Inspection on 19/03/09 for The Laurels

This inspection was carried out on 19th March 2009.

CSCI found this care home to be providing an Adequate 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 13/08/08

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE The Laurels 130/134 Church End Lane Runwell Wickford Essex SS11 7DP Lead Inspector Bernadette Little Unannounced Inspection 19th March 2009 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Laurels DS0000018035.V374668.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.V374668.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 28 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 (28) The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th August 2008 Brief Description of the Service: The Laurels is registered for the accommodation and care of twenty eight 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.V374668.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The site visit was undertaken over a nine hour period as part of a routine key inspection. Both the manager and deputy manager were available during the inspection and it was possible to meet the proprietor. This was the second key inspection of The Laurels in the past year and took place as part of the Commission’s procedures in response to the rating of Poor outcomes for people using the service found at the last key inspection. There were 23 people living at The Laurels at the time of this site visit. Time was spent with residents, visitors and staff and information gathered from these conversations, as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. A tour of the home was undertaken and a range of records relating to the home and the services offered were reviewed. Prior to the first key inspection of The Laurels this year, the manager completed an Annual Quality Assurance Assessment. This is a self-assessment document detailing what the home does well, what has improved and what still needs to be improved. Some information from this has been incorporated into the main text of the report. Improvements were noted from the last key inspection and some requirements met. The outcomes of the site visit were fed back in detail and discussed with the manager and opportunity was given for clarification where necessary. A number of requirements remain not met and are included again in this inspection report as repeat requirements. Should the registered provider not address shortfalls as identified within this report, the Care Quality Commission may consider taking legal action. The assistance provided by all of those involved in this inspection is appreciated. What the service does well: People wishing to live at The Laurels are assessed prior to admission so that the manager can be sure they are able to meet the person’s individual needs. They are also invited to visit the home to help them to make the decision about living there. Residents and visitors spoken with had only good things to say about the manager and staff working at The Laurels such as tell them and it gets done The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 6 and you cant fault the staff, they are very good. Relatives and residents spoken with also said they were satisfied with the care provided at The Laurels and one person said, they are very good to the residents. Visitors also said that they felt welcome. Comments from residents regarding the food at The Laurels were positive included the food is nice, I have no grumbles at all. The Laurels provides a clean and well maintained environment for the people who live there. Residents spoken with said they were happy with their own rooms and were comfortable. What has improved since the last inspection? What they could do better: While improvements have been noted in relation to care planning, further developments are needed in this and in risk assessment to ensure that peoples care needs are identified and staff have sufficient detail to meet these safely. Training for staff needs to continue to be developed to ensure they can meet the needs of the resident group and promote their safety and well-being in all aspects of care provided. Development of effective management must continue to ensure positive outcomes for people living at The Laurels and include for example ensuring that all requirements identified in this report are met promptly and fully and that required records are maintained to evidence this. The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 7 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.V374668.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.V374668.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 and 5. Standard 6 is not relevant to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of living at The Laurels will have their needs assessed to determine if they can be met there and they will have adequate information on which to base their decision. EVIDENCE: The statement of purpose has been updated as required by the last inspection and now provides more accurate and relevant information about the service provided. It also had some clearer information on the complaints procedure. It was disappointing that the information on complaints in the service user guide had not been updated. The service user guide could be in larger print and use symbols to make it easier for people using the service to read and understand. A relative spoken with confirmed that they had received a copy of the service user guide as part of the pre-admission process. The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 10 The statement of purpose advises that the pre-assessment will be carried out by the manager or a senior member of the team before residency can go ahead, with the results of the assessment being used to base a decision on whether they are able to provide appropriate care to the individual. The manager’s AQAA stated they try to undertake Preadmission assessments at an early stage so they can produce a mini profile to ease the transition for the person and also allow them time to visit the home. Assessments were viewed for two more recently admitted people. These demonstrated that a preadmission assessment had been undertaken so that the manager could be sure that the persons needs could be met at The Laurels. They contained appropriate information about the persons needs and preferences including in relation to any cultural, religious and dietary needs. One resident spoken with advised they were unable to visit The Laurels prior to admission although invited, because they lived too far away. However, a relative visited on their behalf. Another resident and relative spoken with confirmed that they had visited prior to admission, advised that they were involved in the admission process and had received the service user guide. A relative spoken with confirmed they had also received a contract. Intermediate care is not offered at The Laurels. The Laurels DS0000018035.V374668.