standard of care from all staff. When I, or my XX’s friends visit, we are always warmly welcomed by staff. In my opinion the care afforded to XX and all other residents of Laurieston is of the highest standard and sets the standard by which other residential care homes should be measured’ and ‘if my XX wasn’t in Laurieston and didn’t have the care they give, XX certainly would not be here now. I have every faith in the home and XX’s care.’ Further comments included ‘this home gives exceptional care to my XX. Carers regularly go on training courses re the care of the elderly. This is important because they can distinguish the different types of dementia and challenges that arise. They are professional and care for my XX’s needs and keep me informed of any changes in her care. Mrs Jobbins could not be praised enough for the care that she delivers to my XX. Residents are treated as individuals and I am consulted in any changes of management etc. The staff are consistent and deliver first class care. The home is always clean and relatives are welcome any time. This team really does go that extra mile with the care they deliver. The peace of mind knowing that XX is being looked after by such a professional bunch is a real help. In my opinion, a lot of care homes could learn from Laurieston House.’ Three GP’s confirmed satisfaction with the overall care provided to residents. Both reported that they could meet with their patients in private. They also confirmed that medication was appropriately managed. Within residents comment cards, five reported that they always receive the medical input they require. One said ‘sometimes.’ A record of all health care appointments is maintained. GPs and District Nurses visit on a regular basis. At the last inspection a requirement was made to ensure that the management of conditions such as diabetes was evidenced. In relation to this, documentation now demonstrates what to do when the residents’ blood sugar levels are at various levels. Within a daily record, a staff member commented upon a broken area of skin so they lightly applied talcum powder to the area. This was Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 14 not identified within the plan of care and the decision to use talcum powder was not evidenced. Mrs Jobbins was advised to monitor such practices. Within the inspection residents received regular drinks. Cold drinks were also available in the lounge to promote residents’ fluid intake. Mrs Wallace reported that all residents choose to give staff the responsibility of their medication. A monitored dosage system is used, which is ordered on a monthly basis. The medication is stored securely in a locked metal cabinet. Mrs Wallace reported that all staff have undertaken the monitored dosage system training. Not all staff however administer medication. Mrs Jobbins undertakes competency tests with those staff who are more senior or have more experience. Residents were asked for their permission for the inspector to view their medication. The storage of medication was ordered. There was one gap in the medication administration. Mrs Wallace said this had been identified and was being addressed with the staff member. The record identified the number of tablets given within a variable dose, such as pain relief. All medication was appropriately receipted. Mrs Wallace confirmed that specific sealed pots are sent from the pharmacy for medication that has been refused. Mrs Wallace confirmed that staff must contact the ‘on call’ senior before administering any ‘as required’ medication. Mrs Jobbins was advised to develop guidelines for the medications use. Homely remedies are not used due to possible complications with prescribed medication. At the beginning of the inspection, Mrs Wallace asked all residents for their permission to enable the inspector to view care planning information and medication systems. Mrs Wallace also asked permission to enable bedrooms to be seen. For those residents who were unable to make these decisions, relatives were contacted. Staff were observed to promote privacy through assisting with personal care in rooms, with the doors shut. However it was observed that staff gave residents some toilet paper on their way into the toilet. This was discussed with Mrs Jobbins, due to compromising residents’ dignity. Mrs Jobbins explained the reasons for this and reported that toilet paper is freely available in the other bathroom. Therefore, those residents who may find the restriction difficult could use the bathroom. Mrs Jobbins reported that she didn’t have any ideas of how to solve the problem but would be open to ideas. It was agreed that further consideration was required. Laurieston House DS0000028410.V302192.