Inspection on 12/10/06 for Laxfield House Residential And Nursing Home

This inspection was carried out on 12th October 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Laxfield House Residential And... 15/12/05

Laxfield House Residential And... 05/10/05

Laxfield House Residential And... 10/02/05

Laxfield House Residential And... 20/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Laxfield House Residential And Nursing Home Cundy`s Lane Brent Eleigh Sudbury Suffolk CO10 9PL Lead Inspector Jill Clarke Key Unannounced Inspection 12th October 2006 10:35 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 Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laxfield House Residential And Nursing Home Address Cundy`s Lane Brent Eleigh Sudbury Suffolk CO10 9PL 01787 247429 P/F 01787 247429 mrsepknight@laxfieldhouse.freeserve.co.uk 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) Mrs Elizabeth Priscilla Knight Post Vacant Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Terminally ill (1) of places Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Including one resident who is terminally ill Date of last inspection 15th December 2005 Brief Description of the Service: Laxfield House is situated in the village of Brent Eleigh. First registered in 1990, the home provides care with nursing for up to 31 older people. The home is accessed via a small track, and there is ample car parking provided at the side of the home. Due to its rural location there is a limited bus service. The nearest shops and post office are located 2 miles away at Lavenham. Brent Eleigh has its own church and public house, which are located close to the home. There are 23 single, and 4-shared bedrooms, all with en-suite facilities, including a shower. Communal rooms include dining rooms, sitting rooms and a large conservatory providing wheelchair access to the garden. The large garden has a selection of small seating areas, a summerhouse and a patio/terrace. Building and refurbishment work is currently being undertaken at the home, which is due to be completed during November 2006. The home is managed by the Matron Mrs Elizabeth Peters, whose application to be registered with the CSCI, is currently being processed. Charges for care (which includes personal laundry and colour television) are as follows: Residential Care Single room - £450 to £695 per week / Twin room - £375 to £465 per week Nursing care Single room - £600 to £795 per week / Twin room - £475 to £550 per week Short term respite care Residential care £600 per week / Nursing care £650 per week Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 8 ¼ hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Further information was received from the home on the day following the inspection, on fees and staff training. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home at the beginning of May. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the returned residents (19), joint relative/visitor (10), and staff (13) feedback cards have been included in this report. During the inspection time was also spent talking to residents to hear their views of the service, observing staff practice and sitting-in on the afternoon staff handover. Residents, staff, management and owners were helpful and co-operated fully throughout the inspection. A tour of the building, took in all the communal rooms and a sample of 3 bedrooms, laundry, and kitchen. Records viewed included, care plans, staff recruitment and training records, Fire Risk Assessment, Statement of Purpose, Menus and medication records. Previous visits to the home identified that people living at Laxfield House preferred to be known as residents, this report respects their wishes. What the service does well: What has improved since the last inspection? Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 6 To reduce any potential risk of residents being given the wrong medication, the home has reviewed its system for dispensing and transporting medication around the home. Staff now take residents medication records with them, enabling them to check the dosage being given, and dispense medication out directly to the resident, from its original pharmacist container. There has been an increase in staff training, and additional ‘sliding sheets’ purchased, to ensure there are enough for residents to have their own, to assist them with their mobility needs. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The home does not offer intermediate care, therefore this standard was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service can expect to have their needs fully assessed, to ensure that the home can meet the level of support they are looking for. All residents are issued with contracts, which clearly tell them about the service they will receive. Residents cannot be assured that the Service Users Guide will give them all the required information that they are seeking. EVIDENCE: Laxfield House is currently updating their Statement of Purpose as part of their application, to increase their registered numbers from 31 to 32 places, following completion of current building works. Therefore the document was not assessed as part of this inspection, but will be looked at in more detail as part of processing their major variation application. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 9 The home’s service users guide, titled ‘Welcome to Laxfield House’ is given to all service users. The guide informs the reader that its purpose is ‘to enable residents to understand the service provided and in doing so, reduce any possible anxieties’. The guide gives a good level of information on arrangements made for visiting services the home, such as the Hairdresser, Chiropodist, Optician and mobile library. There is also information on the different manual handling aids, which may be used by staff to ensure residents safety, when being assisted with their mobility. A summary of the Statement of Purpose has not been included in the service users guide. Instead, residents are advised that they are ‘free to read’, the Statement of Purpose’ which is situated in the reception area. Where the home does not give residents a copy of the Statement of Purpose, they must ensure a summary is included in the resident’s guide. To be more informative to the reader, the home needs to look at including more information on the day-to day routines of the home in the residents guide– for example meal times, and how to access local facilities. The guide also makes reference to the regulating body being the National Care Standards Commission, instead of the Commission of Social Care Inspection, which came into force in April 2004. All prospective residents are invited to look around the home, and spend time talking with staff who are happy to answer any questions. Feedback from CSCI resident surveys confirmed that they had been given enough information on the home, to be able to identify if it was what they were looking for. One resident said that they had tried ‘respite’ (short care break) first, which gave them a good insight into the home. Residents and relatives said they had also taken into account ‘local information’ on the home, which ‘had always been well spoken of’. One resident who had lived at the home for some years, said as they were ‘self funding’, they would have moved on, if they had been ‘dissatisfied’ with the level of service provided. Another resident spoke of having had a ‘very good first impression’, of the home, which since moving in, ‘had been proved right’. All but 4 of the 19 residents asked, said that they had received a written contract. Contracts for 2 residents were looked at, which confirmed that new residents were being sent a letter stating weekly costs, date of admission, and which room they will be occupying. However, permanent residents were not being sent a full contract, covering terms and conditions of residency – until after they had moved, and they had decided to stay. This led to discussions with the provider that new residents should be given this information, at the point of admission. This is to ensure they are fully aware of what they are paying for, and what is included in the costs. To address the situation, the provider acted straight away, by adding a sample copy of ‘Terms and Conditions’ to the Statement of Purpose. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 10 The new manager (referred to as the Matron) started in May 2006, and as yet, has not been fully involved in assessing and admitting residents. Therefore, the Matron was asked to ‘talk through’ their admission procedures, they would be following. This being: • On initial telephone contact, an enquiry form is completed which gives information on the prospective resident’s name, address, contact number, and any health issues. At this point, the home stated that they always inform the enquirer that they are not registered to look after people requiring dementia care. • A brochure is then sent to the enquirer. • The prospective resident and/or their family are invited to look around the home, which gives them a chance to ask any questions, meet residents and staff. • If there is no vacancy at that time, their name would be added to a waiting list. Staff would then continue to keep in contact with the person, to check if they still wanted to be kept on the list. • Once a place becomes available, the Matron will review the waiting list, taking into account any manual handling needs, and allocate the place. Arrangements are then made to visit the prospective resident, and carry out a pre-assessment, which will form the basis of the persons care plan. Feedback from relatives and residents, confirmed that Laxfield House had a good reputation within the local area, and many recommendations had come via ‘feedback from the community’ on deciding on which care home to move into. Written and verbal comments from residents, confirmed that the home did meet their expectations, and staff had the knowledge skills to provide the care they required. Comments included “I am happy here”, ‘ I have been visiting my parents over a number of years and have found the quality of care exceptionally good’ and ‘ we are very happy that our (relative) is so settled in Laxfield’. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.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. 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 using available evidence including a visit to this service. People using the service can expect staff to monitor their care, and take appropriate action to support their changing physical, and mental health needs. However, care plans do not show what involvement residents have had in their development and review, to ensure it reflects their wishes and preferences. The home has safe systems in place for the storage, administration and disposal of medications. EVIDENCE: The care for 3 residents was tracked during the inspection, which involved looking at their care plan, and where able, spending time with the residents to hear their views on the level of service provided. Care plans held copies of admission summary sheets, which staff had used to identify residents ‘long and short-term care needs’. Written on separate sheets, these gave more detail information on the identified needs, including nursing, and action to be taken by staff to support the resident. There was no evidence that residents had Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 12 been consulted in the drawing up of the care plan, and keeping it under review, to ensure it reflected the residents choices, and preferences. Mobility, dietary and skin risk assessments had been undertaken. Photographic records