Inspection on 30/04/08 for The Laurels

This inspection was carried out on 30th April 2008.

CSCI found this care home to be providing an Poor service.

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

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

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

CARE HOME ADULTS 18-65 The Laurels 1 Lower St Helens Road Hedge End Hampshire SO30 0NA Lead Inspector Laurie Stride Unannounced Inspection 30th April 2008 09:35 The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address 1 Lower St Helens Road Hedge End Hampshire SO30 0NA 01489-799119 02392 251331 dolphin.homes7@btconnect.com 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) Dolphin Homes Ltd Position vacant Care Home 7 Category(ies) of Learning disability (0), Physical disability (0), registration, with number Sensory impairment (0) of places The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Sensory impairment (SI) The maximum number of service users to be accommodated is 7. The home may admit one service user aged 17 years 2. 3. Date of last inspection N/A Brief Description of the Service: The Laurels is a large detached property located in a residential area close to the town of Hedge End that has been converted to provide accommodation and personal care to seven people who have a learning disability, sensory impairment and/or physical disabilities. The provider Dolphin Homes Ltd has several services for people in these categories registered with the Commission in the Hampshire area. The accommodation is arranged over two floors with the first floor being reached by staircase or passenger lift. All communal areas of the home are wheelchair accessible. The current fee is £1,200 per person per week. Additional support may be provided at £12.00 per hour. This information was obtained at the time of the inspection visit. Members of the public may wish to obtain more up-to-date information from the care home. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was the home’s first unannounced key inspection since it was registered on 08/11/07. The visit lasted approximately nine hours, during which we, the commission, looked at how well the home is meeting peoples’ needs and supporting them to have a good quality of life. During our visit we looked at samples of records and spoke with the Director of Care and the company’s training manager. There is currently no registered manager. We also spoke in depth with one of the members of staff on duty. We spoke with two of the people who use the service and observed staff interacting with them in a respectful and friendly manner. Further information used in this report was obtained from the home’s annual quality assurance assessment (AQAA), which we received on the day before the inspection visit. The AQAA was due to be received on 14/04/08. We sent a reminder letter on 16/04/08 and also telephoned the person responsible for the organisation about the AQAA on the same date and on 21/04/08 and 29/04/08. What the service does well: What has improved since the last inspection? What they could do better: Care could be improved through better recording of peoples’ goals and aspirations. A full record of the training provided for staff in the home needs to be available for inspection, in order to demonstrate that all staff members have received The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 6 the relevant training. The training programme would also benefit from the inclusion of specialist subjects in line with the homes’ registration. The organisation needs to be more active in monitoring the home to ensure that it is conducted in a way that demonstrates that all the relevant regulations and standards are met. The organisation needs to be more active in ensuring that the annual quality assurance assessment (AQAA) is fully completed and sent to us within the timescale. 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 DS0000071115.V363121.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 & 3 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. The home has suitable procedures for assessing individual needs before they are admitted to the service. Staff do not have all the necessary specialist training and skills to care for individuals who may be admitted. EVIDENCE: The home has a statement of purpose and service user guide, a copy of which is available in the hallway near the entrance of the home. We saw evidence of the home’s own pre-admission assessments in relation to three of the people who use the service. These documents included details of, for example, peoples’ physical, mental, social and emotional needs, communication and known risk factors. Records of assessments for the other two individuals were not on file. The Director of Care said that she had carried out these assessments and made a telephone call to ask for the documents to be sent to the home. There was a lot of additional information on file about the two individuals, which had been obtained from previous placements and relevant agencies during the assessment process. We also saw that care plans The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 9 and risk assessments had been developed for all three people and that their needs were being continually re-assessed and reviews had been held. The Director of Care informed us that one person had a wrong diagnosis at the time of their admission to the home. The home and relevant agencies were now involved in planning suitable alternative strategies in relation to this person. In January, prior to our visit, the placing authorities met to discuss concerns about the suitability of the service and the decision was reached not to place a further two people in the home. Further to this and our own enquiries, the service providers had written to us stating there will be no further admissions to the home until June 2008 at the earliest, to ensure the home exceeds stakeholder expectations. It is also planned to restrict the number of admissions to 6 (the home is for 7) for the foreseeable future. This letter also stated that further environmental improvements were being made to the property, which at the time of our visit we noted had been carried out. The current staff training programme, which is under review, does not fully reflect the specialist services the home is registered to provide, for example physical disability and sensory impairment. We saw evidence of some relevant specialist and clinical guidance being available to assist the home in working to meet people’s needs. We observed staff communicating effectively with people who use the service. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit through having opportunities to be involved in planning the care and support they receive. Support plans are in place reflecting the changing needs of people, which would be further enhanced by better recording of peoples’ goals and aspirations. EVIDENCE: We case tracked two of the people who use the service to see how well the home is meeting their needs and supporting them to have a good quality of life. Care records for each individual are held in two large files that contained a lot of information, including duplicated records. Two care plan formats are in use, a standard organisational one and another put in place by the funding authority. The Director of Care said that to date the home has been monitored frequently by the Primary Care Trust and care plans have been more on the The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 11 clinical side. We saw there was a lot of information about what people like doing in the care plans but not much evidence of the specific goals and aspirations to be currently worked on. The Director of Care said that personcentred plans will be developed more now and we saw some evidence of this, developed by the deputy manager, in peoples’ files. Current care records included risk assessments for each individual, with guidelines for staff on how to manage behaviours that may be challenging. Staff we spoke with had a good knowledge of people who use the service, demonstrating that they knew, understood and worked to the recorded strategies that are in place to meet the assessed needs of individuals. We saw written evidence of continuing care reviews involving staff from the home and health and social care professionals. People who use the service are invited to attend these reviews and we saw that input from relatives is also obtained. The Director of Care said that care plans are to be reviewed again with the new manager, who will be in post from 06/05/08. The revised care plans will include the evidence of recent positive changes such as reductions in incidents of challenging behaviour exhibited by some individuals. Through observation, talking with staff and looking at records, we saw that the home supports people in making decisions for themselves. A staff member said that the staff have got better at promoting choice for people who live in the home. Communication support has been developed further since the home opened, with more staff able to use sign language. This has had a particularly beneficial effect in relation to one individual, whose challenging behaviours have decreased. The home is currently engaged in supporting two individuals to have more access and control over their finances. With regard to the other people who use the service, the home supports them to manage their personal finances and there is a system for recording how this is done. Balances and expenditure are checked at least daily and access to money is restricted to safeguard the individuals concerned. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service are supported to make choices and to develop their life skills. The home ensures that a range of social activities, community access and support with maintaining relationships is available to people. EVIDENCE: Care plans contained details of things people like doing, such as shopping, swimming and going out to various places and there was evidence in the daily records of these and other activities taking place. We saw ‘flow of the day’ charts showing the things individuals are involved in doing during the day. One person was out at college, two were going sailing in the afternoon and another was planning to go to the cinema later in the day. One person we spoke with was very interested in the boating activity and told us he had also been to the hydro-pool that morning. Another indicated that The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 13 she was happy with the activities on offer. The home has its own purpose built vehicle to provide transport for people who use the service. An external facilitator also arranges activities for people who use the service. Another individual is due to start attending college later this year. Communication tools are now being used, which are enabling staff to work with people in an individual way. One person uses picture symbols to tell staff how she feels. Each person has a member of staff who acts as a key worker, which allows continuity and relationships of trust to develop. Records showed that people are supported to maintain contact with friends and relatives, through visiting and telephone calls. People who use the service are also supported to take part in the daily routines of the home. Individual choice is promoted through house meetings held each Sunday. For example pictures and books are used to assist individuals to decide the weeks menu. We saw that the menu was varied and a person who lives in the home told us that they like the food. Nutritional assessments are in place where required and these are kept under review. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service have access to health care when they need it and staff provide personal care in the way that individuals prefer. Medication systems have not always followed good practice or safe practice guidelines and have needed action. EVIDENCE: Prior to our visit, concerns had been raised by external agencies regarding the home meeting the healthcare and medication needs of people living in the home. This had resulted in a change in management within the home and further training for staff individually and collectively, although fully up-to-date records of training were not available at the time of our visit. Health and social care professionals have provided care planning guidance and training for staff around conditions such as epilepsy. The home has also provided further epilepsy training and agreed protocols are in place that staff telephone for an ambulance if someone has a seizure. We saw that individual nutritional needs and support are documented and have been reviewed. Health care appointments and visits are recorded with details of the outcome. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 15 Care plans contain guidance for staff about how to give personal support in the way that the individual prefers. We saw that getting up times and other activities are flexible, although people are encouraged to keep to commitments such as going to college. Individuals can choose the type of clothes they like to wear. The home has suitable aids and equipment to assist people with their mobility. Records of moving and handling assessments and medication reviews are on file. Currently there are no people living in the home who manage their own medication. The Director of Care reported that relationships with the local doctors’ surgery have not been good. A meeting between representatives of the home and the surgery has been arranged. Previously there were concerns over the management of people’s medication and the use of invasive procedures to administer medication. Through discussion with a staff member and looking at records of medication reviews we saw that individuals no longer require this type of medication and procedure. The Director of Care said that the home’s first manager had not managed people’s medication properly. We saw that the home has suitable arrangements for the storage and management of medication, including controlled drugs if necessary. There is a medication policy and staff were observed following the procedures, such as two staff members signing for incoming medication and checking medication that is given before signing the records. Individuals’ medications are stored separately within the locked cabinet and there is a record kept of medication returned to the pharmacist. We observed staff preparing to administer medication to people and this was done in a way that upheld the individuals’ privacy and dignity. The available records and discussion with staff indicated that staff receive training in the administration of medication. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a suitable complaints procedure. People who use the service have not always been protected from abuse and changes are being made to address this. EVIDENCE: The home has a complaints procedure and a record of complaints received by the home, with details of the complaint and actions taken. Some of the outcomes could be more clearly recorded and we discussed this with the Director of Care during our visit. Staff we spoke to felt that they would be able to identify if a person using the service had concerns or was dissatisfied, through knowledge of the way individuals’ communicate and daily monitoring records. The home has a copy of the most recent local authority safeguarding procedures. The training manager for the organisation is undertaking training to enable her to deliver safeguarding training to staff. We had been notified of two safeguarding referrals and investigations taking place in relation to the service and the home had kept records of these. The first of these indicated that some staff had lacked adequate knowledge, training and support when the home opened to safeguard people who use the The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 17 service and meet their needs. The home is subsequently supporting a member of staff who now works in another service. The second case had been referred to social services by the home and a joint action plan was in place. The home’s annual quality assurance assessment (AQAA) states that the homes’ plans for improvement in the next twelve months include training all staff in safeguarding and whistle blowing policies and procedures. A staff member we spoke to said they had received training in relation to the theoretical aspects of safeguarding procedures and would like more practical training. Not all staff, we were told, had covered the theory training yet. The staff member demonstrated an awareness of the procedure to follow if reporting any suspected abuse. We discussed the procedures for notifying the commission about incidents with the Director of Care, who confirmed that the home follows the latest guidance in relation to these. A staff member we spoke to confirmed they have received training in managing challenging behaviour and that other staff members are to receive this training. The staff member told us that the service has improved since the home opened, for example through better communication and promoting of individual choice, so that people who use the service are happier and calmer. This has resulted in fewer incidents of challenging behaviour. The training manager informed us that the only physical interventions the company permits staff to use are a shielding technique and a ‘grab release’ technique. The training manager is also going to train to be able to deliver training for staff in managing challenging behaviour. The home supports individuals’ to look after their personal finances and has a system of checking and recording transactions and balances. The homes’ records also showed that robust recruitment procedures are followed in order to protect people who use the service. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit from a clean, well-maintained and comfortable environment. EVIDENCE: The commission undertook a visit to the premises prior to registering the home and found the premises to be appropriate for the running of this service. There are seven bedrooms, two located on the ground floor and five on the first floor. The passenger lift is fully wheelchair accessible with level access and large, easy to use controls. All bedrooms have an en-suite wet room with shower, toilet and sink and have adaptations in place for those with mobility problems. Extractor fans and non-slip flooring is fitted. Hot water temperature safety valves are fitted to all hot water outlets. All areas of the home have safety covers and individual temperature controls fitted to the radiators. Restrictors and security locks are fitted to windows. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 19 During this visit we undertook a tour of the communal areas and bedrooms. We saw that structural alterations had been made to the hallway in order to improve wheelchair manoeuvrability. The Director of Care informed us that further development was being planned, pending advice from the town council. A conservatory has also been added, although people who use wheelchairs may need assistance from staff to access this from the lounge. There is a separate dining room that is also used as an activities area. The home has an enclosed garden with ramp access. The bathroom on the upper floor has been fitted with an overhead-tracking hoist and is a good size and suitably equipped. There is a small utility room that has a sink and lockable storage for COSHH (Control of Substances Harmful to Health) substances and a commercial washing machine, with sluice facility, and tumble dryer. The home’s annual quality assurance assessment (AQAA) indicates there are plans to see if access to this area can be improved to enable wheelchair users to use the laundry independently. At the time of our visit, we observed a good standard of cleanliness throughout the premises. The Director of Care informed us that the environmental health officer had been contacted regarding the hand-washing facilities in the kitchen and had confirmed these to be suitable for use until replaced. We had been made aware of the concerns of external agencies in relation to the environment not providing suitable space to manage any challenging behaviours that individuals may exhibit. Through records, discussion with staff and the Director of Care, we were informed that there were some identified risks regarding one individual, who had a wrong diagnosis at the time of their admission to the home. Staff reported that this person was responding to the improved communication methods by staff and exhibiting much less challenging behaviour. The Director of Care reported that the home and relevant agencies are looking at possible alternative strategies to meet this persons needs. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 & 35 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Further improvement is needed to demonstrate that all staff members receive suitable training to ensure they can meet people’s needs. The home operates a robust recruitment process to protect people who use the service. EVIDENCE: The home has a mix of both male and female staff and there are currently two vacancies for full time staff, for which interviews were being held on the day of our visit. The home’s annual quality assurance assessment (AQAA) states that the service could do better through encouraging staff to attend more training and that the home is improving on this. The AQAA also says there are plans to use fewer agency staff to cover shifts. A member of staff told us that staff continuity has improved and regular staff members sometimes cover additional shifts. Staff regularly work three twelve-hour shifts followed by two days off as part of the normal rota. We saw that the home’s rota indicated that there are usually four staff members on shift plus the manager and deputy and two staff awake at night. On the day of our visit the home was short-staffed by one carer due to sickness. There are currently five people living in the home The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 21 and we observed people being supported with their personal care as required and to do their planned activities. There are ten regular staff members in the team, including the deputy manager. The AQAA stated that 70 of these staff members are qualified to National Vocational Qualification (NVQ) level 2 or above. Other elements of training are provided through both internal and external trainers. There is a structured induction that is in line with the Skills for Care Common Induction Standards. The organisation provides a range of training which includes NVQ, fire safety, moving and handling, first aid, health and safety, epilepsy, medication, food hygiene, infection control, managing aggression, risk assessment, diet and nutrition and the Mental Capacity Act. A full record of the training programme for staff in the home was not available at the time of our visit, so it was not possible to ascertain if all staff members have received all the relevant training. We spoke with the training manager, who said they were planning to update the training records this week and had asked staff to bring in their training certificates. Through looking at the available records and talking with a staff member, we were able to confirm that some staff members have completed mandatory training and other training to meet the needs of people who use the service. The current training programme does not include specific training relating to physical disability and sensory impairment. Staff confirmed that they receive regular supervision, approximately every six weeks. There is a supervision agenda covering such matters as key-working and staff issues, training and dress code. The AQAA stated that the service carries out thorough staff recruitment checks and we confirmed this through inspecting a sample of staff files. The three staff members’ files contained evidence of Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks, two written references, completed application forms with employment histories. These also included information about staff induction and supervision. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 People who use the service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. A number of management changes since the home opened and a lack of effective monitoring by the organisation have destabilised the service. EVIDENCE: There is currently no registered manager in post. A new manager has been recruited and is due to commence work on 06/05/08 and the person responsible for the organisation has told us this person will be submitting an application to register. An acting manager had been in post since 10/12/07 and had transferred to another home two weeks before the new manager is due to take up position. On the day of our visit we met the company’s training manager, who informed us she will be overseeing the day-to-day management of the home until the new manager arrives, although she had not been aware of this fact when she arrived at the home on 21/04/08. The training manager The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 23 demonstrated a confident approach to managing the service and this was further confirmed through comments from the staff team. The manager of the home is supported by a deputy manager. The person responsible for the organisation wrote to us on 01/05/08 to confirm the current management arrangements of the service and apologised for not following the correct procedures for notifying us of the management changes. We saw records of monthly visits to the home, undertaken in line with Regulation 26, by the organisations’ Director of Care. These visits had been documented up until 26/01/08, including some discussions with the managers of the home at the time, and the Director of Care said there are another two visits to be written up. We talked with the Director of Care about the importance of the organisation demonstrating that the quality of the service is being monitored regularly, particularly in light of the absence of a registered manager and concerns received from external agencies about the service shortly after it opened. We had written to the responsible individual for the organisation in January, stating the necessity of monitoring the home to ensure that it is conducted in a way that demonstrates that all the relevant regulations and standards are met. The home’s annual quality assurance assessment (AQAA) was returned after the deadline and we had further reminded the service providers of the legal requirement of this. Entries in the AQAA document are brief and do not provide a full picture of how the service is and intends to develop. For example, in the management section of the AQAA it states that the service does well at Regulation 26 and quality assurance training, but prior to and at the time of our visit the service was unable to demonstrate this. As mentioned in the relevant sections of this report, improvements need to be made in relation to staff training. There had been previous concerns around the giving of personal care and medical interventions due to poor management practice within the home, which led to additional support being given by Adult Services and the Primary Care Trust. The Director of Care said that the home is starting to settle now and staff morale is improving. This view was reflected in comments made by members of staff. The minutes of staff meetings held on 29/11/07 and 04/01/08 were on file and we were informed that the home will send out quality assurance The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 24 questionnaires to stakeholders, as the home is in its first year. Reports on how individuals who live in the home are experiencing the service were on file for February and March. The Director of Care said that homes’ policies and procedures have all been reviewed to reflect current legislation and are due to be reviewed again in March 2009. We saw the home’s fire logbook was up-to-date with details of equipment tests and drills and there is a fire risk assessment for the building. Safety devices are installed in the home, such as hot water temperature safety valves, radiator covers and window restrictors. Portable electrical appliance testing is due at the end of the year. The home has suitable accident/incident recording books. The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 1 X X 3 X The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 26 N/A 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 YA35 Regulation 18(1) Requirement A full record of the training provided for staff, including specialist subjects, must be held in the home and available for inspection. This is to demonstrate that all staff members have the necessary training to meet the needs of people who use the service. A system of quality assurance monitoring must be established and maintained to ensure the service is run in the best interests of, and includes, the people who use the service. Up-to-date records of quality monitoring visits, undertaken by the responsible individual or their representative, must be kept in the home and be available for inspection. Timescale for action 29/07/08 2. YA39 24(1) 29/07/08 3. YA39 26(4) 29/07/08 The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Laurels DS0000071115.V363121.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000071115.V363121.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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