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Some activity is organised yet further consideration to enhance opportunities may be of benefit to some residents. Visitors are welcomed and hospitality is evident. While residents are offered choice, routines need to be monitored so they do not restrict individual wishes. Meal provision is of a good standard and based on individual preferences. EVIDENCE: On the first day of the inspection there was no arranged activity. Those residents in the lounge were either reading, watching the activity of the home or sleeping. Later in the day, a member of staff turned on some background music. Interactions between staff and residents were positive when staff were in the vicinity of the lounge. Mrs Jobbins confirmed that there are various activities that take place on a regular basis. These include an exercise group, manicures, painting and going into town. Some residents also assist with housekeeping tasks such as washing up, laying the table, cleaning the silver, folding laundry and preparing vegetables. A number of residents have recently attended a show and some also join in with Mrs Jobbins’ family functions. Mrs Jobbins reported that pantomimes, dance shows and car rides are also undertaken. Calendar events and residents’ birthdays are celebrated. Within Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 16 daily records, staff had documented some residents’ involvement with shopping and painting. Individual preferences of hobbies and interests were not apparent. It was evident that on the day of the inspection, with only two staff on duty, activity provision could not be successfully accommodated. Wishes, such as a resident wanting to go outside with a member of staff for a walk, would also be limited. Mrs Jobbins reported that interest with activity is often limited and many residents choose be quiet and to rest. On some occasions a trip out has been arranged although residents have decided not to go at the last minute. Within comment cards, two residents stated that there were always activities in which they can join in with. Three said ‘usually’ and one said ‘sometimes.’ Two relatives reported that they would like to see more activity. Such comments included ‘on the whole Laurieston House is an ideal residential care home and the best in the area. Although more attention to residents social/activities in regard to stimulating occupation of time should be made’ and ‘I would like to see XX more stimulated during the day and taken out more if only to the shops. XX was always out and about and one of the things we asked for. We were prepared to pay extra for this facility.’ Mrs Jobbins reported that residents are able to do as they please. However many choose to spend their time in the lounge. Within a daily record it was noted that a member of staff had asked one resident to get up, as they ‘couldn’t start breakfast without her.’ Mrs Jobbins reported that this was not so, as the resident often has breakfast in their room. Mrs Jobbins confirmed it was a reporting issue that was not in context. Mrs Jobbins was informed however of the need to monitor the situation. Visitors are welcome at any time. Residents are able to meet with their relatives in the privacy of their room or in communal areas. Staff also offer refreshments and on the day of the inspection, hospitality was evident. As stated earlier in this report, Mrs Jobbins reported that good support is received from families. Within comment cards, eleven relatives stated that staff made them feel welcome. Eleven also confirmed that they were able to visit their relative in private. There have been no changes to meal arrangements since the last inspection. The menus are based on residents’ known preferences. Mrs Wallace reported that alternatives, based on individual requests, are also given if a resident does not feel like eating what has been prepared. Staff on duty undertake all food preparation. Currently, diabetic diets are also catered for. On the day of the inspection, the meal looked appetising and was served according to individual need. During the meal, some residents were being prompted to eat and some were receiving assistance. Within comment cards received from residents, three said they always liked the food. Two said ‘usually’ and one said ‘sometimes.’ A large bowl of fruit was available in the dining room so that residents could help themselves as required. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 17 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Systems are in place to enable residents and their families to comment upon the service and raise any concerns. Residents are assured greater protection through recent adult protection training. However, further consideration regarding local reporting procedures would give greater strength to the system of protecting vulnerable adults. EVIDENCE: From comment cards, it was evident that five residents knew who to speak to if they were unhappy. Five also knew how to make a complaint. Ten relatives confirmed that they were aware of the home’s complaint procedure. Mrs Jobbins reported that she encourages relatives to give their views and aims to address matters through discussion. Mrs Jobbins confirmed that she is currently addressing an issue regarding a staff member. This is similar to that identified within the staffing section of this report. Mrs Jobbins expressed confidence that residents or relatives would raise any discontentment. The home has a copy of the Wiltshire and Swindon Vulnerable Adults protocol. Copies of the ‘No Secrets’ documentation are also available in the policies and procedures file. Mrs Jobbins confirmed that staff have undertaken adult protection training and a video has also been watched. The training was further developed by a listening course. A Psychiatric Nurse, who is now specialising in a training role, provided the training. Mrs Jobbins was recommended to also Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 18 consider training regarding local reporting procedures. Mrs Jobbins was advised to contact the local Vulnerable Adults Unit for information. Within daily records there was evidence of an incident between two residents. It appeared that a resident kicked another although there were no witnesses. In the event of any further incidents, Mrs Jobbins needs to make a referral to the Vulnerable Adults Unit. It was also noted that one resident has focused dislike on a member of staff. The possible reasons and triggers for this were discussed. Mrs Jobbins reported that the situation is currently being monitored and the member of staff has been asked to reflect on their interactions. Again Mrs Jobbins was advised to discuss this with others. In this instance, as the resident does not have a care manager, discussion with the Vulnerable Adults Unit may be appropriate. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 19 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, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Laurieston House provides comfortable, homely accommodation to residents. Attention to health and safety matters has significantly reduced potential risks to residents, yet monitoring is required. Residents’ choice of sharing a bedroom should be kept under review, so that individuals remain content with their environment. Positive improvements are being made to the environment yet require completion. EVIDENCE: Communal areas consist of a comfortable sitting room and a spacious dining room. Both rooms have patio doors, which open onto a patio area and wellmaintained, pleasant gardens. Residents’ bedrooms are located on the ground and first floor. There is no lift so all residents with rooms on the first floor need to be able to manage the stairs. Mrs Wallace reported that Mrs Jobbins has investigated the option of a stair lift. The stairs were assessed as too narrow. There are two single rooms and four twin rooms. All have accessible call bells. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 20 All twin rooms have screening to be used as required. It was recommended that Mrs Jobbins should evidence residents’ choice of sharing a room. Mrs Jobbins confirmed that residents are given the option before their admission. A twin room is also stipulated within the contract, which is signed following the period of assessment. Although acknowledged, Mrs Jobbins was advised to monitor residents’ wishes and ensure the procedure for obtaining a single room is known. Since the last inspection, work has been undertaken to create two en-suite facilities. The hand washbasins and the toilets have been fitted although the showers are awaited. The flooring has not been applied and decoration has not been undertaken. The bathroom on the first floor has also been refurbished with new furniture installed. New tiling has been undertaken although the bath side has not been fitted and new flooring is required. On the second day of the inspection Mrs Jobbins reported that the work was progressing and would be finished shortly. There is an additional bathroom on the ground floor, which has a mechanical hoist. It was noted that the seat was stained and the metal areas at the bottom were rusted. Within the bathroom, there was also a wheeled commode. The commode had bandaging on one of its arms. Both items created an infection control risk. On the second day of the inspection Mrs Jobbins confirmed both matters had been addressed. Since the last inspection all radiators have been covered. This minimises the risk of injury to residents. Hot water regulators have also been fitted. Mrs Wallace was advised to monitor the temperature however, as the hot water from a number of outlets was 46°C. Mrs Wallace immediately called the plumber to address the problem. Mrs Jobbins is now ensuring staff regularly monitor the temperature of the outlets. All windows on the first floor have keys so that they can be locked. Mrs Jobbins was advised to risk assess this, as within many rooms, the keys had been left in the lock. This may enable a resident to unlock the window and potentially fall. A number of residents’ bedrooms were furnished with varying levels of personal belongings. One room in particular appeared sparse and the armchair was showing signs of wear. Mrs Jobbins reported that she was in the process of addressing this although the resident would not tolerate many items in the room. The carpet appeared a trip hazard as it had additional pieces of carpet on top of the original. Mrs Jobbins reported that this had been assessed and due to the residents’ good mobility, the risk was considered low. Mrs Jobbins was informed of the need to monitor this regularly and document the assessment accordingly. Following a small fire in the kitchen, the door from the corridor now has a keypad lock to restrict access. The kitchen is small and domestic in style yet is need of some refurbishment. A number of cupboard doors have come off and the worktops are showing signs of wear. The kitchen has a small hand washbasin although paper hand towels were not evident. Mrs Jobbins confirmed that kitchen refurbishment is the next area of development. The laundry is located in a small room that has no natural light. The boiler is also located in this room and due to the warmth; clothes are aired on a rail. Such facilities have been in place since the home opened. Mrs Jobbins confirmed Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 21 that at the time of registration, the fire officer agreed the area. Mrs Jobbins reported that she also ensures staff clean the area regularly to minimise the risk of ignition. Through discussion it was agreed that further up to date advice should be received to ensure safety. Within comment cards, six residents confirmed that the home is always fresh and clean. Mrs Wallace confirmed that the Wiltshire Health Authority Guidelines regarding infection control are in place. Such policies are referred to within care planning information. Laurieston House DS0000028410.V302192.