Inspection on 03/07/07 for The Laurels

This inspection was carried out on 3rd July 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 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 26/07/06

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE The Laurels 43 Salisbury Road Harrow Middlesex HA1 1NU Lead Inspector Judith Brindle Key Unannounced Inspection 3rd July 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 DS0000017546.V340808.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.V340808.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.V340808.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. 26th July 2006 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.V340808.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 throughout a day in July 2007. There was one vacancy at the time of the inspection. The inspector was pleased to meet and talk with all the people living in the home apart from one resident who was on holiday. Staff on duty were also spoken with. The registered manager/provider was present during the inspection, and supplied documentation requested by the inspector. The inspection focussed on spending time talking with people living in the care home and observing interaction between residents and staff. Documentation inspected included, resident’s care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether the requirements from the previous inspection had been met also took place during the inspection. 24 National Minimum Standards for adults, including Key Standards, were inspected during this inspection. I thank all the people living in the care home, visitors and the staff for their assistance in the inspection process. What the service does well: The care home has a very welcoming atmosphere. Residents live in a homely environment. People living in the home were positive about the care home and staff, and confirmed that they were happy living in the home. There is close liaison with healthcare professionals and other specialists as and when required/needed by the residents. Residents’ contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. A caring, competent staff team demonstrate knowledge, and understanding of the varied needs of people living in the care home. The home has a well maintained enclosed garden. Residents spoke of enjoying this facility. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 6 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 summary of this inspection report can be made available in other formats on request. The Laurels DS0000017546.V340808.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.V340808.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 3 (6 is not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective residents to have the information that they need to make an informed choice about where to live, but this information should be updated, and further developed. Arrangements are in place to ensure that residents have their needs assessed prior to moving into the care home. EVIDENCE: The care home has a service user guide and statement of purpose documentation, which is accessible and specific to the care home, and explains the service provided. This documentation was dated 2005 and should show evidence of being reviewed and updated to include all relevant information including a record of the manager’s recent management qualification. There should be a format (i.e. listening tape/or CD) of the service user guide that makes its information about the service accessible to a resident who has visual The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 9 impairment. Until then the registered person should ensure that it is documented in the care plan that information in the service user guide has been communicated to the resident. This was discussed with the registered manager. There have been no recent admissions to the care home. The manager confirmed that she carries out an initial assessment of a prospective resident, and when applicable, assessment information is received from the funding Local Authority during their referral process. Documentation inspected confirmed that the manager has knowledge and understanding of the need to ensure that a comprehensive initial assessment is always carried out and that the prospective residents and/or significant others are involved in this process. The Laurels DS0000017546.V340808.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): Standards 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s individual personal and healthcare needs are met, but there could be further development in improving care plans, risk assessments and staff guidance to meet some specialist health needs. Arrangements are in place to ensure that the residents are respected and their right to privacy upheld. Medication is stored and administered safely. EVIDENCE: All the residents have a plan of care. The manager spoke of several residents having recently become increasingly frail. Four care plans were inspected. These included evidence that people living in the home have had their needs identified. These include health, social, religious/cultural and emotional needs. Each care plan included a ‘life history’, some of which could be reviewed. The care plans include basic information necessary to deliver residents’ care but is The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 11 not detailed nor person centred. There was evidence of recorded staff guidance to meet resident’s assessed needs, but this varied in its level of comprehensiveness. Efforts need to be made to ensure that staff guidance and changing needs are further developed and recorded. There needs to be evidence that people living in the home are supported and encouraged to be actively involved (if able) and/or their relatives or significant others in the review and development of their care plan, which should be detailed and ‘person centred’. The care plans did not indicate that they were working documents that consistently reflect the care being delivered. Several care plans had not been comprehensively reviewed regularly, though one