Inspection on 26/07/06 for The Laurels

This inspection was carried out on 26th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Laurels 03/07/07

The Laurels 29/11/05

The Laurels 24/05/05

The Laurels 16/11/04

The Laurels 08/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE The Laurels 43 Salisbury Road Harrow Middlesex HA1 1NU Lead Inspector Judith Brindle Key Unannounced Inspection 26th July 2006 08:45 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 DS0000017546.V303339.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 DS0000017546.V303339.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address 43 Salisbury Road Harrow Middlesex HA1 1NU 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) 020 8861 4320 Mrs Bernadette Mitchell Mrs Bernadette Mitchell Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (6) of places The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No person who cannot without significant assistance ascend or descend stairs shall reside on the first floor of the home. 29th November 2005 Date of last inspection Brief Description of the Service: The Laurels is a care home providing personal care and accommodation for up to 6 older people. The care home is located in central Harrow, within a few minutes walk or drive from a variety of shops, banks, restaurants, a park and other amenities including bus and train public transport facilities. Mrs B Mitchell owns the care home, and is also the registered manager. The home was first registered in 1993. The building is a semi-detached house located on a quiet residential road near the centre of Harrow. The home is in keeping with other houses within the area. The home has four single rooms, and one shared room. One of the single rooms has en-suite facilities. Three bedrooms are located on the first floor and two are situated on the ground floor. The home has an enclosed, accessible, and well-maintained garden. Information/documentation about the service and the range of fees (£430-450) is accessible from the care home to residents and others. Additional costs are recorded in resident’s statement of terms and conditions, and in the statement of purpose. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place during a day in July 2006. The inspector was pleased to speak to all the residents during the inspection. There was one vacancy at the time of the inspection. The purpose of the inspection was to spend time with the residents, assess key National Minimum Standards, and to follow up and assess as to whether requirements and recommendations from the previous inspection had been met. The inspection included a tour of the premises, and inspection of resident’s care plans, staff personnel files, medication storage and administration systems, and inspection of a variety of other records. The inspector also spent a significant part of the inspection talking with residents, and observing interaction between residents and staff. A prospective resident and a Care Manager also kindly spoke with the inspector. The registered manager was present during the inspection. Staff kindly provided all the information, and documentation requested by the inspector during the inspection. The inspector thanks all the residents and staff, and others, for their participation in the inspection process. 25 National Minimum Standards including key Standards were assessed during this key inspection. What the service does well: The care home is located in a quiet residential street within a few minutes walk of the numerous and varied amenities and facilities of central Harrow. The care home has a very welcoming and warm atmosphere. Staff are very knowledgeable of the residents needs, and have a particularly caring and pleasant manner. Residents spoke of being happy living in the care home and confirmed that staff were very caring and helpful. A Care Manager spoke positively about the service provided by the home. The home is very clean, homely, and well maintained. The registered manager/provider has managed the care home for several years and has a very much ‘hands on’ approach in regard to the provision of care to the residents. Residents spoke very highly of the registered manager/provider. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 6 Meals are varied and wholesome, and presented in an attractive manner. Residents spoke positively about the meals provided by the care home. All the care plans inspected included a statement of terms and conditions of residence. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1, 3 (6 is not applicable) Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that residents have their needs assessed prior to moving into the care home. Information in regard to the service is accessible to residents and prospective residents and others. EVIDENCE: The care home has a statement of purpose and a service user guide, which was available for inspection, and recorded evidence of having been reviewed. The registered manager/ person confirmed that this documentation is supplied to all residents. The three care plans inspected (including the plan of care of a recent resident admission to the care home) all contained recorded evidence of assessment of individual residents’ needs. This assessment information included manual handling assessment, falls risk assessment, pressure area risk assessment, assessment of physical health needs, mental health needs, orientation, communication needs, social needs, and personal care needs. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 9 The registered manager/provider reported that when a Local Authority is funding a prospective resident, a referral from a Care Manager is received by the care home. The registered manager/provider confirmed that she would then assess the prospective residents needs with involvement from the service user and from their family/friends (if agreed by the service user). The registered manager confirmed she also completes a comprehensive assessment of the needs of all privately funded residents. She gave an example of having recently visited a prospective resident at the resident’s home to initially assess their needs. A prospective resident visited the care home for lunch and afternoon activities during the inspection. The registered manager demonstrated that she gained assessment information from this service user during their visit to the care home. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7,8,9 and 10 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s health social and personal care needs are set out in an individual care plan, but there needs to be evidence of regular review and development of care plan documentation. Residents are treated with respect and their right to privacy upheld. Medication is stored and administered to residents safely. EVIDENCE: All the residents have care plan documentation. Three care plans were inspected, including the plan of care of a recently admitted resident to the care home. All the care plans inspected recorded evidence of assessment of individual residents needs, but did not show evidence of having been recently reviewed. Prior to the start of 2006 it was evident that care plans were reviewed generally on a monthly basis. Care plan documentation needs to be regularly reviewed with the resident, and relatives/significant others (following resident’s agreement). The care plans inspected need further development to include all assessed needs, and staff guidance to meet assessed needs of residents i.e. behaviour The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 11 from residents that might challenge the service, specialist medical needs of residents, pressure area care guidance, and any changes in needs. This was discussed with the registered manager/provider. There was evidence of some risk assessments for some residents i.e. bathing risk assessment, pressure area risk, and risk of falls, but these needs to be further developed i.e. a road safety risk assessment in regard to a resident who sometimes goes out on her own to visit a relative, to ensure that all residents are at minimal risk to their safety, but enabling residents to remain as independent as possible, and to keep their developed skills. Comprehensive ‘daily’ resident’s progress records were recorded. Records confirmed that resident’s health needs are met. Appointments with the GP, dentist, community nurse, chiropodist, were documented. There should be evidence of regular monitoring of residents weight. The manager reported that there were no resident’s who had pressure sores, and that pressure relieving equipment when needed, is accessible to residents. The care home has a medication policy/procedure. Medication is stored securely. Medication administration records were fully recorded. Following the unannounced inspection the registered manager/provider supplied the Commission for Social Care Inspection documentation in regard to the recorded content of ‘in house’ medication training provided to care staff by the manager. This confirmed that a staff member had received this medication training, and provides evidence that a previous inspection requirement has been met. All staff should receive regular ‘refresher’ medication training to ensure that there is evidence that staff are competent to administer medication. There needs to be appropriate recording and storage systems in place in regard to a resident’s particular night sedation. Records confirmed that the pharmacist who supplies the resident’s medication had recently visited the care home. Resident’s privacy was observed to be respected during the inspection. Residents spoke of staff being understanding of their needs, and confirmed that they wear their own clothes. Residents have access to a telephone. Records are kept securely. Residents preferred form of address should be recorded in their plan of care. The staff induction training should include recorded evidence of staff having been informed of the importance of confidentiality and respect. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12,13,14 and 15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to enable residents to participate in activities of their choice, and to maintain contact with family/significant others, as they wish. Meals are varied and wholesome, and pleasantly presented. EVIDENCE: The care home has a recorded activity programme. Resident’s activity interests are recorded in their care plan documentation. Daily records recorded evidence that residents participate in a variety of activities. These activities include exercise sessions, listening to the radio, going out shopping, watching television, and going for walks in the local park. The manager reported that residents are offered exercise sessions at least 3 times a week. Residents spoke of the activities that they enjoyed. These included knitting, reading, completing word search puzzles, and quizzes. It was evident that there has been development in regards to the provision of activities for the residents. It was evident from observation and from talking to residents that they had recently received a manicure. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 13 A resident spoke of her attendance at some local clubs, which she had had attended prior to her admission to the care home. She spoke of being glad that she could maintain contact with friends. Residents were observed to access the garden during the inspection. Several residents spoke of enjoying the garden facility. Residents kindly spoke to the inspector about their visitors. This with information from resident’s daily records indicated that there are frequent visitors to the home. This should be reflected in the visitor’s record book. A visitor was very positive about the care and support provided by the care home. Residents spoke of regularly going out into the community with relatives, and sometimes with staff. The menu was available for inspection. The lunch provided on the day of the inspection was as recorded on the menu. Recorded meals were judged to be varied and nutritious. Records of food eaten by residents are not up to date. Residents spoke of enjoying the lunch provided during the inspection, and of the meals in general. The lunch consisted of sausage casserole with a variety of vegetables and residents received a choice of puddings. The meal was very nicely presented and unhurried. Residents were given support from staff in a sensitive manner with their meal as and when they needed it. The registered manager reported that there were no residents with particular religious or cultural needs that were linked to specific dietary requirements/needs. A choice of hot or cold drinks were offered regularly to residents during the day. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 and 18 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that complaints are dealt with promptly and effectively, and that residents are protected from abuse, but the complaints procedure needs to be accessible. EVIDENCE: The registered manager could not access the complaints procedure, which she reported had been removed from the policy/procedure file. This procedure needs to be easily accessible. The registered manager should consider displaying this document. It is recommended that the complaints procedure be summarised in the statement of purpose and the service user guide, as the complaints procedure attachment to this document was not available for inspection. The complaints procedure has been inspected following an inspection in May 2005. The home has a complaints recording record book. There were no complaints recorded. The registered manager/provider should develop ways of ensuring that all communicated ‘concerns’ from residents (and others) are fully recorded and appropriate action taken to resolve them. Residents reported that they had ‘no complaints’ about their care. A resident spoke of speaking to the manager if she had a ‘concern’ or complaint. The care home has accessible protection of vulnerable adults procedures/guidance, which include the Local Authority guidance and an ‘in house’ procedure. There was some evidence that some staff had received abuse awareness training, but this was documented as taking place in 2004. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 15 There needs to be evidence that all care staff have received training in abuse awareness, and others should receive ‘refresher’ abuse awareness training. The registered person reported that some staff had completed some abuse awareness training whilst completing NVQ care courses. Accessing protection of vulnerable adults training for staff was discussed with the registered manager. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19, 21, 24 and 26 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The location and layout of the care home is suited for its stated purpose, and is generally well maintained, and very clean. Planned development in regard to bathing facilities should be carried out. Residents have comfortable personalised bedrooms. EVIDENCE: The home is located close to the amenities and facilities of central Harrow. The house is in keeping with others in the vicinity. A tour of the premises took place during the inspection. The home, including the enclosed garden is well maintained. The garden is an attractive facility, which residents spoke of enjoying. The care home is ‘homely’ with furnishings and fittings of quality. A resident kindly showed the inspector some pictures that she had brought to the care home, which the manager had hung in the communal areas. The resident expressed pleasure that her pictures were displayed in the home. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 17 The carpet in the sitting room was loosely fitted in some areas and needs to be refitted to ensure that it does not become a trip hazard. The registered manager spoke of plans to complete this in the next few days. Until it has been repaired the registered person/manager needs to ensure that there is a risk assessment in regards to the loose carpet possibly being a trip hazard. There needs to be a lampshade on the exposed light facility in the ground floor bathroom. The call bell system needs to be in working order. The registered manager reported that an electrician was coming to repair the system on the day of the inspection. Until the call bell system is repaired the manager needs to ensure that a risk assessment is completed which includes staff guidance in regard to monitoring the welfare of residents particularly at night. A planned provision of a ‘walk in’ bath facility for the first floor of the care home should be actioned by the registered person. This was a previous recommendation. The registered person confirmed that this maintenance work would be carried out this year (2006). Toilets are accessible to residents and are located close to communal areas. One bedroom has ensuite facilities. Two residents kindly showed the inspector their bedrooms. They spoke of being happy with their room. There is one shared bedroom, with screening facilities. The registered person should ensure that it is recorded in residents’ care plans that they are happy to share a room. Bedrooms inspected recorded evidence of being individually personalised. If not needed by a resident, the commode should be removed from their bedroom. The laundry facilities are located away from food storage and food preparation areas. The home has suitable clothes washing and drying facilities. Hand washing facilities are accessible. A resident spoke positively of the laundry service provided by the care home. Another resident assisted staff with hanging washing out in the garden during the inspection. A resident spoke of her participation in the care of her laundry. Records indicated that staff had received some infection control training. The care home has an infection control policy. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27,28,29 and 30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that staffing numbers and skill mix meet the needs of the residents, and that residents are protected by the care homes’ recruitment and selection procedures, but there needs to be evidence that these procedures are followed at all times. Staff have received appropriate training to ensure that they have the skills and competency to meet the needs of residents, but this needs to be further developed to ensure that all staff receive up to date appropriate training. EVIDENCE: The staff rota was available for inspection. There are two staff on duty at all times during the day and one staff member on duty at night. The registered manager works several shifts a week in the care home, and due to living close to the home she can be contacted at anytime. The manager spoke of regularly reviewing staffing needs in regard to changing needs of residents, and so ensuring residents are able to access preferred community based activities. Care staff complete domestic duties in the care home. The manager reported that there were presently no staff vacancies. The manager reported that four care staff have completed an NVQ level 2 care course. This is approximately 50 of the staff workforce. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 19 The home has a recruitment and selection policy/procedure. Three staff personnel files were inspected. Two staff records included required documentation. One staff file of a staff member who has worked in the care home for several years did not include evidence of a satisfactory enhanced Criminal Record Bureau check, and only had evidence of one recorded reference. This was a previous requirement. An immediate requirement form was issued during the inspection requiring the registered person to take action to meet this outstanding requirement. Following the unannounced inspection the registered manager provided the Commission for Social Care Inspection recorded evidence of a staff members second written reference, and records confirming that an enhanced Criminal Records Bureau check and Protection of Vulnerable Adults check had been applied for. The previous requirement in regard to these checks and a staff reference has been partially met. Records confirmed that staff have received appropriate training to develop their skills and competencies, but there was not evidence of any recent staff training. Records indicated that staff have received an induction programme. This induction format should be further developed to ensure that all areas in regard to staff roles and responsibilities are covered in their induction programme. The home should have an up to date training plan. It is recommended that the content of ‘in house’ training and NVQ care training courses carried out by staff is recorded in their training record. Recorded staff training included food and hygiene training, basic first aid, manual handling training, moving and handling training, and dementia care training. The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31,33,35, 36 and 38 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The resident’s benefit from an experienced and competent management approach to the care home. There need to be development in recorded quality monitoring systems to ensure that the service provided by the care home is monitored and improved as necessary to meet the aims and objectives of the home. Resident’s financial interests are safeguarded, and the health, safety and welfare of residents and staff are promoted and protected. Staff need to be regularly supervised. The health and safety of residents and staff are promoted and protected, but there should be evidence of more frequent fire checks/drills. EVIDENCE: The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 21 The registered manager/provider has managed the care home for several years. She is experienced and knowledgeable in regard to meeting the care and support needs of the residents. Residents spoke highly of the manager, and were very positive about the care provided by the care home. The registered manager, and the staff team were judged to have a good understanding of the needs of all the residents, and were observed to be particularly respectful, caring, and sensitive in regard to meeting the care, and support needs of residents, in a positive friendly atmosphere. The registered manager achieved completion of NVQ level 4 in management in 2005. She spoke of her plans to complete an NVQ level 4 course in care. This should be actioned by the registered person/manager. The manager should record evidence of training that she has participated in to ensure that her skills are maintained and updated. Records, residents, and staff confirmed that there are clear lines of accountability within the care home. The managers’ job description was available for inspection. Quality assurance monitoring systems were discussed with the registered manager. Records and the manager informed the inspector that there is limited evidence of these monitoring systems being in place. The registered manager needs to show evidence that residents and others are asked for their views of the service. Policies and procedures, risk assessments, and care plan documentation should show evidence of more regular review. The manager spoke of plans to complete an annual ‘review’ development plan in regard to the service. This needs to be actioned by the registered person and a copy of the documentation supplied to the Commission for Social Care Inspection. This was a previous inspection requirement. Residents should have the opportunity to participate in regular resident meetings, and minutes of these meetings should be recorded. This was a previous recommendation. The care home has a financial policy/procedure in regard to resident’s monies. Relatives/significant others generally manage resident’s finances. Small amounts of monies for the purchase of toiletries and for hairdressing needs are managed by the home. Records are maintained and up to date. All residents should have an individual assessment in regard to the management of their monies. There needs to be evidence that staff receive regular required supervision. This was a previous requirement and needs to be met. Records confirmed that weekly maintenance checks of the environment are carried out, and that required electrical checks are carried out. The home has a fire risk assessment, which shows evidence of having been The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 22 reviewed. Fire equipment has been serviced as required. The last recorded fire drill was 04/10/05. Following this inspection the registered manager provided the Commission for Social Care Inspection with recorded evidence that a fire drill which included staff ‘in house’ fire training was carried out on the 27/7/06, and that a visual fire safety check of the environment, fire call points and fire extinguishers was carried out following this inspection. There should be evidence that there is continued fire safety monitoring and that fire drills and appropriate fire safety checks take place regularly. Staff should participate in at least two fire drills a year. This was discussed with the registered person. The home has a health and safety policy/procedure, and has recorded general safety risk assessments, which include kitchen safety, the use of the stairs, and the use of personal appliances. There is an accessible accident policy, and accidents/incidents are recorded appropriately. The Laurels DS0000017546.V303339.