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 adequate. This judgement has been made using available evidence including a visit to this service. While improvements are noted, there remain some shortfalls in the management of care planning and risk assessment that mean residents cannot be reassured that their care needs will always be safely met. EVIDENCE: The manager advised that new care planning formats had been introduced. Care files and associated documents were sampled for three residents to consider if the manager had effective systems in place to identify peoples individual needs and give staff adequate information on how to meet these safely in practice. Two of the care files were of people recently admitted and related well in many areas to the information about the person in their needs assessment. They showed resident and/or relative involvement, which is an improvement from the last inspection and this was confirmed in discussion. Care files contained some baseline risk assessments such as for nutrition and fractures. Where one assessment showed a high risk of fracture the manager confirmed there should have been a falls risk assessment in place that crossThe Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 12 referenced with relevant other areas of the person’s plan of care. While relating to a different aspect of risk assessment, this was a requirement of the last inspection. Care plans included instruction for staff that advised of both the person’s abilities and the help they needed and referred to ensuring that people’s privacy and dignity was respected. The manager confirmed that two areas of a care plan had not yet been completed and there was no reason for this. Care notes were clearly written and included relevant information. The care plan for a resident who had lived at The Laurels for some time demonstrated review and reflected some changes, for example that the person’s mobility was now poor and that they needed to be hoisted for all transfers. A record was available to explain the use of restraint in relation to a lap belt while the resident was in a wheelchair to prevent them falling. A record was also available that a pressure mat was next to their bed. The manager stated that this was to stop other people disturbing their sleep, however agreed that it was more appropriate for this to be in the doorway, if this was the rationale behind the use of the pressure mat. A risk assessment in relation to tissue viability was in place, but this was undated and contained some out of date information about the person. The manager confirmed that, while no resident at The Laurels currently had a pressure sore, there needed to be up to date risk assessments and care plans in place to provide adequate instruction for staff on how to support good preventative pressure area care, including for example the frequency of turns and the noted advice of the Community Nurse. While a nutrition record could not be produced for one of the more recently admitted residents, a daily record of the nutritional intake of the more dependent person was available including amounts eaten, that should also include supper and any other snacks provided. Records show that residents have access to a range of health care professionals such as chiropody, community nursing services, physiotherapist and the GP. The manager reports that the GP surgery is very supportive, that the GP is now doing a mini surgery once a month at the home and also responds well at other times. The manager also advised that there is regular input now from the community nursing team. Both of the more recently admitted residents had recorded their input to an assessment of whether they wanted to, or were able to, manage their own medication, which supports people to maintain skills and dignity. For one person managing their own medication the risk assessment needed to develop further to consider if there were potential risks to other people. The resident was spoken with and confirmed that they are provided with a lockable facility in the bedroom where they keep their medication. The last inspection identified poor practice in a number of areas relating to medication management. While some areas continue to need attention, improvements are clearly noted. The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 13 Since the last inspection, a different supplier now provides medication services using a monitored dosage system. The medication trolley was securely stored. There was no record of the temperatures in the medication storage room to ensure they are in line with the manufacturers instructions. There was no record available containing the sample signatures and initials of those people who sign the Medication Administration Recording (MAR) charts and whom the manager has designated as competent to administer medication. The folder containing the MAR charts was well organised and photographs were available of all residents to support identification, which is good practice. The deputy manager had colour coordinated MAR charts in line with the colours of the blister packs and the timing of medication rounds to support staff to ensure that the resident got the right medication at the right time. Staff spoken with were aware of the timings for specific medications for individual residents that were not part of the routine drug round, for example those prescribed for Parkinsons disease and these were appropriately recorded. An audit of the medications available and the record of medications received and administered for one resident tallied accurately. For another resident, staff had recorded clearly whether the person had