reflected the recent changes in need of a resident. Care plans need to reviewed more regularly (i.e. at least monthly) for all residents, and more often in response to residents significant changing needs i.e. following hospital admission, and/or increasing frailty. The manager reported that she had ordered a new bed for a resident, which would be an aid in the prevention of pressure sores. Following the inspection the registered manager reported that she was in the process of reviewing all the care plans, including the risk assessment documentation, and would be reviewing them on a monthly basis, or more often in regard to changing needs of residents. Records confirmed that risk assessments including risk of falls, personal safety risk, moving and handling, bathing risk assessment, pressure sores, and nutritional risk assessments are completed, but these are basic, and need to be further developed to include comprehensive staff guidance/procedures to minimise identified risks. These risk assessments, need to record evidence of being regularly reviewed, to ensure that people living in the home are safe, supported to be as independent as they are able to be. ‘Daily’ and night resident’s progress records are documented. There were some gaps in recording night records. From speaking to residents, staff and inspection of records it was evident that people living in the home are having the support and care they need to meet their personal care needs. Health needs are monitored and appropriate intervention taken. The manager reported that there are no residents who have pressure sores. Residents and records confirmed that people living in the care home have access to healthcare professionals including the GP, community nurse, chiropodist, and have regular eye checks. A resident spoke of having seen a GP recently. Two people living in the care home are receiving treatment and care from the GP and community nurse, but this information, though recorded, had not been updated in the care plan. There needs to be clear recorded evidence that care plans are updated and developed following visits to the GP, and community nurse, This was discussed with the manager. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 12 There was some evidence of monitoring resident’s weight, but this was not consistent. The registered manager needs to ensure that each resident’s weight is monitored closely particularly in view of several residents becoming increasingly frail, and one resident having a poor appetite. Medication storage and administration systems were inspected. Medication is stored securely. Medication administered was fully recorded. There was not an accessible medication policy. The manager spoke of it being mislaid. Following the inspection the manager reported that she had found the medication policy. There needs to be a medication policy/procedure which is accessible at all times, to staff, to ensure that staff are aware of how to safely administer medication to residents. Records confirmed that staff had received medication training, which included some ‘in house’ medication training. This medication training needs to be further developed to ensure that there is recorded evidence that staff are aware of how to deal with problems when administrating medication, such as for example if there is an error or if a resident refuses medication, and that the training also includes the principles behind all aspects of the home’s policy on medicines handling and records. All staff should receive regular ‘refresher’ medication training to ensure that there is evidence that staff are at all times competent to administer medication. An up to date British National Formulary medication reference book should be obtained for the home. People living in the care home have access to a telephone. A resident spoke of choosing her own clothes. Residents preferred name is recorded in their care plan. Staff were observed to interact with residents in a respectful and sensitive manner. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that residents have the opportunity to participate in some activities, but there could be further development in the provision of opportunities for daytime activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so that residents have the opportunity to develop and maintain important relationships. Residents are supported to make choices. Meals provided are varied and nutritious. EVIDENCE: Records confirmed that people living in the home had the opportunity to participate in some preferred activities. A resident spoke of enjoying reading the newspaper, another spoke of enjoying some programmes on television. Several residents spoke of enjoying the garden in warm weather. I was informed that some residents had helped place in the ground some plants in an area of the garden. There is a large park that is accessible from the end of the garden. A resident spoke of sometimes taking walks in the park. Staff spoke The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 14 of accompanying residents to the park on occasions. A resident spoke of having recently had a manicure, and kindly showed me her newly varnished finger nails. Staff spoke of the various activities that they supported residents with, some of which were documented. There should be clear records of the number and variety of activities, which residents participate in, to provide evidence that residents have the opportunity to exercise their choice in relation to meaningful leisure pursuits. A staff member spoke of a resident who regularly participates in household duties, such as hanging washing out on the line. People who use the service have the opportunity to develop and maintain personal and family relationships. The registered person does not impose restrictions on visits (unless requested by the resident concerned). Residents spoke of the visitors that they receive on a regular basis. Two residents spoke of having recently gone out with their relatives. Staff spoke of one resident who regularly attends social clubs of her choice to meet up with friends. The home has a menu. This recorded varied and wholesome meals. Residents spoke of enjoying the meals provided. This included the lunch provided during the inspection. Condiments were provided during the meal to residents, and lunch was unhurried. Staff were observed to encourage residents with their meal and to provide assistance when needed. Drinks and biscuits were offered regularly in between meals. Some dietary needs and preferences are recorded in the care plan, but this could be further developed. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled objectively. The accessibility and format of the complaints procedure could be improved. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm, but staff training in safeguarding adults could be further developed. EVIDENCE: The care home has a complaints policy. It is recorded as being attached to the service user guide and statement of purpose, but was located separately. The manager should include the procedure within this documentation, and the complaints procedure needs to be in a format that is accessible to residents with a visual impairment. A resident spoke of talking with the manager if she had a concern/complaint. No complaints were documented. The home has a protection of vulnerable adults policy. This needed to be reviewed to ensure that the procedure is clear in that any suspicion or allegation of abuse is reported to the lead Local Authority (and if criminal, the police) without delay, prior to any commencement of investigation, and also that the Commission for Social Care Inspection be informed without delay. The manager amended this policy/procedure during the inspection. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 16 Staff who spoke with the inspector were aware of the procedures for responding to an allegation or suspicion of abuse, but there needs to be evidence that all care staff have received training in abuse awareness. This was a previous requirement. The manager reported that she and some care staff were on the waiting list to complete safeguarding adults training provided by the Local Authority. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 17 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): Standards 19, 23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely and comfortable. The premises are suitable for the care home’s stated purpose. Residents bedrooms are individually personalised, meet their individual needs. The care home is clean, and odour free. EVIDENCE: The care home is located within a few minutes walk from central Harrow, and so is accessible to a variety of shops, banks restaurants, and leisure facilities. The inspection included a tour of the premises. The home is very well maintained clean, bright, airy, and free from offensive odours. The manager reported that she was planning to install (this year) an improved bath facility in the upstairs bathroom. This should be carried out. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 18 The garden is an attractive accessible facility, which residents spoke of enjoying. The carpet in the sitting room and the communal hallway needs stretching and securing. The manager spoke of having had this done but that it has become loose again. There needs to be appropriate flooring’ in place, which is not a trip hazard. The manager needs to complete a risk assessment in regards to the loose carpets and replace them if necessary. Bedrooms are personalised. Pictures, photographs and ornaments were among the items located in resident’s rooms. The manager spoke of residents being able to use their own furniture if they wish. People living in the home spoke of being happy with their bedrooms. The call bells in the home are in working order. The home has an infection control policy/procedure. The laundry facilities are located away from food storage and food preparation areas. The home has a washing machine and clothes dryer. Care staff undertake cleaning duties. Records confirmed that staff had completed infection control training. Staff were observed to wear protective clothing as and when needed. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 19 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): Standards 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities, but there could be further development in ‘refresher’ statutory staff training. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: People living in the care home spoke highly of the staff, and reported that they know them well. Staff were observed to communicate with people living in the home in an effective and sensitive manner. A staff rota was available for inspection. There are two staff on duty during the day and one ‘wake’ staff at night. I was informed that two staff had achieved an NVQ 2 care qualification, and that one staff member was planning to commence training in an NVQ 3 qualification in care. Staff records were inspected and included required documentation. The home has a recruitment and selection policy/procedure, and an equal opportunities policy. Four staff personnel files were inspected. This documentation included evidence that required and appropriate recruitment procedures had been carried out. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 20 There have not been any new staff employed in the home for sometime, most staff have worked in the care home for several years. Records confirmed that staff had completed basic induction training, but that the induction format/programme did not include several areas of training appropriate for their role. The registered manager amended this induction format during the inspection to include the issues of abuse awareness, and confidentiality, but the registered manager needs to review the induction format so that it meets the Skills for Care Common Induction Standards, to ensure that there is evidence that all future new workers will know all that they need to know to work safely and effectively, and to also prepare the worker for health and care National Vocational Qualifications. Following the inspection I supplied the manager with a copy of the CSCI (Commission for Social Care Inspection) / Skills for Care guidance on Common Induction Standards. The home should have an up to date training plan. Records confirmed that staff had undertaken statutory training, and some other training appropriate to their role. Training included first aid, moving and handling, and food and hygiene training, health and safety training. There was little evidence of any training having taken place in 2006. The registered manager needs to ensure that all staff have the opportunity to undertake ‘refresher’ statutory training. This was a previous requirement and needs to be met. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager/provider is qualified and experienced to run the care home. Arrangements are in not fully in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provision for people living in the care home. Arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of residents and staff is promoted and protected, but it needs to be evident that all systems within the care home are monitored closely. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 22 EVIDENCE: 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, and communicates a clear understanding of the key principles and focus of the service provided by the care home. The manager has recently received training in falls and risk assessment. The manager spoke of having plans to achieve an NVQ 4 qualification in care. Residents spoke highly of the manager, and were very positive about her approachability, and of 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 manager’s job description was available for inspection. During the inspection I was informed that there were three instances when people living in the home had been admitted to hospital. Though appropriate action was judged to have been carried out by the manager in ensuring that these residents had had appropriate input from healthcare professionals, she had not notified the Commission for Social Care Inspection as is required. This issue was discussed with the registered manager/provider, and following the inspection I supplied the manager with a copy of the (CSCI) reporting of significant events. Quality assurance monitoring systems were discussed with the registered manager. Records and the manager informed me 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. The manager spoke of plans to complete an annual ‘review’ development plan in regard to the service, and a format of this was available for inspection. The registered person/manager needs to complete an annual development plan, and the registered person needs to supply a copy of this documentation to the Commission for Social Care Inspection. This was a previous inspection requirement. Following the inspection the manager spoke of the significant progress that she had made in completing an annual development plan for the care home. This is positive. Residents should have the opportunity to participate in regular resident meetings, and minutes of these meetings should be recorded. This was a previous recommendation. Staff meetings take place but the format of these meetings could be further developed. 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. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 23 Records confirmed that a staff member had received 1-1 staff supervision. The manager spoke of carrying out ongoing supervision with staff, and of planned 1-1 recorded staff supervision. The manager should ensure that all staff supervision is documented. Records confirmed that weekly maintenance checks of the environment are carried out. The inspector was informed that recently the home had received a food safety inspection by the Local Authority Environmental Health Department, which was generally satisfactory. The registered person should ensure that she meets the recommendations, which followed that visit, including completing the ‘food safety monitoring manual’. The home has an accident policy/procedure. Accidents were recorded in daily records and care plans, but appropriate accident forms were not completed though this documentation was accessible. The registered person needs to ensure that all staff have knowledge and understanding of appropriate accident recording procedures. Fire equipment has been serviced as required, and fire drills are carried out as required. The home has a fire risk assessment but this could be further developed. A copy of the Harrow/Brent Local Authority fire risk assessment format for care homes was supplied to the manager following the inspection. 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. Fridge and freezer temperatures are monitored. The manager spoke of having had the gas systems serviced in May 2007, but no up to date gas safety certificate was available for inspection. There was not an up to date portable electrical appliance certificate available for inspection. The manager spoke of this electrical check being due to take place during the week of the inspection. Following the inspection the manager reported that she had had both the gas system check and the electrical portable appliance check had been completed and was awaiting the certificates. She confirmed that she would supply copies of these certificates to the Commission for Social Care Inspection. The care home has an up to date employers liability insurance certificate. The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 24 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 2 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 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 25 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 Care plans need to reviewed regularly at least monthly and more often in response to residents changing needs. • It needs to be evident that people living in the home are actively involved (if able) and/or their relatives or significant others in the review and development of their care plan, There needs to be clear recorded evidence that care plans are updated and developed following visits to the GP, community nurse, and other healthcare professionals, to ensure that health