were kept of pressure ulcers and wounds, to support staff in monitoring its progress whilst healing. During handover staff were given information on any resident’s dietary needs being monitored, which included offering nutritional supplements. Information on care plans was being reviewed monthly, or as required. Care records showed that the local General Practitioner (GP) visited as required, and routinely once a month. Resident’s records also gave information on visits from/to Chiropodists, Dentist, Opticians and hospitals. Good practice was seen where Nurses had identified 1 resident as requiring support with their communication, and asked staff to promote communication by taking the lead in ‘instigating conversations’. However, no further information, had been given on ideas for topics of conversation, such as the resident’s interests, working life or family history, which would have been useful, especially to new and agency staff. A daily record is completed for each resident, which reflected the information given during the staff handover. One resident’s daily records referred to them ‘whining on and off’ which was a negative way of describing them calling out/speaking loudly, which was observed during the inspection. If staff felt that the use of ‘whining’ was accurate – work needs to be undertaken to see what the issues are, that are causing the resident to complain or raise concern. Care plans seen, gave a good level of information on resident’s nursing and physical needs, but did not fully cover how social and psychological health needs were being met, and monitored. There was no life histories, or information to evidence how the resident liked to spend their day, giving staff a ‘pen picture’ (insight) of residents likes and dislikes, especially if they are unable to communicate this themselves. Time spent with residents confirmed that they felt staff respected their privacy and dignity. This was observed during the inspection, with staff seen to knock and wait for a reply before entering bedrooms, and addressing residents by their first or surname, depending on the resident’s preference. Although the standard around dying and death was not assessed at this visit, residents care plans looked at, clearly stated their wishes in regard to funeral arrangements. Since the last inspection, staff have reviewed their medication procedures, to address previous requirements (see inspection report dated 15/12/2005) relating to how staff dispense, and transport medication around the home. Nursing staff now give out medication, straight to the resident from the labelled pharmacist’s box or bottle, which is transported around the home in a lockable container. Dispensing medication straight from it’s original container, Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 13 promotes safe practice and reduces any risk of residents being given the wrong medication. The lockable container also holds copies of residents Medication Administration Records (MAR) charts, which staff sign to confirm that medication has been given as instructed by the resident’s GP. Codes are also used to record any reasons why the resident may have not been given their medication. Generally the standard of recording medication received into, and out of the home was good. However 1 shortfall was identified where staff had forgotten to record the quantity of antibiotics received. The home has safe systems in place to dispose of medication no longer required. A sample check of 4 residents medications held against the homes records, including 1 controlled drug, was found to be correct. The home’s policies and procedures for safe dispensing of medication was not looked at during this visit, as the home had received a separate visit from the CSCI Pharmacist Inspector (7/2/06), which covered this area. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to choose their life style, and keep in contact with family and friends. Social and recreational activities do not currently meet all residents’ expectations and preferences. The home provides a healthy, varied diet according to residents assessed nutritional needs and choices. EVIDENCE: Out of the 20 residents who had completed CSCI surveys, 12 felt that the home always had activities that they could take part in, 3 said ‘usually’, 2 ‘sometimes’, and 2 ‘never’. Comments varied from ‘activities are always available and I am asked if I wish to participate’ to ‘I would like to see more activities being arranged. One relative wrote on their survey, ‘I would like to see more activities being arranged for the residents to enable them to remain alert and interested in daily living’. This view was also shared during discussions with 2 residents, who were aware that staff were “very busy”, but would like to be able to go out for walks more, which they could not do independently. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 15 The social event list for October showed that activities had been arranged for 18 out of the 31 days. Activities included a Doctors visit, Holy Communion, Manicure, and pre-dinner drinks. There were also Bingo and Scrabble sessions, and a resident who organised sessions, listening to classical music. One new activity, which a resident said they had “really enjoyed”, was “their first movement to music session” it was felt more activities like this should be arranged. Feedback from residents identified that sometimes due to staff sickness, organised activities such as manicures had been cancelled. Good practice was seen with the home contacting outside agencies to identify a ‘befriender’ for a resident. One care plan looked at, contained a social activity sheet, which showed the arranged activities they had joined in. This included “a party” at the owner’s house, where they had been able to invite relatives and friends. There were no individual