received one or two tablets where this option was available. The deputy manager confirmed that there are currently no residents refusing medication except for example those prescribed on an ‘as required’ basis for constipation, if the person feels they do not need it. The controlled drugs register was appropriately maintained. No record or protocol was in place to explain why Temazepam, prescribed on an ‘as required’ basis was administered to the resident, to help with effective monitoring. There have been two sessions on medication training for those staff involved in this area of resident care and the manager stated that the new supplier will provide updated training to staff routinely. The management team will be implementing routine assessment of staff competence in administration and recording of medication to ensure that standards are maintained to promote satisfactory care outcomes for residents. The manager stated they had printed off some information about Preferred Priorities for Care and Advanced Decisions, which refers to end of life care preferences and care planning, which will now be developed. This will be reviewed at future inspections. The Laurels DS0000018035.V374668.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents of The Laurels can expect to have their social care and dietary needs met and to be supported in making choices. EVIDENCE: The manager advised that two staff are employed as activity coordinators at The Laurels and that the additional activity coordinator hours provided have had a very beneficial impact on residents daily life. While this was noted on the rota, there was no evidence of how many actual hours are set aside for this role. An activity calendar for the month showed the activities for each weekday including dancing, arts and crafts, cake decorating, singalongs and games. The recommendation from the last inspection to provide clearer information on activities, including in pictorial format for residents, has not been implemented. Care plans reviewed recorded some information on people’s social interests, hobbies, religious and cultural needs, but did not clearly indicate how these were to be met in practice. A separate record is maintained of each days activities and the residents involved to ensure all residents have opportunity to participate. Residents spoken with confirmed that a range of activities were available including, for example, a reminiscence session or an outside singer The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 15 and entertainer or the hairdresser. They also advised of the choice of whether or not they joined in these activities and that their preference on occasion to enjoy their own company was respected. Minutes of a recent resident meeting suggested that families would like a weekly list of planned activities to help both them and the resident decide if they want to participate. There was also a suggestion for armchair exercise, which the manager advised is now part of the current activities and this was noted in activity calendars. The managers AQAA states that they encourage, welcome and assist residents to maintain social relationships and interests. Visitors spoken with said they always feel welcome and this was confirmed by residents spoken with. Residents spoken with and able to express a view felt that they were able to exercise choice in many aspects of their daily life at The Laurels, including spending time alone in their room, coming to tea wearing dressing gown and pyjamas, taking themselves to bed when they wish and going out for walks with family and friends. One resident stated they did not think this was so easy to apply to residents who were not so mentally alert or so able to express views. Staff spoken with said that residents exercise everyday choices relating to their meals and drinks, went to wake up or on what to wear. Staff said they would show some residents a choice of two outfits if they were unable to verbally make a choice and see if they indicated a preference that way. Staff said they would ask also residents if they could give them personal care, or if they would like a bath, and if the person refused they would inform the shift leader and ask them again later as they may have changed their mind. The daily menu was handwritten on the whiteboard and shows that residents have a choice of meals at both lunch and tea time. A limited number of pictures of foods were available as follow-up to the recommendation in the last report that consideration should be given to devising a menu in a larger print or pictorial formats to help residents to make an informed choice. It was noted positively that residents are asked on a daily basis for their choices. Care staff spoken with were able to advise that this is better for residents, particularly those who may suffer from memory loss as part of their condition, and that asking them the day before for their choice was not really helpful to them. Ample food stocks were available and residents spoken with were satisfied with the meals served. The cook was aware of peoples individual preferences and need, including for new residents, for example for cranberry juice in the morning, as noted in their plan of care. Residents had a choice of drinks at lunchtime, which is good practice. The dining area was spacious and staff provided sensitive assistance to residents who required this. It was disappointing that the tablecloths were removed from the tables before residents sat down to eat and were replaced after the meal, this does not demonstrate respect for residents. When this was queried, the manager advised that this rule is set by the registered provider. The Laurels DS0000018035.V374668.