Inspection on 11/12/07 for The Laurels

This inspection was carried out on 11th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Laurels 12/02/09

The Laurels 23/01/07

The Laurels 18/10/05

The Laurels 16/11/04

The Laurels 05/05/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Laurels Westfield Lane Draycott Cheddar Somerset BS27 3TN Lead Inspector Sally Murphy Unannounced Inspection 11th December 2007 10:30 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 The Laurels DS0000043864.V353302.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. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address Westfield Lane Draycott Cheddar Somerset BS27 3TN 01934 742649 01934 743580 The.Laurels@blueyonder.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) Brightwell Residential Care Limited Wendy Caroline Perkins Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2007 Brief Description of the Service: The Laurels is a large detached property situated in the village of Draycott, between Cheddar and the city of Wells. Service user rooms are located on the ground and first floors. There is a stair lift, assisted bathrooms and call bell system available at the home. The Laurels is registered with the Commission for Social Care Inspection to provide care for up to 20 people over the age of 65 years who require assistance with personal care. The Registered Provider is Brightwell Residential Care Limited and the Registered Manager is Wendy Perkins. The home has been decorated and furnished to a good standard. There is a large, cultivated garden and some residents’ rooms have private patio areas. Fees at this home range from £361 to £436 per week with additional charges being made for chiropody, hairdressing, newspapers, personal items and taxis. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and was completed by Sally Murphy and Justine Button Regulation Inspectors. The previous inspection was completed on 23 January 2007 and was unannounced. In the course of the inspection, discussions were held with people living at the home, staff members, the Registered Manager and Provider. Care practice was observed. Records examined relating to relating to people living at the home, staff members and health and safety were also examined. Prior to the inspection the Registered Manager completed an Annual Quality Assurance Assessment. Surveys were also issued to people who receive the service, relatives, staff members and health and social care professionals. The findings from these documents have been incorporated within this report. We would like to thank the Registered Manager, staff and people living at the home for their assistance during this inspection. What the service does well: Prospective residents and their families are encouraged to visit the home to assess the facilities provided. People are able to enjoy meals at the home, or stay overnight before deciding to stay for a longer period. The home has advised that nearly 40 of the people living at the home have chosen to receive long term care at The Laurels following a respite stay. People living at the home provided positive feedback regarding the care provided. One person wrote that ‘staff are very nice and helpful’, and another that ‘they are very attentive will do all that can to help’. ‘ Family members are welcomed to social activities at the home. Relatives who completed surveys confirmed that they are kept in touch with any changes and that they are satisfied with the care provided. The home will care for a service user until the end of their life wherever possible. The home works closely with the GP, District Nursing and hospice team to ensure that people receive appropriate health care support and remain comfortable. Positive feedback was received regarding the meals provided. There is always a choice of menu, and a vegetarian option available. The home has provided specific food to meet people’s individual dietary preferences and needs. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 6 13 out of the 18 care staff employed have completed the NVQ level 2 qualification and seven staff have NVQ level 3 or an equivalent social care or nursing qualification. This represents a high proportion of the care staff employed and is to be commended. Staffing levels are appropriate, and flexible to meet people’s’ needs. Newly appointed staff are provided with induction training, and all staff are provided with regular updates in mandatory training. Staff receive appropriate supervision. The home has operated a robust recruitment procedure. There are systems in place to seek the views of people living at the home. Equipment servicing records had been appropriately maintained. What has improved since the last inspection? What they could do better: The Registered Manager should ensure that the Service User Guide contains a copy of the most recent inspection report, as the guide provided included a report from 2005. Written contracts outlining the terms and conditions of residency should be available for all people, irrespective of how their fees are paid. Staff must give greater consideration to the language used within records, as these may be viewed by people living at the home, and should be completed in a manner that promotes their dignity. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 7 Risk assessments relating to the self-administration of medication must be regularly updated, and the secure storage provided for people should be made more accessible. All hand transcribed entries must have a signature and date recorded. It is good practice for all amendments to medication records to be signed and dated and checked by a second person to reduce the risk of human error. It is recommended that two people complete and sign for the receipt of medication into the home. Requirements were also made regarding hand transcribed entries at the previous key and random inspections. A record must be maintained regarding the administration of prescribed creams. The registered person must revise the policy on abuse to ensure that it complies with the guidance on Safeguarding Adults from Somerset County Council. Staff must be provided with training on the updated guidance. The Registered Manager must respond to any concerns or complaints raised in an appropriate manner that encourages feedback on the service provided. Staff must ensure that baths are cleaned thoroughly to reduce the risk of cross infection within the home. Appropriate hand washing facilities must be available for staff within the laundry. The Registered Manager must undertake a risk assessment in relation to cleaning fluids being accessible to people living at the home and take any appropriate action. 