social/daily activity living plans, linked around individual residents hobbies and interests. One resident said that they had really enjoyed a flower arranging session, and liked the more practical tasks/activities they could join in with. The location of the home being rural, benefits from being set in well kept, mature gardens, where residents were observed walking and sitting out during the inspection. Residents confirmed that their visitors can visit when they wished. This was also reflected in relatives/visitors feedback which confirmed that staff always made them feel welcome, and they were able to visit the residents in private. Good practice was seen with the recent ‘launch party’ of the home’s new ‘Laxfield House Magazine’. It includes anagrams, crosswords puzzles, jokes, poems and word searches. Staff hope that residents will contribute and make suggestions for what they would like to see featured in future editions. Although there is no information about issues affecting the home or useful information on the local community, the magazine could easily be developed in this way to keep residents updated. One resident was asked if they felt moving into a care home had restricted them in any way – were they still able to choose what they wanted to do?. They said they did not feel restricted, saying they would go to bed when they wanted, and as they “liked to get up early” that “staff are very kind” and always brought “them a cup of tea in bed”. The home does not hold residents money for safekeeping, instead residents are encouraged to use their lockable safes provided in their bedroom. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 16 Observation of the lunch service was positive, with staff assisting residents up to the table until just before the meal was served. During the morning residents were seen completing their menu choices, which is undertaken 2 days in advance. One resident did not want either of the 2 main choices for lunch, when asked what they will do, replied that they would request their favourite meal instead, which staff always cooked for them. Residents are given a menu list to complete their choices for breakfast, lunch and high tea, 2 days in advance. They are free to tick as many items as they wish off the list, and write any special requests. Breakfast, choices included fruit juices, Prunes, cereal, Porridge, Eggs (and how they would like them cooked), Bacon, Tomatoes, Sausage, Toast, Bread & Butter. Preserves, Tea or Coffee. Completed menus showed that one resident had written ‘crisp’ under the word toast. This reflected a comment made in the CSCI survey, where a resident had written ‘I just wish the toast at breakfast could be properly toasted & hot! - it’s a daily irritant’. Residents asked through the CSCI surveys if they liked the meals at the home? 7 replied ‘Always’ and 13 ‘Usually’. Although 1 resident who had ticked usually, had also said that they were ‘picky’. Another resident’s comments included that ‘there are always alternatives on the menu and I can always ask for something different if I don’t like any of them’. Prior to lunch the tables had been laid up, and were well presented with linen cloths and napkins, tablemats, cutlery and pre-ordered fruit juices. Residents had a choice of 3 dining areas, and the mealtime had a relaxed, unhurried atmosphere with staff offering assistance discreetly. Meals carried around the home were covered, and residents commented positively on the presentation of the dessert. Completed menus for the previous day showed residents were given a choice of Tomato, Orange, Apple or Cranberry juice to start. Garlic lamb with Soy Sauce or Macaroni Cheese, served with a choice of ‘Seasonal Vegetables’, Rice, and New Potatoes, followed by Chocolate Chip Bread and Butter pudding and/or Vanilla Ice Cream. High tea served at 6pm normally consists of Soup with crusty roll/toast or Bread & Butter, and a light cooked snack such as Fish Fingers and Baked Beans, Smoked Salmon with Prawns, Corn Beef Hash, sandwich with a choice of 2 fillings and dessert such as Crème Caramel. Hot drinks are served at set times during the day, and also available on request. Jugs of cold drinks were seen in communal rooms and resident’s bedrooms. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: Three out of the 10 relatives surveyed, said they were not aware of the home’s complaint procedure. During the inspection the complaints procedure was seen to be included in the home’s Statement of Purpose, and displayed on the Matrons office door. The resident’s users guide, did not give the full complaints policy, instead it made reference to discussing any concerns with the staff, or if not satisfied with the outcome, the proprietor or NCSC. From discussions with residents, and feedback from surveys, evidenced that residents felt comfortable to voice any concerns direct with staff. One resident when asked (CSCI survey) ‘Do you know how to make a complaint?’ had replied ‘Yes – but I don’t have many as most things are done to keep residents happy and as well as possible’. Staff record all concerns and complaints made in a book, which showed that no formal complaints had been made. Where concerns had been made, such as the ‘meat was tough’, staff had recorded in the book what action they had taken to stop a reoccurrence. The home’ s complaint procedure encourages people to contact the CSCI if they are unhappy in the way the home has handled their complaint. No complaints have been received by the CSCI since the last inspection. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 18 During the last inspection concerns were raised by the CSCI, that not all of the staff had received Vulnerable Adult Training, and therefore, may not be aware of the correct procedures to use when reporting abuse. The home was asked to address the situation by ensuring the appropriate training was arranged. Due to the home keeping individual training lists on staff files, it would have taken too much time out of the inspection day, for the inspector to check each file to see if the home had complied. Therefore, the home was asked to check the files and supply the CSCI with a list of all the staff that had completed the abuse awareness training. This was sent to the CSCI office the next day, and showed that staff had completed the training, and all new care staff now undertook the training as part of their induction. The home had the latest copy of Suffolk’s inter-agency policy procedures and guidance for staff, in reporting abuse, for staff to use as reference if required. Discussions with residents identified that they “liked” the staff, felt safe and had no concerns over staff practices. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a clean, comfortable and homely environment to live in, which has been furnished and maintained to a good standard. EVIDENCE: The inspection coincided with building work being undertaken at the home, which the CSCI had been made aware of through Laxfield House’s application to increase their registered numbers by 1. To do this, they are removing one bedroom and building 2 new bedrooms. The work also includes a new treatment room, Matron’s office, function room, and the nurses station is to be ‘upgraded’. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 20 Although building work is being undertaken, staff were ensuring during the inspection that the work did not impose on the residents daily lives. It was noted to be quite noisy at one stage during the morning, however this did not concern the residents, and everything was quiet at lunchtime, to ensure a relaxed atmosphere. Residents were seen to make full use of the conservatory, which looks out onto the home’s well-kept mature gardens and terraces. Residents were seen to be walking in the garden, and another informed the inspector they had “spent most of the summer sitting out”. All areas of the home visited were found to be clean, airy and well-maintained, taking into account current building works. Residents surveyed, confirmed that this was the normal standard of the home. With 1 resident writing ‘cleanliness is emphasized which the cleaners are very well aware, and so are conscientious at all times’. The arms and backs of armchairs had freshly laundered covers. This not only enhanced the ‘homely’ feel, but also assisted 1 resident, getting around, as their very limited sight, enabled them to “pick out the white arms of the chairs”. At the time of the inspection due to the building works, the bathroom was out of use, however, all residents had their own shower, and no complaints were raised. Bedrooms were personalized, and depending on the size of the bedroom, also held items of resident’s own furniture. One resident, said although they felt their bedroom was on the “smaller side” , it was plenty “big enough to meet their needs”. They also enjoyed the view over looking the gardens, and having ‘French doors’ leading out on to the terrace. Running the hot water in 1 resident’s en-suite, identified that although comfortably warm at first, the water became cooler. The home confirmed that all water outlets are fitted with safety devices to ensure the temperature of the hot water falls within safe temperatures. However, this related to the upper limit, and did not identify if the hot water was getting too cool. One resident had commented ‘Hot water in bathroom basin does not flow adequately’ in the home’s own quality assurance survey, no further information had been given if this concern related to the water pressure or temperature. An Environmental Health officer undertook a routine inspection of the new kitchen in June 2006, which found that the home had satisfactory arrangements in place for the cleanliness and storage of food. Residents were seen to move freely around the home, which has 2 lifts. CSCI surveys received from staff and residents identified that another hoist was required, as sometimes residents had ‘to wait to be transferred’. This also reflected a comment made in the home’s quality assurance survey, where 1 resident raised concerns over the availability of the hoist. Discussions with the manager and review of records identified they had sufficient hoists, however the problem may be more due to the layout of the building. Staff’s comments highlighted that delays were caused from ‘dragging hoists from one end of the Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 21 home to the other’; they also spoke of the difficulty fitting the hoist into the lift, which was a snug fit. One member of staff said ‘we need sliding sheets for every room that we use them in’. This was fed back to management, as there were also concerns about infection control. The Matron confirmed that new sliding sheets had recently been purchased, and there was enough for all residents who required them, to be able to have their own. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing physical and nursing needs of the residents. However, residents cannot be assured that the current staffing levels will address their social needs. EVIDENCE: The staffing levels as given in the Statement of Purpose, are: • • • 7.30am – 2.30pm – 1 trained nurse and 5 care assistants. 2.30pm – 9.00pm – 1 trained nurse and 4 care assistants. 