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can generally expect to be listened to and to be safeguarded and this would be enhanced by clearer information and improved staff training and competence. EVIDENCE: Information on the registered persons complaints procedure was displayed. The service user guide and statement of purpose contained updated information on contacting the Commission. The information on making a complaint at The Laurels was somewhat limited in detail and disappointingly, although identified in the last inspection report, did not include advice on the available option of taking their complaint to Social Care (Social Services). The manager confirmed that they had not received any complaints about the service since the last inspection. The Commission has not received any complaints about The Laurels. Residents and relatives spoken with said they would feel able to tell the manager or the girls if they were unhappy with any aspect of the service, as they find them approachable and easy to talk to and the girls do listen. One person said they can bring issues to the manager who will say if they can deal with it and, if they can, it will be done straight away. One person said that the registered person is now better at listening and taking action in positive response to issues raised. The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 17 A number of cards and letters of thanks and compliment were displayed in the main entrance hallway with comments such as “for help, kindness and support given. The manager confirmed that no safeguarding issues had been highlighted since the last inspection. The manager had not acted on the best practice advice of the last inspection report on providing staff with a simpler and clearer procedure to follow should a safeguarding issue arise. However, an information folder for staff had been produced that included information booklets and guidance on whistleblowing issued by the Commission for Social Care Inspection. It was noted positively that the manager had access to the current Southend, Essex and Thurrock guidance, protocols and alert forms. The manager confirmed that some staff have attended training on safeguarding vulnerable people and managing challenging behaviour following the issues raised in the last key inspection. This was confirmed by two staff spoken with and on files sampled. The manager also confirmed that not all staff have attended this training and that this is out of their control, as they do not have a training budget allocated by the registered person and so can make limited decisions. The manager had however sourced planned training for the three members of the management team for later this month. The manager and three staff members spoken with demonstrated an understanding and awareness of safeguarding procedures. Some staff spoken with confirmed they had attended training on safeguarding and/or management of challenging behaviour since the last key inspection. The manager confirmed that there had been no instances of restraint used at The Laurels since the last inspection and currently there were no residents living there that demonstrated aggressive behaviour. The manager stated that something had been learned from the incident noted in the last key inspection report and that “staff are now more aware”. An example given was that teatime was a trigger now recognised for example for some people who wanted to go home to get their spouses tea. Observation of practice showed staff supporting people positively in this situation. The Laurels DS0000018035.V374668.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at The Laurels live in a pleasant, clean and safe environment that meets their needs but does not fully respect their privacy. EVIDENCE: All communal areas of the home were viewed along with some residents’ bedrooms. The home was well maintained, with a high standard of furnishing and décor. Peoples bedrooms were personalised to various degrees with photographs etc. and residents spoken with said they were satisfied with their own rooms and found them “comfortable”. Building works are still ongoing but none of the people spoken with said they found them an issue. There has been a recent increase to the number of people the home is registered to accommodate to incorporate six additional single bedrooms. Residents have access to a beautiful garden that is well maintained. One person said they liked sitting in the conservatory area looking at it, but they The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 19 were more looking forward to being able to go out there later and enjoying it fully. The toilet leading from the main hallway did not lock, which does not respect resident privacy and dignity. CCTV cameras are fitted both inside and outside the home. These enable the registered provider and the manager from their office to observe the kitchen/new staffroom, the laundry and staff toilet and also to observe and monitor residents in the communal areas around their home. Staff spoken with advised that they find it inappropriate to feel they are constantly being watched. A relative spoken with stated that they feel the use of CCTV cameras within the home is an infringement of residents’ right to privacy and the manager confirmed their agreement with this. Concern was expressed concern that the survey one person had completed stating their disagreement with the registered person’s use of CCTV cameras inside the home, which they found an infringement of peoples privacy, was missing and not included in those provided for inspection. The registered provider has not yet forwarded the outcome of the survey to the Commission as required. The statement of purpose contains a section on Privacy and Dignity and advises that staff are trained to strive to preserve and maintain the dignity, individuality and privacy of all service users living within a warm and caring atmosphere. Neither the statement of purpose or service user guide advise prospective residents that their movements will be monitored and their privacy infringed in this way. No health and safety issues were observed. One washing machine was out of order but it was advised that this was being addressed. There was safe storage of hazardous items. Hot water temperatures were sampled throughout the home to ensure they were safe for residents. All areas of the homes were clean with no unpleasant odours. The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a stable staff group that will offer them consistency, but may not be adequate in number or appropriately trained to meet their individual needs safely. EVIDENCE: The manager stated that they have had a large turnover of staff about eighteen months ago but in the past few months there has been a more stable team, and this has provided better outcomes for residents in terms of consistency of care. There were 23 people living at The