CARE HOMES FOR OLDER PEOPLE
The Laurels Bull Lane South Kirkby West Yorks WF9 3QD Lead Inspector
Tony Railton Unannounced Inspection 7th December 2005 08:30 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 DS0000006194.V271008.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 DS0000006194.V271008.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Laurels Address Bull Lane South Kirkby West Yorks WF9 3QD 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) 01977 640721 01977 640721 Superior Care Homes Limited Mrs Jessie Stringer Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st August 2005 Brief Description of the Service: The Laurels is a care home providing personal care and accommodation for 28 older people. It is owned by Superior Care Homes Ltd a privately owned limited company. The home is situated close to the centre of South Kirkby, a small former mining community. The premises a former vicarage that has been adapted and extended. Service user accommodation is arranged on two floors and there is a passenger lift. There are twenty bedrooms for single occupancy of which one has en-suite facilities. There are four bedrooms designed for shared occupancy of no more that 2 people. The home, which is close to local amenities, has a car park to the front and gardens and a patio area to the rear. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector arrived early at 08.30 for this unannounced inspection to observe the morning routines in the home. Throughout the morning there was the opportunity to speak to nearly all residents, the manager, five care staff and two domestic staff, one relative, a visiting District Nurse and the handyman. An inspection of the home was also undertaken. A number of residents and staff files were examined including staff training and supervision records, residents care plans, reviews and financial records. This was a very positive and enjoyable inspection and the inspector would like to take the opportunity to thank all residents and staff for their patience and co-operation throughout the inspection. What the service does well:
On the day of the inspection there was a relaxed homely atmosphere. Residents appeared to be happy and comfortable with care staff carrying out their duties in a relaxed and unhurried manner. All residents without exception were appropriately dressed and in particular all ladies clothing was matching and colour co-ordinated. Residents appeared well having their hair groomed and nails manicured. All residents without exception said that they were happy, some said that “the food is very good” others that the care staff are “great” and “very caring”. Throughout the inspection there was a sense of teamwork and the atmosphere was open and inclusive. A visiting District Nurse said that there have never been any problems with the home and that residents always appear happy and well cared for. A visiting relative said that what he liked about the home was the “homely atmosphere” and that it was good to see “local older people cared for by younger local people”. A number of residents said living in the home was like “home from home”. Care staff said that they like working in the home and it was noted that staff turn over is minimal. Over 50 of care staff are NVQ trained and residents can be confident that they are cared for by very experienced, confident and competent staff. Residents bedrooms are homely and comfortable and most are surrounded by their own possessions. The communal areas are decorated and maintained to a good standard and are comfortable and “lived in”. One the day of the inspection all areas of the home were clean and free from unpleasant odours the care staff and in particular domestic staff are to be commended for their efforts in maintaining such a good standard of cleanliness throughout the home. The home looked very festive with Christmas trees and decorations throughout. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 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 Laurels DS0000006194.V271008.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 DS0000006194.V271008.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): 3&6 No residents’ move into the home without having had their needs assessed and been assured that these will be met. EVIDENCE: Residents’ record’s show that before they are admitted to the home they are assessed by the manager or senior carer. Most residents also have a Care Management Programme Assessment carried out by the local authority or health authority. Discussion with the manger indicated that the home does not provided intermediate care. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 9 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 &10 Residents’ health, personal and social care needs are set out in an individual plan of care. Residents are also assisted to make decisions about their lives with the help and assistance they require. EVIDENCE: Residents care plans show that their individual personal and healthcare needs are set out in their care plans. It was noted that the care plans used are based on the fourteen activities of daily living and cover every aspect of residents’ lives. Examination of the daily records show that they would benefit from an increase in the use of descriptive words to reflect residents choices, preferences, likes and dislikes. Medical records also show that their healthcare needs are met and they also show that the home is supported by local community based healthcare professionals including District Nurses and General Practitioners. A visiting District Nurse said that there have never been any problems with the home. She went on to say that the staff are always very helpful and residents always appear to be well cared for.
The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 10 Discussion with the manager and examination of staff training records and medicine administration records indicate that residents are safeguarded and protected by the medication administration policies and practices. Through observation it was noted that there is a positive relationship between staff and residents who are treated with dignity and respect at all times. One relative said that whenever he visits the care provided by the home appears to be very good. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 11 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): 12, 13, 14 & 15 Residents find the lifestyle experienced in the home matches their expectations and preferences, and meets their social, cultural, religious and recreational interests. EVIDENCE: Through examination of residents records including care plans, reviews, daily and activities records and discussion with the residents, their relatives, the manager and care staff. It was established that residents are happy living in the home. Observation of residents and staff show that there is a good positive relationship fostered which is respectful as well as inclusive. Examination of the record of activities, daily records and residents’ assessments showed that they have opportunities to participate in activities which are organised on a regular basis. Through observation and discussion with residents, relatives and visiting District Nurse the inspector is convinced that residents do have choices and preferences and do make decisions about what they do on a day to day basis .However, the daily records and record of activities do not adequately reflect residents choices, preferences, likes and dislikes. The manger said that the daily records and record of activities would be better if they had descriptive words to reflect what residents choose to do and not to do to demonstrate that residents have some control over their own lives.