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels, although maintained in line with the previous registration authority, are not sufficient to address individual opportunities for residents. Further training is needed to ensure staff have the knowledge and skills to more effectively manage specific behaviours of residents. Current documentation is insufficient to demonstrate adequate and robust recruitment procedures. EVIDENCE: On the first day of the inspection there were two members of staff on duty. The staffing policy confirmed these levels, yet on the staffing roster there were occasions when three or four staff were designated to work. Staff also undertake housekeeping tasks and meal provision. It was evident that with only two staff available, the level of care provision that could be given was minimal. Activity and individual time with residents was restricted. Mrs Jobbins reported that only two staff on duty was not the norm. On many occasions there were three or four. Mrs Jobbins confirmed, that when there are two staff on duty, one member undertakes light housekeeping duties. Mrs Jobbins explained that in such circumstances, the duties can be left, to engage with any resident who requires assistance. Mrs Jobbins stated that the second carer is also available to carry out any residents’ requests. Within comment cards, two relatives reported that they felt, in their opinion there were insufficient staff on duty. Five residents felt the staff were ‘always’ available when required Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 23 and one said ‘sometimes.’ Due to these views and current needs of residents, Mrs Jobbins is advised to review staffing levels and provide additional staff at key times of the day. Mrs Jobbins confirmed there is always a senior member of staff on call at all times. At night there is one waking member of staff and another provides sleeping in provision. Within the daily records there were a number of entries detailing specific behaviours of some residents. This included ‘went to bite my arm. I told XX this action was unacceptable and walked away’ and ‘helped back to bed three times. Advised XX people were trying to sleep so she needed to settle.’ A further entry, detailed a resident who was unable to locate the toilet. A staff member had written ‘I asked her what she was doing. I was ignored.’ The way in which these entries were written, demonstrated that there was a limited understanding of the residents’ needs. Discussion took place with Mrs Jobbins regarding these areas. It was advised that despite recent dementia care training, further training or discussion around such topics is required. Mrs Jobbins reported that she had spoken to staff about these incidents and believed the difficulty to be that of a reporting matter. Within one daily record, a member of staff had written ‘became extremely aggressive to myself and XX (another member of staff.) As stated within the earlier section of this report, greater clarity is required with subjective terms such as ‘aggressive.’ Mrs Jobbins is advised to ensure the necessity of two members of staff assisting a resident with personal care, so that this is not a contributory factor to challenging behaviours. Within one comment card, it was reported ‘one senior carer, is verbally aggressive to all residents. This trait goes unnoticed and does not occur when management are present. It is felt a complaint would result in repercussion for residents from this member of staff.’ Mrs Jobbins expressed a possible explanation such as briskness in the staff member’s voice, which was not intentional. It was agreed that although this may be so, the practice needed to be addressed. Mrs Jobbins reported that she has already spoken to the member of staff but would ensure further follow up discussion. Mrs Jobbins also reported that she would undertake further monitoring and has already commenced more unannounced visits. At the last inspection, a requirement was made to ensure that the home’s application form is developed. This has not been addressed. The application form therefore continues to be minimal in the information that it requests. There is no space for the candidate to sign or to state the relationship of their referees. The form asks for experience rather than systematic information of previous employment. There is also no mention of criminal convictions. Mrs Jobbins reported that all such aspects are asked at interview. Mrs Jobbins confirmed that the application form is viewed as the start of the process. An informal interview with residents and staff is arranged and then a formal interview is held. Mrs Jobbins undertakes this with another senior member of the staff team. Mrs Jobbins reported that much of her assessment regarding the candidate’s suitability for the job involves communication. In particular Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 