Laurels at the time of the site visit. The manager advised the current day staffing levels as being four care staff including the senior and two staff at night including the senior and this concurred with the rota. However, the manager had given verbal agreement on behalf of the registered provider as part of the recent commissioning of extra beds at the home that this would have been increased to five care staff during the day, and three at night, once resident numbers exceeded 22. The last inspection report included a requirement to ensure there are sufficient staff on duty at all times. When the failure to comply with the agreed minimum staffing levels was discussed, the manager advised that this had only overlapped for one week so far, that they were interviewing this week and The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 21 hoping to appoint more staff to address this and that this would not continue for long. Rotas reviewed did not indicate the time that staff were on duty to show the hours of care provided for residents, neither did they record the hours worked by the manager, who advised their hours are supernumerary. The manager advised that of 18 care staff, one senior has completed NVQ4 and one is currently undertaking this, seven staff have completed NVQ3, six staff are currently undertaking this, and two staff are undertaking level 2. On completion, The Laurels will exceed the National Minimum Standard recommended 50 per cent of staff achieving at least NVQ level 2. The managers recruitment process was reviewed to ensure appropriate checks and references are undertaken on prospective staff to safeguard residents. The file of a person recruited since the last inspection showed improvement, with a full employment history, two written references and a Povafirst check in place prior to employment commencing, along with the other required information. There was also subsequent evidence of a suitable Criminal Records Bureau check to the required level. The lack of induction to Skills for Care standards was identified in the last inspection report. The manager advised that they and the deputy manager attended a very recent two-day train the trainer course on Common Induction Standards and will in future be implementing a robust induction to Skills for Care standards for all newly employed staff. To develop their skills they are practising on a current and long serving member of staff with their agreement, which will also enable them to receive feedback. No training matrix was available to show which staff had attended which training and when, so that this could be monitored and kept updated as required in a timely way. The manager confirmed that there has been much additional training provided recently that has come about because of the Requirements identified in the last inspection report. This had included medication, infection control, fire awareness, managing challenging behaviour, safeguarding vulnerable people and tissue viability for varying numbers of staff. The manager, deputy and team leader are undertaking training on medication through Chelmsford College and will now complete regular competence assessment of staff as part of medication monitoring. The last inspection report identified that of the staff files sampled, two people had no record of having undertaken manual handling training and this was required to be addressed as a matter of urgency. At this key inspection, two staff spoken with advised that they had not yet attended training on manual handling although they had been employed for some months. However both the manager and the staff separately confirmed that they were booked to, and would be attending this training, next week. Additionally the manager advised that training is booked and planned in the next month on food hygiene, first aid, stoma care, epilepsy awareness and mouth care. The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 22 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 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, however the lack of clear role responsibility within the management team could mean that the best outcomes for people living there are not always achieved. EVIDENCE: The manager has been, in name, in day to day charge of The Laurels for several years but no application has yet been made to the Commission for them to be assessed as fit to be registered for this role. The manager has completed relevant training including the Registered Managers Award, a recent management workshop and is now undertaking NVQ training on administrative skills. Since the last inspection, the manager has had the support of a newly employed deputy manager who also has experience in management in care settings. While the manager advised that there has been a lack of clarity within The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 23 the management team that they are trying to develop, the responsibilities of their role were discussed with them including in relation to notifying the Commission that despite giving assurances of increased staffing levels to obtain agreement to register the additional beds, these had not been implemented. The manager stated that the registered provided is actively involved in the home and management suggestions have to be agreed with the registered provider before they can be implemented. The manager has no authority in relation to budget planning and relevant decision-making in developing the service, for example in relation to training. On the day of the site visit, staff advised that they had run out of milk for the residents. The manager confirmed that they are not allocated a petty cash float and the registered provider remains in control of all such aspects of the service management. A quality assurance system is in place that includes obtaining the views of residents and relatives. A report of information gathered during the year showed outcomes of relatives and residents surveys and from resident meetings. These demonstrated overall satisfaction with issues such as food/choices, the staff and activities provided with some negative comments around the building work and how this had affected people living in the home. The manager has implemented observations of staff practice, including early morning care, as part of care