Inspection on 27/12/07 for The Laurels

This inspection was carried out on 27th December 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Laurels 31/07/09

The Laurels 01/12/08

The Laurels 15/11/06

The Laurels 06/02/06

The Laurels 16/08/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Laurels West Carr Road Attleborough Norfolk NR17 1AA Lead Inspector Janie Buchanan Unannounced Inspection 27th December 2007 09:30 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 DS0000064440.V357067.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 DS0000064440.V357067.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address West Carr Road Attleborough Norfolk NR17 1AA 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) 01953 455427 Gooderham@btconnect.com Goodwood Care Homes Ltd Mr Ian Richard Gooderham Mrs Lois Fagg Care Home 39 Category(ies) of Dementia - over 65 years of age (39), Old age, registration, with number not falling within any other category (39), of places Physical disability (39) The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No further Service Users falling outside the category of DE(E) to be admitted to the home. 15th November 2006 Date of last inspection Brief Description of the Service: The Laurels is a single storey building that is registered as a residential home. The registration has recently changed to include residents with dementia. The registration for older persons without dementia or for adults over 50 with physical disability is only for those residents who are already in the home. The long term plan is that only service users suffering from dementia will be accommodated. The home provides thirty-three single bedrooms and three shared rooms. None of the rooms has en-suite facilities and there are four bathrooms, one shower and eleven toilets available to service users. The shared rooms are only used to provide care to residents that chose to share together. The home does not provide nursing care but health care is by access to community resources. A chiropodist and dentist visit the home as required and a hairdresser visits weekly, for which additional charges may be made. Weekly charges are £404 plus a £35 third party top up. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Surveys returned to us by people using the service, by staff and by relatives and family members. We received a total of 18 of these surveys. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The previous key inspection We also visited the home and talked to five residents, one visiting relative, one visiting district nurse and three members of staff. We undertook a brief tour of the home and viewed a number of documents and policies. Eleven requirements and four recommendations have been made as a result of this inspection. What the service does well: What has improved since the last inspection? The frequency of activities has increased and they are now available both in the morning and afternoon, offering residents both stimulation and social interaction. Fresh fruit is now available for residents each day at the home. The number of domestic staff has increased ensuring that residents live in a clean and hygienic environment. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 6 What they could do better: There is much this home needs to do to improve its service and ensure the safety for its residents: • All residents must be provided with a contract at the point of moving into the home, so that they are fully aware of the terms and conditions of their stay, the fees payable, and by whom. Care plans addressing specific needs of residents must be drawn up so that their health and well being can be maintained. The plans should be reviewed meaningfully at least once a month, to reflect their changing needs. Residents must be assessed for their risk of pressure sores, and appropriate intervention recorded in their plans of care so that their health is maintained. Suitable activities for residents with visual impairments should be provided so that all residents can have access to stimulation. Medication recording must be improved so there is a clear and auditable record of what medicines residents have received. The water system must be repaired so that residents and staff have access to hot water when required. This problem has been on-going for a number of months and must be resolved. All staff must receive up to date training in moving and handling, fire safety, food hygiene, and health and safety so that residents are fully protected. Suitable references must be obtained for all prospective employees to ensure that only the right people are employed to look after residents. All staff should receive regular supervision so that their working practices can be discussed and their training needs identified. This is outstanding from previous inspections but little improved. Water temperatures around the home must be monitored more regularly so that residents are not put at risk of scalding themselves. The local Fire Safety Officer should be consulted on the risk entailed in residents’ bedrooms not being protected by fire doors. • • • • • • • • • • The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good. Prospective residents have the information they need to decide if the home is right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives who completed the surveys told us they received information about the home, before deciding if they should move in. Each resident is issued with a ‘Service User’s Handbook’, which gives good information about the range of facilities on offer at the home. It is written in large print so that it is accessible to those with impaired vision. However, not all residents are issued with a contract that clearly states the terms and conditions of their stay at the home and the fees payable and by whom. The manager assesses all prospective residents to the home. The files of two recently admitted residents were viewed and each contained pre-admission information about their needs. The Laurels DS0000064440.V357067.