Inspection on 22/07/08 for The Laurel

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 The Laurel 23 Park Lane Swindon Wiltshire SN1 5EL Lead Inspector Elaine Barber Key Unannounced Inspection 22nd July 2008 10:10 The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 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 The Laurel DS0000071732.V365247.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 Adults 18-65. 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. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurel Address 23 Park Lane Swindon Wiltshire SN1 5EL 01793 496458 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) Wardsign Limited Mr Robert Theobald Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection This is a new service Brief Description of the Service: The Laurel is a large semi-detached house in the Rodbourne area of Swindon. It is close to local shops including the Designer Outlet Village on the site of the old railway works. The house is in keeping with other houses in the street. The home has recently seen a change in ownership. Dr Chetna Satra of Wardsign Ltd, now owns the home. Mr Robert Theobald is now the Registered Manager. Mr Theobald is also the manager of Dean Park, another care home, run by the same company, which is next door to the Laurel. The Laurel provides care and support to six adults who have learning disabilities. There is a lounge, dining room, kitchen and two bedrooms on the ground floor. One of the downstairs bedrooms has an en-suite shower. There are two single bedrooms, and one double bedroom upstairs with a toilet and shower and bathroom and shower. There is a large garden and a garage, which is being converted into a room for activities. There is at least one member of staff on duty in the home. One member of staff sleeps in at night for both the Laurel and Dean Park. The manager covers both homes. The fees are paid by the local authority and are negotiated according to a person’s needs. Information is available in a statement of purpose. Copies of inspection reports are available from the home and can also be seen on the Commission’s website at: www.csci.org.uk The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors visited the Laurel on 22nd July 2008 and staff did not know they were coming. Mr Theobald was available at times during the inspection. Feedback was given to Mr Theobald at the end of the visit. The manager sent us an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they are performing. It also gave us information about what had happened since the new owners took over the home. We met with five people who lived in the home. The sixth person was away at the time of the visit. We met with the two staff on duty during the day, to obtain their views about the service. We also observed interactions between the staff members and the people who lived in the home. As part of the inspection process, we sent surveys to the care home for distribution to the people who lived there and their relatives. We received surveys back from three people who live at the Laurel and two relatives. We looked at various records and documents during the visit. These included care plans, risk assessments, health care and arrangements for managing medication, activities, complaints, staff recruitment and training. We looked at systems such as health and safety and quality assurance and also the accommodation. During the visit we assessed all key standards. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people who live in the home. What the service does well: People’s needs had been assessed before they moved into the home so that their needs could be identified. New care plans were being developed. These included more up to date information about people’s needs and abilities. They were written from the point of view of the person and clearly showed how each person liked to be supported to make sure that their needs were met in ways that suited them. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 6 People had opportunities to make choices and decisions and to be involved in all aspects of life in the home. This was helping them to develop their abilities and independence. People had opportunities to access various social activities both inside and outside of the home. Links with families and friends were maintained, where possible. Peoples’ rights were respected and promoted. People were offered a varied diet and could choose their meals. People received health care support in ways they preferred and required. People’s immediate health care needs were being met. Each person saw their GP and other healthcare professionals such as the dentist, optician, community nurse and podiatrist as needed. Most people had single bedrooms and there was a large amount of shared space. There were sufficient toilet and washing facilities for people. The laundry facilities were sufficient to meet people’s needs. People were benefiting from support from staff who were properly recruited, inducted, qualified and supervised. The appropriate recruitment checks were being made before new staff started to work with people. Three people had been involved in interviewing for new staff. Staff had induction and other basic training. Several staff had National Vocational Qualifications (NVQ) in care. Staff had regular supervision with the manager. People were benefiting from a home run by a manager who is appropriately qualified and experienced. The manager had identified many service improvements and was working towards developing these. People’s health and safety were generally promoted within the home. What has improved since the last inspection? What they could do better: The manager was developing key information for the service including policies and procedures and the service user guide. This will provide information for people about the service in ways that they understand. More work needs to be done to develop the care plans and risk assessments. The support guidance should be developed further to include people’s diversity needs and promote equality of opportunity. The risk assessments should take account of particular risks to each person as well as the benefits to them of taking risks. This will help to make sure they have opportunities for independence and they are kept safe. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 7 Improvements need to be made to the recording of medication to show that people are being given the right mediation at the right time. When staff are storing medicines for people a cupboard, which complies with the requirements for the storage of controlled drugs in care homes, should be obtained so that if people are prescribed controlled drugs they can be stored safely. There were systems for recording any complaints or concerns, however these need to be further developed to make sure people’s complaints are listened to and acted upon. Greater care needs to be taken to ensure that people are safeguarded from financial abuse. Information about what is included in the fees should be included in the statement of purpose and service user guide. Although the home is clean and tidy, most areas would benefit from being redecorated and refurbished. It would be good practice to keep a complaints log in the home, so that any complaints or concerns are recorded, along with timescales and outcomes to make sure people’s complaints are listened to and acted upon. The complaints policy needs to be updated to make sure people’s complaints are followed up. The recruitment process could be improved by introducing a checklist and a risk assessment when staff start work before their Criminal Records Bureau check is returned. This will help to reduce the risk of people being cared for by unsuitable staff. The introduction of learning disability award training as prior knowledge for National Vocational Qualifications and equality and diversity training would give staff a greater understanding of people’s needs and best practice. The monthly visits by the owner should focus more on the standards of care in the home to ensure people are receiving appropriate care. As this is a new and developing service and he needs support to improve it, it is important that the manager receives regular supervision by his line manager, and that records are kept. A quality assurance system must be developed based on people’s views so that the home is run in people’s best interests. The owner should produce a development plan, prioritising areas to focus on, to assist the manager in developing the service. Improvements need to be made to the health and safety arrangements so that people are kept safe. This includes conducting a fire risk assessment, making sure fire instruction to staff and fire drills happen, reviewing the environmental risk assessments, particularly risks relating to hot water and hot surfaces, and making the upstairs carpet safe. 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. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is adequate. Up to date information was not available for people about the service offered by the new owners so that they would know what to expect from the service. People’s needs were assessed before they moved into the home so that their needs could be met. Each person had a contract with social services and the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the Statement of Purpose. This contained the required information but it was in quite small print and not easy to read. We also looked at the service user guide. This was an amended version of the document produced by the previous owners. It was also not in an easy to read format and people did not have a copy. The manager told us that he was still developing the service user guide and he intended to put it into formats that people could understand. Three people completed surveys. Two had help from support workers, one completed their survey independently. Three said they were asked if they wanted to move into the home and they got enough information to decide if it The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 10 was the right place for them. Two relatives who completed surveys said they always received enough information to make decisions and one said they usually did. We looked at the files of three people. Each of these people had had their needs assessed by a social worker before they moved into the home. Each person had a person centred plan, which contained assessment information about their needs. We saw that each of these three people had a contract with the home and the social services department. There have been no new admissions to the home since the change of ownership. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate Written information was being reviewed and changed to make sure that people’s needs were met and they could take risks as part of an independent lifestyle. People had opportunities to make choices and decisions and to be involved in the all aspects of life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three people’s personal files. Each person had a person centred plan, which had been developed by the previous owners of the care home. The plans were very long and complicated and not easy to read. The manager told us that he and the staff were developing new person centred plans for all the people who lived in the home. He told us that he wanted the plans to be working documents for the staff and to be kept up to date and reviewed regularly. He also told us that he wanted the keyworkers to develop the plans with each person. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 12 The three people had new style plans called support guidance. When we looked at these we found that they contained sections about personal hygiene, activities and work, monies and finance, household, spirituality, communication, food and eating, drinks and drinking, sexuality, behavioural support and emotional support. We noted that some sections, including spirituality and sexuality had not yet been completed. The other sections were completed from the point of view of the person and contained information about their abilities. They clearly showed how the person liked to be supported and how they were able to make choices. However, the guidance did not yet provide any information about the person’s diversity needs. For example how, as a person with a learning disability, they would be supported to integrate into the community, and how needs related to their sexuality, spirituality and culture would be addressed. Two relatives told us in their surveys that the care home always meets the needs of their relative and one said that they usually met their needs. There was information in the care plans about how people made choices, for example, choosing how to spend their money. The manager, a