CARE HOMES FOR OLDER PEOPLE
The Laurels Care and Nursing Home Bankside Lane Bacup Rossendale OL13 8HG Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 16th September 2005 10:00 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 Care and Nursing Home DS0000056864.V252785.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 Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Laurels Care and Nursing Home Address Bankside Lane Bacup Rossendale OL13 8HG 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) Regency Healthcare Limited Mrs Claire Tighe Care Home 28 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (8), Old age, not falling within any other category (28), Physical disability over 65 years of age (25) The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. A maximum of 25 service users requiring nursing care who fall into the category of either OP or PD A maximum of 28 service users requiring personal care who fall into the category of OP A maximum of 8 service users requiring care who fall into the category of MD(E) or DE Staffing for those service requiring nursing care will be in accordance with the Notice issued dated 27th April 1998 The total number of service users within these categories not to exceed 28 (twenty eight) The registered provider shall, at all times, employ a suitably qualified and experienced person who is registered with the National Care Standards Commission as manager of The Laurels Nursing Home 9th November 2004 Date of last inspection Brief Description of the Service: The Laurels offers 24 hour care for up to 28 older people including those suffering form dementia or a mental disorder. The home provides both nursing and personal care. The Laurels is a detached grade 2 listed building with extensive grounds. There is a garden area, which is easily accessible to residents when the weather permits. A car park is available for use by visitors and staff. Accommodation is provided in single and twin-bedded rooms. There are no ensuite rooms but toilet and bathroom facilities are easily accessible, Communal lounges and dinning rooms are located on the ground floor. The home is situated close to the centre of Bacup and all local amenities. The Laurels Care and Nursing Home DS0000056864.V252785.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 one and a half days. One additional unannounced visit has been made since the last inspection. This visit was to investigate an anonymous complaint, which was not upheld. The report of this investigation is available from the CSCI office on request. At the time of this inspection 26 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the registered manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
Records relating to the management of medication have improved and included details of all medication received into the home and disposed of by a licensed waste carrier. A policy and procedure relating to physical and verbal aggression by a resident was accessible to all members of staff. This should help to prevent such incidents and protect residents from abuse. To promote the health and safety of all residents’ covers were being fitted to all radiators. Following the last inspection the broken drawer handles in a number of bedrooms had been replaced. To ensure all members of staff were familiar with the fire procedures attendance records at fire drills were kept. The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 6 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 Care and Nursing Home DS0000056864.V252785.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 Care and Nursing Home DS0000056864.V252785.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 Admission procedures were thorough. A pre-admission assessment was completed for each resident prior to admission. EVIDENCE: Individual records of four residents were inspected. Each contained a preadmission assessment of need. A senior member of staff visited prospective residents in hospital or their own home prior to admission. Prospective residents received confirmation in writing that their needs could be met at the home. The assessment of need provided useful information for the care plan. The Laurels Care and Nursing Home DS0000056864.V252785.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 and 10 Detailed care plans were in place for all residents. However, not all care plans were up dated when the needs of the resident changed. This meant that there was the potential for some care needs not to be fully met. Medication was managed efficiently promoting good health. Care was given in a manner, which promoted the privacy and dignity of all residents. EVIDENCE: The individual care plans of four residents were inspected. These plans identified the care needs of each resident and explained how these needs were met. Risk assessments relating to nutrition, pressure sores, moving and handling and falls were in place. However, it was unclear from two of the falls risks assessments how the overall risk had been determined. Although care plans were reviewed monthly they were not always updated when the needs of the resident had changed. Records relating to the care of wounds did not contain sufficient information about the size and condition of the wound. Where possible residents or their relatives were involved in care planning. At the time of the inspection none of the residents were self-medicating. Registered nurses were responsible for administering all medication. Records
The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 10 relating to the management of medication were seen to be up to date and included details of medication received into the home and disposed of by a licensed waste carrier. The manager was advised to provide written instructions stating when medication prescribed ‘when required’ should be given to individual residents. A number of medicines prescribed ‘when required’ were out of stock. The manager explained that she was in the process of asking GP’s to review the medication for these residents. Medication was stored correctly in a locked trolley and cupboards inside a locked utility room. The temperatures of these areas was checked and recorded daily. Controlled drugs were appropriately stored and a stock check was satisfactory. Members of staff were observed attending to residents in a caring and professional manner. One resident said, “The staff are very nice.” Personal care was carried out in the privacy of the resident’s own room. Privacy and dignity was discussed with three members of staff. They all described in detail how they promoted privacy and dignity when helping residents with personal care. The Laurels Care and Nursing Home DS0000056864.V252785.