24 their attitude, how they speak to the residents and what they can bring to the home. If successful, references are sought and the CRB process is initiated. It was noted that some references were requested over the phone. These were then confirmed in writing. Others were sent a standard reference request format. Of those references viewed, some were addressed to ‘whom it may concern’ and some did not evidence a letterhead. Mrs Jobbins confirmed that these references were delivered to her by hand, evidencing their authenticity. However, through documentation, a robust recruitment procedure could not be evidenced. Mrs Jobbins reported that she is extremely careful regarding whom she employs. Mrs Jobbins confirmed she believes she asks sufficient information at interview. She also believes that due to speaking to referees on the telephone, formalities within the references are not required. Mrs Jobbins was informed of the need to evidence a robust procedure so was advised to consider ways in which she could do this. Within documentation sent to the CSCI prior to the inspection, Mrs Jobbins confirmed that three staff have NVQ level 2 and three have commenced level 3. Mrs Wallace, the deputy manager has commenced her Registered Manager’s Award. One member of staff has a nursing qualification although has not kept her registration up to date. All staff have recently completed a dementia care course. This took place over a period of six weeks. Infection control training has also been undertaken and staff have viewed a challenging behaviour and abuse video. Mrs Jobbins confirmed that food hygiene training has been arranged for December 2006 and first aid will be undertaken in January 2007. Within documentation it was evident that a member of staff had provided training regarding the prevention of a pressure sore. It was of concern that the member of staff was insufficiently trained in this area, as she had not received any up to date training herself. Mrs Jobbins was advised, in future, to ensure a specialist health care professional undertakes all such training. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. While Mrs Jobbins has regular contact with residents and relatives, a formal quality assurance system is required to ensure systematic improvement within the home. The management of residents’ personal monies must be more robust to ensure protection. Developments within the environment have minimised, a number of potential risks to residents. EVIDENCE: Mrs Jobbins commenced the Registered Manager’s Award approximately 18 months ago. Mrs Jobbins confirmed that some work has been completed yet there have been many difficulties with training providers. This has made progress slow and motivation has been difficult to maintain. Mrs Jobbins reported that at present, she is waiting for further confirmation regarding the assessment process. On receipt of this, it is expected that further progress will Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 26 be made. Mrs Jobbins continues to spend time within the home on an informal basis and as part of the working roster. Mrs Jobbins confirmed that she aims to work with all staff to monitor their practice. At the last inspection, a requirement was made to ensure the development of a quality assurance system. To date this has not been addressed. Mrs Jobbins confirmed that she talks to residents and their families on a regular basis in order to determine individual wishes. If appropriate, these are then put into place. Mrs Jobbins reported that areas of the environment are also, always being developed. This includes the en-suite facilities and the planned refurbishment of the kitchen. Mrs Jobbins reported that she undertakes many care shifts so that she is aware of what is going on in the home. A formal system however to demonstrate these areas is not in place. At the last inspection, a small number of residents chose to have some of their personal monies held within the home’s safe. This has now increased significantly so that all residents now have some money held. Mrs Jobbins and senior staff have access to the safe. Residents or their relatives have signed an agreement regarding the management of the process. Receipts are gained for all expenditures. At the end of the month, a statement is forwarded to the main relative. Each resident has a purse and transactions are demonstrated within individual notebooks. A sample of the monies was checked against the balance sheets. Two errors were noted. Mrs Jobbins was advised to keep a running balance and ensure that this is checked during each transaction. Mrs Jobbins confirmed that all staff are now receiving formal supervision on a regular basis. The documentation was not examined on this occasion. Some risks within the environment have been minimised through the completion of fitting radiator covers to all areas accessible to residents. All hot water outlets have been fitted with temperature controls yet water temperatures must continue to be monitored. As stated earlier in this report, consideration must be given to the safe use of the stairs. The accident book contained details of a number of falls and an incident of spilling a hot drink. Mrs Jobbins is advised to ensure that such matters are addressed within the risk assessment process. The fire log book demonstrated satisfactory testing of the fire safety systems, yet not all staff had had fire instruction. Documentation showed that external contractors regular service the fire safety systems. On a tour of the accommodation, it was noted that when in use, the dining room door was propped open with a wedge. A mechanical device, which releases in the event of the fire alarm sounding, is required. As a result of a small fire in the kitchen, a keypad lock has been fitted to the kitchen door. Laurieston House DS0000028410.V302192.R02.