Inspection on 05/12/05 for The Laurels

This inspection was carried out on 5th December 2005.

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 17/04/07

The Laurels 25/04/06

The Laurels 22/06/05

The Laurels 16/09/04

The Laurels 21/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Laurels 45 High Street Market Deeping Lincs PE6 8EB Lead Inspector Sue Hayward Unannounced Inspection 5th December 2005 10:35 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 DS0000002447.V270843.R01.S.doc Version 5.0 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 DS0000002447.V270843.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Laurels Address 45 High Street Market Deeping Lincs PE6 8EB 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) 01778 344414 Mr Desmond Micheal Shiels Mrs Jacque Sonia Shiels Mr Desmond Micheal Shiels Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2005 Brief Description of the Service: The Laurels is a grade II listed building originating from the early 1800’s. It is situated a quarter of a mile from the town centre of Market Deeping. The town has a range of facilities including shops, pubs and banks. On the ground floor there are six single and one shared bedroom and on the first floor there are eleven single and two shared bedrooms. There is a courtyard area to the side of the property with chairs and tables and a grassed area to the rear. The home is registered to provide accommodation for up to twenty-three older persons who need personal care however as one twin room is being used as a single the maximum occupancy is currently for twenty-two residents. This is a family run business, the owners working in the home on a daily basis. One has overall responsibility for care management within the home. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours. It was the third inspection conducted since April 2005 and was carried out by one inspector. The main method of inspection used was “case tracking”. This consisted of tracking the care and support of two residents at the home through their care records, discussion with one of them and a staff member on duty as well as with the owners. One other resident’s record was also checked and two other residents were spoken to during the inspection. Two relatives gave their views on the quality of care the home provides. A sample of regulatory records and policies and procedures were seen and a partial tour of the premises took place. This included viewing a sample of residents’ bedrooms as well as communal rooms. What the service does well: What has improved since the last inspection? Work was in progress at the time of the visit to improve the access to the home for vehicles such as ambulances that may need to visit. The owners confirmed that once this work was finished the builder would then be commencing work to the rear of the property to level the entrance from the conservatory to the garden. It was anticipated that this work would be completed by the end of January 2006. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 6 There have been improvements to the storage arrangements for medications and staff have had training from a pharmacist. Progress has been made to implement a more formal quality assurance system. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 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 DS0000002447.V270843.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Standards 6 does not apply. The admission procedures in place ensure residents if able or their relatives are given sufficient information about the home. However it does not include obtaining photographs or recording all risk assessments undertaken in relation to residents. This has the potential to affect residents’ safety. EVIDENCE: There is a statement of purpose and service users guide. This is in the process of being reviewed and updated. The care records of a resident who had been admitted to the home since the last inspection indicated that information in relation to the statement of purpose, terms and conditions of residency, the aims and objectives of the home and information about how to raise complaints had been given to the resident and their relatives. Relatives confirmed that they had been given information about terms and conditions of residency and were aware that they could approach the CSCI if they wished to raise concerns. They also confirmed that one of the registered owners had visited their relative in hospital and at home prior to their admission and that they felt they had been given sufficient information about the home and knew who to approach if they needed more. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 9 Discussions and records indicated that one of the registered providers visits residents and conducts an assessment prior to accepting admissions and visits to the home are welcomed. Care records included to demonstrate that information was obtained from other professionals such as social services. Of three care records checked on this occasion none contained photographs of residents, which is a regulatory requirement. The registered providers confirmed that they were addressing this matter and had purchased a digital camera for the purpose. All records checked contained a care plan. Whilst risk assessments had been completed and documented in relation to some matters others had not. For example a risk assessment had been completed since the last inspection in relation to a resident who goes out on their own but there was not a documented risk assessment in relation to the risk of falls for another resident’s records checked. (See requirement made in relation to standard 7) One resident commented that the Laurels “was a beautiful place to live”. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 All residents have care plans however some did not demonstrate that they were reviewed regularly. The arrangements for storage, administration and the disposal of medications is satisfactory but the homes procedures need to be reviewed in order that they provide sufficient information to safeguard residents. Residents are treated with courtesy and respect and their health is promoted. EVIDENCE: All care records checked on this occasion contained a plan of care. They contained signatures of resident’s relatives but did not indicate that care plans were being reviewed on a monthly basis. Staff had a good knowledge of the needs of residents and the care they required but this was not fully reflected in the care plans seen. For example one did not contain information to demonstrate whether a risk assessment in relation to falls had been carried out. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 11 Records were noticed to contain information to demonstrate that residents’ health is promoted, for example visits from district nurses, general practitioners and chiropodist were noted. A resident’s relatives commented that they had been pleased that their relative had been able to continue to receive a service from the same G.P and chiropodist that she had used prior to her admission to the home. A comment from a resident confirmed that they only had to tell staff if they needed to see a doctor and a visit would be arranged. Since the last inspection the home has changed its arrangements for the supply of medication. Staff have had training from the pharmacist in relation to medication handling. The arrangements for the storage of some medications has been changed to ensure that they are more secure, for example a separate lockable fridge has been purchased to store those medications that require a cooler temperature. A matter that remains outstanding is in relation to the review of the homes medication procedures. One of the registered providers confirmed that they would be working in conjunction with the pharmacy to review this document and had obtained information via the Internet. A good rapport was noted between staff and residents. Staff treated residents in a polite and respectful manner. Comments from residents were positive about their relationships with staff and indicated that their privacy was respected. Relatives also confirmed that staff respected residents’ privacy. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 Residents have choices and are able to make decisions about how they lead their life in the home. A balanced diet that caters for residents’ individual preferences is provided. EVIDENCE: Comments from residents and observations made on the day indicated that residents make choices as to how they lead their lives in the home as far as they are able. For example, a resident said that staff made them aware of any events or entertainment arranged and they had a choice as to whether they participated or not. Another comment made was that a resident could choose what time they got up or went to bed. Residents were noticed to come and go as they pleased within the home. Care records checked contained information detailing dietary requirements and the equipment needed to assist residents with their dietary needs. It was noticed that staff ensured that residents received the help and support they required at the lunchtime meal. Guidelines and information is in place for staff to refer to when handling or preparing meals. A staff member spoken to had a good knowledge of the The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 13 dietary needs and preferences of the residents asked about and indicated that drinks and snacks are available on request outside of mealtimes. Satisfactory records are kept in relation to the meals provided. Whilst the main meal is a set meal there are records kept of residents individual preferences and these are catered for. The main meal was noted to consist of a choice of two vegetables, potatoes and minced meat. Residents spoken to made complimentary comments about the food provided. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 There are satisfactory procedures in relation to complaints and adult protection matters to ensure residents are protected. EVIDENCE: Neither the home nor the CSCI have received any complaints about the service since the last two inspections. Relatives confirmed that they were aware of the complaints procedure and had received a copy of it and had had it explained to them. They knew that they could contact the CSCI if they had any concerns. They also said that they felt able to approach staff at any time and had been told to raise any suggestions or concerns they may have. Residents spoken to all said that they would feel comfortable to talk to staff if they had any problems and knew who was in charge. Since the last inspection the registered persons have obtained a copy of the revised local authority adult protection procedures. The homes own policy needs to be reviewed in the light of this to ensure that it links with local authority procedures as it was noted that it made reference to the home conducting its own investigation. No adult protection matters have been raised. Residents’ described staff as being approachable, good and kind. A staff member was clear about the reporting procedures that she should follow should an adult protection matter be raised with her. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 21 A comfortable, clean and well-maintained environment is provided for residents. However bathrooms do not fully protect residents’ privacy. Progress has been made to address the requirements of the fire brigade with only one matter now remaining outstanding. EVIDENCE: Those areas of the home seen included the sitting rooms, dining room, kitchen and a sample of residents bedrooms and bathrooms. The home is clean and tidy and residents are able to furnish their rooms with their own personal effects if they wish. Residents described their rooms as comfortable and one said, “It is a beautiful place”. Work was in progress to extend the access to the front of the building for larger vehicles such as ambulances. One of the registered persons confirmed that when this was complete work would start on levelling the area from the conservatory to the garden. This matter was raised by the fire safety officer during his visit of 11/03/05 and has the potential to compromise residents’ safety. It was understood that a patio area is also planned. The registered The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 16 persons are requested to verify with the CSCI when this work has been completed. Two bathrooms were viewed on this occasion. Neither were lockable. Discussion with the registered persons indicated that residents who use these bathrooms have a staff member with them when bathing, however further consideration needs to be given to ensuring residents privacy when using these rooms either by ensuring they are lockable or if not appropriate to the needs of residents through the use of signs to denote when they are in use. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 The home is being staffed to meet the needs of residents. However, records do not demonstrate that the home is operating a thorough recruitment procedure to ensure as far as possible the protection of residents. EVIDENCE: From the information residents, relatives and staff gave on the day and from records checked, the home is staffed to ensure residents’ needs are met. There have been few staff changes ensuring that there is a consistent staff team. Residents described staff as being “kind and good” and provided support needed as soon as they could. Relatives said they were always made to feel welcome in the home and staff were approachable. Staff were attentive to residents needs during the inspection offering assistance when needed. One was observed to take a resident out for a walk and a comment from a resident confirmed that staff kept them informed of events in the home should they wish to attend. Records checked of the recruitment procedure did not demonstrate in some instances that a thorough recruitment procedure had been followed. For example some staff records did not contain a photograph although it was seen that a request for this had been pinned to the notice board. Staff records checked in two instances did not contain dates of commencement of The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 18 employment and references could not be produced in one instance. Criminal Record Bureau Checks (CRB) were in place, however one of these had not been carried out by the registered persons. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 Some progress has been made to develop a more formal system of quality assurance to obtain residents views about the service. EVIDENCE: The comments from residents and relatives were positive about the care provided at the home. A questionnaire has been used with some residents and their relatives to give feedback about the quality of the service. It is recommended that this be dated. It is the intention that this will be used initially after the first three months of residents being at the home and thereafter annually. The registered persons said that any issues raised from this would be dealt with on an individual basis. A staff member confirmed that she felt valued and supported in her work and that the registered persons were always contactable when not in the home. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 20 Residents confirmed that they felt they could raise any problems and knew who was in charge. Relatives spoken to also said that they had been made aware that if they wanted to make suggestions or raise concerns to let staff know. Standard 35 does not apply, as the homes policy is not to hold residents money currently. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 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 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X X The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 22 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 2 Standard OP3 OP7 Regulation 17 1a Schedule 3-2 13(4) & 15(2) Requirement Timescale for action 28/02/06 It is a requirement that each care record of residents include a photograph of the resident. Care records must contain 28/02/06 information to demonstrate that any risks to the health and safety of residents have been identified and as far as possible eliminated for example in relation to the risk of falls. The registered person must ensure that it can be demonstrated that care plans are reviewed on a monthly basis. There must be written policies 28/02/06 and procedures in place on all aspects of medicine handling and management. Previous timescale of 03/12/2004 not met. The registered person must 31/01/06 ensure that all recommendations of the fire brigade are addressed. It is acknowledged that only one matter remains outstanding in relation to the levelling of the exit from the conservatory and that the DS0000002447.V270843.R01.S.doc Version 5.0 3 OP9 13 (2) 4 OP21 23(4) & 12(1) The Laurels Page 23 5 OP19 12 (4) 6 OP29 19(1) & 17(2) registered person confirmed this would be addressed by January 31/01/06. The registered person must consult with the fire brigade to ensure that this timescale meets with their approval. Previous timescale of 30/09/05 not met. Bathrooms and toilets must 28/02/06 ensure residents’ privacy and dignity either through the provision of locks or other means. Any locks provided must meet with the fire brigades recommendations and be accessible to staff in an emergency. Previous timescale of 31/08/05 not met. 28/02/06 Records must be available to demonstrate that a safe recruitment process is in operation, which includes two written references and evidence of a satisfactory CRB/POVAFirst check undertaken by the employers prior to employment, photos and dates of employment. Previous timescale of 31/08/06 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations The registered persons should ensure that the homes own adult protection procedure is reviewed to link with Lincolnshire County Councils Adult protection procedures which were revised in February 2005. It is recommended that the home produces an annual development plan for the home reflecting the aims and DS0000002447.V270843.R01.S.doc Version 5.0 Page 24 2 OP33 The Laurels outcomes for residents. The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Laurels DS0000002447.V270843.R01.S.doc Version 5.0 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. 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