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Each resident has a care plan but these are not consistently detailed enough or reviewed meaningfully to ensure their needs are fully met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in residents’ plans of care was variable. Some plans were detailed and contained comprehensive information about residents’ family and social histories. They also contained good information about residents’ needs in relation to their personal hygiene, eating, drinking and continence promotion. In other plans information was unsigned and undated so it was hard to tell if it was current and relevant. Not all the plans had been reviewed monthly and even when they had been, no changes had actually been noted, even in over a year. There was no evidence that residents had actively been consulted about, or involved in, reviewing their care. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 11 Residents have access to a range of healthcare professionals, evidence of which was clearly recorded in their care plans. One relative told us: ‘My experience is if staff have any concerns at all about auntie’s health, they call in the appropriate doctor/paramedic showing they have the necessary skills to recognise this’. However, residents who are at risk of pressure sores are not routinely identified at the home, and one resident had developed a sore on her sacrum. There was no specific care plan as to how this was to be managed by staff. Another resident was MRSA positive and, once again, no specific care plan had been put in place as to how this was to be managed. The home’s medication storage and record of administration records were viewed. The following worrying points were noted: • There were numerous gaps in the record, where staff had forgotten to sign that they had administered medication to residents. As a result it was not possible to tell if residents had actually received their medication. • Written instructions on the MAR sheet were confusing, causing one resident to have possibly received two lots of the same medication at the one time. • Handwritten additions to the MAR sheet had not been signed or dated • There was no adequate explanation of the coding system, and therefore impossible to tell why someone had not received their medication • Fridge temperatures for medicines requiring cool storage and not been monitored daily • The temperature of the room in which mediation was stored was not monitored at all. Residents were dressed appropriately and individually. All interactions observed between residents and staff were sensitive, respectful, and encouraging, with many staff clearly having a good rapport with residents. The Laurels DS0000064440.V357067.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Resident have access to activties and family members are made welcome at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a specific member of staff for 25 hours a week to organise activities for residents and there is a weekly schedule of events that is advertised around the home. However one resident commented: ‘there are activities but I don’t usually go as I can’t see’. Activities for those with visual impairments should be provided. Relatives who completed the survey told us that they were kept up to date by staff with important issues affecting their family member and that they always felt welcome at the home. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 13 We received mixed comments about mealtimes at the home. On the day we visited residents told us they enjoyed their meals and the food served at lunch was tasty and nutritious. However residents who completed the surveys told us: I would like to see more on the menu, I’m fed up of having custard with everything’. Another ‘teatime could be better’ and another, ‘the teatime soup is sometimes cold’. There is reported to be a choice of menu at lunchtime although the day we visited the only dish on offer was sausage casserole and staff and residents were unaware of what the alternative dish was. No other dish was advertised on menu boards around the home. The Laurels DS0000064440.V357067.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Staff at the home takes concerns raised seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is advertised in the service user’s handbook, a copy of which is available in every resident’s bedroom. Relatives told us that they were aware of the procedure and that the home responded appropriately when they had raised concerns. Files viewed showed that staff had undertaken training in protecting vulnerable adults so that they are aware of the different types of abuse and reporting procedures. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21,23,26 Quality in this outcome area is adequate. Residents live in a well maintained and clean home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, well maintained and free from strong smells on the day we visited. The home has implemented a number of environmental changes to meet the needs of residents with dementia: all toilet doors are painted red with pictorial images to help residents recognise them; hand rails and skirting boards are defined; and door frames are of contrasting colours. However many of the corridors are long and very similar looking and better signage, indicating where main communal areas are for example, would help residents find their way around more easily. There is a small enclosed courtyard area, giving residents access to fresh air and sunlight. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 16 The home continues to have serious problems with its water system and many of the bedrooms were without hot water on the day we visited. One member of staff told us that she frequently has to fetch water from another part of the home in order to wash residents. One relative too was unhappy about this. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There is a sufficient number of staff on duty to meet the needs of residents, however some staff do not have adequate training to protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Many positive comments were received about the quality of staff both from residents and relatives. These included: ‘staff treat residents with care and respect and nothing seems too much trouble for them’; and ‘plenty of staff on duty and always very friendly’. However, one relative commented that there was sometimes a problem communicating with some of the overseas staff. There is a minimum of six staff on duty in the morning, five staff on in the afternoon/evening and three staff on during the night to meet the needs of 39 residents. Residents told us that staff were available when they needed them and they only occasionally waited a long time for assistance. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 18 The training records for three members of staff were checked and showed that staff had received training in dementia care, first aid and medication. A number of staff have also completed an NVQ level 2 in care. However there were serious shortfalls in the mandatory training for staff. Records viewed showed that one member of staff had not received any training in moving and handling for four years, another for three years. Some members of staff had not received any training in food hygiene, or fire safety. There was little evidence in the files that they had undertaken training in health and safety and infection control. The personnel files for two recently employed members of staff were viewed. Adequate CRB and POVA checks had been completed for each staff member, however the references obtained were not suitable. For one member of staff one of her references was from someone who had only known her two weeks, the other was from a care home manager who refused to comment on her practice. The manager had not explored the reason for this refusal. For the other member of staff, one reference was from her recent employer and the other from a friend, despite this member of staff having worked in a number of residential care homes previously. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. Residents’ views are sought about the quality of the service they receive, however the management of health and safety is poor, putting residents at unnecessary risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has an NVQ level 4 in care and has significant experience in the field of social care. Staff who completed the surveys told us that the manager gave them adequate support. Despite this, supervision for staff is erratic, with none receiving it as frequently as recommended by the standards. One member of staff had received no formal supervision whatsoever, despite having worked at the home for a number of years. This issue has been raised at previous inspection but little improves. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 20 The home completed an annual quality assurance audit, with questionnaires being sent to both residents and relatives, requesting their feedback on a number of issues including the quality of care, the friendliness of staff, the standard of cleanliness and activities. Most respondents rated the home well and a clear analysis of the results is on display in the entranceway to the home. The home holds some cash for residents and a sample of their cash sheets were viewed. These were generally all right, although more detailed is required to explain how residents’ money is spent, as are clear receipts. A number of records in relation to health and safety were examined, including portable appliance testing, gas safety, hoist servicing, liability insurance and water temperatures. It was of concern that the only gas safety certificate that could be found was dated 2003 and water temperatures had not been monitored since June 2007. It was also of concern that none of the residents’ bedroom doors were fire doors, and therefore would fail to protect residents in the event of a fire in the home. As already mentioned in this report some staff lack mandatory training in food hygiene, fire safety and moving and handling. This puts both staff and residents at unnecessary risk. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 21 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 2 x 2 x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 1 x 1 The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP2 Regulation 5 (1)(a)(b) Requirement All residents must be provided with a contract at the point of moving into the home, so that they are fully aware of the terms and conditions of their stay, the fees payable, and by whom. Care plans addressing specific needs of residents must be drawn up so that their health and well being can be maintained. Residents must be assessed for their risk of pressure sores, and appropriate intervention recorded in their plans of care so that their health is maintained. Medication recording must be improved so there is a clear and auditable record of what medicines residents have received. The water system must be repaired so that residents and staff have access to hot water when they need. Timescale for action 01/03/08 2. OP7 15 01/03/08 3 OP8 12 (1) 01/03/08 4 OP9 17(1)(a) schedule 3 23(2)(j) 01/03/08 5 OP21 01/03/08 The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 23 6 OP29 7,9,19 Schedule 2 Suitable references must be obtained for all prospective employees to ensure that only the right people are employed to look after residents. 01/03/08 7 OP30 18(1) All staff must receive up top date 01/04/08 training in moving and handling, fire safety, food hygiene, and health and safety so that residents are fully protected. All staff must receive regular 01/03/08 supervision so that their working practices can be discussed and their training needs identified. This is outstanding from previous inspections but little improves. The professional opinion must be sought from the local Fire Safety Officer on the advisability of installing fire retardant doors on residents bedrooms. The home’s gas appliances must be checked and a copy of the Landlord’s Gas Safety Certificate sent to the CSCI Water temperatures around the home must be monitored more regularly so that residents are not put at risk of scalding themselves. 01/05/08 8 OP36 18(2) 9 OP38 23(4) 10 OP38 23(2)(c) 01/03/08 11 OP38 23(2)(c) 01/03/08 The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 24 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 OP7 OP22 OP36 Good Practice Recommendations The plans should be reviewed meaningfully at least once a month, to reflect their changing needs. Better signage around the home, indicating where main communal areas are, should be in place to help residents find their way around more easily. All staff should receive regular supervision so that their working practices can be discussed and their training needs identified. This is outstanding from previous inspections but little improves. The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Laurels DS0000064440.V357067.R01.S.doc Version 5.2 Page 26 - 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!