needs of people living in the home are being met. • Risk assessments need to be further developed to include comprehensive staff guidance/procedures to minimise identified risks for people living in the home, • and need to record evidence of risk assessments being DS0000017546.V340808.R01.S.doc Timescale for action 01/09/07 2 OP7 12(1) 15(2) 01/09/07 3 OP7 12(1) 13(4) 15(2) 01/09/07 The Laurels Version 5.2 Page 26 4 OP8 12(1)(2) 5 OP9 13(2) 6 OP16 22(2) 7 OP18 18(1)(a) 8 OP19 23(2) 9 OP30 18(1) regularly reviewed, to ensure that people living in the home are safe and supported to be as independent as they are able to be, and that their changing needs are regularly assessed. The registered manager needs to ensure each resident’s weight is monitored closely particularly in view of several residents increasingly frailty and one residents poor appetite. • This medication training needs to be further developed to ensure that there is recorded evidence that staff are aware of how to deal with problems when administrating medication, such as for example if there is an error or is a resident refuses medication, • and that the training includes the principles behind all aspects of the home’s policy on medicines handling and records. The complaints procedure needs to be in a format that is accessible to residents with visual impairment. There needs to be evidence that all care staff have received training in abuse awareness. Previous timescale 01/11/06, 01/04/07 not met The manager needs to complete a risk assessment in regards to the loose carpets and replace them if necessary. The registered manager needs to review the induction format so that it meets the Skills for Care Common Induction Standards, to ensure that there is evidence DS0000017546.V340808.R01.S.doc 01/09/07 01/10/07 01/10/07 01/10/07 01/09/07 01/10/07 The Laurels Version 5.2 Page 27 10 OP30 18(1) 11 OP31 37(1)(2) 12 OP33 24 (1)(2)(3) 13 OP38 12(1) 14 OP38 12(1) 13 (4) 23(2) 15 OP38 12(1) 13(4) 23 (2) that all future new workers will know all that they need to know to work safely and effectively There needs to be evidence that staff have received recent appropriate statutory staff training, including ‘refresher’ training courses. Previous timescale 01/12/06, and 01/04/07 not met. The registered person shall give notice to the Commission without delay of the occurrence of all notifiable events. 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 01/12/06, 01/04/07 not met. The manager needs to ensure that all staff have knowledge and understanding of the accident recording procedure. An up to date gas safety certificate needs to be supplied by the manager to the Commission for Social Care Inspection, to ensure that there is evidence that she is ensuring the safety of people using the service. The manager needs to supply the Commission for Social Care Inspection with a copy of an up to date portable electrical appliance certificate, to ensure that there is evidence that she is ensuring the safety of people using the service. 01/11/07 01/08/07 01/10/07 01/09/07 01/09/07 01/09/07 The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 28 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 OP1 Good Practice Recommendations The statement of purpose and the service user guide should show evidence of being reviewed and be updated to include all relevant information including a record of the manager’s recent management qualification. • There should be a format (i.e. listening tape/or CD) of the service user guide that makes its information about the service accessible to a resident who has visual impairment. • Until then the registered person should ensure that it is documented in the care plan that information in the service user guide has been communicated to the resident. The registered person should ensure that there are no gaps in recording of night resident’s progress records. • An up to date British National Formulary medication reference book should be obtained for the home. • All staff should receive regular ‘refresher’ medication training to ensure that there is evidence that staff are competent to administer medication. Recorded residents’ dietary needs and preferences could be further developed, in their care plans. • The manager should include the complaints procedure in within the service user guide and statement of purpose documentation. • 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. • and develop a format that is accessible to residents who have a visual impairment. All care staff should receive ‘refresher’ abuse awareness/protection of vulnerable adults training. The registered person should obtain an up to date copy of the Local Authority Safeguarding Adults procedure. The registered person should ensure that it is recorded in residents care plans that they are happy to share a room. • Residents should have the opportunity to participate in regular resident meetings, and minutes of these DS0000017546.V340808.R01.S.doc Version 5.2 Page 29 • 2 3 OP7 OP9 4 5 OP15 OP16 6 OP18 7 8 OP24 OP33 The Laurels 9 OP33 10 11 12 OP31 OP36 OP38 meetings should be recorded. Staff meetings take place but the format of these meetings could be further developed. Resident meetings should be recorded. The registered person should examine the information recorded in National Minimum Standard (OP) 33, and Regulation 24 in regard to reviewing the quality of care in the care home. Residents should have the opportunity to complete service user questionnaires about the service provided. The registered manager should complete an NVQ level 4 course in care. The manager should ensure that all staff supervision is documented. The registered person should ensure that she meets the recommendations from the Environmental Health Inspection, including completing the ‘food safety monitoring manual’. • The Laurels DS0000017546.V340808.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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 DS0000017546.V340808.R01.S.doc Version 5.2 Page 31 - 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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