Inspection on 23/03/07 for The Laurels

This inspection was carried out on 23rd March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Laurels 19/12/05

The Laurels 03/06/05

The Laurels 03/11/04

The Laurels 09/06/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Laurels St Margaret`s Lane Titchfield Hampshire PO14 4BL Lead Inspector Ruth Burnham Key Unannounced Inspection 23rd March 2007 09:30 The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 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 DS0000028542.V330950.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 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 DS0000028542.V330950.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address St Margaret`s Lane Titchfield Hampshire PO14 4BL 01329 841919 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) Rivers Reach Care Limited *** Post Vacant *** Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: The Laurels is a large family home on two floors, converted to meet the needs of the service user group. It is located in a quiet road, in a semi rural area several miles outside Titchfield Centre. Accommodation is provided in single bedrooms . Communal space comprises two lounges, dining room and a large fitted kitchen. There is a large enclosed garden at the rear of the property. The Laurels is part of Rivers Reach Care Limited which runs three homes for people with Learning difficulties. The home is registered for service users with moderate to severe learning difficulties aged 18 to 65 years. The aims and objectives of the home are to enable service users to participate fully in daily living and meeting their own identified needs. Service users are encouraged to participate in the day to day running of the home and to access opportunities for education, employment and activities within the local community. Information about fees and charges was not available at the time of the inspection. This information can be obtained through application to the manager of the home. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which was carried out by one inspector who was in the home from 9 am to 3.30 pm. During this time the inspector was able to talk to and spend time with most of the residents who live in the home. All the staff on duty were spoken to as was the new manager and the area manager. Surveys were sent out to health care professional, care managers, residents and relatives before the inspection and all the comments received were positive. What the service does well: What has improved since the last inspection? What they could do better: The home must provide an up to date statement of purpose and service user guide. The homes admission procedures should be followed for all admissions in line with their statement of aims and objectives. Admissions should take account of the wishes and feelings and compatibility of existing residents. There should be clear procedures in place where male carers are employed to provide intimate personal care to female residents that take account of the residents’ wishes and feelings and are in their best interests. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 6 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 DS0000028542.V330950.R01.S.doc Version 5.2 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 DS0000028542.V330950.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is poor. People who are thinking about moving into the home do not have access to up to date and accurate information upon which to base a judgement. Emergency admissions have been poorly managed which has had a negative impact on the lives of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who are thinking about moving into the home are not provided with up to date information about what it is like to live there. Information is not in a form which could be understood by people with learning disabilities. The statement of purpose and service users guide is out of date. There have been 2 admissions in the last 3 months which were intended to be short term. One resident moved from another home with only hours notice, the other resident moved in temporarily while the house to which she was moving was completed. The situation is further complicated by the fact that both of these service users are being supported by their own staff teams. This means that 3 distinct staff teams are operating in the home, all under different line management. Staff said that all this was done without any consultation with staff or existing service users. The area manager said that one admission had only been intended for one night however the local social services The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 9 department had insisted that the resident must remain at the Laurels for 6 weeks, the area manager said he had felt unable to challenge this. He assured the inspector that both short term residents would be leaving in the next week or two. The home’s own admission procedures were seen and had been completely ignored when admitting the 2 residents. It was clear to all that existing residents were being adversely affected by the current situation. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 - 10 Quality in this outcome area is good. People who live in the home have their needs met and are supported to retain as much independence as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home have their care needs recorded. The last manager revised care plans for permanent residents, the new manager and staff are not clear about the new format and discussion took place about the content. The new manager intends to meet with staff and revise the care plan format again to ensure that they are easier to work with and cover all aspects of residents’ lives. Records seen demonstrate a good knowledge of the needs of service users. People who live in the home are supported by a caring staff team who understand their needs. Although the 2 emergency admissions and increased staff presence have disrupted the normal running of the home it was clear that staff try their best to provide service users with all the care they need and to support them to make decisions where needed. Any instances where staff The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 11 make choices for residents are recorded. Care plans take account of individual choices and preferences. People in the home are consulted about how their needs can be met. There are regular group meetings for service users that provide an opportunity to discuss with staff the things they would like to do, for example holidays, outings and other activities. Residents can choose to speak to staff on a oneto-one basis if they prefer. Staff provide support to residents who need assistance with managing their finances, for example going with them to the bank or building society. People who live in the home can choose to use their personal allowances as they wish. Staff support them to manage their money to ensure they have enough for activities they take part in. Transactions are recorded and signed for and receipts are numbered and kept. Comments received from service users and relatives who were surveyed were very positive and all responses indicated that they were satisfied with the care and support provided. