Inspection on 15/12/05 for Laxfield House Residential And Nursing Home

This inspection was carried out on 15th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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... 12/10/06

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

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

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

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Claremont House

Oak Ridge

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Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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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 Helen Fontaine Unannounced Inspection 15th December 2005 09:00 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 Laxfield House Residential And Nursing Home DS0000024431.V273895.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. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 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 01787 247495 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 Miss Joanne Sandra Emms 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.V273895.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Including one resident who is terminally ill Date of last inspection 5th October 2005 Brief Description of the Service: Laxfield House is situated in the village of Brent Eleigh. First registered in 1990, the home provides nursing care for up to thirty-one older people. The home is accessed via a small track, which leads to the large modern building sent in mature landscaped gardens. Due to its rural location there is a limited bus service. The nearest shops and post office are located two miles away at Lavenham. Brent Eleigh has its own church and public house, which are located close to the home. The accommodation consists of twenty three single rooms, and four double rooms, all rooms provide an en suite facility, which consists of a lavatory, hand basin and shower. Communal rooms include dining rooms, sitting rooms and a large conservatory providing wheel chair access to the garden. The large garden has a selection of small seating areas, a summerhouse and a patio. The home is managed by Miss Joanne Emms. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Laxfield House took place over four hours and was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. The manager of the home, Miss Joanne Emms, who is referred to as the matron, assisted the inspector; this term will be used throughout the report. During the inspection five residents were spoken to, a tour of the building was undertaken and a number of records were looked at. What the service does well: What has improved since the last inspection? What they could do better: The home does need to improve their knowledge of the practical procedures for reporting abuse and that all staff are fully aware of the homes policies, procedures and practices. The home does need to make sure that all staff are fully trained and conversant in issues with adult abuse. The home also needs to make sure that it’s residents feel able and know who they can report any issues around adult abuse, as well as any concerns or complaints. The home Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 6 needs to make sure that they have regular residents meetings that are documented, as an opportunity for residents to express any concerns or requests. The home’s medication practices are considered by the Commission to be inappropriate. The home does need to make sure that they review their current medicine administration practice and this has been referred to the Commission’s Pharmacist Inspector. 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. Laxfield House Residential And Nursing Home DS0000024431.V273895.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 Laxfield House Residential And Nursing Home DS0000024431.V273895.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): 2 The residents on entering the home will receive a written contract, statement of terms and conditions with the home. EVIDENCE: Two residents files were looked at, one was for the newest resident in the home and the other was a resident that had been in the home for sometime. Both of the files contained the home’s written Statement of Terms and Conditions. The document was in sections and these covered the areas of, resident and payment fees and medical, personal requirements and fire precautions. The proprietor and the next of kin for both of the residents files looked at had signed the document. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 9 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): 8, 9 and 11 People who use this service can expect to have their health needs met and have an individual plan of care drawn up, however they cannot be assured that the present practices with medication will protect them. Service users final wishes will be on record on their care plan and be acted on. EVIDENCE: The home does meet the health needs of its residents as there are qualified nurses on duty at all times, as the home is registered as a Nursing home. The care plans for three residents were looked at; one for a resident who is terminally ill and a married couple that live in the home. The care plan documents from the pre-admission assessment, the residents pulse, blood pressure and temperature, as a guide of any changes over the time they are living at the home. The home’s care plans looked at documented any nursing needs, that the home’s own qualified staff meet. The care plan had a section for visiting health professionals with two documents, the first document being divided into various health professionals, GP, Hospital, opticians, chiropodist, and dentist. The other form was GP visits and the outcome of the visit with any new treatments. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 10 The care plans looked at also had a section around death and dying and this was covered on the care plan at the beginning. The care plan looked at had a section, which documented what undertakers the resident wished the home to contact, in the event of their death. The home’s practices around medication are considered by the Commission to be in appropriate. The inspector observed the sister on duty giving medication during the resident lunchtime. The sister said that she had dispensed the medication into marked containers, earlier that morning. The medication had been dispensed into marked pots and then placed in a locked cash tin. The sister did not complete the Medical Administration Records Sheet but when asked by the inspector said they completed were when they had finished all the medication administration. The Commission for Social Care Inspection, considers these practices inappropriate for the following reasons: The removal of medicines from original pharmacy prepared containers into secondary containers introduces a level of risk. Medical Administration Records charts are not examined immediately prior to administration of the medicine. This practice may result in a differing person being involved in the actual administration of the medicine than that preparing the medicine. Medical Administration Records charts are not completed immediately after each medicine administration. The storage of medicines on top of the trolley may not provider adequate security. This judgement is based on the RPSGB guidance ‘The Administration and Control of Medicines in Care Homes and Children’s Homes 2003’ and Nursing & Midwifery Council guidelines as enshrined in the Standard 9.4 of the Care Homes for Older People, National Minimum Standards Care Homes Regulations. This matter has been referred to the Commission’s Pharmacist Inspector who may undertake a further visit to monitor compliance with safe medicine administration practice. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 11 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): These standards were not tested on this visit. However evidence from the last inspection was that, residents can expect that the lifestyle experienced in the home satisfies all their needs. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the four standards. At the time of the last inspection, all of the outcome standards were assessed as met. These standards will be re-tested at a future inspection. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service may find their complaint is not taken seriously and that they may not be protected from abuse. EVIDENCE: Residents spoken to during the inspection had mixed views on whether their complaints and concerns would be listened to. One resident said, “If they did everything that we commented on, we would be left with nothing to talk about.” Other residents spoken to commented positively about the support and felt that if they had any concerns they would tell the staff and it would be acted on. However another resident was not confident that they would be listened to and had not told anyone of a complaint they had. The home must make sure that all residents feel able to and know how to complain and that it will be listened to and action taken. The home must make sure that residents meetings take place, to give the residents and possible their relative a forum to air their views. This does need to be documented and then a copy given to the residents as a form of reference for the next meeting. The home does need to be committed to having an open culture within in the home, which enables residents to feel confident to make complaints without any fear of victimisation. During the inspection an incident was brought to the notice of the inspector and an Adult Abuse procedure was put into action. The matron of the home had some difficulty in being clear about what the procedures were, the home does need to make sure all staff have training in Adult Abuse as a matter of urgency. The home must make sure that all it’s residents are safeguarded Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 13 from physical, financial/material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, as a matter of urgency. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 This home provides a clean and well-maintained environment for service users. The communal facilities are of a high standard and service users are able to personalise their own bedroom. EVIDENCE: During the inspection a tour of the home was undertaken and it was noted that the home is kept to a very high standard. It was spotlessly clean and yet not clinical, this is a difficult balance and something the home has really achieved. All the residents spoken to could not compliment the home enough for the high standard that it is maintained. The home’s domestic, handyman and laundry assistant are to commended for their hard work. The home has a number of smaller dining rooms, rather than one large one and these rooms can double up as quiet room or visitors rooms. The home also has a conservatory, where a number of residents were sitting listening to light music. One resident commented on how they like to sit in the conservatory and look at the lovely gardens. The home makes a particular effort not to have the television on, unless the residents request to watch a Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 15 particular programme. At the time of the inspection the activity was music and with the festive season so near the residents were listening to Christmas Carols. Each of the residents had their own room with en-suite and in addition to their showers the home had a number of additional bathrooms if they wanted a bath. All the rooms seen were personalized; these were furniture and pictures of families as well as treasured ornaments. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 People who use this service can expect that the number of staff, will allow their needs to be met EVIDENCE: The home has on duty through the whole twenty-four hour period, a trained nurse. On the morning of the inspection the matron was working, sister and six care assistants, three domestics, one cook and kitchen assistant. The home also has a handyman and a gardener that helps with decorating internally and externally. The matron said that normally the home has five care assistants, but there are currently twelve residents needing the support of two staff at all times. During the afternoon shift the matron is still present, a sister and four carers, and at night there is a sister and three carers. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 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 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): 33 and 35 People who use this service can expect to live in a home that is well managed with policies and procedures that protect their health and safety. EVIDENCE: The home has in place a quality monitoring procedure and the homes policy lays’ out its aims. The home has a questionnaire that covers all areas of service in the home. The questionnaire asks the residents various questions about the home and gives them a choice of A, very satisfied, B, quite satisfied, C, not very satisfied and D, not satisfied at all. The questions cover the areas of, food provided, efforts to satisfy your individual requirement, religious and cultural needs. There was a section on the questionnaire about the homes menu’s and another eight questions around the food. Section B in the questionnaire was about personal care and support, C was about daily living, D the premises and E management and general comments. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 18 The home’s admin assistant deals with the resident’s finances, however a number of residents are responsible for their own finances and there is a safe in the rooms for this purpose. All the extra’s like hairdressing are billed to the home and the home then bills either the resident themselves or the families. The matron said that there are no residents that the home manages their finances and they either manage it themselves or family/representatives do. Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 1 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X X Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 20 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 OP16 Regulation 21 Timescale for action The registered manager must 16/01/06 make sure that all residents feel they are able to make a complaint and that this will be listened to. The registered manager must 16/03/05 make sure that all staff receives training in adult abuse. This has been a Recommendation on two previous reports. The Registered manager must 16/01/05 review current medicine administration practice. Requirement 2 OP18 13(6) 3 OP9 13(2)(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Laxfield House Residential And Nursing Home DS0000024431.V273895.R01.S.doc Version 5.0 Page 22 - 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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