Inspection on 22/11/05 for The Laurels

This inspection was carried out on 22nd November 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Laurels 14/04/06

The Laurels 27/04/05

The Laurels 11/01/05

The Laurels 11/05/04

The Laurels 09/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 The Laurels The Green Wilmcote Stratford On Avon Warwickshire CV37 9UU Lead Inspector Maggie Arnold Unannounced Inspection 22nd November 2005 10.00 The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 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 DS0000004358.V267870.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Laurels Address The Green Wilmcote Stratford On Avon Warwickshire CV37 9UU 01789 262547 01564 795388 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) Mrs Jillian Amy Desperles Mrs Jillian Amy Desperles Care Home 3 Category(ies) of Learning disability (2), Mental disorder, registration, with number excluding learning disability or dementia (1) of places The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Accommodation When the existing service user no longer occupies the top floor attic bedroom this room must not be used for any other service user. Use of Rooms The registered person must seek agreement from the Commission for Social Care Inspection, in advance, to the use of any other room to be used as a bedroom by service users. 27th April 2005 Date of last inspection Brief Description of the Service: The Laurels is located in the village of Wilmcote, which is approximately two miles outside of Stratford upon Avon. The village, including parts of the Home, has a number of links with Shakespeare, which date back to Shakespearean times, the Home was known as a public house at that time. The Home provides accommodation and support to three people. It is privately owned and managed by the proprietor, opening in the early 1990’s. There is a shop and public house in the village and tourist attractions. The Home is domestic in nature and is a detached property on the village green. There is a garden to the front of the property, which is easily accessible to the residents. The accommodation in the home is over three floors, and accessed by two staircases. Each resident has their own bedroom. One bedroom is on the second floor of the property, the resident has the sole use of a bathroom on the same floor. The second bedroom is on the first floor of the property with the third bedroom being on the ground floor. Two residents share a shower facility that is on the first floor of the property. Shared indoor space in the home consists of a large family kitchen cum dining room, laundry area, downstairs toilet and residents have their own separate sitting room. The Laurels is also home to a number of family pets and as such in not a suitable placement for people who do not like cats and dogs. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In practice the residents live within the owner’s family home, which is managed more in line with an Adult Placement. In view of Stratford Social Services not having an Adult Placement Scheme, this provision, by default, falls under the more robust National Minimum Standards for Care Homes for Younger Adults 2001. In order not to detract from the small homely service the Commission has made the decision to inspect the home with a ‘lighter touch’. This unannounced visit took place on a weekday and was carried out between 10.00 am and 1.30 pm. A resident, Mrs Desperles (the owner/manager) and a staff member were in the home for the duration of the inspection. The main focus of the inspection was to talk to resident, check the home’s had compliance with the five requirements arising from the previous inspection and to monitor statutory records. What the service does well: What has improved since the last inspection? What they could do better: Whilst it is acknowledged that the family are very familiar with the needs and preferences of the residents, the lack of statutory training and sparse essential records continues to give some cause for concern. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 6 The residents must have written and costed contracts/statement of terms and conditions. These will serve to protect both the interests of the residents and the home. Although the family are well informed, day to day records are very sparse and do not give a general overview regarding the residents’ daily life or areas of concern. As discussed with Mrs Desperles, over a period of time “word of mouth” information becomes hazy or is forgotten. The failure to ensure that all persons living or working in the home have undertaken a Criminal Records Bureau check does place the residents at potential risk. Additionally, the ongoing lack of core training also places both the residents and persons working in the home at potential risk. To summarise; The Laurels is a small care home with support being provided by four main family members, which clearly benefits the three residents. During the course of this, and the previous two inspections, the inspector had very good feed back from the residents regarding the care they receive. Mrs Desperles (the registered manager) and her family are extremely familiar with the needs and preferences of the residents who have all lived in the home for a significant length of time. The Laurels has a nice atmosphere and is run in a very relaxed and homely manner. The residents are happy and benefit from living in a small family environment. However poor record keeping and filing systems means that there isn’t enough detailed and orderly essential information. This results in a lack of accountability and has the potential to place the residents at risk, for example in the event of an extreme family crisis, when other professionals may need to care for the residents. 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 Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 No new residents have been admitted to the home in the previous twelve years. The continuing lack of individual written contracts means that the residents’ legal rights have not been fully protected. EVIDENCE: One care plan and accompanying records were seen on this occasion. The three residents have lived in the home between twelve and fourteen years. Although there was no evidence of the initial social work referral, a social worker’s assessment had been undertaken three years ago that confirmed the needs of the resident. The requirement for residents to have individual written contracts or statement of terms and conditions within the home remains outstanding. At present the residents do not have any documents that tells them the contractual details of their placements or terms and conditions of living in the home. Nor is there any documentary evidence detailing how much of the placement costs or contributions are to be paid by the residents. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 &10 Residents are encouraged and supported to make decisions about their lives and various aspects of life in the home. Subject to risk assessments, residents also enjoy a relatively independent lifestyle. The failure to maintain orderly filing systems makes it very difficult to find specific records or letters. Mislaid essential records have the potential to place residents at risk. EVIDENCE: This section was fully assessed at the time of the previous inspection. The inspector spoke to one of the residents in the presence a member of staff. The resident was more forthcoming and confident than on previous visits and was happy to have a few short chats. She talked about the changes to her day care routine, shopping trips, interest in drawing, helping in the house. The resident also said how much she liked the animals and in particular the extremely tame large pet rabbit. These discussions combined with The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 10 observations made throughout the inspection confirmed that the resident is consulted about and participates in various aspects of life in the home. Although there has been some improvement in records regarding daily life in the home, the records are still very sparse and are not an accurate reflection of activities undertaken and residents’ views or reactions. In compliance with a requirement arising from the previous inspection, the home now has a lockable filing cabinet for the safe storage of records of a confidential nature. Most of the individual resident’s records are filed in separate slings. Records would be further improved if they were filed in an orderly manner. At present all of the paperwork is just stored in the sling in any order, with complete disregard to content or date. This makes it time consuming and very difficult to find specific records or letters. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 16 &17 Residents are supported to take part in the local community and engage in appropriate activities and leisure activities. The home is run in a manner that respects the rights of residents and encourages residents to exercise a degree of responsibility. EVIDENCE: Discussions with the resident, proprietor/manager and staff member confirmed that residents are supported participate in the local community. As part of a small community other villagers know the family and residents. The residents use local facilities such as the post office and newsagents. At the time of the inspection a neighbour was visiting the home and a friend popped in later in the morning. Two of the residents are fairly independent and with guidance and support from the family enjoy a reasonably flexible lifestyle. For example, one resident regularly attends a day care facility but also travels independently to visit her family and friends. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 12 As noted in the summary of this report, The Laurels is not a traditional care home and residents and family members share most of the facilities and spend a lot of time together. With the exception of bedrooms most of the facilities are shared. The proprietor and residents have their own sitting rooms but share a large kitchen cum dining room. Throughout the inspection process the resident frequently came into the proprietors sitting room, which also holds records relating to the residents and management of the home. In addition to making drinks or snacks, residents also do little jobs around the house such as refilling the animal’s feeding bowls or popping to the local shops for a newspaper. The residents get a small allowance from the proprietor for undertaking these tasks. Since the last inspection the kitchen has been refurbished. The good quality units, cupboards, table and chairs are suitable for the residents and enhanced the appearance of the kitchen. A new coffee table and cupboard has also been purchased for the residents’ lounge. The resident confirmed that she continues to enjoy the meals and snacks provided by the home. Menus and food stocks were not assessed on this occasion. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The failure for the home to routinely adhere to its own medication policies and procedures places the health and well being of the residents at risk. EVIDENCE: Standards 18, 19 & 20 were fully assessed at the time of the last inspection, which took place on 27th April 2005. The home records dates of healthcare appointments and confirms that these have been attended. However no records are kept of the outcome of the appointments. For example, whether there is to be a change in medication or any other healthcare concerns. Mrs Desperles also discussed arrangements that had been made between the local GP, home and one of the residents, however this was not recorded on her file. Medication was securely stored and there was no evidence of excess stocks of medication. A completed MAR sheet was on file evidencing that the home is now in the routine of recording medication issued. However it is of concern that the current daily administration record (MAR) sheet could not be found. The home must ensure that statutory records are always available for inspection. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The failure to ensure that, with the exception of the residents, all persons living in the home have been subject to statutory police checks places the residents at potential risk. The lack of training in Protection of Vulnerable Awareness (POVA) poses a potential risk to the safety and well being of the residents. EVIDENCE: These standards were fully assessed at the time of the previous inspection. A requirement arising from the previous inspection said that “All persons working in the home must undertake Vulnerable Adult Awareness training. The manager must liaise with the Local Authorities Vulnerable Adult Co-ordinator and ensure the homes policy and procedures are in line with the multi-agency guidance. All persons working or living in the home, with the exception of the residents, must undergo a criminal records bureau check.” Although there was documentary evidence to show that the home had made some effort to contact the Local Authority and complete criminal record bureau checks these requirements remain outstanding. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28 & 30 Not assessed on this occasion. EVIDENCE: This section was fully assessed at the time of the last inspection, which took place in April 2005. Since the last inspection the home has undertaken a number of refurbishments. The garden has undergone a major transformation with newly laid paving and decking and two arbours. The work has opened the garden up and makes it look much larger and brighter. The resident said she liked the new garden and sat in the garden for her morning coffee. Internally, the kitchen has been refurbished with good quality units, table and chairs. Areas seen were the kitchen and two sitting rooms. The Laurels continues to be a homely, comfortable and relaxed environment. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The ongoing lack of core training has the potential to compromise the health and safety of the residents. EVIDENCE: Standards 33, 34 and 35 were assessed on the previous inspection, which took place in April 2005. As noted in the previous inspection report, Mrs Desperles, who is the owner/manager, her daughter, daughter-in-law and granddaughter form the basis of the staff team. All four are very familiar to the residents. At the time of this inspection Mrs Desperles and her daughter-in-law were in the home. A requirement arising from the previous inspection, which took place on 27th of April 2005, stated that; “Persons working in the home are required to undertake core training such as food hygiene, fire safety and moving and handling as well as training regarding learning disabilities and mental health relevant to the present residents. The registered provider must provide a training and development plan for staff working within the home.” Whilst there is evidence that some steps have been taken towards exploring possible training opportunities, this requirement remains outstanding. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 The failure to comply with requirements arising from the previous inspection results in the lack of accountability for the management of the home and does not safeguard the safety and well being of the residents. EVIDENCE: Standards 40 and 42 were assessed on the last inspection. Considering Standard 40. Discussions with Mrs Desperles and a check of the home’s policies and procedures manual evidenced that an outstanding requirement, to clearly note which of the policies and procedures are relevant to the home, remains outstanding. There are concerns about the continuing lack of core training for staff supporting the residents (Standard 42). Concerns also remain that not all staff or persons, excluding the residents, working or living in the home have undergone criminal bureau checks. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 18 Considering Standard 37. Mrs Desperles has had responsibility for the overall management of the home since it was registered in 1991. As noted at the beginning of this report the residents live in Mrs Desperles family home and share a number of facilities including the gardens, kitchen cum dining room, laundry and a toilet facility. Also as noted at the beginning of this inspection, as a result of Stratford Social Services not having an Adult Placement Scheme, The Laurels falls under the more robust National Care Standards for Younger Adults 2001. Consequently the Commission has made the decision to inspect the home with a ‘lighter touch’. Discussions with Mrs Disperles combined with evidence of various correspondence regarding training programmes, demonstrates that limited action has been taken towards meeting this standard. There is no evidence to show that Mrs Disperles has followed up the initial action. For example, no training days or courses have been booked and no one working in the home has received any core training. Policies and procedures are not fully established (refer to requirement arising from the inspection report of 27th April 2005). Residents still do not have written contracts/terms and conditions. Additionally certificates and licences of various maintenance checks, such as gas and electrical appliances were missing. Regarding Standard 39. On this occasion only one resident was seen during the inspection process. Discussions with the resident, Mrs Desperles and her daughter in law showed that, with regards to the day to day running of the home, the residents views are taken into consideration. For example, the resident was aware of future development plans for the refurbishment of the home. The resident was also aware that the home is proactive in ensuring that opportunities for day care provision were being followed up on her behalf. As noted in the summary of this report four of the five requirements arising from the previous inspection report remain outstanding with the fifth requirement being partly met. The Laurels DS0000004358.V267870.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 2 Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 3 2 x 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x 3 LIFESTYLES Standard No Score 11 x 12 x 13 3 14 3 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Laurels Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 2 x DS0000004358.V267870.R01.S.doc Version 5.0 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5.3 Requirement The registered manager must develop a costed contract/statement of terms and conditions between the home and the resident. The home must ensure that it maintains more detailed records regarding the health, safety and daily activities of the residents. The manager must make statutory records available for scrutiny by the Commission for Social Care Inspection. The registered manager must make sure that medication administration record charts are available for inspection. The registered manager must ensure that all persons working or living in the home undergo a Criminal Records Bureau check. All persons working in the home must undertake Vulnerable Adult Awareness training. Persons working in the home are required to undertake core training including food hygiene, fire safety, moving and handling as well as training regarding DS0000004358.V267870.R01.S.doc Timescale for action 28/02/06 2 YA8YA7 17 (1-4) 28/02/05 3 YA20 13 (2) 14/12/05 4 YA23 13(6) 31/12/05 5 YA37YA35 18 (1) (c) 28/02/05 The Laurels Version 5.0 Page 21 6 YA40Y 13 (6) 17(2) Sch 4 learning disabilities and mental health awareness as relevant to the residents. The manager must ensure that the home’s polices and procedures manual are relevant to the home. 28/02/05 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 YA10 Good Practice Recommendations Serious consideration should be given to reviewing the home’s filing systems. 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