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 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 24 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(2) Requirement The care plans: • need to record evidence of having been regularly reviewed. • need further development to include all assessed needs, and staff guidance to meet assessed needs of residents. Risk assessments needs to be further developed i.e. road safety, to ensure that all residents have received comprehensive risk assessment. There need to be appropriate recording and storage systems in place in regard to a resident’s particular night sedation. The complaints procedure must be accessible to residents, visitors and significant others. There needs to be evidence that all care staff have received training in abuse awareness. • The carpet in the sitting room was loosely fitted in some areas and needs to be refitted. • the registered person DS0000017546.V303339.R01.S.doc Timescale for action 01/11/06 2 OP7 12,13,14 01/11/06 3 OP9 13(2)(4) 01/10/06 4 5 6 OP16 OP18 OP19 22 13(4)(6) 13(4) 23 (2) 01/10/06 01/11/06 01/10/06 The Laurels Version 5.2 Page 25 7 OP19 12,13(4) 23 8 OP29 12,13(4) (6) 19 9 OP30 18 10 OP33 24 needs to ensure that there is a risk assessment in regards to the loose carpet possibly being a trip hazard. • There needs to be a lampshade on the exposed light facility in the ground floor bathroom. • The residents’ call bell system needs repair. • Until the call bell system is repaired the manager needs to ensure that a risk assessment is completed which includes staff guidance in regard to monitoring the welfare of residents particularly at night. There needs to be evidence of a satisfactory Criminal Records Bureau check for a staff member. Previous timescale 01/02/06 not met. There needs to be evidence that staff have received recent appropriate staff training, including ‘refresher’ training courses. • An annual development plan in regard to the service needs to be actioned by the registered person and a copy of the documentation supplied to the Commission for Social Care Inspection. Previous timescale 01/03/06 not met. The registered manager needs to show evidence that residents and others are ask for their views of the service. The registered person needs to DS0000017546.V303339.R01.S.doc 01/11/06 01/11/06 01/12/06 01/12/06 • 11 OP36 18(2) 01/11/06 Page 26 The Laurels Version 5.2 ensure that there is a system in place for the recording and provision of ‘one to one’ formal staff supervision. Previous timescale 01/03/06 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP8 OP9 OP10 Good Practice Recommendations There should be evidence of regular monitoring of residents weight. All staff should receive regular ‘refresher’ medication training to ensure that there is evidence that staff are competent to administer medication. • Residents preferred form of address should be recorded in their plan of care. • The staff induction training should include recorded evidence of staff having been informed of the importance of confidentiality and respect. All visitors should be recorded in the visitor’s record book. Food eaten by residents should be documented and these records kept up to date. • It is recommended that the complaints procedure be summarised in the statement of purpose and the service user guide. • The registered manager should consider displaying the complaints procedure document. The registered manager/provider should develop ways of ensuring that all communicated ‘concerns’ from residents are fully recorded and appropriate action taken to resolve them. All care staff should receive ‘refresher’ abuse awareness/protection of vulnerable adults training training. A planned provision of a ‘walk in’ bath facility for the first floor of the care home should be actioned by the registered person. • The registered person should ensure that it is recorded in residents care plans that they are happy DS0000017546.V303339.R01.S.doc Version 5.2 Page 27 4 5 6 OP13 OP15 OP16 7 OP16 8 9 10 OP18 OP21 OP24 The Laurels 11 OP30 12 OP31 13 14 15 OP33 OP35 OP38 to share a room. If not needed by a resident, the commode should be removed from their bedroom. • This induction format should be further developed to ensure that all areas in regard to staff roles and responsibilities are covered in their induction programme. • There should be a staff training plan. • It is recommended that content of in house’ training and NVQ care training courses carried out by staff is recorded in their training record. • The registered manager should complete an NVQ level 4 course in care. • The manager should record evidence of training that she has participated in to ensure that her skills are maintained and updated. Residents should have the opportunity to participate in regular resident meetings, and minutes of these meetings should be recorded. All residents should have an individual assessment in regard to the management of their monies. There should be evidence that there is continued fire safety monitoring and that fire drills and appropriate fire safety checks take place regularly. Staff should participate in at least two fire drills a year. • The Laurels DS0000017546.V303339.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 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 DS0000017546.V303339.R01.S.doc Version 5.2 Page 29 - 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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