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 2 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Laurieston House DS0000028410.V302192.R02.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 OP3 Regulation 14(2) Requirement The Registered Person must ensure that all assessments contain sufficient information and detail to determine whether the needs of the person can be met within the home. The Registered Person must ensure that all care plans demonstrate residents’ individual needs including preferred daily routines and the way in which they are to be met. The Registered Person must ensure that guidelines are available for staff to effectively manage individual behaviours that challenge. The Registered Person must ensure that any decisions made, which may imply restrictions, are discussed with the resident’s care manager and their family. The rationale for any such decision must be stated within care planning information. The Registered Person must ensure that all toilets/bathrooms have the required facilities such as toilet paper. If there is a DS0000028410.V302192.R02.S.doc Timescale for action 20/11/06 2 OP7 15 28/02/07 3 OP7 12(1)(a) 31/01/07 4 OP7 12(3) 31/01/07 5 OP10 12(1)(a) 31/12/06 Laurieston House Version 5.2 Page 29 6 OP12 16(2)(n) 7 OP25 13(4)(c) 8 OP27 18(1)(a) 9 OP29 13(4)(c) particular reason for any such restriction, this must be discussed with residents, their care managers and representative. All agreements must be fully documented. The Registered Person must ensure that consideration is given to developing a more regular and varied social activity programme. The Registered Person must ensure that hot water temperatures are regularly monitored to ensure that the regulators are in good working order. The Registered Person must review staffing levels to ensure that there are sufficient staff on duty at all times in order to meet residents’ individual needs. The Registered Person must ensure that a robust recruitment procedure is evidenced. A requirement was made at the last inspection to review the content of the application form. This has not been addressed. The Registered Person must ensure that the identified interactions are investigated and such practice is monitored and discussed with staff on a regular basis. The Registered Person must ensure staff’s competence within these areas. The Registered Person must ensure that the identified member of staff’s practice is discussed within formal supervision and strategies for improvement are agreed. These must be monitored and addressed accordingly. The Registered Person must ensure that any specialised DS0000028410.V302192.R02.S.doc 28/02/07 20/11/06 31/01/07 20/11/06 10 OP30 18(1)(a) 31/12/06 11 OP30 18(1)(a) 31/12/06 12 OP30 18(1)(a) 20/11/06 Page 30 Laurieston House Version 5.2 13 OP33 24 training such as the prevention of a pressure sore is undertaken by a trained, health care professional. The Registered Person must develop a formal system for monitoring and improving the quality of care provided in the home. This was identified at the last inspection and the timescale of 28/02/06 has not been met. The Registered Person must ensure that each transaction involving residents’ personal money is checked and documented to minimise the risk of error. The Registered Person must ensure that fire doors are only held open with a mechanical device, which is activated on the sound of the fire alarm. 28/02/07 14 OP35 12(1)(a) 20/11/06 15 OP38 13(4)(c) 20/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP3 OP7 OP7 OP9 OP18 Good Practice Recommendations The Registered Person should ensure that clarity is given to terms such as ‘all care needed’ and ‘needs assistance.’ The Registered Person should ensure that staff replace subjective terminology such as ‘snappy’ and ‘uncooperative’ with factual information. The Registered Person should ensure, that greater clarity is given to the use of the stairs within the risk assessment process. The Registered Person should ensure that protocols are available for all ‘as required’ medication. The Registered Person should ensure that additional adult protection training that is facilitated by the local DS0000028410.V302192.R02.S.doc Version 5.2 Page 31 Laurieston House 6 7 8 YA23 OP30 OP33 Vulnerable Adults Unit is undertaken. The Registered Person should ensure that the residents’ choice of sharing a room is documented and kept under review. The Registered Person should ensure specialist advice is gained regarding the positioning of the washing machine and the boiler. The Registered Person should ensure that the topic of quality assurance is researched in order to assist with the implementation of the home’s individual system. Laurieston House DS0000028410.V302192.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laurieston House DS0000028410.V302192.R02.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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