member of staff and some of the people who lived at the Laurel told us that people chose what time they went to bed. One person liked to go to bed around 9 pm while other people liked to stay up later. The manager told us that people had chosen where to go on holiday during a house meeting. There was information about the holiday on a notice board in the dining room. One person told us that they helped with the shopping and liked to choose what food to eat. The manager told us that people were more involved in choosing the menus. We saw new style menus, which had pictures on them. One person told us that they talked about the menus during house meetings. During our visit we saw the manager and a member of staff ask each person what they wanted for their evening meal. Three people told us in their surveys that they always made decisions about what to do each day, and could do what they wanted during the day, evenings and weekends. One said that they were supported by staff to make decisions and frequently went out at the weekend with friends. There were examples in the person centred plans of how people were involved in the routines of the home such as meal preparation, washing and making drinks. A member of staff told us that people were supported with the cleaning, meal preparation and hanging out the washing. The manager said that people were being encouraged to be involved in the running of the home and doing more things for themselves. He said that people were able to be more involved but had not been used to doing so. There was a section about risk in the old style person centred plans. We noted that people had risk assessments which were identical and included more general risks such as open windows, uncovered radiators, helping in the kitchen, moving round the home and going out in the community. These assessments had been produced by the previous owners. The new manager told us that they were still using some of these and they had reviewed them. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 13 The manager also told us that new risk assessments were being developed when new risks arise. We saw a new risk assessment that had been developed for one person who had had a fall and been admitted to hospital. It focused on keeping them safe from falls. However, their risk assessment about radiators said that they were not at risk from hot surfaces. None of the radiators were covered and their risk assessment in relation to radiators should be reviewed. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. People had opportunities to access various social activities both inside and outside of the home. Links with families and friends were maintained, where possible. Peoples’ rights were respected and promoted. People were offered a varied diet and could choose their meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the home two people were at home. One person was sitting in the lounge, while the other person was tidying their bedroom. Mr Theobald explained that he was planning to accompany one person on a visit to the doctor during the morning. People told us about a barbeque that had taken place at the weekend. The daily notes reported that families and friends had been invited to the event. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 15 One person commented that their sister and sister in law had come with their husbands, which they enjoyed. They added that they ‘enjoyed the hot dogs’. The house diary and daily notes recorded various activities that have taken place. These included trips to Jubilee Gardens, attending local fetes, shopping trips, farm visits and going for walks in the park. One person who lived at the home told us they regularly attend local football matches. The person added that they enjoyed visits to a local venue to see tribute bands. They reported that the manager had arranged the tickets for two people to attend. The manager accompanied them. Some people who use the service attended Upham Rd day centre during the week. On the day of our visit, one person reported that they had attended a meeting at the centre that day, and showed us a copy of the agenda. When people arrived back to the home from the day services, they all appeared relaxed and comfortable in the home environment. People chatted to the manager and staff and discussed what had happened during their day and what their plans for the evening and next day would be. One person had plans to go swimming that evening. A poster on the dining room wall, informed people of a holiday planned for September to Butlin’s in Bognor Regis. Mr Theobald explained that the venue was decided by the people who lived at the home during a ‘resident’s meeting’. He added that one person from Dean Park and their friend would also be joining everyone on the holiday. People we spoke to confirmed that they were looking forward to the trip. Mr Theobald reported that some times he brings in his guitar and they will have a music session. He told us that he is hoping to convert the garage into an activity room, which can be shared between both homes. The garage already had an electric organ and musical equipment for people to use. He showed us a canvas he had prepared with one of the people who lived at the home. The people who use the service, if they wish to be involved, could then paint these. One person explained that they were currently doing some voluntary work locally. They explained their role as ‘ a meeter and greeter.’ They added that they were also involved in an advocacy project. Care plans demonstrated that people were involved in some household tasks if they wished to do so. One plan stated that ‘X enjoys helping with household tasks such as preparing their dinner. It reminds staff to ‘praise x after they have completed tasks, as it is important that x feels appreciated.’ The statement of purpose stated that ‘overseas trips are organised to give residents a wider choice of enhancing their knowledge.’ There was no The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 16 evidence to indicate that this has happened. Mr Theobald reported that as far as he was aware this had not happened to date, although there were plans for a summer holiday. Records demonstrated that the people who used the service were supported to make decisions where possible. People told us that they were involved in making food purchases for the home. The weekly menu showed that people had the opportunity to choose what they eat. Photographs of set meals supported the menu. One person told us, that they had suggested some changes to meal times and that this had now taken place. The manager confirmed that mealtimes had changed so that people could go to bed at a time that reflected their age. We looked at the menus, which appeared varied and well balanced. The staff added that they have a good knowledge of people’s likes and dislikes. There appeared to be adequate supplies of food available. There was plenty of fresh vegetables in the fridge and ample fresh fruit in the fruit bowl. We found bottles of squash being stored in a cupboard under the sink, with scouring pads. We asked the manager to move the bottles to a more appropriate place. Fridge and freezer temperatures were regularly checked and recorded. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. People received health care support in ways they preferred and required. People’s immediate health care needs were being met. People were not wholly protected by the medication practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw in the person centred plans records of how people liked to be supported. Personal care took place in the privacy of the bedrooms and bathrooms. Each person was registered with a GP and had a health action plan. These plans identified any health needs and action taken to meet these needs for example appointments for different health checks. They did not contain evidence of routine health screening such as access to well man clinics. Appointments with health professionals were recorded. We saw that people had appointments with their GP, the community nurse, continence nurse, podiatrist and dentist. One person said that they also had hospital appointments to have special shoes made. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 18 There were records in the person centred plans of people’s consent to take medication. Medication was stored in a locked cupboard. This did not meet the requirements for the storage of controlled drugs. However, no controlled drugs were prescribed at the time. A local pharmacist provided the medication and also some printed medication administration record (MAR) sheet. Medication received was recorded on these sheets. There were also separate records of the weekly audit of medication received into the home, administered and returned to the pharmacy. We observed staff giving medication to one person on two occasions. They put the tablets into a medicine pot and gave them to the person with a drink of water. They watched the person take the tablet then signed the MAR sheet. We looked at the MAR sheets and saw that there were some gaps in them where staff had not signed or recorded a symbol. It was therefore not clear whether the person had had the right medication at the right time. We saw that some written additions had been made to the sheets. Some of these had been signed by one member of staff but not dated. Some additions were neither signed nor dated. It was not possible to tell when the addition was made or when. It was also not possible to cross reference the changes with the health care records to see whether a doctor had directed the change. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. There were systems for recording any complaints or concerns, however these need to be further developed to make sure people’s complaints are listened to and acted upon. Greater care needs to be taken to ensure that people are safeguarded from financial abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a copy of the complaints procedure within the statement of purpose. The procedure is in need of reviewing as it was last updated in 2003. There are forms available for registering a complaint, which were used by the previous owner. We discussed with Mr Theobald the need to develop a complaints log, which will provide timescales, actions taken and outcomes. The manager confirmed that he would action this. Staff members told us that they have seen a copy of the local protocols for safeguarding people, ‘No Secrets’. They confirmed that they understood the contents of the guidance and the ‘whistle blowing policy’. Staff confirmed that they had attended training in safeguarding people. Some people had some of their personal monies held for safekeeping. We examined financial transactions, examined receipts and checked that cash within the personal money tins balanced with the records. Two people’s cash The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 20 tins held by the home were sampled. Both cash and records balanced for both people. There needs to be greater clarity within the Statement of Purpose and Service User Guide as to what is included within the fee for living in the home and what people can expect to pay for themselves. It was noted that people were paying for their own meals when they were on shopping trips or visiting the pub for lunch. One staff member confirmed that the people who lived in the home purchased their meals, while staff paid for their own meals when they were out. The Statement of purpose clearly stated that ‘three meals are provided daily’. If people are to be expected to pay for meals on day trips this needs to be clear within the Statement of Purpose and Service User Guide. However, people who live at the home should not be regularly paying for their main meals, these should be included within their fees. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 Quality in this outcome area is adequate. Although the home is clean and tidy, certain areas would benefit from being re-decorated and refurbished. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was a large mid terraced house situated on a main road close to Swindon town centre. It was in keeping with other houses in the street. We looked at all the communal living areas, including the lounge, dining room and recreation room in the converted garage, and the bedrooms. There were three people’s bedrooms on the first floor and two bedrooms on the ground floor. One of the ground floor bedrooms had an en-suite toilet and shower. The home was clean, tidy and free from any offensive odour. Three people said in their comment cards that the home is always fresh and clean. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 22 We saw that new fire doors had been fitted throughout the home since the new owners took over. We noted that most areas of the building were showing signs of wear and tear. There were cracks around the shower tray in the shower room and some of the wash basins in people’s rooms were very low and had worn looking vanity units. The manager told us that there were plans to decorate the communal areas and the bedrooms. There was mould on the walls in the double bedroom. Some of the duvet covers and sheets looked worn and thin. We noticed that the lock on the door in the shower room did not work. There was a laundry area next to the dining area. This contained a washing machine and tumble drier and there were hand wash facilities for staff. Cleaning materials were stored in a locked cupboard under the sink. There were infection control guidelines. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. People were benefiting from support from staff who were properly recruited, inducted, qualified and supervised. The introduction of learning disability award training as prior knowledge for National Vocational Qualifications would give staff a greater understanding of people’s needs and best practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the rota, which showed that there was usually one member of staff on duty during the day. The manager also worked during the day in both the Laurel and the home next door. There was one member of staff on duty in the evening for the Laurel and one member of staff sleeping in at night for both homes. A member of staff told us this was usually the case and there were sometimes two staff on duty to support people with activities. We looked at the files of two staff who had been recruited by the new owners since they were registered. The staff had both completed an application form including a declaration that they had no convictions. One member of staff had The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 24 some gaps in their employment record and the manager had made notes on their application form about the reasons for the gaps. Both staff members had completed separate declarations that they were physically and mentally fit. Copies of their birth certificates and passports were being kept as proof of identity. Two written references, a protection of vulnerable adults (POVA) first check and a criminal records bureau (CRB) check had been received for one member of staff before they started work. It was not easy to tell from the records what date this member of staff had started work. Two written references and a POVA first check had been received for the second member of staff before they started work. The manager told us that this staff member had started work on the day of the inspection and they were working with them until their CRB check was received so they would be supervised at all times. We also noted that the new member of staff had taken people out to lunch accompanied by another member of staff. We did not find an assessment of the risk to people who lived in the home of allowing this member of staff to work with people before their CRB check was received. One person told us that they had been involved in interviewing the staff. The manager told us that two other people had also been involved in interviewing the staff. The statement of purpose said that staff were given in house training up to National Vocational Qualification (NVQ) level 2. The first member of staff had an NVQ level 2 in health and social care. The new member of staff already had NVQ level 2 and had received a range of training in a previous job including prevention from abuse. The first member of staff was receiving an induction using the Skills for Care common induction standard. We noted that an induction booklet with the common induction standards was in the new member of staff’s file ready for them to complete. We did not see any evidence of Learning Disability Award training being used although there was a reference to it in the common induction standards. We noted when looking at the care plans that equality and diversity issues were not being addressed fully in the plans. Staff would benefit from equality and diversity training so that they can recognise and record how to meet these needs. We saw supervision records in the file of the first member of staff. These showed that they had had supervision meetings with the manager about once a month since they started work. The supervision format covered training needs, performance and any issues relating to work. Action points were noted so that they could be followed up at the next supervision meeting. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. People benefit from a home run by a manager who is appropriately qualified and experienced. Systems need to be developed to capture the views of the people who the service and their representatives so that the home is run in people’s best interests. People’s health and safety are promoted within the home, however greater consideration could be given to environmental risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is qualified and has many years experience within the care sector. He told us that he is aware of the areas in need of development and is working towards achieving this. He also told us that he does not have regular supervision from the owner. As this is a new and developing service, it The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 26 is important that Mr Theobald receives regular supervision by his line manager, and that records are kept. The people who live in the home told us that the manager and new owner have settled in well. One person commented ‘It was strange at first but I am getting used to them now’. We saw that the manager is taking a ‘hands on’ role, and people appeared at ease with him. One person mentioned that one improvement for them since the new management was the fact that they know had their own front door key and a key to their bedroom. There are currently no systems in place for canvassing the views of the people who use the service or their representatives. The manager reported that this is an area he will be addressing. He had already started to obtain people’s views for improvements through residents’ meetings. The provider makes regular visits to the home and records are kept of each visit. However, we felt that they are not sufficiently auditing the service to ensure they are meeting the National Minimum Standards. Overall health and safety checks