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 Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 8 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 The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 9 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 & 5. (Standard 6 does not apply). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An assessment of need is completed prior to any service user moving in, to ensure that the home will be able to fully meet their needs. Prospective service users and their families are encouraged to visit the home to assess the facilities provided. EVIDENCE: The home has a Statement of Purpose that provides information regarding the services and facilities at the home. The Registered Manager should ensure that the Service User Guide contains a copy of the most recent inspection report, as the guide provided included a report from 2005. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 10 Within the information provided to CSCI prior to the inspection it states that ‘We encourage prospective residents to visit the home and spend time with us before making a decision to move in, we invite them to stay overnight at no charge and we invite them to all family social events and entertainment days’ and that ‘nearly 40 of our residents first sampled The Laurels through a respite stay and enjoyed themselves, later moving in for long term care’. The first month’s stay is on a trial basis. Within the AQAA it also stated that ‘all needs and preferences are assessed and discussed with residents an families prior to moving in’ and that staff will also visit people in their own home. Completed pre-admission assessments were seen within care plans. During the inspection one person who had recently moved into the home stated that they were ‘very impressed’ with the care provided. A copy of the written contract was seen, and found to contain all necessary information regarding rights and responsibilities, and any notice periods required. Within the care records examined, a written contract had not been provided for one person living at the home. These should be available for all people, irrespective of how their fees are funded. The Laurels DS0000043864.V353302.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, 10 & 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans now provide staff with clear guidance regarding the actions required to meet people’s needs. People living at the home, and their relatives are consulted regarding the care plans, and are satisfied with the care provided. Medication records had not been completed appropriately, and may place people at risk. EVIDENCE: Since the last key inspection the Registered Manager has undertaken work to re-write the care plans in conjunction with the people living at the home and their relatives. The new care plans provide staff with clear guidance regarding The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 12 the level and type of assistance required by each person. There was evidence within the care records of the care plan being reviewed monthly. Within the information provided to CSCI prior to the inspection, it states that there are ‘comprehensive and holistic care plans are in place for all residents and acknowledged by resident and family as applicable’, and that ‘residents are encourage to remain independent and maintain their own personal hygiene wherever possible. Residents are able to choose which member of staff assists them with personal care’. There is a key worker system in place. Within the surveys received by CSCI, people living at the home were asked Do you receive the care and support you need? Six people answered always and two usually. Relatives were asked Does the care home give you relative the care that you expect or agreed? Seven people answered always, and two that this was usually the case. Four care plans were examined in detail. It was found that care plans relating to the risk of falls had been completed and updated as necessary. Appropriate diabetes and catheter care plans were in place. The moving and handling assessments had been updated following an increase in need. Staff must give greater consideration to the language used within records, as the daily record for one person referred to them being ‘buzzer happy’. Records may be viewed by people living at the home, and should be completed in a manner that promotes their dignity. Risk assessment had been completed in relation to the storage of denture cleaning tablets. Nutritional and pressure risk assessments had been completed and weight records maintained. For one person who has a low weight there was evidence of weight gain. This person had also increased the range of activities they participated in, both within and outside of the home. Prior to the inspection surveys were received from two GPs. These provided positive feedback on the care provided and stated that the home provides a ‘good personal service’. The storage, administration and recording of medication were examined. Medication had been stored securely within the locked trolley in the hallway and in the office. In the bedroom of one person living at the home, two white tablets were found, which were believed to be co-codamol that had been purchased by the person’s relatives. There were also two inhalers, and some Gavison accessible within the room. The home had completed a risk assessment relating to the self-administration of medication and provided secure storage for this service user within their room. Care records examined indicated that this person’s level of need had recently increased. It stated that they were ‘becoming more forgetful and generally confused about things, she sometimes does not distinguish day and night’, this change may impact their ability to safely manage their medication, however the risk assessment had not been updated since 25/7/07. The risk assessment should also address the The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 