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 and 15. Social activities were well managed and visitors were welcomed into the home at any reasonable time. The meals were wholesome and menus offered variety and choice. EVIDENCE: Leisure activities were advertised in the home. These included dominoes, pamper sessions, videos, listening to music and reading newspapers or magazines to residents. Resident’s interests and hobbies were recorded in their individual care plans. During the inspection members of staff were sitting and chatting with the residents. Visitors were welcomed into the home at anytime and offered refreshments. The residents could choose whether to see them in the lounge or in their bedroom. The meal served at lunchtime looked wholesome and appetising. The menus were varied and offered choice. Lunchtime was unhurried allowing residents time to chat and enjoy their meal. Members of staff were observed assisting residents in a sensitive and patient manner. All the residents asked said the meals were good. The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 12 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 Complaints would be taken seriously and investigated. Members of staff had a clear understanding of adult protection issues, which protects residents from abuse. EVIDENCE: A copy of the complaints procedure was included in the service user guide and displayed in the home. The Commission has investigated one complaint relating to medication since the last inspection. This complaint was not upheld. No complaints have been made to the home. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was discussed with four members of staff. They were aware of the procedure and said they would report any concerns immediately. A policy relating to challenging behaviour was also available. The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 13 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): 20, 24, and 25. The home was clean, comfortable and provided a safe environment for residents. EVIDENCE: At the time of the inspection the home was clean, tidy and free from offensive odours. One resident commented that the home was very nice and comfortable. Residents were encouraged to personalise their rooms with photographs, ornaments small items of furniture etc. One lady said, “ I’ve got a nice big room and my own things”. Communal rooms were spacious and suitable for a variety of activities. However, a connecting door between the dining room and lounge could only be opened from the dining room. To promote the safety of residents covers were being fitted to all radiators. The manager explained that further improvements to the home were planned beginning with the renewal of all curtains and bedding. The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 14 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, 29 and 30 Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were thorough. Training for all members of staff was actively encouraged. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. Staff turnover was very low with only one new employee since the last inspection. The file of this member of staff was inspected and indicated that all the required pre-employment checks to ensure protection of the residents had been completed. It was evident from discussions with the manager and four members of staff that training was actively encouraged. This included, induction training for new members of staff, moving and handling, fire safety, first aid, dementia care, basic food hygiene, and NVQ levels 2 and 3. Detailed records of all training activities were kept. The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 15 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): 38 Appropriate procedures were in place to safeguard the health, safety and welfare of residents. EVIDENCE: Fire alarms and emergency lighting were checked weekly. Fire drills were held monthly. Records of these were seen. Records of the routine servicing of equipment were seen. This included a gas safety certificate. However, a gas safety certificate was not available. Records maintained by the cook included fridge, freezer and food temperatures. Safety notices were displayed in the home. At the time of the inspection wheelchairs without footplates were in use. Where residents do not wish to use footplates, this must be subject to a risk assessment and recorded in individual care plans. The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 16 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 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 2 X X X 3 3 X STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2)(b) Requirement Timescale for action 28/10/05 2 OP8 17(1)(a) Schedule 3 3 OP9 14(2)(a) (b) The registered person shall, (b) keep the service user’s plan under review. Care plans must be updated when the needs of the resident change. The registered person shall – (a) 19/09/05 maintain in respect of each service user a record which includes the information, documents, and other records specified in schedule 3 relating to the service user (k) a record of any nursing provided to the service user, including a record of his condition and any treatment including surgical intervention. Detailed records of the size, treatment and condition of all wounds must be kept. The registered person shall 28/10/05 ensure that the assessment of the service user’s needs is (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to any change in circumstances. Medication prescribed ‘when required’ must be reviewed by
DS0000056864.V252785.R01.S.doc Version 5.0 The Laurels Care and Nursing Home Page 18 4 OP38 13(5) the GP when the needs of the resident change. The registered person shall make 28/10/05 suitable arrangements to provide a safe system for moving and handling residents. Footplates must be used for all residents unless a risk assessment states otherwise. Timescale of 31 Dec 2004 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 2 3 Refer to Standard OP7 OP9 OP20 Good Practice Recommendations Falls risk assessments should clearly indicate how the overall risk has been determined. Written instructions should be in place for individual residents stating when medication prescribed when required should be given. The connecting door between the lounge and dining room should be adjusted to facilitate opening from both rooms. The Laurels Care and Nursing Home DS0000056864.V252785.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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