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11 – 17 Quality in this outcome area is good. People who live in the home are provided with opportunities to engage in a variety of activities. They are supported by staff who respect their individual choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are able to choose how they wish to live their lives. Routines in the home are flexible and relevant. Staff take account of individual interests, choices and aspirations. There are a variety of activities available to residents including attending day services, visits with relatives, outings, relaxation, shopping and car boot sales, in-house activities, and arts and crafts. Residents are also supported to develop their daily living skills by being involved in domestic tasks. The recent emergency admissions have had some adverse effect on activities however staff have worked very hard to support residents throughout the last few months and minimise any disruption to their routines. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 13 People who live in the home are supported to maintain contact with family and friends. Significant relationship links are recorded in individuals’ care plans, and the home welcomes and encourages families, friends and representatives involvement in residents’ lives. A written policy states that visiting times are flexible although visitors are asked to respect mealtimes, and that service users can choose whether to receive visitors or not. Visits are recorded in daily contact reports. Relatives who responded to the survey confirmed that they are kept up to date and are able to be as involved as they wish to be. Residents can choose when to be alone or in company, and are able to move about the communal areas of the house without restrictions. Staff were observed interacting in a friendly and respectful manner with people who live in the home. The home’s menus are planned with the residents. Their comments indicated that they liked the food. The dining room provides a pleasant setting in which to eat. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 21 Quality in this outcome area is good. The health of people who live in the home is promoted. Their dignity and privacy is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are supported to be as independent as possible. Staff mainly provide verbal encouragement with personal hygiene and daily routines. Care plans contained information about service users’ preferences with regard to how staff provide support and evidence of external specialist support and guidance. There was some concern that waking night staff are all male and no evidence was found of consultation or agreement with residents about this. The Area manager agreed that this was not an ideal situation and said that this was under review. Service users’ comments indicated that staff treat them well and respect their privacy. People who live in the home are supported with their healthcare needs. Staff accompany them to appointments where necessary. Records show that access is provided to GPs, dentists, opticians and hospitals. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 15 Residents are protected through safe handling of medication. The home has a medication policy and procedures for the receipt, disposal, safe storage and administration of medication. The policy enables residents to manage their own medication if appropriate although no service users currently does so. Staff at the home have been assessed with regard to competency in administering medication. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 - 23 Quality in this outcome area is good. People who live in the home are listened to. They are protected form harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are protected from abuse and are free to offer comment or complaint. The home has copies of relevant procedures such as the Hampshire Adult Protection guidelines, Whistle Blowing and Department of Health guidance on physical intervention. Staff have received training in safe breakaway techniques. There is also a written policy regarding aggression toward staff members. Staff are provided with information about the General Social Care Council (GSCC) code of practice. Staff are aware of the home’s procedures for responding to any allegation or suspicion of abuse, keeping appropriate records and reporting to the manager and relevant agencies. People who live in the home are listened to and are free to offer comment or complaint. The homes complaints procedure is displayed in the home, and response timescales were inside twenty-eight days. The procedure is issued to service users and other stakeholders as part of the Service User Guide, and includes the name, address and telephone number of the Commission for Social Care Inspection. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 – 30 Quality in this outcome area is good. The comfortable and homely environment enhances the lives of people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the comfortable environment. There is a choice of communal areas, two lounges and a separate dining room next to the kitchen. There is a small garden at the back and ample parking at the front of the house. The home is comfortable, well maintained and suitable for purpose. The furnishings and fittings were all good quality and domestic in appearance. The premises are in keeping with the local community and have a style and ambience that reflect the home’s purpose. The home provides transport for service users to access services and facilities. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 18 The environmental health officer visited the home recently and the manager is taking action to meet the recommendations made in the subsequent report.. New chopping boards are being ordered to ensure that residents are protected from risk of infection. There are sufficient bathrooms and toilets to meet the needs of the residents. The shower room on the ground floor needs some attention as there appears to be a leak and the floor was wet. The manager said that this was being dealt with. People who live in the home benefit from the well equipped kitchen and laundry. Discussion took place about the practice of locking cupboards and the kitchen door at night. The manager said that this was necessary to protect residents. There is good office accommodation for staff and the manager. The laundry is suitable for purpose and sited away from the kitchen with easily cleanable walls and impermeable flooring. Staff are trained in infection control procedures and are equipped with gloves and aprons. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 36 Quality in this outcome area is good. People who live in the home are supported by a caring, committed and well trained staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are supported and cared for by a committed staff team. Interaction observed during the inspection demonstrated that there are good relationships between staff and residents. Staff showed patience and good humour and clearly knew the residents very well. Staff know when to request specialist advice and demonstrated ability to observe and analyse situations well. The management of the home are committed to providing the training needed for staff to carry out their roles. This includes National Vocational Qualifications and training in specialist needs. There are sufficient staff on duty to provide good support for residents including one waking and one sleep in staff member at night. New staff are provided with structured induction training. They are provided with formal and informal supervision through regular one to one sessions and staff meetings. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 20 At the time of the inspection there was an unusually high ratio of staff to residents in the home due to the extra support needed for the residents on short term emergency placement. Staff from two other homes are augmenting the regular staff group. This temporary situation is causing some stress and staff are looking forward to getting back to normal. They have worked very hard to minimise the adverse effects on permanent residents of any disruption. People who live in the home are protected through sound recruitment procedures. Records seen show that application forms are completed to show work history, 2 written references are obtained along with a satisfactory Criminal Records Bureau check prior to appointment. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People who live in the home are supported by a committed management team who have their best interests at heart. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are supported by a committed management team who strive to manage the home in their best interests.. This has been particularly difficult in the last year where there has been some instability at management level. A manager was dismissed in the summer of 2006. The home then ran for a period of time without a manager until a new manager was recruited at the end of the year. This manager only remained in post for a few weeks. The new manager has only been in post for a few days and is still learning about her role. However she has long experience of working with the residents and supporting staff through her previous role as team leader. The area manager is providing additional support during her induction. Staff The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 22 spoken to were pleased with the appointment of the new manager who they believe will be accessible and supportive in her new role. Decisions which have been taken in the last few months have clearly had a negative impact on staff and permanent residents at the Laurels in that 2 residents from other homes with complex needs have been admitted for short stays. They in turn have been supported by staff from 2 other homes. This has led to some confusion where staff working in the home are being managed by 3 separate line managers. It is to the great credit of staff and the new manager, in her previous role as team leader, that people who live in the home have coped so well with the disruption. The area manager explained the circumstances of the current situation and gave assurances that the temporary residents would be moving on very soon. Planning for improvement in the quality of care for residents is carried out through regular consultation with residents and relatives. There is ongoing liaison with the community learning disability team and social services. The health and safety of residents is promoted. Recommendations from a recent Environmental health inspection are being implemented. The fire safety log-book is up to date and regular fire drills are carried out. Staff are provided with training in health and safety, first aid, fire safety, moving and handling, food hygiene and infection control. Other records held in the home show that safety checks are carried out on gas and electrical appliances. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 1 2 1 3 2 4 2 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 3 3 3 3 X x 3 x The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 24 no 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 YA1 Regulation 6 Requirement The registered person shall keep under review and, where appropriate, revise the statement of purpose and the service users guide; and notify the Commission and service users of any such revision within 28 days. In that the information should be accurate and appropriate for the client group 2 YA2 12(3) 31/05/07 Timescale for action 31/05/07 The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. In that admission should take place in line with the homes policies and procedures and involve the existing residents in the decision. The Laurels DS0000028542.V330950.R01.S.doc Version 5.2 Page 25 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 YA18 Good Practice Recommendations Where male carers are employed to provide personal care to female residents appropriate consultation should take place and the wishes, needs and feelings of residents should be taken into account I line with the homes policies and procedures. 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