are regularly carried out to ensure the safety of staff and the people who live in the home. This said, all environmental risk assessments should be reviewed and updated to safeguard people. The manager told us that all of the people who use the service are able to judge temperatures for themselves, with regard to water and radiators. However, consideration should be given to assessing the risk of unguarded radiators as people who live at the home become frailer. We noted that some carpet on the landing has begun to show signs of wear and tear. This has resulted in some fraying, which could cause people to trip or slip. To ensure the health and safety of the people living at the home, this carpet should be repaired or replaced. We saw that most checks relating to fire had been carried out regularly. Records showed that staff had not received fire instruction for April to June 2008. Records also showed that a fire drill had not been carried out since March 2008. The manager was asked to address this. The home did not have a fire risk assessment in place. A requirement is set to ensure that this is rectified immediately. The home has a Gas safety certificate dated 4th June 2008. Evidence shows that small electrical appliances have been checked. The Laurel DS0000071732.V365247.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 Adults 18-65 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 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 2 28 2 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 2 x The Laurel DS0000071732.V365247.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. 2. 3. 4. Standard YA1 YA1 YA19 YA20 Regulation 4 (1) b 5 (1) a to f (2) 13 (1) b 13 (2) Requirement The Statement of Purpose must clearly detail what people are expected to pay for. The registered person must ensure that each person has a copy of the service user guide. Each person must be offered the opportunity to have routine healthcare checks. When staff administer medication to a person who lives in the home they must sign the medication record sheet or insert a symbol to explain why the person did not take the medicine. This is to show that the person has been given the right medicine at the right time. The mould in the double bedroom must be treated and the décor made good so that the people sleep in a pleasant and safe environment. It is important that the manager receives regular supervision by his line manager, and that records are kept so that he has the support he needs to develop the service. Timescale for action 15/08/08 15/10/08 01/09/08 22/07/08 5. YA25 23 (2) b, d 15/08/08 6. YA37 18 (2) a 22/07/08 The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 29 7. YA39 24 (1) a, b 8. YA42 23(4A) b 9. YA42 13 (4) c 10. YA42 23 (4) d, e 11. YA42 13 (4) a The registered person must ensure quality assurance and quality monitoring systems are in place to take account of the views of the people using the service and their representatives. The registered person must ensure a fire risk assessment is completed and kept under review. The registered person must ensure that all risks from hot surfaces are assessed and minimised where possible. All staff must receive regular fire instruction and fire drills must take place so that staff know how to protect people in the event of a fire. To ensure the health and safety of the people who live at the home, the upstairs landing carpet must be repaired or replaced. 15/10/08 15/08/08 15/08/08 22/07/08 15/08/08 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. 2. 3. 4. Refer to Standard YA1 YA1 YA1 YA6 Good Practice Recommendations The Service user guide should clearly state what the fees cover and what extras people are expected to pay for. The Statement of Purpose and service user guide should be available in alternative formats. A copy of the Statement of Purpose should be available to people in the home, at all times. The support guidance should be developed further to include people’s diversity needs and promote equality of opportunity. The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 30 5. YA9 YA42 6. YA20 7. YA20 8. 9. 10. YA22 YA22 YA24 The risk assessments should be reviewed and developed further to include the individual risks to each person, the reasons why people are taking risks and the benefits of risk taking. Particular attention should be paid to the risk to one person of uncovered radiators so that they are kept safe. When a member of staff makes a written addition to the medication administration records they should sign the record and a second member of staff should witness the addition and sign the record to confirm that it is correct. A cupboard, which complies with the requirements for the storage of controlled drugs in care homes, should be obtained so that if people are prescribed controlled drugs they can be stored safely. A complaints log should be kept within the home to enable trends to be monitored. The complaints policy should be updated. Consideration should be given to re-decorating and refurbishing the areas in need of attention, as identified within this report. This will make sure people live in a comfortable, pleasing environment. A checklist should be used to record when all recruitment checks are received and when a new staff member starts work. This will make it easier to tell whether all the recruitment checks have been made before a new staff member starts work to reduce the risk of people being cared for by unsuitable staff When a member of staff is employed following a POVA first check and before their CRB check, a risk assessment should be conducted to reduce the risk of people being cared for by unsuitable staff. All staff should receive equality and diversity training so they know how to recognise and meet people’s diverse needs. New staff should receive Learning Disability Award training as underpinning knowledge for NVQ’s. The regulation 26 visits should focus more on the standards of care in the home to ensure people are receiving appropriate care. The owner should produce a development plan, prioritising areas to focus on, to assist the manager in developing the service. The environmental risk assessments should be reviewed to safeguard people. 11. YA34 12. YA34 13. 14. 15. 16. 17. YA35 YA35 YA37 YA39 YA42 The Laurel DS0000071732.V365247.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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