The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 12 The inspector agreed. One relative said that he can visit the home at anytime and is always made to feel welcome. Some residents said that the food is good and that they enjoy their meals. The manager said that residents do have a choice of menu and a record is made of the food provided. The cook said that she has everything she needs and is preparing for the Christmas festivities. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 13 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 & 18 Residents and their relatives can be confident that their concerns and complaints will be listened to and acted upon. Residents are also safeguarded and protected by the home adult abuse and protection policy, procedure and practices. EVIDENCE: Examination of the complaints book and discussion with residents, their relatives, visiting District Nurse, the manger and care staff it was established that complaints are treated positively and appropriately dealt with. It was noted that the complaints policy and procedure in residents’ bedrooms has been updated to reflect the name, address and telephone number of the Commission for Social Care Inspection. It was noted that the home has a copy of the Wakefield Social Services and Health Multidisciplinary Adult Abuse and Protection Policy and Procedure which forms part of the induction training for staff. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 14 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): 19,20,21,22,23,24 & 26 Residents live in a safe, well-maintained, homely, comfortable environment which meets their individual and collective needs. EVIDENCE: Inspection of the home showed that residents’ bedrooms are homely, comfortable and most are surrounded by their own belongings. Discussion with some residents’ indicate that they are pleased with their bedrooms and with where they live. One relative and a number of residents’ said that “its like home from home”. On the day of the inspection all areas of the home were noted to be clean and free from any unpleasant odours. The care staff and in particular the domestic staff are to be commended for their efforts in maintaining such a good standard of cleanliness throughout the home. The inspector was impressed with the pro-activity of the handyman in replacing the in-tumescent strips on the bedroom doors. The handyman also said that he had also replaced a faulty door closure on one bedroom door. This work is to be commended.
The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 15 It was also noted that a number of bedrooms have been decorated since the last inspection and parts of the corridor and stair carpet have been replaced. The manager said that the home are due to take delivery of new easy chairs for the lounges and hopes that these arrive before Christmas. Discussion with the manager and examination of the programme of renewal, maintenance and decoration for the home shows that there are plans to provide a new dining room carpet in the coming year The inspector commends the investment made by the homes owners in improving standards to the environment. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 16 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): 27,28,29 & 30 Residents’ needs are met by experienced staff who are, confident, competent and NVQ trained. Residents are in safe hands and protected by the homes staff selection and recruitment policies and practices. EVIDENCE: Staff personnel files show that appropriate checks are carried out before new staff are employed and that residents are protected by the staff selection and recruitment policies and practices. Staff training records show that over 50 of care staff have a National Vocational Qualification Level 2 or above. The Social Care Association Residential Staffing Formula completed by the manager shows that enough staff are provided to meet residents personal care needs. On the day of the inspection staff were observed to be in available in sufficient numbers to carry out their duties in a relaxed and unhurried manner. Staff training records show that staff receive training and update training in Moving and Handling, Basic Food Hygiene and First Aid. Discussion with care staff showed that they are competent and confident in their work and that they feel supported by the homes manager and owners. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 17 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): 31,33,35 & 38 Residents live in a home that is managed by a person who is fit to be in charge, of good character and able to discharge her responsibilities fully. Residents also benefit from living in a home which is open and inclusive. EVIDENCE: The registered manager is very experienced and knows how to run her home properly. The management systems in the home including care planning and reviewing staff selection, staff training and staff supervision is good. Residents and staff benefit from living in and working in a home that open and inclusive and where they know that their comments will be listened to and acted upon. The inspector was impressed with the positive attitude of the manager and her staff team towards residents and their well-being. Staff training records show that health and safety training and update training is provided for all staff.
The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 18 Staff supervision records show that all staff receive six line management supervision sessions per year and a record made. However, the manager said that more detail may be needed in the supervision notes to reflect what staff had to say when given the opportunity to speak about their work. One relative said that one of the strengths of the home is that its “local people being cared for by local people.” The inspector agreed that this is an advantage and the contributions made by the manager and staff team and the support offered to residents unique and appropriate. A visiting District Nurse said that the care provided by the home is good and residents appear to be happy and have a good quality of life. The owners are to be commended for their foresight and investment in providing a local home which is managed well and run by local people for local people and which provides a good quality service. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 19 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 2 X 3 X X 3 The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP12 OP14 OP33 OP33 Good Practice Recommendations The daily records would benefit from the use of descriptive words to reflect residents care plans and in particular their identified likes and dislikes choices and preferences The record of activities would benefit from an increase in descriptive words to reflect residents choices and preferences regarding activities The daily records would benefit from descriptive words to indicate when residents make a decision about how they live their daily lives. Service users and their relatives and other stakeholder surveys as part of quality assurance monitoring should be undertaken. The information gathered through quality assurance monitoring surveys should be collated and a report published reflecting the outcomes for residents. The Laurels DS0000006194.V271008.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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