Inspection on 15/11/05 for Lauriston House Nursing Home

This inspection was carried out on 15th November 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 House Nursing Home 06/09/06

Lauriston House Nursing Home 05/08/05

Lauriston House Nursing Home 14/12/04

Lauriston House Nursing Home 29/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Lauriston House Nursing Home Bickley Park Road Bickley Kent BR1 2AZ Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 15th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lauriston House Nursing Home Address Bickley Park Road Bickley Kent BR1 2AZ 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) 020 8295 3000 020 8295 3674 Ashbourne Life Ltd Ms Penny Hammond Care Home 100 Category(ies) of Old age, not falling within any other category registration, with number (99), Physical disability (1) of places Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Staffing Notice issued 10 January 1995 12 beds designated for intermediate care 1 place registered for service user category PD for named service user only. Date of last inspection Brief Description of the Service: Lauriston House is a purpose-built care home for the nursing care of older people. Twelve beds are designated for intermediate care. These beds are due to be moved in the next two weeks to another home. Ninety-eight beds are currently being used. At the time of the inspection the home had ninety-seven residents with one vacancy. The accommodation for residents is on three floors, with access by passenger lifts. There is a large garden at the back of the home and parking at the front. The home is two miles from Bromley town centre and within walking distance of Bickley rail station for those with full mobility. The home is on a bus route. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced by three inspectors. The inspectors visited each floor independently and assessed the documentation whilst on the particular floor. The inspectors met with residents, staff and any visitors who were in the home. One inspector talked with the pharmacist and noted that the dentist and a GP came in to visit people, although were not spoken to. The findings related to in this report may vary as these were the observations of the individual inspector and related to that particularly area. The home was clean tidy and well organised. Inspectors observed staff to be interacting positively with residents and relatives. The majority of the documentation was to a good standard with the exception of those records referred to in the body of the report. The home has a strong management team who oversee all care practices, records and provide staff with support to work effectively. The inspector received eight comment cards from residents and seventeen relatives comment cards. The majority related positive comments about the home and staff, with the exception of two, which are referred to under the section “Personal Care “. What the service does well: What has improved since the last inspection? The systems for checking qualified nurses’ registration details has improved with monthly checks being conducted. Documentary evidence for the checking of PIN numbers was in place. Requirements and recommendations given at the previous inspection were being met. Both lifts were functioning properly. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 6 The manager had purchased a new, additional, mobile hoist, (a “Tempo”) which is proving very useful in safe moving and handling of Service Users. Care plans on the ground floor were well maintained and with sufficient information for health care and risk assessments. 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 House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 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 House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 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): 1,2,3,4. Residents are provided with a statement of terms and conditions, which outlines the level of service and fees payable. All residents are assessed by suitably trained staff prior to admission and documentation available to support this assessment. EVIDENCE: Terms and Conditions of residency were available in the individual resident’s files, for all those residents occupying frail elderly beds. The intermediate care beds have a different payment structure as these are paid for directly through the Primary Care Trust. Three contracts were seen on three files reviewed and one letter confirming the homes ability to meet assessed needs was seen. The Statement of Purpose and Service Users Guide were both available within the home. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 9 On the ground floor, there was evidence of good pre-admission assessments in two care plans. These contained comprehensive information regarding health needs, medical history, medication, communication and social needs, history of falls, personal safety, nutrition and pressure area care. There were good records showing that one of the residents had been reassessed after transfer to hospital to ensure that the home could meet the needs should this resident be returned to the home. One resident had developed dementia needs and the manager had ensured that she was appropriately re-assessed. A placement was being arranged to a more suitable home. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 Health and personal care are well addressed in this home and reflected in the care plan documentation. EVIDENCE: Two care plans on the lower ground floor garden suite, were inspected - that of a recently admitted resident and one of a gentleman with whom the inspector had met. The care plans are standard Ashbourne format with supporting risk assessments including those for manual handling, nutrition and falls. All aspects of the documentation were completed with reviews in place. One female resident was identified as “low risk”, as detailed in her nutrition assessment, her weight was not recorded. The staff explained that it was not possible to get this lady on the scales due to her physical heath. Generally the standard of record keeping was good. Staff were seen to provide care with bedroom doors closed and divider curtains used. Staff were seen to interact with residents in a friendly positive manner. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 11 Residents said that they felt that their needs were addressed. Residents were either in the communal areas or their bedrooms, call bells and fluids were in reach. Two comments referred to in the comment cards said that fluids were provided frequently, but sometimes delays in taking residents to the toilet occurred. The medications on the lower ground floor had good records in place. The medication charts were completed with residents’ allergies and the amount of medication received into the home was documented. One hand transcription of medication was noted to have only one staff signature in place. It is recommended that two staff sign to ensure accuracy of the information recorded. The controlled drugs were checked and found to be accurate with full supporting records in place. On the ground floor, the inspector examined three care plans. These were set out in individual folders and had different sections for easy access of information. Each care plan had a photograph of the resident at the front, and identified the named nurse and key worker for that person. Assessments were included for different aspects of care (e.g. personal care needs, communication, pain management, social needs, mobility, nutrition, continence, and risk assessments.). Separate care plans were written for further aspects of care where additional information was required. These care plans included subjects such as pressure area care, wound care, diabetic needs and catheter care. The assessments were re-evaluated monthly, signed and dated appropriately. Additional care plans were re-evaluated more frequently, depending on the severity of the residents’ condition. For example, wounds were re-evaluated at each dressing, and diabetic needs were re-evaluated according to the stability of the diabetes, blood sugar tests, and nutritional intake. Falls risk assessments were included in each file, and risk assessments were in place for residents who were at risk of falling out of bed, and had bed rails. The need for these was discussed with the resident where possible, otherwise with the next of kin. Residents’ files contained confirmation of staff action in relation to personal care needs. Daily reports were written by the care staff who actually carry out the care, and these are added to by the nurse on duty as necessary. Daily reports included evidence of meeting personal hygiene needs, such as “bed bath given”, “hair done by hairdresser today” or “refused to wear dentures.” Details included assistance given with feeding; catheter care; extra fluids given; turns given for pressure relief; use of hoist for moving and handling; and blood sugar tests taken. Moving and handling assessments included detailed information of the type of hoist to use, and the size of sling. Turn Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 12 charts were used to record 2-hourly turns for pressure area care, food and fluid charts are used to record nutritional intake for residents in poor health. A separate record is retained of multi-disciplinary visits, such as GP visits, dentist, chiropodist, social worker, tissue viability nurse or dietician. A dentist and a GP both visited residents in the home during the inspection. The home was equipped with plenty of pressure-relieving equipment, such as special mattresses and cushions. Residents were provided with suitable beds for their individual conditions; these were mostly nursing beds, but others had divan beds, and one had a futon, for clearly assessed reasons. The inspector examined one care plan in detail in regard to wound care. Each wound was recorded on a separate care plan, and these were re-evaluated separately, showing the progress of the wound area, the dressing to be used, the size of the wound, and any other treatment to be given. The wounds were re-assessed weekly, and photographs were taken at each stage (with permission from the resident). The GP had been called in appropriately and additional treatment given as prescribed. Medication for the ground floor is stored in a locked clinical room. There are two corridors on this floor, and there is a separate medicine trolley for administration in each corridor. Medicine trolleys are kept locked to the wall. Administration is carried out using the Monitored Dosage System (MDS), and the inspector checked one trolley to see these had been given properly on the day of the inspection. Other medicines were stored in locked cupboards, and internal medication is stored separately to external medication. The cupboards and medicine trolley were in satisfactory order, with no identified overstocking of medication, and evidence of good stock rotation. One cupboard contained a box of homely remedies, which had been agreed with the GPs. Three of these medicines were found to be out of date, and a requirement is given to ensure that these are replaced, and not allowed to go out of date in the future. Audit trails had been carried out by the Pharmacist, and by nursing staff when ordering, although there was no written evidence for these. Medication Administration Records (MAR charts) were stored in separate folders for each corridor and one folder was inspected. These had been well completed, and confirmed that medicines are checked and counted in on receipt from the pharmacy. Again, as with the last inspection, the medications on the intermediate unit were poorly managed, difficult to audit trail and all of those checked were inaccurate. On the intermediate care unit residents were well groomed, with attention to detail such as tidy hairstyles and the addition of jewellery. Personal care is Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 13 given in privacy, and shared rooms were fitted with suitable screening facilities. Care plans included a section to record any specific wishes of the resident in the event of death. Some of these had detailed information, but others noted that the resident did not wish to discuss this, and relatives would make the decisions at the appropriate time. Please see requirement 1. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 14 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): 12,13,15 Within this large communal setting activities are provided for groups of residents. Individual activities are as decided by the residents themselves. EVIDENCE: The home has two part-time activities coordinators; neither were on duty for the duration of the inspection. The inspectors were informed that the two staff had made great strides in leisure and recreational activities for residents. On a weekly basis there is an organised activity externally, with daily in house activities. Recently there had been in-house Halloween celebrations with a best fancy dress competition. There are activities such as video afternoons and indoor games including bingo. The home has an in-house Church service every two weeks, and some residents enjoy attending this on a regular basis. The menu was on display for the day, and contained a choice of different main courses and desserts. Some residents stated that the menu was changed and notice was not given in respect of this. This should be investigated with the kitchen staff. Residents were seen to have their own newspapers. Please see recommendation 1. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 15 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 Staff are trained in abuse prevention and aware of the action to take in the event that abuse is suspected. EVIDENCE: There were good staff training records for “Residents’ Welfare”. This training is given to all staff in the home, and includes understanding of different types of abuse, prevention of abuse, and action to be taken if abuse is suspected. Staff confirmed that they had received training in abuse and were aware of the action to take mainly that they would refer it to the senior person or CSCI. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 16 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): 19,20,22,25,26. The home is generally well maintained with sufficient aids and equipment to deal with the needs of the residents. EVIDENCE: The lower ground floor was clean, tidy and odour free as the inspector toured. COSHH products and storage areas were secure. There were no portable fans in use on this floor. The home has a risk assessment for the patio bedroom doors which open onto the balconies. The dining tables were nicely presented prior to lunch with serviettes, cloths and condiments. Hoists were seen to be used appropriately and labels indicated recent servicing under the LOLER regulations. The inspector noted that appropriate precautions and equipment were in use for infection control measures. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 17 The ground floor was clean and generally well maintained. There were no offensive odours. There is a mixture of single and shared rooms, and all rooms have en-suite toilet facilities. Some also had en-suite showers. A large bathroom contained an assisted bath, and there were suitable mobile hoists available for moving and handling purposes. These had been recently serviced. The manager and the maintenance man were aware that some of the bedrooms were due for redecorating. This is difficult to carry out when rooms are shared, as they are rarely vacant. The maintenance man has a record book on each floor for staff to record any repairs needed, and these are dealt with as soon as possible. A broken commode was seen stored in a bathroom, and this needed to be repaired or replaced. Commode buckets were quite stained, and may be ready for replacement. On the first floor the communal space was tidy and clean, no malodour was present. The residents relaxed and enjoying TV. Bedrooms were clean and tidy but a number of radiators were ‘falling apart’ and need to be actioned. In bedroom 5 there was a free standing heater. This was very hot and one of the occupants was prone to falls. A risk assessment must be in place and measures taken to ensure the resident’s safety. The hot water urn was accessible to residents on both the nursing and intermediate care units. The facilities in place to prevent spread of infection were hand washing, liquid soap, and adequate stocks of protective clothing. Please see requirement 2. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 18 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): 27,29,30 Staff are subject to robust recruitment procedures, provided in sufficient numbers and with suitable training to enable them to address the care of residents in a competent manner. EVIDENCE: Staffing levels appeared to be satisfactory. There were six care staff on the top floor, nine on the ground floor, and six on the lower ground floor. These included trained nurses – for which there were two on the ground floor, one for each corridor. Senior care staff decide each day where different care staff are deployed, and responsibilities are given for allocated rooms, kitchen liaison duties, laying dining tables, toileting after meals, and assisting residents who want to rest on their beds after lunch. The nurses oversee specified areas in the home, as well as administering medication, carrying out nursing procedures, and supervising staff. Staff training files were viewed for two floors, and these showed good records for mandatory training. The home has two home trainers – one for day duty and one for nights. These had completed the home trainer courses, and updated as needed. Training records showed detailed training for fire awareness, moving and handling, health and safety, basic food hygiene, and residents’ welfare. Each course included the information given for specific subjects, and written assessments for each staff member who had completed the training. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 19 The home has also been employing adaptation nurses from other countries. These have to complete an adaptation course prior to working as nurses in this country. One of the staff nurses on duty had completed this training, and said that the home had given her very good induction, and the opportunity to work alongside other staff. Adaptation nurses are given a half-day every week for study time, as well as having a college day each week. One employee file was checked. The employee had moved from another home in the organisation. All relevant documents were there except the references and the NMC check. The manager had addressed the NMC issue and said she would have the references forwarded from the other home. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 20 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): 31,32,37. This home is well managed by a competent staff team who promote an open and inclusive atmosphere where resident’s safety and welfare are promoted. EVIDENCE: The Manager gives a clear lead and direction to other staff. There are good systems in place for staff to be accountable for their own areas of responsibility, and to develop their skills and knowledge. Records viewed were stored securely, and were well maintained. Policies and procedures are easily available for all staff to access. Mandatory training is carried out to ensure safe working practices in the home. The maintenance man carries out routine fire alarm checks, and fire drills are carried out randomly. These are at times to include night staff as well as day staff. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 3 X 3 X X 2 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X 3 X Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 22 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 OP9 Regulation 13 Requirement The Registered Manager must ensure that robust medication systems are in place and comprehensive information retained, including all supporting records, particularly on the intermediate care unit. All homely remedies must be audited for expiry dates Previous time frame for action 31/1/05. This is now outstanding The Registered Manager must ensure all parts of the home are well maintained including loose fitting radiator covers. All hot water dispensers and portable heaters/fans must be made safe and have appropriate risk assessments in place. Timescale for action 30/12/05 2 OP25 23 30/12/05 Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 23 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 OP15 Good Practice Recommendations The Registered Manager must ensure that all changes to the menu are related to the residents in a timely manner Changes to the menu should, where possible, be avoided. Lauriston House Nursing Home DS0000010139.V263161.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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