13 potential risk to other people living at the home who may be able to access these medicines when they are not stored securely. These matters were discussed at the close of the inspection with the Registered Provider and Manager, and it was recommended that a review be held as this person is also prescribed paracetamol medication so may be at risk from exceeding the daily dose. Following the inspection the home has confirmed that this review has taken place. Medication Administration Records (MAR charts) were examined. A photograph had been provided on the MAR chart for each service user. A record had been maintained of all medication brought into the home. It is recommended that this process is completed and signed for by two people. Some hand transcribed entries did not have a signature recorded; therefore it was not clear who had made these amendments. It is good practice for all amendments to medication records to be signed and dated and checked by a second person to reduce the risk of human error. Requirements were also made regarding hand transcribed entries at the previous key and random inspection. Following the inspection, copies of care plans were forwarded to CSCI, which provided appropriate guidance regarding the administration of PRN medication and provided evidence of variable doses being recorded. There was no record for the administration of creams. Opening dates had been recorded for most prescribed creams. People living at the home spoken with confirmed that they are treated with kindness and respect. They confirmed that staff always knocks the door before entering. People spoke highly of the support provided by staff, and one person stated that they were ‘most staff are very helpful and kind’. The home will care for a service user until the end of their life wherever possible. The home works closely with the GP, District Nursing and hospice team to ensure that people receive appropriate health care support and remain comfortable. Within the information provided to CSCI it states that ‘families are accommodated to stay at the home overnight if required during resident’s final days’. The Laurels DS0000043864.V353302.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 & 15. 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 are able to participate in a range of activities. People are supported in exercising choice and their wishes are respected. Meals are of a good standard, and offer a well balanced diet. The home caters to meet people’s individual dietary preferences and needs. EVIDENCE: People living at the home are provided with a monthly calendar of forthcoming events and entertainments. This includes the mobile shop, musical entertainers on alternate weeks, bingo, afternoon at the pictures where DVDs are played, and flexercise. During the month of December there was also a Christmas party that friends and family were invited to attend, and a music and wine appreciation morning. Within the information provided to CSCI prior to the inspection it states that ‘life at The laurels is relaxed, friendly and enjoyable for residents. Residents The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 15 participate in planning and deciding wheat they individually or as a group want to undertake’. On the day of the inspection people were observed going for walks and spending time as they wished. The home has maintained records of activities and outings enjoyed within a photo album. Holy communion is held in the house each month by an Anglican minister and the Roman Catholic priest visits weekly providing individual communion. Several people also attend church on Sunday in the village. Within the surveys provided to people living at the home, they were asked Are there activities arranged by the home that you can take part in? Three people answered always, two usually and three sometimes. Within the surveys received from relatives all stated that they are always or usually kept up to date. The majority of relatives who completed the survey felt that the home supported people to live the life they choose. One person at the home has an advocate. Activities, outings and meals are discussed at the residents meetings. Meals are prepared on the premises. People are able to eat meals in the dining room or their bedroom, as they prefer. The home is able to cater for specialist diets. There is always a choice of menu, and a vegetarian option available. The home has provided specific food to meet people’s individual dietary preferences and needs. Within the surveys received two people stated that they always like the meals and six people that they usually do. One person stated that ‘food is very well cooked, homely fare’. Most of the vegetables are grown on the land at the rear of the property. On the day of inspection positive feedback was received regarding the meals provided. Wine is always offered at Sunday lunch, and sherry is available at all times. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 16 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 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are confident that staff listen to them and act on what they say. The policy on the protection of vulnerable adults does not reflect good practice; this does not provide staff with appropriate guidance regarding the actions that they should taken, and may place people living at the home at risk. EVIDENCE: The home has a complaints policy. Following the inspection the home has amended this policy to state that external agencies such as CSCI might be contacted at any time. A safeguarding adults meeting had been held two weeks prior to the inspection, as the result of a complaint made, however this complaint had not been recorded within the complaints log. CSCI were provided with a copy of the letter sent to the complainant in response to the concerns raised. The content of this letter demonstrated that the home did not have an understanding of the updated guidance provided by The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 17 Somerset County Council, as the guidance states that concerns may be raised with the home or directly with Somerset County Council. The home should also ensure that communication regarding concerns is written in a manner that supports feedback regarding the service from health care professionals or others involved in the care of people living at the home. The home has a policy on abuse. This states that the home would investigation any allegation made. This is contrary to the guidance provided by Somerset County Council that indicates that a referral should be made to the Vulnerable Adults Lead at Social Services who would decide which person or agency would be the most appropriate person to investigate this concern. Within the questionnaires received by CSCI all of those people living at the home and their relatives stated that they knew how to make a complaint. All of the people living at the home confirmed that staff listen to them and act on what they say. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 18 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): 19,20,21,22,23,24,25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable environment and there is sufficient communal space and bathing facilities to meet their’ needs. The home has appropriate infection control procedures, however these had not been fully implemented within communal bathrooms and the laundry. Generally, the home was found to have a good standard of cleanliness EVIDENCE: The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 19 Service user accommodation is provided on the ground and first floors. There is a stair lift to the first floor. Assisted bathroom, and a call bell system are also available. There is an ongoing programme of re-decoration and refurbishment at the home, with five bedrooms having been re-decorated this year. Since the last inspection electric profiling beds have been provided for two residents suffering back pain, an electric reclining chair has also been purchased and the stair lift replaced. Communal areas comprise of a large lounge, and dining room. There is a large, cultivated garden that is accessible to people living at the home, and the majority of ground floor rooms have private patio areas. At the time of the inspection work was taking place within the garden to improve accessibility for people living at the home who use walking frames or wheelchairs. People are able to bring personal possessions with them, such as photographs, pictures and small pieces of furniture to individualise their room. During a tour of the premises it was noted that there was a malodour in one bedroom, and a brown mark that appeared to be faeces on the cover on the chair, and side of the commode. Three armchairs within the lounge were stained and require cleaning. The home has two assisted bathrooms. Bathing temperatures had been recorded and were within appropriate limits. There were build-ups of lime scale within toilets, making it difficult for these to be cleaned. There was talcum powder visible on the bath panel and debris within the plugholes. Staff must ensure that baths are cleaned thoroughly to reduce the risk of cross infection within the home. The laundry is well organised. There was no liquid soap or paper towels for staff to wash their hands within the laundry. Staff spoken with stated that they usually wash their hands within the staff toilet or kitchen. Appropriate hand washing facilities must be available within the laundry. Throughout the inspection the door to the laundry was propped open. This door has a sign fitted stating that it is a fire door. There were also cleaning fluids and washing powders stored within the laundry that were accessible to people living at the home. These matters were discussed with the Registered Provider and Manager at the close of the inspection who agreed to take appropriate action to address these risks. Within the surveys received by CSCI, five people stated that the home is always clean and fresh and two people that it is usually. Within the surveys received from relatives, two people stated that cleaning could be improved within bedrooms and en suite bathrooms. A further two comments were received regarding the need for maintenance work inside and The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 20 outside of property. One stated that the ‘general appearance of the property does need more maintenance and some updating inside and out’. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 21 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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate, and flexible to meet people ‘s’ needs. Staff have received the training required to undertake their roles. The home has operated a robust recruitment procedure. EVIDENCE: Duty rotas are maintained. The level of staff is varied to reflect levels of dependency. On the day of inspection there was the Registered Manager, duty manager, a carer, care support worker, and cook on duty. The Registered Manager advised that they are supernumerary for eight hours a week. Within the last twelve months agency staff have only been required to cover one shift. Within the information provided to CSCI prior to the inspection, it states that ‘We have adjusted early morning cover with both carers and support starting earlier to help residents who wish to get up and dress before taking breakfast in the dining room’. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 22 Services user spoken with during inspection advised that ‘staff are all kind, but they are short staffed sometimes’. Within the surveys completed by staff members, ten out of the eleven staff who answered this question stated that there are always or usually enough staff to meet the individual needs of all the people who use the service. One staff member stated that ‘ sometimes I feel there is not enough time to sit an talk to the residents or help them with a task or maybe do a puzzle or something’. Another wrote that ‘if a service user is very ill they will always put another member of staff on to look after the individual’ . Within the information provided to CSCI prior to the inspection, it states that 13 out of the 18 care staff employed have completed the NVQ level 2 qualification and seven staff have NVQ level 3 or an equivalent social care or nursing qualification. This represents a high proportion of the care staff employed and is to be commended. Staff have recently received updated training on fire safety, manual handling, dementia care and the protection of vulnerable adults. All duty managers have received training on the safe administration of medication. The recruitment file was examined for two staff members. These were found to contain all of the documentation required, including two references, a POVA First check, enhanced CRB and record of induction training. A record had not been maintained of the interview. Following the inspection the home has provided records to demonstrate that staff have been provided with a copy of the GSCC code of conduct. The application form does not comply with changes to employment legislation and should be updated. Within the surveys received from staff members, staff confirmed that they received appropriate induction training, and worked within a senior member of staff during their first few weeks at the home. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35,36,37 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is experienced, and approachable. There are systems in place to seek the views of people living at the home. Staff receive appropriate supervision. Equipment servicing records had been appropriately maintained. EVIDENCE: The Registered Manager is Wendy Perkins. She has many years experience of providing care to older people and has been the manager at this home since The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 24 March 2006. Mrs Perkins was formerly a qualified nurse and is studying for the Registered Managers Award. People living at the home are able to express their views during residents meetings, or with any members of staff or the management team on an individual basis. The home issued anonymous surveys to residents. These provided positive feedback, particularly with regarding to the care provided and atmosphere at the home. The home has received Quality rating from Somerset County Council. The home does not assist anyone living at the home in managing their finances. The home displays appropriate Employers Liability insurance. Within the surveys received from staff members, staff were asked ‘Does your manager meet with you to give you support and discuss how you are working? 9 staff answered that this takes place regularly, 1 often and 2 sometimes. One staff member wrote that the ‘manager is very approachable and always willing to go through any issues’. Information forwarded to CSCI following the inspection evidenced that staff receive supervision every three months, annual appraisals, and regular staff meetings. Records relating to people living at the home are stored securely and appropriately maintained. The fire system had been tested on a weekly basis and appropriate records maintained. The fire system, stair lift, hoist, fire extinguishers and electrical hardwiring had been serviced as required. All staff have received regular updates in fire safety training. Fire drills had been held on the monthly basis, and the fire risk assessment reviewed in January 2007. The home uses the Safer Food Better Business system for maintaining kitchen records. Cleaning materials, including bleach had been stored within a cupboard on the first floor and there was a bottle of unlabelled liquid within the laundry. The Registered Manager must undertake a risk assessment in relation to cleaning fluids being accessible to people living at the home and take any appropriate action. Accidents had been recorded and reported as required. The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 25 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement When hand written entries are made on the medication administration record charts that the quantity received, the actual dosage, the dose frequency, the date of receipt are all recorded and that the chart is then signed by the person making the entry and a safe system is in place to verify this entry (Previous timescale of 23/02/07 was not met) Arrangements must be made to record the administration of all medicines including those used externally at the time of administration. This is to enable the correct monitoring of the effectiveness of medicines prescribed. Risk assessments relating to the self-administration of medication must be regularly reviewed and updated when there is a change in a persons’ level of need. 2. OP10 12 (4) [a] Staff must give greater DS0000043864.V353302.R01.S.doc Timescale for action 31/01/08 31/01/08 Version 5.2 Page 27 The Laurels consideration to the language used within records, as these may be viewed by people living at the home, and should be completed in a manner that promotes their dignity. 3. OP18 13 (6) The registered person must revise the policy on abuse to ensure that it complies with the guidance on Safeguarding Adults from Somerset County Council. 28/03/08 4. OP24 13 (3) Appropriate action must be 31/01/08 taken to address the malodour in one room. The commode and chair cover must be thoroughly cleaned in this room. Three armchairs within the lounge require cleaning. 5. OP26 13 (3) Staff must ensure that baths are cleaned thoroughly to reduce the risk of cross infection within the home. This is with regard to talcum powder on the bath panel and debris within the plughole. Appropriate hand washing facilities consisting of liquid soap and paper towels must be provided within the laundry. 15/02/08 6. OP38 13 (4) [a] The Registered Manager must undertake a risk assessment in relation to cleaning fluids being accessible to people living at the home and take any appropriate action. 15/02/08 The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 28 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. Refer to Standard OP1 OP2 Good Practice Recommendations The Registered Manager should ensure that the Service User Guide contains a copy of the most recent inspection. Written contracts outlining the terms and conditions of residency should be available for all people, irrespective of how their fees are paid. It is recommended that two people complete and sign for the receipt of medication into the home. It is good practice for all amendments to medication records to be signed and dated and checked by a second person to reduce the risk of human error. 4. 5. OP16 OP29 A record must be kept of all complaints. The application form does not comply with changes to employment legislation and should be updated. 3. OP9 The Laurels DS0000043864.V353302.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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