Inspection on 13/08/08 for The Laurels

This inspection was carried out on 13th August 2008.

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

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 19/03/09

The Laurels 22/06/07

The Laurels 26/07/06

The Laurels 30/11/05

The Laurels 21/07/05

The Laurels 10/11/04

The Laurels 17/09/04

The Laurels 10/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/12/2008.

CARE HOMES FOR OLDER PEOPLE The Laurels 130/134 Church End Lane Runwell Wickford Essex SS11 7DP Lead Inspector Michelle Love Unannounced Inspection 10:00 13 and 21 August 2008 th st 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 DS0000018035.V366641.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 DS0000018035.V366641.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address 130/134 Church End Lane Runwell Wickford Essex SS11 7DP 01268 764105 01268 450909 enquiries@thelaurelsltd.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) The Laurels Limited - Roger Green & Co Manager post vacant Care Home 22 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (5), Old age, not falling within any other of places category (22) The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2007 Brief Description of the Service: The Laurels is registered for the accommodation and care of twenty-two older people over the age of 65, who may have a range of care needs. One double room is provided and there are some en-suite facilities provided. The home provides a comfortable lounge area with a large adjoining conservatory. Further facilities include a dining/sitting room and a small television room that can also be used to provide a private area for service users and visitors. Bathrooms and toilet facilities are provided throughout the home in sufficient numbers. A passenger lift accesses the first floor. The home is furnished and decorated to a good standard. To the rear of the home there is a landscaped garden with a decked area. The home is located within a short distance of Wickford town centre on bus and train routes. There is off road parking facilities to the front of the home. The range of fees given at the time of the site visit was £575.00 to £600.00 per week. Any additional fees will need to be discussed directly with the home before admission. The home’s Statement of Purpose and Service User’s Guide can be obtained from the home on request. The Laurels DS0000018035.V366641.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 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection. The visit took place over two days by one inspector and lasted a total of 13 hours, with all but one key standard inspected. Additionally, the manager’s progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment. This is a self-assessment document detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a full tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the inspection, surveys for relatives, staff and healthcare professionals were left at the home for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The manager, team leaders and other members of the staff team assisted the inspector on both days of the inspection. Feedback on the inspection findings were given throughout and summarised at the end of each day with the manager. The registered provider was also present on the first day of inspection for feedback. The opportunity for discussion and/or clarification was given. As a result of concerns relating to medication practices and procedures, inadequate care planning/risk assessing an Immediate Requirement Notice and Serious Concern Letter were issued. What the service does well: Prospective people are assessed prior to admission to ensure they are suitable for the care home. The assessment process is thorough and prospective people are invited to visit the care home prior to admission. Visitors to the home are made to feel welcome. Food provided to residents is homely and comments from residents relating to meals provided, was positive e.g. “the food is lovely” and “oh I like the food”. There is a varied menu and various alternatives are available if required. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 6 The home is homely and comfortable for residents, and the décor is of a good standard. Residents spoken with during the inspection were satisfied with the home environment and their personal space. There is a good range of activities provided for people living in the care home. Both activities co-ordinators demonstrate commitment and enthusiasm to ensuring that residents have an opportunity to participate in a varied programme of activities. Staff rapport between residents and staff was seen as positive. What has improved since the last inspection? What they could do better: Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that residents are protected. The manager advised on the second day of inspection that the shortfalls had been addressed. The manager was advised that these areas would be examined at the next inspection to the home. Further development is required in relation to care planning and risk assessing processes, so as to ensure that individual plans of care are comprehensive, up to date, reflective of people’s current care needs and ensure that the care provided to residents, meets their specific requirements. People living at the care home and/or their relatives need to be more involved in the care planning process. Appropriate staffing levels at the home must be maintained so as to make sure that residents needs are met at all times and are in line with people’s dependency levels. Further development is required to ensure that robust recruitment procedures for staff are adopted so as to ensure residents safety and wellbeing. Further training and personal development is required for staff to ensure that they have the skills and competence to meet resident’s needs and to deliver good care. Particular attention must be provided for those conditions associated with the needs of older people and within specific core areas. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 7 Consultation must take place with residents, relatives, staff and other interested parties, with regards to the CCTV system so as to ensure that people are happy with the arrangements. 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 DS0000018035.V366641.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 DS0000018035.V366641.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, and 3. Standard 6 does not apply to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect that they will be properly assessed prior to admission and assured that their care needs can be met. People cannot be assured that information telling them about the home’s services are accurate. EVIDENCE: A copy of both the Statement of Purpose and Service User’s Guide was provided to the inspector. The manager advised that both documents have recently been updated. On inspection of the Statement of Purpose, a further review is required to ensure that information recorded is correct and accurate. For example under the heading of `Aims and Objectives`, the document makes reference to catering for male residents from the age of 65 and female residents from the age of 60, however the category of registration for The Laurels, details that the home is registered to provide care to older people over the age of 65 years of age. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 10 The document also states under the heading of `Care Plan Reviews` that, “care plans are reviewed monthly (or sooner if necessary) as service users needs and circumstances change. They are an up to date record of service users needs and will enable staff to ensure the correct care package is delivered”. Evidence showed that of those care plans inspected, these had not always been reviewed or updated to reflect individual’s current care needs. Additionally both the Statement of Purpose and Service User’s Guide make reference to people contacting us should they wish to make a complaint. This needs to be rewritten to reflect that we no longer investigate complaints and that these should be referred to the Local Authority. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective resident’s needs. In addition to the formal assessment procedure, supplementary information is sought from the individual resident’s placing authority and/or hospital and formal assessments relating to dependency, falls, pressure area care and nutrition are completed. The AQAA details under the heading of `what we do well`, “A full and informative pre assessment is undertaken before a new service user moves into the home”. The document also details that wherever possible prospective residents and/or their representatives are invited to visit the care home prior to admission. One relative spoken to during the inspection confirmed that they visited The Laurels on behalf of their member of family to assess its suitability and that an assessment was undertaken by the manager, prior to their member of family’s admission. They also confirmed that they had been given a copy of the home’s Statement of Purpose and Service User’s Guide detailing the services and facilities provided at the care home. On inspection of one care file for those people newly admitted to the care home, evidence indicated that a pre admission assessment was completed by the management team of the home prior to the person’s admission. Information recorded was observed to be detailed and informative and included a comprehensive profile detailing background information, family histories, medical history etc. The home does not provide intermediate care. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can expect to have an individual plan of care in place, however significant shortfalls in actual care planning, risk assessing and medication practices means that residents cannot be assured that their needs will always be met or that their health and wellbeing will be maintained or proactively managed. EVIDENCE: At this inspection, a random sample of 3 care files were examined. There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by care staff, however information recorded was seen to lack detail in some instances. Evidence showed that individual resident’s needs are not fully recorded, do not include the interventions required so as to ensure the appropriate delivery of care and are not regularly reviewed to reflect individual resident’s changed needs and how this affects their daily life. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 12 Additionally formal assessments are completed in relation to dependency levels, manual handling, falls, pressure area care and nutrition. Care file documentation for one person showed they had a history of poor mental health and would require this aspect of their healthcare to be monitored. However, no care plan was devised detailing how their mental health affected their everyday life or what steps to be taken should this deteriorate and/or relapse. Additionally records recorded they had a formal diagnosis of dementia, however no care plan was recorded detailing how this impacts on their activities of daily living. The inspector witnessed an incident following the first day’s inspection whereby one resident had left the building and was wandering outside. The care file for this person was examined on the second day of inspection and showed they had a formal diagnosis of dementia, a history of wandering and could become aggressive on occasions. Daily care records showed that the resident had managed to leave the home on a previous occasion, and made other attempts to exit the care home over several months. Additionally, records showed consistently that the resident could become agitated and/or aggressive towards staff and others. It was of concern that no care plan/risk assessment was devised in relation to the above. No guidelines were available providing proactive measures for staff as to how to deal effectively with the person’s inappropriate behaviours and several entries recorded no actual interventions by staff. This is inappropriate and shows a lack of knowledge and understanding by staff and the management of the home around dealing with residents’ physical and/or verbal aggression. The