CARE HOMES FOR OLDER PEOPLE
The Laurels Care and Nursing Home Bankside Lane Bacup Rossendale OL13 8HG Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 17th October 2007 10:15 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.V348162.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 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 (UK) Limited Mrs Claire Tighe Care Home 28 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (25), Physical disability over 65 years of age (25) The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 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 care home should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. Up to 25 service users in the category of OP (over 65 years of age, not falling within any other category) requiring nursing or personal care. Up to 25 service users in the category of PD(E) (physical disability over 65 years of age) requiring nursing or personal care. Up to 15 service users in the category of DE(E) (dementia over 65 years of age) requiring nursing or personal care. Up to 3 service users in the category of MD(E) (mental disorder over 65 years of age) requiring nursing care 9th January 2007 Date of last inspection Brief Description of the Service: The Laurels offers 24-hour care for up to 28 older people including those suffering from 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 current fees charged at The Laurels are £319.50 to £550 per week. Additional charges are payable for hairdressing, newspapers and toiletries. A statement of purpose and service user guide is available to prospective residents and their relatives on request. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at The Laurels Care and Nursing Home on the 17th October 2007. No additional visits have been made since the last inspection. Eight completed surveys were received from residents, four from the relatives of residents, two from members of staff and one from a GP. At the time of this inspection 28 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 manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
All the requirements made at the last inspection have been addressed. Care plans identify the care needs of each resident and explain how these needs are to be met. Wound care records provided detailed information about the care and condition of the wound and were updated at each dressing change. To promote the health and safety of residents and staff an up to date gas safety certificate was available.
The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 6 Members of staff were observed using wheelchairs correctly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured sufficient information was obtained in order to identify the needs of each resident. EVIDENCE: A senior member of staff visited and assessed prospective residents in hospital or their own home before admission. The care records of a recently admitted resident included a pre-admission assessment. This assessment provided important information for the care plan. Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents individual care needs were identified and met. Deficiencies in the management of medication could affect the health and wellbeing of residents. EVIDENCE: The individual care plans of three residents were inspected. These plans identified the care needs of each resident and explained how these needs were to be met. Appropriate risk assessments had been carried out. Information about how identified risks were managed was also included in the care plans. The wound care records of a resident suffering from pressure sores included details of dressing changes and the condition of the sores. A written report about the care given to individual residents was completed during each shift.
The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 10 Residents were registered with a GP and had access to other healthcare professionals. Medication was stored correctly in a locked trolley and cupboards inside a locked room. The temperatures of these areas was checked and recorded daily. Records for the management of medication were in place. However, on a number of medication administration records the nurse had not signed to indicate the medication had been given to the resident and a reason for it’s omission was not recorded. A record of the receipt of some medication was not kept. A packet of travel sickness tablets had been purchased on the advice of the doctor for one resident. Information about these tablets was not included on the medication administration record and there were no written instructions about when this medication should be given. Tablets prescribed by the doctor for the same resident were not recorded on the medication administration record. The manager said the resident had not needed them for several months. A tube of ointment without any instructions or a chemist’s label was also found in the trolley. A box containing soluble paracetamol had two chemist’s labels on it for different residents. Both labels stated that 60 tablets had been dispensed. The manager said one of these residents was no longer living at the home and paracetamol was not currently prescribed for the other resident. Keeping unwanted medication in the trolley increases the risk of medication error. A blister pack strip of paracetamol capsules was kept on a shelf of the medicine trolley. There were no instructions with these capsules and the manager explained they had been obtained as a ‘homely remedy’. One resident was prescribed paracetamol ‘when required’ but a supply of this medication prescribed by the doctor was not available. Handwritten instructions on the medication administration records were not signed or witnessed. Controlled drugs were stored correctly and a stock check was satisfactory. Records of the disposal of unwanted medication were available. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 11 Personal care was carried out in the privacy of the resident’s own room or the bathroom. Two members of staff explained how they promoted privacy and dignity for all residents. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s decisions were respected but a lack of suitable leisure activities means residents do not have the opportunity to participate in meaningful activities of their choice. EVIDENCE: A limited range of activities was advertised in the home. A member of staff said resident’s watched films, listened to music and an entertainer visited the home monthly. This member of staff also said they had tried playing cards and dominoes but the residents weren’t interested. A frequent visitor to the home said she had never seen any activities taking place. One resident was asked what she did all day and replied, “I sit about in here.” Visitors were welcomed into the home at anytime and offered refreshments. Residents were encouraged to make decisions about their lifestyle and daily routine. One resident said, “I get up and go to bed when I feel like it.” The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 13 All the residents asked said the meals were good. The menus were varied and offered choice. At lunchtime members of staff were observed assisting residents in a sensitive and patient manner. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives felt able to express their concerns. Staff had the training necessary to ensure the safeguarding of vulnerable adults. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in the statement of purpose and service user guide. One visitor said she would feel confident to talk to staff about any concerns. Policies and procedures about the safeguarding of vulnerable adults were in place. Training on safeguarding was included in the induction programme for all new employees. This issue was also discussed with two members of staff. They were aware of the procedure and said they would report any concerns immediately. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents lived in a comfortable and ‘homely’ environment. However, communal areas would benefit from re-decoration. EVIDENCE: The home was clean, tidy and free from offensive odour. Residents were encouraged to personalise their rooms with photographs, ornaments etc. Communal rooms were spacious but in need of redecoration. The provider said this would be done in the near future. The shower room was not usable at the time of the inspection and only two bathrooms were in use. The provider was advised to have the shower repaired as soon as possible. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 16 Recent improvements to the home included a new carpet and chairs in the dining room and new televisions for the lounge used by residents suffering from dementia and the smoker’s lounge. The grounds and gardens were well kept and accessible to all residents. Laundry facilities were appropriate for the size of the home. An infection control policy was available. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Members of staff were encouraged to acquire the skills and knowledge needed to provide effective care for the residents. Recruitment procedures were thorough. EVIDENCE: Examination of the duty rota confirmed that staffing levels were appropriate to meet the assessed needs of the residents. The files of two members of staff appointed since the last were inspection were examined. These files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. It was evident from discussion with members of staff and the manager that training was encouraged. This included induction training for new employees, moving and handling, basic food hygiene, fire safety, dementia care, infection control and first aid. Nine members of staff (50 ) had an NVQ qualification at level 2 or above in care. In addition to this a further two members of staff were working towards NVQ level 2. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a competent manager. The views of residents are considered when decisions about the care and facilities provided at the home are made. EVIDENCE: The registered manager is an experienced nurse and has recently attended meetings organised by the primary care trust about tissue viability. This training has enabled her to develop a resource file about the prevention of pressure sores. She has also attended study days for management skills and end of life care. The home has achieved the nationally accredited ISO 9001 and the Investors in People award. Residents and their relatives completed anonymous satisfaction questionnaires in June 2007.
The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 19 An annual development plan to help monitor the quality of the service and further improve outcomes for residents was available. Records of transactions involving resident’s money were seen to up to date. Although records of accidents involving residents were available at the home the commission had not been informed when the resident had needed hospital treatment. Fire alarms were tested weekly. Emergency lighting was serviced every six months. Fire drills took place every three months and a fire risk assessment was in place. Records of the routine servicing of equipment were seen. These included up to date gas safety and electrical installation certificates and evidence that the testing of small electrical appliances had taken place in July 2007. Records maintained in the kitchen included fridge, freezer and food temperatures. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 20 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 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 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 X 3 X 3 X X 2 The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP9 Standard Regulation 13(2) Requirement To ensure medication is managed safely a record of all medication received into the home must be kept. Unwanted medication must not be kept in the home. To ensure residents do not run out of their prescribed medication a system for reordering must be in place. To prevent medication errors an accurate record must be made of all medicines kept in the home for individual residents and the date and time they were administered to the resident. If medication is omitted a reason for this must be recorded. To enable serious incidents to be monitored the commission must be informed of all accidents when the resident requires hospital treatment. Timescale for action 30/11/07 2 OP9 3 OP9 13(2) 30/11/07 Schedule 3 17(1)(a) 3(i) 30/11/07 4 OP38 37 07/11/07 The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 22 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 OP12 OP19 OP21 Good Practice Recommendations To enable residents to have a fulfilling lifestyle a range of leisure suitable activities should be organised. To promote the wellbeing of residents communal areas on the should be redecorated. To ensure the personal hygiene needs of residents are met the shower room should be repaired. The Laurels Care and Nursing Home DS0000056864.V348162.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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