9.00pm – 7.30am – 1 trained nurse and 3 care assistants. Rotas looked at, showed that the home tries to maintain these levels, using agency staff when applicable, such as on the day of the inspection. For consistency, they try to use the same agency staff. Relatives surveyed, were asked if they felt the home had enough staff, all had replied ‘yes’, with 1 relative adding ‘mostly’. This reflected the outcome of the resident’s surveys, with 13 out of 18 saying staff are ‘always’ available when they needed them, and 5 saying ‘usually’ they were. Residents commented during the inspection “staff seem so busy”. Although everyone spoken with, felt they received a good level of physical and nursing care, they expressed a wish for staff to have more time to be able to take them for walks, and arrange more activities (see Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 23 Daily Life and Social Activities section). However, residents said they were aware, that there were others requiring more care, and they needed to come first. They said a manicure session was cancelled due to shortage of staff. Residents said that there was no dedicated ‘activities person’ instead, the work was undertaken by staff who were on duty. They also said that this had led to sessions being cancelled if staff were off sick. With 7 staff having obtained an National Vocational Qualification (NVQ) award at level 2, the home has currently not achieved having 50 of their staff trained to this level. However, they have 6 staff wanting to access a training course, which they are looking to start in December. The home has also obtained funding for 2 members of staff to undertaken their NVQ 3. All new care staff undertakes their formal induction training with an external training centre, as well as undertaking the home’s 2-day induction. The expectation is for staff to then be able to access a NVQ course, as part of their on-going development. Without checking each individual staff’s training file, it was difficult to ascertain if all staff had received a minimum of 3 days training. However, from the sample of 2 staff training files looked at, it was identified that they had received this amount of training, which included, prevention of Vulnerable Adults, and Manual handling training. Ten of the 13 staff completing the CSCI survey felt that the home had a good training and development programme, to support them in their role. From the 3 staff that did not feel there was enough training, from information given this related to accessing NVQ courses (which the Matron is now organising) and manual handling training, which has now been undertaken. The new Matron confirmed that they were committed to ensuring staff received the level of training required, and were reviewing all staffs training needs. Action being taken was reflected in comments made by a member of staff ‘we have recently had a new Matron who is now putting into place sufficient training, but before I don’t feel there was enough’. Although the Nurse’s training files were not looked at during this inspection, Nurses are encouraged to access training through hospitals and specialist centres, to update their skills and knowledge. Residents spoken with, felt that staff did a good job, and raised no concerns over their professional abilities. To ensure the home was following safe recruitment procedures, 3 newly recruited staff records were looked at. This identified that the home was ensuring they had obtained references, Criminal Record Bureau (CRB) checks, and paperwork to confirm the person’s identity before they started employment at the home. However, the application forms did not clearly convey, that applicants should give information on their full employment history. This had resulted in 2 out of the 3 applicants not giving enough information on their previous employment, including any dates (and reasons) for when they may not have been working. Good practice was seen with the use of recruitment checklists, to track all required paperwork had been received. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff feel supported by the management, and are committed to providing a good level of care within a safe environment. EVIDENCE: The new Matron, Mrs Elizabeth Peters, was promoted from Deputy Matron to Matron in May 2006, so was already known to the residents. This enabled the ‘Matrons’ to have a handover period, resulting in a smooth transition for both residents and staff. One resident described the Matron as being “very kind”. Mrs Peters has applied to the CSCI to become registered, as a manager with the Commission, and their application is currently being processed. Qualifying in 1983 as a Registered General Nurse (RGN), Mrs Peters has gained experience in Orthopaedics, and has worked 10 years as a Community Nurse. Although Mrs Peters does not hold a Certificate in Management qualification, Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 25 they are currently to address the situation by undertaking the Registered Managers Award. Discussions with residents and staff, and observation during staff ‘handover’ showed that the management approach of the home creates an open, positive and inclusive atmosphere. The handover was informative, and staff felt comfortable to ask any questions or clarify any information given. The owner, who lives close by, is in regular contact with the home, and had recently invited all the residents and their guests, to lunch at their home. Thank you letters seen, showed residents and visitors had enjoyed the event. The home has recently completed their annual quality assurance survey, which was sent out to all residents, and is in the process of analysing the results. Residents were asked to respond to all questions by ticking the ‘Very Satisfied’, ‘Quite Satisfied’, ‘Not Very Satisfied’ and ‘Not very satisfied’ boxes. The questions asked, covered all areas of the service provided, catering, personal care and support, daily living, premises and management. There was also space for residents to write any additional comments or suggestions they may have. Once this has been analysed the residents will receive a copy of the results. This led to discussions that it would also be informative to add to the home’s Statement of Purpose. From the completed surveys seen, the majority of