Commission for Social Care Inspection had not received a Regulation 37 Notification informing us of times when the resident had left the building undetected. The manager was advised that under this regulation we are to be notified of any event, which could potentially affect an individual’s wellbeing. Of those care plans inspected there was little evidence to suggest that these had been devised with the resident and/or their representative. Staff surveys forwarded to us recorded under the heading of `how do you think the care home or agency can improve`, “more information on residents needs such as dementia care and how each stage progresses” and “proper assessment of the residents and continuous care of the residents”. Staff, were observed to interact positively with residents e.g. with respect and dignity and evidenced a good rapport with individual people throughout both days of the inspection. However it was evident that some staff are far more confident than others in talking with residents. In discussions with the manager, the manager advised that she was aware of the above but hoped that team leaders would support all staff members. Mixed comments were noted from relatives’ surveys and from speaking with relatives about the care provided at The Laurels. This refers specifically to some people not feeling that the care home were meeting the needs of their The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 13 member of family on occasions to “we are very happy with the care provided at The Laurels and confirm that our member of family is well looked after and has their needs met”. Of those residents spoken with, all were complimentary regarding the care provided and stated, “the girls are lovely” and “I like it here”. As a result of the above deficits and areas of concern, a serious concern letter was forwarded to the registered provider/manager. Information provided by the home in their AQAA states, “Our care plans have improved with the enrolment of a senior carer of long employment with us, overseeing all care plans and speaking with staff re: their plans on a weekly basis”. The manager advised during feedback from the inspector that she would undertake a more active role in overseeing/monitoring the care planning processes so as to ensure that these were up to date and reflective of people’s care needs. Records showed that residents have access to a range of healthcare professional services such as chiropody, optician, District Nurse services and GP as and when required. However, records relating to professional visits were not consistently completed and did not always include details of the outcome from the visit. This needs to be improved so as to evidence healthcare interventions provided to individual residents. The majority of medication is managed through a monitored dosage system (blister pack) and storage facilities for the safekeeping of medication were seen to be secure. However, the room, which stores medication for residents, was observed to have a sign informing people as to its contents. The manager was advised to consider removing the sign so as not to advertise the room’s contents. Fridge temperatures for medication that requires cold storage, did not always comply with recommended safe levels of between 2-8° centigrade e.g. in June and July 2008 records regularly recorded 9.4° centigrade and in May 2008, temperatures were recorded between 13.8° and 26.2° centigrade. The manager was advised that the failure to store medicines at the proper temperature could result in residents receiving a treatment that is ineffective. Records detailed that the fridge was not working properly, however there was little evidence to show that appropriate steps had been taken prior to this inspection to rectify the issue. Medication records were not up to date, with gaps in recording and information. This refers specifically to no record of some medicines having been given to the resident when they were due, as the entries on the MAR (Medication Administration Record) record had been left blank and not signed/initialled by staff. Where the prescriber’s instructions state 1 or 2 tablets to be administered, the actual dose administered was not always recorded. The MAR record for some people showed medication was not administered, as this was not available and staff had failed to ensure a sufficient supply of medication. MAR records for two people showed, the prescriber’s instructions were not always being followed by The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 14 staff. Some staff spoken with demonstrated a lack of knowledge and understanding as to the specific instructions to be followed. This refers specifically to 2 residents who are prescribed Alendronic Acid, Flucloxacillin Capsules and/or Risedronate. Where some residents consistently and/or regularly refuse medication, no evidence was available to indicate this was under discussion with the person’s GP or under review and some MAR records did not always detail the quantity of medication received, the date or who by. Training records for staff showed that not all staff, who administer medication, have up to date training. It is of concern that 3 members of night staff do not have evidence of having received medication training. Additionally there was no evidence as part of good practice procedures to show that staff, are regularly assessed as to their continued competency to administer medication. This does not concur with what is recorded within the home’s Statement of Purpose under the heading of `Medication`, which states, “All medication administrators are thoroughly trained in-house before commencing this duty. On top of this staff also go onto “The Care of Medicines” course and The Accountability and Safe Administration of Medicines training, all of which are run by our pharmacists and by Chelmsford College”. As a result of the above deficits and areas of concern, an Immediate Requirement Notice was issued. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home can be assured that their social care needs will be met and that they will receive a varied diet that meets their needs. EVIDENCE: The manager advised that 2 activities co-ordinators are employed at The Laurels for a total of 27 hours per week, Monday to Friday. There is no budget provided to the activities co-ordinators to purchase equipment/materials for activities, however the inspector was advised that the emphasis is for staff to fund raise so as to fund items required. The inspector spoke with both activities co-ordinators and it was positive to note that both demonstrated enthusiasm and commitment to ensuring that people at the care home are provided with a range of activities which meets individual’s needs, personal preferences, likes and dislikes. Records showed that the range of activities included arts and crafts, bean-bag therapy, netball, skittles, manicures, reminiscence, cooking, bingo, board games, gardening, religious observance etc. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 16 Both members of staff also advised that they have an activity file specifically centred around activities for people with dementia and wherever possible people are supported to maintain skills/sense of purpose by laying the table for meals, folding napkins, polishing furniture and peeling potatoes. It is hoped for the future that individual memory boxes will be created for residents. Photographs of activities/events undertaken are displayed within the home. On the first day of inspection, several residents were observed to enjoy cake decorating during the morning and in the afternoon to play games. One relative spoken with advised the inspector that since the new activity programme has been devised and implemented (April 08), their member of family “has blossomed and become more mentally alert”. It is clear that improvements have been made as comments expressing dissatisfaction about the activity programme were highlighted and recorded in resident/relatives meetings. Residents when asked, stated they were happy with the activities provided and looked forward to participating on a daily basis. Consideration should be given to devising a larger print and/or pictorial activity programme so that residents are enabled to make an informed choice. Also, consideration should be provided for the activities co-ordinators to attend a training course specifically designed around activities. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. The manager advised the inspector that residents are encouraged and supported to maintain contact with family and friends. The menu for the day is displayed on a white board within the main lounge and dining area. The meals provided to residents at both lunchtime and teatime on the first day of inspection, were seen to be plentiful and well presented. Again, consideration should be given to devising the menu in larger print and/or pictorial format so that residents are enabled to make an informed choice. Mealtimes were observed to be unhurried and people were given sufficient time to eat their meal. Where people require support from staff, to eat their meal, this was seen to be undertaken with dignity and sensitivity. Both the manager and the cook advised that alternatives to the menu are readily available. Nutritional records were noted to be disorganised and incomplete in some cases. The manager was advised that there, needs to be better record keeping so as to evidence individual’s dietary intake, specifically where concerns are highlighted in relation to individual’s possible weight loss/poor appetite. Comments from residents in relation to meals provided were positive and included, “I like the food, it’s good” and “Yes I enjoy the meals provided”. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate systems are in place to ensure that residents are safeguarded and that any concerns raised are dealt with proactively, however it is not clear that staff understand or have the skills to deal with resident’s inappropriate behaviours. EVIDENCE: A copy of the home’s complaints procedure was displayed within the main reception area of the home. The manager was advised to ensure that this is reviewed to inform people that the Commission for Social Care Inspection no longer investigates complaints and these should be referred to the Local Authority. Since the last inspection the management team of the home has received 1 complaint. There was evidence to show that the manager had investigated the issue and taken all necessary action. Both staff and relatives surveys forwarded to us recorded that people know how to make a complaint and feel confident about raising concerns with the manager should the need arise. One relative survey recorded, “If I have any worries it is sorted very quickly”. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 18 However from discussions with some relatives and from surveys received, concern was expressed that some people find it difficult to speak with the registered provider and find him at times unapproachable. Whilst negative comments have been made about the registered provider, following the inspection several items of correspondence were forwarded to us providing positive comments about the registered provider and these included, “we have always found the management both accessible and approachable”, “Mr Dobson has a soft heart and loves the personalities of his guests and I have nothing but praise for him, he works hard for what he believes in” and “we have found Terry a very approachable and friendly person”. A board within the home’s reception area displays a numerous number of cards and letters, which are complimentary about the care provided at The Laurels. No safeguarding issues have been highlighted since the last inspection. A safeguarding policy and procedure was readily available, however the manager was advised to consider devising a simpler set of guidelines for staff to follow, which would give clear instruction/guidance should a safeguarding issue arise. The manager and 3 staff members spoken with demonstrated an understanding and awareness of safeguarding procedures. Staff training records showed that not all members of staff have received training relating to safeguarding however some members of staff are