CARE HOMES FOR OLDER PEOPLE
Lauriston Christian Nursing Home 40 The Green St Leonards On Sea East Sussex TN38 0SY Lead Inspector
Liz Daniels Unannounced Inspection 19th January 2006 13:40 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 Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 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. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lauriston Christian Nursing Home Address 40 The Green St Leonards On Sea East Sussex TN38 0SY 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) 01424-447544 01424-447522 lauriston@schealthcare.co.uk Trinity Care Ltd Lynn Carrol Carter Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (60) of places Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. To accommodate one specific service user with a learning disability To accommodate one specific service user under sixty-five (65) years of age for respite care Service users must be older people aged sixty-five (65) years or over on admission The maximum number of service users to be accommodated is sixty (60) 25th August 2005 Date of last inspection Brief Description of the Service: The Lauriston Christian Nursing Home is registered to provide care with nursing for a maximum of sixty clients under the category of elderly care. Of those sixty beds, twenty two may be used for continuing health care. It is owned by Southern Cross Healthcare Ltd and situated in a residential area of St. Leonard’s-On-Sea, near to a main bus route. Lauriston is a large purpose built building with level access to the front door and accommodation set out over two floors. A lift provides access to each floor and well-maintained grounds that are accessible to wheelchair users surround it. There are six comfortably furnished lounges and three dining rooms to provide communal space for clients and their visitors. All the bedrooms are single rooms and all have ensuite facilities. Lauriston has a Christian ethos, although clients with other faiths are welcomed. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of six hours, beginning at 1.40pm. The Manager was unwell on the day of the Inspection and the Deputy was also off site. The Inspector therefore met with the senior Registered Nurse on duty and four other members of staff. Although a full tour was not undertaken at this Inspection, there was the opportunity to talk with two residents in the privacy of their bedroom and to meet other residents informally, before inspecting a range of key records and documentation. As some of the documentation was not readily available to the Registered Nurse facilitating the Inspection, the Inspector re-visited the Home several days later to meet with the Manager. This report should be read in conjunction with the report from the first inspection this year, on 25th August 2005. What the service does well: What has improved since the last inspection?
The Manager liaises closely with Health and / or Social Services as part of the pre-admission assessment process for the Home, for residents admitted under Care Management arrangements. A letter has been developed to send to prospective residents following their pre-admission assessment, confirming in writing that the Home can meet their needs in respect of health and welfare. These both meet the Requirement of the last Inspection. New documentation for Care Planning and Risk Assessments is being introduced: the staff are managing the transition well and the residents’ Care Plans have remained comprehensive and individualised throughout the changeover. Good progress has been made in providing the choice of privacy for residents, by offering the opportunity to hold a key for their room. This meets the Recommendation from the last Inspection.
Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 6 By amending the policy for the Protection of Vulnerable Adults to reflect Social Services as the lead agency, the Home has met the Requirement from the last Inspection. The Home has also worked hard to ensure staff are trained in Adult Abuse, meeting the Requirement from the last Inspection. Currently over 50 of care staff are trained to NVQ level 2 or above and very good progress has been made in providing a programme of training whereby staff receive their mandatory training in Fire, Moving & Handling and First Aid. Staff are well supervised in their practice and good progress has been made to ensure staff have more regular supervision sessions. 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. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 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 Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 6 Good practice is now in place as there is close liaison between Health and / or Social Services as part of the pre-admission assessment process for the Home, for residents admitted under Care Management arrangements. A letter has been developed to send to a prospective resident following their pre-admission assessment, confirming in writing that the Home can meet their needs in respect of health and welfare. Both these developments meet the Requirement of the last Inspection. EVIDENCE: A copy of the Home’s Statement of Purpose and the Service User guide for Southern Cross are given to prospective residents when they look around, or have decided to move into the Home. The Manager confirmed that since the last Inspection, she always asks Social Services/Health for copies of their assessments prior to undertaking a pre-admission assessment, but these are not always available. It was agreed that a record of that conversation would be documented in future. Nursing assessments were evident in the resident’s files viewed, although they were dated after the admission of the resident. Once the Manager (or whoever undertakes the assessment) has undertaken the pre-admission assessment, she then confirms to the resident, in writing,
Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 9 that the Home can meet their needs. A statement of the Terms & Conditions of occupancy is then completed and agreed between the resident (or their representative) and the Organisation: it covers (amongst other information) the room to be occupied, the care & services provided and the fees. The notice period is also included. The documentation for five of the residents was viewed, including those for three residents who have been admitted since the last Inspection. The information gathered at the pre-admission assessment is recorded on a client admission sheet and a pre-admission draft care plan is formulated. Lauriston Christian Nursing Home provides respite care and short-term rehabilitation following surgery but it does not offer intermediate care. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 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 and 10 The Home has developed very good care plans, which are individualised and contemporaneous. Good progress has been made in providing choice of privacy for residents by offering the opportunity to hold a key for their room. This meets the Recommendation from the last Inspection. EVIDENCE: The documentation for recording resident’s care needs has changed since the last Inspection. Five resident’s files were viewed and the Inspector met with two of those residents. Each resident has a client admission sheet and draft care plan from the pre-admission assessment. Social and emotional needs, such as enabling the pursuit of hobbies or encouraging particular interests, are recorded in a client social profile. A Risk Assessment for falls, a nutritional assessment, an assessment of mobility and an assessment of tissue viability were evident. Generally, all had been reviewed monthly. Needs identified during any of the assessments are then subsequently recorded on the Care Plan. They are specific in detailing the clinical care needed: specialist health professionals are accessed as needed and their advice sought. Evaluations of care are then recorded in the Daily Record Sheet and a Care Plan index is also maintained.
Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 11 At the last inspection the door of some resident’s bedrooms were being held open with sandbags as many of the residents prefer not to have their door closed when they are in their rooms, particularly if spending long periods in bed. The Manager confirmed that, following advice from the Fire Authority, the Organisation have now purchased magnetic door guards. During this Inspection, some bedroom doors were being held open with sandbags as the door guards have not yet arrived and been fitted. The bedroom doors have locks on them: the Inspector saw a copy of a letter being sent to each resident to ask if they would like the key to their room. The Manager confirmed this will be discussed on admission in future and a Risk Assessment completed if it is not appropriate. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 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): 14 The staff at Lauriston Christian Nursing Home recognise the importance of offering choice and flexibility for the routines of daily living. Good financial management of personal monies is in place. EVIDENCE: On the day of Inspection, residents were spending time in their rooms and in the lounges. Residents are encouraged to be as independent as they are able and to choose how much they wish to join in with the activities in the Home. The Inspector was able to meet two residents in their bedrooms and look into other rooms during the day. The rooms are personalised with pieces of furniture, furnishings and personal possessions. Residents are enabled to manage their own financial affairs for as long as they are able, but they are encouraged not to hold large sums of money in their room. Although the Home does not act as the appointee for their financial affairs, they hold a small amount of personal monies on behalf of the residents: balances for each individual are maintained. Information leaflets regarding advocacy services are publicised in the main entrance of the Home, enabling residents and their relatives to contact external agents who will act in their interests if they wish. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The Home has contemporaneous policies to ensure correct processes are in place for the protection of vulnerable adults. By being amended to reflect Social Services as the lead agency, they have met the Requirement from the last Inspection. The Home has also worked hard to ensure staff are trained in Adult Abuse, meeting the Requirement from the last Inspection. EVIDENCE: This standard was assessed at the last inspection and therefore not inspected in full at this inspection. Good practice had been found to be in place but the Home’s policy did not reflect the need to contact Social Services as the lead agency. Since the last inspection a new flowchart for potential alerters has been developed to guide the reader to contact Social Services and to notify the Commission. Contact details are included. Although, at the last inspection, there had been progress in staff training in Adult Abuse, there were still staff who had worked at the Home for sometime, who had not had training. The training records at this inspection indicate that all staff who work regularly at the Home have had training in Adult Abuse. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 25 Lauriston Christian Nursing Home provides safe, comfortable bedrooms for residents, with their own possessions around them. Privacy is promoted by offering the opportunity for residents to hold their own key. This meets the Recommendation from the last inspection. All radiators must be guarded to ensure residents are protected from unnecessary risks to their health and safety. EVIDENCE: This Inspection again provided the opportunity to look around the Home and to spend time with some of the residents in their bedrooms. Accommodation is provided over two floors. The bedrooms seen were homely and comfortable with many personal possessions and small items of furniture. The residents who met with the Inspector said they liked their rooms and were pleased to have their own telephone line and some of their own furniture with them. All the bedrooms are single and have en-suite facilities. Locks are fitted to the doors and as stated earlier in this report, all residents are now being asked if they would like to hold their own key. In future, residents will be asked on admission, or a Risk Assessment completed if not appropriate. The Manager
Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 15 reported that the central heating boiler has been replaced recently but that the system needs draining down, as some of the radiators do not heat as effectively as they should. This is planned for the warmer weather in the summer. Meanwhile, portable radiators were being used in some of the bedrooms: these were not guarded and did not have low temperature surfaces. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Lauriston Christian Nursing Home demonstrates a commitment to training care staff. Currently over 50 of care staff are trained to NVQ level 2 or above. Very good progress has been made in providing a programme of training whereby staff receive their mandatory training in Fire, Moving & Handling and First Aid. EVIDENCE: There are currently two carers undertaking NVQ level 2 and two studying for NVQ level 3. There are already three carers in post who have attained NVQ level 2 and ten who have qualified to NVQ level 3. As there are a total of twenty-five carers in post, 68 of them are trained to NVQ level 2 or above. The Home also employs Bank staff and currently has nine carers on their Bank: as four of them have also undertaken their NVQ training, 44 are trained to NVQ level 2 or above, although many of the Bank staff work only incidental shifts. The Home also has carers in post who are trained nurses from overseas. Although they are assessed informally there is currently no assessment tool in place to measure their level of competence against NVQ, as advised by the Nursing & Midwifery Council (NMC). This was discussed with the Manager and it was agreed an appropriate tool would be explored. The training matrix for all staff was reviewed. All staff have induction for their first three shifts in post. They are issued with a staff handbook with a checklist of areas to be covered. The Manager explained that this programme is being revised and it will last over 13 weeks after which there will be a review meeting with the Manager. The Fire Training Officer for the Organisation left last year: he has now been replaced whereby the Home anticipates a
Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 17 programme of fire training sessions will soon be provided. The Maintenance Manager for the home provides basic fire training during Induction and any fire drills are followed up by a teaching session ascertaining staff knowledge and reviewing any difficulties identified during the drill. The Deputy Manager has now completed her training to be the Home’s trainer in Moving & Handling. A programme of training is in place that includes initial training for those staff new to the Home and follow-up training for those staff that need their mandatory update. Staff are allocated a place and their training is rostered into the off duty. A training video with a test at the end is used for training carers in First Aid and trained nurses access St. John’s Ambulance. The training matrix seen indicated that the majority of staff at the Home have now had their mandatory training. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 and 38 Staff are well supervised in their practice and good progress has been made to ensure staff have more regular supervision sessions. However, the session should include opportunities for discussion about career development needs, the philosophy of care in the Home and all aspects of practice. Very good maintenance checks are in place to ensure the health, safety and welfare of residents are promoted and protected. However, bedroom doors should be held open with a device that will release if the fire alarm is activated. This was a Requirement from the last inspection. EVIDENCE: As assessed at the last inspection, the staff have supervision sessions, which are usually used as teaching opportunities or a chance to reflect on situations that have arisen. Since the last inspection the responsibility for supervision has been cascaded down enabling it to be more frequent than previously. Supervisors and supervisees are being encouraged to document their sessions although the Manager explained this still does not always happen. A new proLauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 19 forma has just been developed which the Manager hopes will make documentation easier. In general the sessions happen every two months although they tend to be unscheduled. The benefits of supervision being planned and timetabled were discussed. It was agreed the sessions could be broadened to also include discussions about personal and professional development needs and any learning needs, as well as discussions about the philosophy of care in the Home and reflection on any events that may have occurred. Documentation for safety checks were viewed and found to be in order. The Fire Alarm system and Emergency Lighting for one zone are tested weekly: the Home is divided into 14 zones. An outside contractor then services the whole system every six months, last done on 8th December 05. There are 5 fire exits, one of which is checked each week to ensure they release: they are also connected to the nurse call system, whereby it will alarm if a door is opened when the fire alarm has not been activated. Fire Drills have been held monthly, the last one being on 18th January 2006 and the Fire Extinguishers are checked each Tuesday, last recorded as being done on 17th January 2006. Contracts are in place for the disposal of medications, contaminated waste and general waste. A current annual gas service contract was viewed and a current Electrical Wiring Certificate is in place. PAT testing was carried out for 267 items in January 2005 and the next check was booked for 20th January 2006. The temperature for all water outlets in the bathrooms and showers are recorded each week, last documented as being on 9th January 2006. At the last inspection the door of some resident’s bedrooms were being held open with sandbags as many of the residents prefer not to have their door closed when they are in their rooms, particularly if spending long periods in bed. The Manager confirmed that, following advice from the Fire Authority, the Organisation have now purchased magnetic door guards. As stated earlier in this report, some bedroom doors were being held open with sandbags during this inspection. The manager confirmed that door guards have been ordered but have not yet arrived and been fitted. Sandbags therefore continue to be used for some bedroom doors but the staff confirmed that the need for their removal, to enable the doors to close in the event of a fire, is emphasised during fire training. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X 3 2 X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 2 Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 21 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. 1. Standard 10, 38 Regulation 12 (1) 23 (4) 13 (4)(a)(c) Requirement Fire doors must not be held open unless by a device that will release when the fire alarm sounds Radiators must be guarded or have guaranteed low temperature surfaces. Timescale for action 31/03/06 2. 25 28/02/06 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. Refer to Standard 36 Good Practice Recommendations Supervision sessions for care staff are now being held more frequently but some sessions should be timetabled and should be broadened to include discussions about career development needs, the philosophy of care in the Home as well as all aspects of practice. Lauriston Christian Nursing Home DS0000014010.V274073.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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