Inspection on 25/08/05 for Lauriston Christian Nursing Home

This inspection was carried out on 25th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Lauriston Christian Nursing Home 10/10/08

Lauriston Christian Nursing Home 22/03/07

Lauriston Christian Nursing Home 19/01/06

Lauriston Christian Nursing Home 07/02/05

Lauriston Christian Nursing Home 15/07/04

Lauriston Christian Nursing Home 26/02/04

Lauriston Christian Nursing Home 25/11/03

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 Lauriston Christian Nursing Home 40 The Green St Leonards-on-sea East Sussex TN38 0SY Lead Inspector Liz Daniels Unannounced 25 August 2005 09:30 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 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 H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lauriston Christian Nursing Home Address 40 The Green St Leonards-on-sea East Sussex TN38 0SY 01424 447544 01424 447522 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Trinity Care Ltd Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (OP) 60 of places Physical disability (PD) 0 Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is able to accommodate one specific service user with a learning disability 2. That the home may accommodate one specific service user under 65 years of age for respite care 3. That service users are aged sixty-five (65) years or older on admission to the home 4. That the homes category of registration is care home with nursing 5. That a maximum of sixty (60) service users can be accommodated Date of last inspection 7 February 2005 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, two may be used for continuing health care. It is owned by Southern Cross Healthcare Ltd. and situated in a residential area of St. Leonards-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. It is surrounded by well maintained grounds that are accessible to wheelchair users. There are six comfortably furnished lounges and three dining areas to provide communal space for clients and their visitors. All the bedrooms are single rooms and all have en-suite facilities. Lauriston has a Christian ethos although clients with other faiths are welcomed. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of eight hours, beginning at 10am and finishing at 6.10pm. The Inspector met with the Deputy Manager, two care staff and six other professionals involved with the Organisation. During a tour of the Home, there was the opportunity to chat with three clients and a relative and to meet with other clients and staff informally. Key records were also inspected. What the service does well: What has improved since the last inspection? What they could do better: Assessments by Health and/or Social Services should be included as part of the pre-admission assessment. Following the Home’s assessment, it should confirm in writing to prospective clients that it could meet their needs in respect of health and welfare. Clients should be offered the opportunity of locking their room when they are not in it, or a Risk Assessment completed to demonstrate reasons why this is not possible. The local Fire Authority for Lauriston should be consulted about the use of sandbags to prop doors open. The policy for the protection of Vulnerable Adults should be amended to include Social Services as the lead agency for investigation. All staff should receive training in Adult protection. Staff should have their mandatory training in Fire, Moving & Handling and First Aid. Care staff should be offered supervision six times per year, which enables discussion about learning needs, reflection on practice and career development. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 6 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 H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 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 standard(s) 1,3,4 and 5 There is good information available for prospective clients and they are offered the opportunity to be involved as far as is possible in decisions about admission. Assessments by Health and/or Social Services should be included as part of the pre-admission assessment. Following the Home’s assessment, the Manager should confirm in writing to prospective clients that the Home could meet their needs in respect of health and welfare. EVIDENCE: The Home has a comprehensive Statement of Purpose, which has been recently updated, and a Service User guide. The Service User guide, which is produced by Southern Cross and not specific to Lauriston, is given to all prospective clients with the Statement of Purpose. Following an enquiry to the home, prospective clients and their relatives are invited to visit. If they wish to pursue the admission, the Registered Manager or Deputy Manager visits them and undertakes an assessment, completing an assessment pro-forma. For those clients being admitted under continuing care, the hospital Consultant continues to oversee their treatment. However, where possible Health and/or Social Services assessments are sought but are not always made available to the Home, prior to the client’s admission. Prospective clients are told verbally during their assessment whether or not the Home can meet their needs. The Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 9 Management Team endeavour to involve the prospective client’s relatives, as much as is possible, prior to admission. Two clients who met with the Inspector had not been well enough to visit themselves prior to their admission, but another had and had seen her room. All are pleased with the Home and the care they receive. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10 Each client’s care plan reflects their nursing, personal and social needs and health care needs appear to be met well. The Home has good contact with local health services. Although no client self-administers their medication, the overall standard for the management of medication was found to be good. Clients should be offered the opportunity of locking their room when they are not in it, or a Risk Assessment completed to demonstrate reasons why this may not be possible. The local Fire Authority for Lauriston should be consulted about the use of sandbags to prop doors open. EVIDENCE: Lauriston Christian Nursing Home provides 24 hour nursing care if required and all the clients have a care plan that reflects their current health and personal care needs. Three clients files were viewed on the day of the inspection; all had comprehensive Risk Assessments and care plans that had been reviewed and updated at varying intervals. The Care Plans seen included a risk assessment of falls, a dependency assessment, a nutritional assessment and an assessment of tissue viability: at the time of Inspection there were nine clients with tissue damage or skin breakdown. Pressure mattresses and cushions are used in the Home when required. The Care Plans reflect the client’s religious and cultural practices. Some have been signed by the client or their relative, demonstrating that they have been shared with them. There Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 11 is input into the Home from health professionals, including a dietician and a tissue viability nurse. It also accesses external dentists, chiropodists, and opticians, with staff accompanying clients to health appointments if relatives are unable to do so. Although the administration of medicines was assessed, there was no client who was able to take responsibility for their own medication at the time of the inspection. The clinical room was seen and was clean and well stocked. The medicine charts were seen and were correctly maintained. Policies and Procedures are in place for the correct receipt, storage, administration and disposal of medicines. Photographs of all the clients are included with the medication charts. Staff confirmed the importance of promoting privacy and respect when clients are undergoing examinations or personal care. Clients can choose to have their own phone in their room, or staff will ensure the phone is made available to them in a private area. However, although there are locks fitted on all the bedroom doors, clients are not offered the opportunity to hold their own key. Any client, who prefers to stay in their room, but have the door open at times, has the door held open with a sandbag. This was discussed during the Inspection and although it has been agreed by the Organisation, it has not been discussed with the local Fire Authority. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 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 standard(s) 12,13 and 15 The Home recognises the importance of ensuring individual needs are met and offers choice and flexibility for the routines of daily living and activities. The menus are varied to provide a balanced diet. Specific dietary requests are accommodated. EVIDENCE: The Inspector found that clients were choosing either to spend time in their room or to sit in the lounge. They are encouraged to furnish their own rooms by bringing personal effects with them and are welcome to have visitors at any time, seeing them in private, or in one of the lounges. An Activities Coordinator is employed and a varied programme of events is organised within the Home, with details displayed on the Notice Board and circulated to the clients. Those spoken with during the inspection knew where to check what activities were planned and felt welcome to join in as they wished. A varied, nutritious menu is offered, which includes several choices. Clients and staff confirmed that specific individual choices are accommodated when possible. The clients and relatives who met with the Inspector described the food as good and varied. The chef confirmed that special diets are prepared and dietary needs are closely monitored. The clients can choose to eat in their rooms or in the dining room. Food and drinks are available throughout the 24hour period. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 There is a complaints procedure in the Home which the clients and staff have confidence in. The policy for the protection of Vulnerable Adults needs to be amended to include Social Services as the lead agency for investigation. All staff should receive training in Adult protection. EVIDENCE: There has been one complaint copied to the Commission, since the last Inspection. The Home has a complaints procedure which staff, when asked, said they were aware of and knew how to access. All complaints and the action taken are recorded and the outcomes fed back to the complainant. Three clients and a relative stated that they could discuss any concerns they have with the Nurse-in-charge for the shift, or the Manager. They have confidence that their concerns would be listened to and acted upon. There is a policy for the Protection of Vulnerable Adults. This does not include Social Services as the lead agency for investigations. Although there has been progress in the training of staff in Adult Protection, there are still some staff who have worked in the Home for sometime who have not had training. Staff, when asked, could identify when to raise any concerns and what action to take. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 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 standard(s) 19,21,22,24 and 26 The accommodation at Lauriston is homely, comfortable and well maintained, with good facilities for wheelchair users and the communal areas and grounds are spacious. The environment appears non-clinical and good practice is in place to minimise the risk of infection. The equipment available enables both support and independence. EVIDENCE: Lauriston Christian Nursing Home provides light, spacious and well-decorated accommodation arranged over two floors and divided into two wings. There is a shaft lift to each floor. All areas within the Home are accessible for wheelchair users and there is a range of equipment and aids to meet individual needs and assist those with reduced mobility. Lounges and Dining Rooms in each area and a family room on the ground floor provide communal space where clients can meet with their visitors. The garden is well maintained and includes a seating area. It is enclosed and easily accessible for wheelchair users. The bedrooms are homely and clients are encouraged to have their own possessions with them. There is a call bell system to ensure assistance as needed. One client commented that the staff are very kind and “when I ring Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 15 the bell, someone comes”. Each room has en-suite facilities with a toilet and washbasin. The bathrooms are spacious enabling easy access for hoists and wheelchair users. Cleaning staff are employed at the Home and on the day of Inspection it was found to be free from odours and clean. There are supplies of disposable gloves available and antiseptic Hand Rub: staff attend training and there is a policy in place, for the control of infection. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 A team of care staff is employed to meet the health needs of clients. Correct recruitment procedures are in place and new staff undertake an induction programme of training. Staff should have their mandatory training in Fire, Moving & Handling and First Aid. EVIDENCE: Registered Nurses lead each shift, supported by care staff. There is a staff rota in place to cover the 24-hour period. 13 carers and 3 nurses are rostered during the day, 12 carers with 3 nurses for the evenings and 4 carers with 2 nurses for the night shift. Kitchen, domestic, laundry and maintenance staff are also employed. The Manager usually works from Monday to Friday and is supported by the Deputy Manager. The Manager is undertaking her Registered Managers Award (RMA). Records indicate that new staff undertake induction training and that there is comprehensive training in place for all staff, some of which is offered within the Company but there is also evidence that staff are accessing external training when appropriate. However, not all staff have had their mandatory training in Fire, Moving & Handling and First Aid. Four carers have completed NVQ level 2 and twelve staff have NVQ level 3. It is anticipated four carers will enrol to start their NVQ level 2 in September. However this will not ensure 50 of care staff will be trained to NVQ level 2. Five staff files were viewed during the Inspection. All files contained references received prior to appointment and a copy of the Terms & Conditions of employment. Recruitment checks had been applied for. Staff are appointed once a POVA first check is received and then supervised until there is CRB clearance. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35 and 36 The Home is well managed. However, care staff should be offered supervision six times per year, facilitated by staff who can discuss learning needs, reflection on practice and career development. EVIDENCE: Although the Registered Manager was on Annual Leave and there was therefore no opportunity for the Inspector to talk with her, the Inspector found that both the staff and clients demonstrated that the Home is managed in a motivated and professional way. Staff and clients stated that the Manager is accessible and very approachable for help and support. The Registered Manager is an experienced first level nurse who has recently been registered with the Commission as recommended at the last Inspection. She is currently undertaking her Registered Manager’s Award (RMA). Policies and Procedures are in place to safeguard and protect the financial interests of the residents. Clients have control of their own money as far as is possible. A small amount of personal money is kept locked at the Home and security protected records relating to personal monies are maintained. The Home’s management team do Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 18 not act as appointees for the financial affairs of the clients. Staff confirmed that they have supervision sessions. Records show that they are usually used as an opportunity for teaching, are unscheduled and that their frequency is variable. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 3 x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x 3 2 x x Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 20 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 3.2 Regulation 14 (1)(a)(b) (c)(d) Schedule 3(1)(a) Requirement For individuals referred through Care Management arrangements, the Home obtains a copy of their Health and/or Social Services assessment. The Home confirms in writing to the service user that, having regard to the assessment, it is suitable to meet their health and welfare needs. Documentary evidence should be provided that the fire authority has approved the practice of holding bedroom doors open with sandbags. The policy for the protection of Vulnerable Adults needs to be amended to include Social Services as the lead agency for investigation. It is required that all staff undergo training in Adult Protection. (This has been a Requirement of the last two Inspections) Staff should have their mandatory training in Fire, Moving & Handling and First Aid. Care Care staff should be offered supervision six times per year, Timescale for action 31 October 05 2. 10, 38 12(1) 23(4) 30 September 05 30 September 05 30 November 05 30 November 05 31 December Page 21 3. 18.2 21(1) 4. 18 12(1) 13(6) 5. 30 13(4)(c) 18 (1)(a)(c) 18(2) 6. 36.2 Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 facilitated by staff who can discuss learning needs, reflection on practice and career development. 05 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 10 Good Practice Recommendations Clients should be offered the opportunity of locking their room when they are not in it, or a Risk Assessment completed to demonstrate why this is not possible. Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT 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 Lauriston Christian Nursing Home H59-H10 S14010 Lauriston Christian Nursing Home V237556 250805 Stage 4.doc Version 1.40 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!