CARE HOME ADULTS 18-65
The Laurels The Green Wilmcote Stratford Upon Avon CV37 9UU Lead Inspector
Maggie Arnold Unannounced 27 April 2005 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 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 Stationary 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 E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Laurels Address The Green, Wilmcote, Stratford Upon Avon, CV37 9UU. Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01789 262547 01564 795388 NA Mrs Jillian Desperles Care Home 3 Category(ies) of LD 2 MH1 registration, with number of places The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1) When the existing service user no longer occupies the top attic bedroom, this bedroom must not be used for any other service user. 2) The registered person must seek agreement in advance from the Commission for Social Care, in advance of any other room to be used as a bedroom by service users. Date of last inspection 11th January 2005 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 E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 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 from 9.15 am to 12.45 pm. The two staff in the home co-operated fully with the inspection. The owner/manager was not present at the time of the inspection. A total of 24 standards were looked at on this occasion of which 18 met the national minimum standards. All three residents were at home for part or the whole of the visit, with two residents being spoken to individually and the third person as part of the group. In addition to talking to the residents and staff the main focus of the inspection was to check the progress made regarding the requirements arising from the previous inspection, which took place on 11th January 2005. A brief tour of the home was also made. What the service does well:
The three residents live in the home of the owner/manager with only family members offering care and support. All three residents have lived in the home for a significant length of time. The staff are extremely familiar with the residents needs and wishes. The home is run in a relaxed and friendly manner with staff and residents mingling together. The three residents all said they were happy in the home. Complete satisfaction was expressed with regards to the care and support they received. The residents said they particularly liked the food and thought the staff were very nice and helpful. Two residents said that they felt the manager and staff listened to them and respected their views. They felt cared for and respected. The third resident is more hesitant to talk to visitors to the home. Discussions with the residents evidenced that they were involved in various individual and home plans and activities. For example, residents knew where the owner/manager had gone and when she was due back and who was responsible for “looking after them” in her absence. Two of the residents also talked about future plans to do with healthcare and day care activities. Throughout the inspection process there was a relaxed and homely atmosphere with a lot of discussion between the staff and residents. Staff were very good at gently prompting and reminding residents of the time and their plans for the day. Discussions between staff and residents regarding
The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 6 money and medication were undertaken in a calm and commonsense manner where the resident was encouraged to make their own decision. It is very positive that the home enables a resident to be responsible for his or her own medication and for all three residents to make decisions regarding their individual finances. What has improved since the last inspection? What they could do better:
With the exception of the poor management of records, The Laurels is a well run, homely and relaxed home where the residents live alongside the family and enjoy a high level of 1-1 care and support from the family members. Following the last inspection the owner/manager forwarded completed care plans and accompanying documents to the Commission. The records were very well written and detailed and easy to understand. These documents were returned to the home. However on this unannounced visit it was difficult to find most of the records and other paperwork such as evidence of the most recent gas checks. The home must ensure that a full audit is undertaken to ensure that all the statutory paperwork is collected together and filed appropriately in a designated locked cabinet. The lack of well ordered accessible care plans and accompanying records poses a significant potential risk to the residents. For example, in the event of an extreme emergency within the owner’s family, external staff would not have the essential information required to ensure the safety and well being of the residents or smooth running of the home. The home must ensure that it continues to progress with the plans for staff training including Vulnerable Adult Awareness and food hygiene. The Home is also reminded that all persons, with the exceptions of the residents, must undergo a criminal records bureau check. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 9 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 standard(s) 4, 5. The lack of individual written contracts means that the residents’ legal rights have not been fully protected. EVIDENCE: No new residents have been admitted since the last inspection, which took place on 11th January 2005. The current residents all visited the home prior to admission. Residents have not been provided with individual written contracts or statement of terms and conditions with the home. Copies of completed contracts could not be found in the home. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 Residents know what their assessed needs and goals are and work closely with staff who support them to make their own decisions. This helps the residents to enjoy a varied and individual lifestyle. EVIDENCE: Two of the three residents talked positively about their day-to-day life at The Laurels. Both residents were aware of the type and level of support they required. The third resident isn’t always happy to talk to people visiting the home. During the course of the inspection staff members talked to all three residents about what they were going to do during the day. This was done in a way that helped residents make their own decisions. Discussions with two of the residents also evidenced that, within the constraints of group living, they enjoyed individual preferred routines and lifestyles. For example, choosing when to go to bed, where to spend their time within the home and activities to be involved in. Residents files were not collated or stored in a lockable cabinet. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 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 standard(s) 11, 12 and 15 Residents are given opportunities for personal development and enjoy varied leisure activities and have appropriate personal and family relationships. This works towards a feeling of well being and good quality of life. EVIDENCE: Residents said that they were responsible for cleaning their own bedrooms and were encouraged to help with meal preparation. Staff confirmed this to be the case. Residents were seen making their own drinks during the course of the inspection. All three residents attend day centres. One resident in particular said that they had frequent family contact and have developed friendships independent of the home and day care services. Another resident said that they enjoyed travelling and shopping on their own and particularly liked the day centre trips and walks. Diary entries confirmed that residents were encouraged to be involved in the local community. For example, local shopping in the village and weekly shopping trips to Stratford upon Avon with a member of staff. The home is in the process of formalising a policy regarding the management of the pets during meal preparation. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 12 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 standard(s) 18,19,20 Residents’ physical and emotional health care needs are met and their medication is managed safely. The personal and health care needs of the residents are met. The home works towards promoting the independence of the residents. EVIDENCE: Discussions with the residents and staff, combined with records seen evidenced that consideration is given to the residents’ physical and emotional healthcare needs. One resident talked about their health care needs and gave details of an appointment that had been made to follow up a particular health concern. Records are maintained of routine and specialist healthcare appointments. At the previous inspection the overall management of medication fell well below an acceptable standard. On this inspection the drugs safe and accompanying daily medication record sheets were very orderly and up to date. One of the residents takes responsibility for the management of their own medication. The resident knew what the tablets were for and explained how they stored the tablets safely and that they were responsible for telling staff when a new prescription was required. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 13 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 standard(s) 22- 23 The home has not completed all of the requirements arising from the previous inspection or ensured that all person’s living and working in the home have undergone the required police checks. Without appropriate training, lack of awareness of the Local Authorities Adult Protection policies and procedures combined with persons, with the exception of residents, not undergoing appropriate checks there is a danger that actual or potential abuse may not be dealt with properly. EVIDENCE: Resident’s said that they feel their views are listened to and, if appropriate, acted upon. One resident said “staff sometimes were worried and didn’t want them to do or go somewhere but always told them why it wasn’t safe”. Discussions with staff combined with recent telephone calls by the proprietor to the Commission for Social Care Inspection evidenced that the home is swift to address potential abuse. For example, from the exploitation of residents by persons outside the home. However with regards to completing requirements arising from the last inspection. Work is in progress to forge links with the Local Authority Vulnerable Adult Co-ordinator. Training in the Vulnerable Adult Awareness remains outstanding. Evidence that Criminal Record Bureau checks has been undertaken on all persons, with the exception of the residents, who live or work in the home also remains outstanding. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 14 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 standard(s) 24, 25, 26, 27, 28, 29 and 30. The Laurels is a comfortable and homely environment, which suits the needs and preferences of the present residents. EVIDENCE: A brief tour of The Laurels was clean, well maintained, comfortable and free from unpleasant odours on this unannounced inspection. All three residents said they liked their individual bedrooms and the shared sitting room. Due to a sloping ceiling, one of the bedrooms is rather small. However it suits the needs of the present occupant. The same resident also enjoys the sole use of a bathroom and toilet situated on the same landing. The layout of the bedrooms and bedroom furniture promotes the residents’ independence. The other two residents have shared use of a bathroom. All three residents also have the use of a ground floor toilet. In addition to their sitting room the residents also have the use of the kitchen cum dining room. The home has a secluded garden area with ample garden furniture, which is safe and accessible to residents. Residents spoken to said that they liked having all the animals around the home. The family have three dogs and numerous cats, which work towards the homely atmosphere. None of the residents require specialist aids or adaptations.
The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 Residents are supported by staff members who are very familiar with their individual preferences and needs. However the lack of staff training and staff files presents a potential risk to the safety and well being of the residents. EVIDENCE: The owner, 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 the inspection the owner was on holidays and two family members were working in the home. Residents spoken to were aware of the staffing arrangements, including details of who was covering the home at night and when the owner was due to return. The two residents spoken to said that they were happy with the arrangements. A requirement for staff training and staff files, including the full names and addresses of all persons working in the home remains outstanding from the previous inspection. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home is generally well run and managed in a relaxed and homely manner that meets the needs, wishes and preferred lifestyles of the three residents. However the fact that not all of the essential records are readily available results in a potential risk to the health, welfare and safety of the residents. EVIDENCE: In response to requirements following the previous inspection the home forwarded various well-written and detailed records to the Commission for approval. These documents were returned to the home. However on the day of this unannounced inspection, not all of the records asked for could be located. The staff member said that work was in progress to update the records and a lockable filing cabinet was due to be delivered. The staff member did offer to telephone the owner who, she was certain, knew exactly where all the various records could be located. Due to the home being managed and run as a family concern, there are significant concerns that, in the event of emergency social services or agency staff may be required to work in the home. The lack of easily accessible well-ordered records presents
The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 17 a potential risk to the residents. Records must be better ordered and be made readily available to staff and other persons authorised to access such information. The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 18 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 x x 3 2 Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 2
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 x x 3 x x Standard No 31 32 33 34 35 36 Score x x 2 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Laurels Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x 2 E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 19 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 YA 5 Regulation 5.3 Requirement The registered provider must ensure that written contracts for the service provision are obtained from the appropriate funding authorities. All residents must have individual copies of their contracts. Residents files must be collated and securely stored in a lockable cabinet when not in use. All statutory required records must be avaiable for scrutiny by authorised persons. All persons working in the home must undertake Vulnerable Adult Awareness training. The manager must liase 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. 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 Timescale for action 24/07/05 2. YA 10 15(1): 12(1)(4)( a) 19/06/05 3. YA23 13(6) 24/07/05 4. YA 33, 35 and 42 18(1)(c) 24/07/05 The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 20 5. YA 40 13(6), 17(2) 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. The home must ensure that the Home’s policy and procedures manual clearly states which of the policies and procedures are relevant to the home. 24/07/05 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 Good Practice Recommendations The Laurels E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 5th Floor, Coventry Point Market Way Coventry CV1 1EB 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 E53 S4358 The Laurels V224296 270405 stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