the answers fell in the ‘very satisfied’ and ‘quite satisfied’ groups. Residents had made constructive comments, which the home will look at, as part of their on-going review of the level of service provided. It was noted that the resident’s names had been written on the surveys before they were given out. Although the home felt this would make it easier to address any individual concerns raised, staff were asked to make sure in future, that residents are able to complete them anonymously, with residents being able to add their name - if they wished. The quality assurance work covers the views of people living in the home, therefore further work needs to be undertaken to include feedback from families, friends and stakeholders (e.g. GP, Hairdresser, Chiropodist) on the level of service they feel the home is providing. The home does not offer safekeeping facilities to look after resident’s monies, instead all residents are provided with either a lockable safe or drawer in their bedroom, and encouraged to use these. Where residents do not wish to pay directly for services such as hairdressing, newspapers, chiropody, the home will pay, and invoice the resident. Monthly accounts for care home charges were seen, and showed where applicable, invoices for other services including copies of receipts. To ensure residents safety, training record showed that staff received mandatory manual handling, food hygiene, infection control and fire safety as part of their induction. Where 1 member of staff had stated on their CSCI Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 26 survey that they had not received manual handling training, further contact made following the inspection, identified that they had now received the training. During the tour of the laundry, it was noticed that where staff had transferred cleaning liquid into ‘trigger bottles’, as per manufactures instructions. However, the hand written labels on the bottles did not give all the required safety information. Although not in an area normally accessed by residents, the home was not complying with Control of Substances Hazardous to Health Regulations (COSHH). As soon as this was pointed out to the management, contact was made with the home’s suppliers, and arrangements made to send the required labels. The day following the inspection, the home contacted the CSCI, to confirm that they had received the labels, and the containers were now appropriately labelled. A COSHH file was kept in the laundry, which listed the different cleaning fluids used by the home, with any relevant data, which had been updated by the home. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 x x 3 Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 28 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 OP1 OP2 Regulation 5 (1) (2) (3) Requirement The home must review their Service Users Guide to ensure it contains all the required information, and supply a copy to new and existing residents using a suitable format, which meets their needs. A copy must also be forwarded to the Commission. The home must ensure a record is kept of all medication received into the home. The home must ensure that they have a range of social and recreation facilities, which meet all residents’ individual preferences and interests. A full employment history must be obtained, and where required action taken to validate information given, before staff start work at the home. Timescale for action 20/11/06 2. OP9 13 (2) 12/10/06 3. OP12 16 (2) (m) (n) 31/01/07 4. OP29 19 (1) (b) Schedule 2 (4) (6) 12/10/06 Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The home should consult with service users, to obtain their views on the home, and what they feel could be included in the Service users guide, to support new residents coming to live at the home. This should also include looking at different formats, to ensure it meets different resident’s sensory needs. The home should review their paperwork, to ensure any reference to National Care Standards Commission has been amended to Commission for Social Care Inspection. Care plans should evidence how residents have been consulted in putting the information together, and the ongoing review of their care plan. This could include the use of ‘life histories’ and information on how the resident would like to spend their day. Staff should ensure that the wording used to described residents actions, for example ‘whining’ truly reflects the situation/action being observed. The home should look at having a separate person to organise group, and 1 to 1 activities and social support for residents, who is not included in the care numbers to ensure a consistent and varied approach. Staff should consider developing their ‘in-house’ magazine further, to include local information on what’s happening in the community, including any contact numbers, and updating residents on any changes happening in the home (e.g. new staff, update on building works). The home should review the location of the hoists, to ensure they are stored in the most appropriate areas, and asses to see if another hoist is required, taking into account risk assessments of staff transporting the hoists around the building, and potential delays in residents being able to access the hoists. 2. OP1 3. OP7 4. OP8 5. OP12 6. OP13 7. OP22 Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 30 8. 9. OP25 OP38 The home should monitor the hot water temperature to ensure it does not full below the range of 41 - 43° The home should put systems in place to ensure labels on cleaning bottles remain in good condition and contain all the required safety information. Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laxfield House Residential And Nursing Home DS0000024431.V315891.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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