booked on training in December 2008 and January 2009. The AQAA details under the heading of `our plans for improvement in the next 12 months`, “To continue staff training and promote a thorough awareness of all forms of neglect and abuse”. As highlighted within the Health and Personal Care section of the report, the inspector witnessed an incident following the first day’s inspection, whereby one resident had left the building undetected by staff. Two member’s of staff were observed to approach the resident in the street and to escort them back into the care home. When this was discussed with the manager (8 days later), the manager advised that she was unaware of the incident having taken place. Daily care records for the resident were completed by staff and recorded the above incident, however records did not reflect staffs interventions to return the person back to the care home e.g. timeframe and diversion methods used to enable the person to return to the care home. It is of concern that no members of staff have received training relating to dealing with challenging behaviour and/or aggression, yet there are people in the home who are not cooperative and are resistant to care on occasions. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Laurels provides a clean, comfortable and safe environment for people living at the care home, which meets their needs. EVIDENCE: A full tour of the premises was undertaken during the day with the manager. The home environment has been undergoing major building works so as to enhance the existing property. An application to increase the current numbers of people accommodated at The Laurels from 22 to 28 has been received by us and is being progressed. Currently the home comprises of 21 bedrooms (one of which is double), with a further 6 bedrooms under construction. Extensions to the lounge, kitchen, main entrance hall, conservatory and utility room are recent additions. The registered provider advised that it is hoped that the main part of the renovations works will be completed by October 2008. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 20 Of those individual bedrooms seen, all were personalised and individualised to reflect people’s personalities. Of those residents spoken with, all confirmed that they liked their personal space and found the home environment to be satisfactory. Communal areas were light, well furnished and maintained to a good standard. The standard of décor, furnishings and equipment throughout the home was seen to be appropriate. On the day of inspection the home was noted to be clean, tidy and odour free. The laundry area was well maintained and following discussion with both the manager and housekeeper, the inspector was advised that a new system was recently introduced and appears to be working well. This refers to the housekeeper undertaking laundry tasks Monday to Friday as part of their role, however at weekends this task is undertaken by staff, with night staff completing ironing and simple needlework tasks. The AQAA details, “We maintain a high level of cleanliness throughout the home at all times”. It also states, “Many comments received from relatives and visitors regarding the cleanliness and pleasant odour within the home”. Relatives spoken with confirmed they are generally happy with the improvements being made at the home and that continued building works have not had a significant impact on their member of family, however at times the noise level of the building works had been quite significant. The large garden has undergone major improvements with attractive landscaping and a purpose built decked area has been built. Some concerns were expressed that people living at the home have had limited access to the garden area as a result of on-going building works. The registered provider and manager must review the security at the home to ensure that residents are unable to exit the building without staff’s knowledge so as to ensure residents safety and wellbeing. A maintenance person is employed at the care home for approximately 8 hours per week for maintenance/gardening. In addition to this, the registered provider is on hand to assist with maintenance within the home. A random sample of safety and maintenance certificates showed that equipment in the home has been serviced and remain in date until their next examination. There was evidence to show that monthly checks are undertaken for the homes emergency lighting and fire alarm system. Records relating to fire drills for staff evidenced that the last one conducted was in July 08. A recent visit by the fire safety officer recorded the standard at the home as satisfactory. As stated at the last inspection, a CCTV system is in operation within the home and cameras are located within the communal lounge, entrance hall, corridors, on exit doors, the kitchen and laundry areas. A requirement was made The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 21 following the last inspection to formally consult with residents and relatives about the installation of the CCTV system, however on the first day of the inspection there was no evidence to show this had been addressed by the registered provider. Following discussion with both the manager and registered provider, both confirmed that no action had been taken. Additionally, relatives spoken with at the time of the inspection confirmed they had not been consulted. On the second day of inspection it was positive to note that letters had been provided to residents/their representatives and staff in relation to the above. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of staffing on occasions restricts the ability of the service to deliver person centred care and to ensure that people’s needs, can be met and that they are safe. Shortfalls in training and staff recruitment procedures means that residents are not fully safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. EVIDENCE: The manager advised the inspector that staffing levels at the home are 4 members of staff between 07.30 a.m. and 21.00 p.m. and 2 waking night members of staff between 21.00 p.m. and 07.30 a.m. each day. In addition to the above a housekeeper and cook is employed Monday to Friday (08.00 a.m. to 13.30 p.m.). At weekends an additional staff member is rostered so as to undertake cooking tasks. The manager’s hours are supernumerary to the above, however she is rostered to work Monday to Friday 09.00 a.m. to 17.00 p.m. The director is also present most days. On inspection of 4 weeks staff rosters these evidence that staffing levels as detailed above were not maintained on 3 occasions. In addition to the above, one relative advised that on one recent afternoon at a weekend, only 2 members of staff were on duty as a result of staff telephoning in sick. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 23 This was confirmed by both the manager and registered provider, however the manager stated that staff had failed to notify either herself or the registered provider of the circumstances. The relative further advised that staff’s comments in relation to the staff shortage were, “we will manage”. No Regulation 37 notification was forwarded to us detailing measures undertaken to address the staffing deficit. The staff rosters are completed monthly in advance with staff completing a fortnightly set routine. The rosters show that some staff work long days/shifts (07.30 a.m. to 21.00 p.m.), however staff have appropriate rest days/days off duty. The AQAA details that during the past 12 months it has been difficult to improve staffing requirements as a result of unreliable staff at times and difficulty in recruiting/retaining staff because of another provider within the local area. Staff surveys returned to us recorded that “staff work well as a team” and “the service on a whole works extremely well”. In general terms, staff surveys recorded that they felt there were sufficient staff on duty, however 2 surveys recorded that more staff were needed to meet residents needs. One relative’s survey recorded “more staff are required at weekends”. The manager advised the inspector that there were no staff vacancies at present and agency staff had not been utilised at the care home since last year. The AQAA details under the heading of `how we have improved in the last 12 months`, that there has been a successful recruitment drive for more staff to cover for staff sickness/holidays. The recruitment files for 4 members of staff were randomly examined at this inspection. The majority of records as required by regulation were evident, however gaps were noted in relation to only 1 written reference for two members of staff, a full employment history not explored for one person and for three members of staff it was of concern that they had commenced employment prior to a POVA 1st and/or CRB (Criminal Record Bureau) check having been received. The manager must ensure that all records as required by regulation are sought and in place so as ensure people’s safety and wellbeing. The above does not concur with the AQAA, which states under the heading of `what we do well`, “Full details and requirements are met during the recruitment process”. On inspection of staff training records, these showed that since the last inspection, some staff members have received training relating to manual handling, basic first aid, dementia awareness, mental capacity act 2005, infection control, palliative care, occupational health and safety, optical awareness and continence awareness. Of those staff files sampled, two staff files showed that neither person had a record of having undertaken manual handling training. The latter is of concern and must be addressed as a matter of urgency. Gaps as stated previously also The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 24 relate to training pertaining to safeguarding, dealing with challenging behaviour/aggression and those conditions associated with the specific needs of older people. Two staff surveys returned to us recorded, “All staff are on training schedules and knowledge and understanding is growing all the time” and “training is very important for us to be aware of the new trend and ways in caring”. One relative survey returned to us recorded, “Many staff are very experienced and care for [name of relative] very well, but some recently appointed staff do not seem very confident”. Staff records showed that people had received an induction pertaining to a general introduction to The Laurels, staffing structure, aims and objectives and tour of the premises (including fire exits/fire procedures), however this was not in line with Skills for Care. The manager on the second day of inspection was observed to make attempts to source information about Skills for Care Inductions. The manager advised that 6 people have attained NVQ Level 2, a further 6 people are currently undertaking NVQ Level 2 and 6 people have achieved NVQ Level 3. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 25 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, 33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements in the home are adequate and shortfalls identified throughout this report could mean that people living at the care home may not be assured of positive outcomes. EVIDENCE: The manager is not formally registered with the Commission for Social Care Inspection but has been employed at The Laurels for over 11 years and overall has 15 years experience within a care field setting. The manager has attained NVQ Level 3 and achieved the Registered Manager’s Award (RMA) and has been in day-to-day charge of the care home for the past 7 years. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 26 The registered provider has an office within the home and is present on most days. Staff spoken with, were very complimentary about the manager and confirmed that she was approachable, provided good support and met with them regularly. One relative survey recorded, “I think the staff do a wonderful job, it can’t be easy” and “the staff always have the people’s welfare in mind”. Relatives, who visited the home on both days of the inspection, confirmed that they found the manager approachable and easy to talk with. It is evident from this inspection that insufficient progress has been made to address previous identified shortfalls. Areas highlighted at this inspection, which require further development relate to care planning/risk assessments, ensuring medication practices and procedures for residents are safe, staffing levels appropriate to meet residents dependency levels and needs, staff recruitment, sustained training and development of staff particularly around those conditions associated with the needs of older people and core subject areas and ensuring that staff receive regular formal supervision. All sections of the Annual Quality Assurance Assessment were completed and provide a reasonable picture of the current situation within the service, however some aspects are aspirational. The evidence to support the comments made is generally satisfactory, however more supporting evidence would have been useful. The manager advised that a supervision schedule for staff is to commence in September 2008. The manager advised that in a “perfect world” all staff would receive formal supervision in line with National Minimum Standards however in reality staff have received only one supervision approximately every 6 months. Staff confirmed the above but stated that informal discussions take place on a regular basis. The manager is looking to enable other senior staff to undertake supervision of staff, however care should be taken to ensure that staff are appropriately trained so that they feel competent and able to undertake this role. The AQAA details under the heading of `our plans for improvement in the next 12 months`, “maintain staff supervision and appraisal documentation and monitoring”. There is a quality assurance system in place to seek the views of residents and their representatives, however the collation of comments, have not yet been undertaken. The AQAA details under the heading of `what we could do better`, “Quality assurance systems are in place but this area needs improvement e.g. putting together in a simpler format”. There was evidence to show that resident/relative meetings are held 3-4 times annually. Records of these meetings were readily available. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 27 A health and safety policy was observed to be in place within the home. In general terms the health, safety and welfare of people living in the care home are promoted and protected. The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 X 3 The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4 and 5 Requirement Ensure that the Statement of Purpose and Service Users Guide is reviewed to reflect accurate information about the services and facilities provided at the care home. Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and ensure that these are regularly updated/reviewed to reflect the most up to date information. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Residents must be protected from harm by having their medication administered safely and in accordance with the prescriber’s instructions so as to ensure their health and wellbeing. Ensure that when medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the DS0000018035.V366641.R01.S.doc Timescale for action 01/10/08 2. OP7 15 21/09/08 3. OP7 13(4) 21/09/08 4. OP9 12(1)(a) 13(2) 13/08/08 5. OP9 17(1)(a) Schedule 3(3)(i) 13/08/08 The Laurels Version 5.2 Page 30 6. OP9 13(2) 7. OP18 13(6) 8. OP18 17(1)(a), Schedule 3(3)(p) 18(1)(a) 9. OP27 10. OP29 19 11. OP30 18(1)(c)& (i) 12. OP31 13(2), 15, 17(1)(a), 18(1)(2) and 19 above. Ensure medication is stored under suitable environmental conditions to prevent residents being put at risk of harm by receiving unsuitable medication. This refers specifically to medication stored within the dedicated fridge. Ensure that all staff receive, appropriate training relating to safeguarding and dealing with challenging behaviour. This will ensure that staff, feel confident, have the skills to deal effectively with issues raised pertaining to the above and residents are protected from harm. Where restraint is used with a resident, a record of any physical restraint used is recorded detailing the type of restraint, the timescale and the outcome. Ensure there are sufficient staff on duty at all times, so as to meet the needs of residents and to ensure their safety and wellbeing. Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents and that all records as required by regulation are sought. Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people and core areas. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. The registered provider must ensure that the day-to-day management of the home is reviewed so that practices, DS0000018035.V366641.R01.S.doc 13/08/08 01/12/08 21/08/08 21/08/08 21/08/08 01/01/09 01/01/09 The Laurels Version 5.2 Page 31 processes and systems within the home comply with regulatory requirements. Previous timescale of 31.8.2007 not met. 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. 5. 6. 7. Refer to Standard OP8 Good Practice Recommendations The outcome of healthcare appointments/interventions by healthcare professionals is recorded within individual resident’s care files. Staff to undertake regular assessments of their practice so as to ensure they remain competent to administer medication to residents. Consider devising the activity programme in larger/simpler and/or pictorial format so that residents can make an informed choice. Nutritional records to be better organised and/or recorded so as to be able to determine what residents have eaten on a daily basis. Consider devising the menu in larger/simpler and/or pictorial format so that residents can make an informed choice. Amend the complaints procedure so as to reflect that we longer investigate complaints. All residents, their relatives and staff to be consulted with regards to the operation of CCTV within communal areas of the home. The results of the consultation to be forwarded to CSCI within 1 month. All staff to receive an induction in line with Skills for Care. OP9 OP12 OP15 OP15 OP16 OP19 8. OP30 The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Laurels DS0000018035.V366641.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!