monitoring. Records showed that the outcome of this was discussed with the staff and with residents and relatives at the most recent resident meeting. The manager holds small amounts of personal money in safekeeping for residents. It was not possible to audit any individual resident’s money as all monies are kept in one collective amount. Records were available to show receipts and withdrawals that included two signatures. However, no receipts were available for individual residents to evidence the authenticity of the withdrawal and effective management systems to safeguard residents. The last inspection report indicated that staff had not received regular supervision and that the manager had plans to designate this task to senior staff to ensure that they could maintain staff supervision at appropriate frequencies. Since then, the manager and the care team leader attended training on supervision. The manager advised they now have plans for implementing the effective supervision using this recent training and the material and formats they received there. A supervision plan is now in place. Two staff files sampled showed a recent supervision session that included a review of training and practice issues. This will be considered further in future inspections to allow the system to be fully implemented and to demonstrate that it is managed effectively, suitably detailed and maintained routinely. Records were noted to be securely stored with care plans in a locked facility in the care team office and staff files securely stored in locked cabinets. However, The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 24 necessary improvements in management of recording systems to promote residents’ well-being have been identified in this report, for example in relation to care planning and effective risk assessment, management of their money, detailed records for all residents to evidence appropriate nutrition and records that show the hours that the manager and staff are available on the premises to care for residents. Records of routine safety checks were requested to ensure a safe environment was maintained for residents and staff. Routine safety inspection certificates relating to the fire alarm, fire equipment gas and portable appliances were available. A current certificate of liability insurance was displayed. Records indicated that fire drills were undertaken routinely and recorded good detail of the event and the staff who attended. However all occurred in the morning and the manager confirmed they had not monitored this to ensure that all staff, including night staff, are regularly included. The manager advised that for resident safety, no key is kept by the front door, which is an identified escape route, but that in a power cut the front door is de-activated and another system is required for key access. No action had been taken to address this. Hot water temperatures had been checked monthly but there was no record of checks of the cold water in relation to management of Legionella, and the chlorination certificate had expired. The Laurels DS0000018035.V374668.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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 2 17 x 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 2 2 2 2 The Laurels DS0000018035.V374668.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 OP7 Regulation 15 Requirement Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and ensure that these are regularly updated/reviewed. So that staff have the most upto-date information to enable them to ensure residents care needs are met. Previous timescale of 21.9.2008 not met. 2. OP7 13(4) Risk assessments must be devised for all areas of assessed risk. So that risks to residents can be minimised. Previous timescale of 21.9.2008 not met. 3. OP18 13(6) Ensure that all staff receive appropriate training relating to safeguarding and dealing with challenging behaviour. This will ensure that staff have The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 27 Timescale for action 01/07/09 01/05/09 01/07/09 the skills to deal effectively with such issues and residents are protected from harm. Previous timescale of 01.12.2008 not met. 4. OP27 18(1)(a) 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. Previous timescale of 21.8.2008 not met. 5. OP30 18(1)(c)& (i) 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 including moving and handling. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs safely Previous timescale of 01.01.2009 not met. 6. OP37 17 Maintain records required by 19/03/09 Regulation to satisfactory levels as identified in the body of the report such as resident care plans and risk assessment, hours worked by staff, auditable records of each resident’ money and nutrition records. 01/06/09 19/03/09 The Laurels DS0000018035.V374668.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. Refer to Standard OP2 Good Practice Recommendations Develop the service user guide to be more user friendly and include relevant information for people using the service including in relation to complaints. Ensure that the temperatures of medicines storage areas are monitored and recorded regularly to ensure a suitable environment exists. Maintain a sample list of staff signatures of those people designated by the manager as competent to administer medication. Ensure respect is shown for residents’ privacy and dignity. This includes reference to the use of CCTV in communal areas of the home for resident use. Include more information in the complaints procedure relating to timescales and right to complain to Social Care (social services). All staff to receive an induction in line with Skills for Care. The registered provider to continue to support and develop effective management systems to ensure best outcomes for people living at The Laurels. Staff to receive formal supervision at least six times annually. Implement a review of fire procedures including in relation to power cuts and including all staff in fire drill and practices. 2. OP9 3. OP9 4. OP10 5. OP16 6. 7. OP30 OP31 8. 9. OP36 OP38 The Laurels DS0000018035.V374668.R01.S.doc Version 5.2 Page 29 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.V374668.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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