Inspection on 17/04/07 for The Laurels

This inspection was carried out on 17th April 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 25/04/06

The Laurels 05/12/05

The Laurels 22/06/05

The Laurels 16/09/04

The Laurels 21/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Laurels 45 High Street Market Deeping Lincs PE6 8EB Lead Inspector Moya Dennis Key Unannounced Inspection 17th April 2007 2:30 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 DS0000002447.V334138.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 DS0000002447.V334138.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address 45 High Street Market Deeping Lincs PE6 8EB 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) 01778 344414 Mr Desmond Michael Shiels Mrs Jacque Sonia Shiels Mr Desmond Michael Shiels Mrs Jacque Sonia Shiels Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2006 Brief Description of the Service: The Laurels is a grade II listed building built in the early 1800’s. It is situated a quarter of a mile from the town centre of Market Deeping. The town has a range of facilities including shops, pubs, and banks. There are six single and one shared bedroom on the ground floor and eleven single and two shared bedrooms upstairs. There is a courtyard area with chairs and tables at the side of the home, and a grassed area to the rear. The home is registered to provide accommodation for up to twenty-three older persons who need personal care. At the time of inspection, there were 17 residents. The Laurels is a family run business, the owners being joint managers and working in the home on a daily basis. The home advertises in Yellow Pages. Fees range from: £379 to £415 per week. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken by one inspector and took place over 4 hours in April 2007. It formed part of a key inspection and focussed on standards in the key areas that most affect the quality of life for residents. Information already held, such as the service history and incidents since the last report, was used to plan the visit. The inspection method used was to case track the care received by a sample of residents by looking at their records and discussing their experiences of care with them. Four residents’ files were inspected; four staff and seven residents gave their experiences and opinions of the service. No staff files were available for inspection. No visitors were present during the inspection. General care practices were observed throughout the visit. Six ‘Have your Say’ surveys were returned before inspection and the responses were used throughout this report. One of the registered managers was on long-term sick leave; the other was not present during the visit. Senior care staff assisted the inspector in the managers’ absence and were given general feedback at the end of the visit. What the service does well: Residents and their relatives were satisfied with the service. Comments included, “Everything’s done properly here.” and, “You couldn’t improve things here, it’s always 100 ”. Visitors said they are always made welcome. The home is clean, well decorated and maintained, providing a homely atmosphere for residents. Staff are employed in sufficient numbers to meet the individual needs of residents. The home is small enough to offer a more personalised service to residents. Low staff turnover provides continuity of care for residents. The owners work within the home on a daily basis and have a good rapport with residents and relatives. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are fully assessed before they move to the home. Stays were on a trial basis to ensure the home could meet assessed needs. EVIDENCE: Residents confirmed the manager had visited them, in their own homes or in hospital, to assess their needs. Records showed that information from other professionals, such as social services contributed to the assessment process. Surveys evidenced that people were given sufficient information before moving to the home to enable them to make an informed choice about where to live. Prospective residents and their relatives confirmed that they had been able to visit and look round before deciding to move there. One resident had lived in the area for most of her life and said, “I set my heart on this place when I knew I couldn’t live alone. I really like it here”. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 9 All stays were initially on a trial basis. This gave new residents the chance to determine if The Laurels was the right home for them, and for staff to conduct a thorough assessment, based on more detailed understanding of individual needs, preferences and aspirations. Senior care staff confirmed that all residents were given a copy of the home’s terms and conditions. The home did not provide intermediate care. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 10 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 contained relevant information but needed to be more organised to enable information to be readily located. Residents’ health needs were protected by robust policies and procedures and staff treated them with courtesy and respect. EVIDENCE: Care plans of four residents were sampled. Two had sufficient information to enable staff to meet assessed needs, with information well organised. Records of two residents comprised a variety of information in loose folders; staff were unable to locate some information. Personal information held included a social history, former employment, significant events, and family structure. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 11 There was evidence that plans were reviewed monthly, or more often if needed. However, there was no evidence of residents’ or relatives’ involvement in reviews. Risk assessment had been completed for a wide range of activities and identified hazards. Records were kept of GPs’, community nurses’ and chiropodists’ visits. Residents said when they needed to see a doctor or any other health professional, staff would arrange a visit. One relative said, “This is a particular strength. The staff always know when mother is unwell and call the doctor”. The home’s medication policies were satisfactory. Medication profiles detailed what medication was take and possible side affects. Medication records were up to date and signed appropriately. Storage and return procedures were complied with. All staff involved in administration of medication had received appropriate training. Residents were encouraged to manage their own medication whenever possible. However, no resident self medicated at the time of inspection. General care practices were observed throughout the inspection. Staff addressed residents by the preferred name recorded on their care plan and were seen to knock on residents’ doors before entering. Staff said the need to be respectful to residents at all times was paramount. They were aware of the home’s policies regarding privacy, dignity, choice, rights and independence. End of life wishes were discussed with residents and recorded in their care plans. Staff said they had not received specific training in palliative care giving. However, they showed a good understanding of managing end of life arrangements in a respectful and supportive way and the need to support relatives, as well as residents, during the end of life stages. They said they had continuous support from management and opportunities to discuss their own anxieties, concerns, and feelings when caring for people at the end of their life. Staff showed the inspector letters of thanks received from families, confirming that they had been able to stay with their relatives during their end of life stage. “Special thanks for the care and support you gave us in her last days.” “Always going on caring the way you do. It’s priceless”. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 12 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. Residents had choice as their preferred routines and leisure activities. Meals were well balanced and varied and all residents were assisted to make choices. EVIDENCE: Residents said, and answered questionnaires that there was ‘sometimes’ or ‘usually’ arranged activities they could take part in. One relative said there were not enough group activities arranged for residents. However, residents were encouraged to be as independent as possible and said whilst they enjoyed organised activities, they were happy to read, watch TV, go out or talk. They said they were always informed as to what was going on and staff asked them if they wished to take part. Entertainers visited the home once a month and residents said they looked forward to these visits. More physical activities had been arranged in the past but residents said they had not enjoyed them and they had been cancelled. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 13 Staff saw socialising with residents to be part of their job and spent time talking to them whenever possible. Visitors said they were always made welcome and kept informed of any changes to their relative’s health and well-being. One relative said, “I have been coming here for 3 years. I enjoy visiting and always seem to be welcomed, both by other residents and the staff”. A minister visited the home every week and communion was given every month. Some residents preferred to attend the local church each week. Responses in questionnaires were positive about the food. Comments included, “Good food, especially the mid-day meal … well cooked, tasty with good portions”. Others said via questionnaires that they, ‘always’ enjoyed the meals. Care plans included information about dietary needs and staff were knowledgeable about residents’ preferences and dislikes. Menus were organised on a 4 week rota, with suggestions from residents. Alternatives were offered at every meal. During the inspection, two residents asked for alternatives to the teatime meal. Both were provided with meals of their choice. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents and relatives benefited from a clear complaints procedure and they were assured that any concerns would be listened to. Residents were protected from abuse by good staff awareness. EVIDENCE: Completed surveys showed that relatives knew how to make a complaint; none had had reason to do so. The complaints file was made available during the inspection. No complaints had been received since the last inspection. Staff had received training on adult protection issues. The owner/manager provided in-house training on this and other issues concerning the protection of vulnerable people. Staff demonstrated a clear understanding adult protection and were able to recognise various forms of abuse. They were aware of the whistle blowing process and said they would feel confident to raise any concerns with the owner/managers. The homes’ adult protection policy reflected Lincolnshire Adult Protection Committee (LAPC) guidelines. Procedures for responding to suspicion of abuse were robust, further ensuring residents’ safety and protection. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 15 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): 19,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoyed a comfortable, well-maintained environment. EVIDENCE: During this inspection, residents invited the inspector to see their rooms. These were clean and well maintained throughout. Residents said they received all the care they needed and had been able to personalise their rooms. Comments included, “I have a lovely room and everything I need around me” … “It’s always kept so clean and tidy; I’m proud to let anyone look around”. One relative noted that there was sometimes a “less than fresh” atmosphere in the home and some carpets were not cleaned as often as necessary. During the inspection the standard of hygiene throughout the home was good, with no The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 16 noticeable odour. Residents said the home was ‘always’ fresh and clean. A senior carer said there had been a problem with one carpet but this had been rectified. Evidence was seen that carpets were cleaned regularly. Staff confirmed that any maintenance issues were reported to the manager and would be dealt with by the maintenance worker. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Competent staff in adequate numbers met residents’ needs. Staff were supported in NVQ training but other training opportunities were limited. Thorough recruitment procedures protected residents. EVIDENCE: Residents and relatives said there always seemed to be enough staff on duty. The residents were very positive about the care they received from the staff. One said ‘they’re very nice and sociable’. Staff confirmed that they had enough time to meet residents’ needs and spend social time with them. Rotas showed adequate cover at all times. 56 of staff had received National Vocational Qualification (NVQ) awards. Five more staff were waiting to start training. Staff confirmed they had clearly defined job descriptions. New staff visited the home, learning about working policies and procedures, getting to know residents, observing general care practice and becoming familiar with the layout of the building. They shadowed experienced staff The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 18 throughout the induction process. All staff had a probationary period of six weeks to determine their suitability for the work. No staff files were available during the visit and so it was not possible to confirm during inspection that they contained all the information required by National Minimum Standards. The manager later provided evidence following the inspection. A requirement was made that arrangements be in place to provide such information in the event of the managers’ absence. One member of staff said they had not received specific training on adult abuse since starting work at the home. However, all staff were able to recognise potentially abusive situations and give comprehensive answers to various scenarios. Records showed that staff had received training on manual handling, hand washing and cross infection and fire safety since the last inspection. Staff had not received training on any areas of dementia or confusion. They said one of the managers usually instructed them, but she had been on extended sick leave and they had received no recent training. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Both managers were experienced in providing care for older people. Residents’ needs were central to the running of the home. Staff had not received formal supervision or specialist training, relevant to the needs of residents. EVIDENCE: Both owners were registered managers and involved in the day-to-day running of the home. There was no formal quality assurance system but residents’ views were sought on a daily basis. A recommendation was made that a more formal The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 20 system of quality assurance be developed to obtain residents views about the service. The managers usually had daily contact with staff, residents and visitors, who said they felt able to discuss any issues with them. Residents said, “They know us, we know them … they ask if everything’s OK, and if it wasn’t, they’d soon fix it”. Staff said, “They’re very good. You can go to them with any problems”. Residents, or their representatives, were encouraged to manage personal finances. The managers held no personal allowances on behalf of residents. One manager was responsible for staff supervision and training. She had been on long-term sick leave and staff had received no formal supervision or recent training. Most staff were unable to recall when they had last had supervision. One staff member said they had not had supervision for a year. The other manager acknowledged the shortfalls and said the issues would be addressed in the near future, when the other manager returned to work. Records relating to residents were disorganised. This had been identified during previous inspections and a requirement was made that all records be more organised. Records showed that fire alarms were tested weekly and all specialist equipment was regularly checked and serviced. The kitchen was clean and well organised. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 1 3 The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 22 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 OP36 Regulation 18(2)(a) Requirement Timescale for action 17/07/07 2. OP37 17 (1)(a) 3. OP37 17(2) The managers must make arrangements to provide staff with regular supervision and ongoing training. This will ensure staff have the support, confidence and expertise to meet the current needs of residents. All records concerning residents 17/07/07 must be organised so information can be easily found. [This requirement was made on 05/12/05. Some progress has been made but further work is needed.] The managers must make 17/07/07 arrangements to ensure that records are available for inspection at all times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 23 1. 2. OP7 OP33 Care plans and reviews should show that residents, or their representatives, have been involved in the process. The way in which residents’ and their representatives’ views are sought and recorded should be reviewed. A more formal system would enable responses to influence future developments in the service. The Laurels DS0000002447.V334138.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 DS0000002447.V334138.R01.S.doc Version 5.2 Page 25 - 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. 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