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Inspection on 02/09/08 for The Laurels Care and Nursing Home

Also see our care home review for The Laurels Care and Nursing Home for more information

This inspection was carried out on 2nd September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents praised the staff for their care and kindness. One resident said, "They look after you and if you ask for something they will do it if they possibly can." Another resident said, "The staff are always about if you need some help." One resident wrote on a survey, `staff are very nice.` The relative of a resident said, "The staff are very good, they`re always helpful and available." Residents said the daily routine was flexible and they could get up and go to bed when they wanted to do. One gentleman said, " I get up and go to bed when I want." Visitors were welcomed into the home at any time and offered refreshments. All the residents asked said the meals were good. The relative of one resident said, "They have a well balanced diet."

What has improved since the last inspection?

The lounges, dining rooms and entrance hall have been redecorated. This has improved communal areas and made them look more `homely` for residents. The shower has been repaired to enable residents to have the choice of a bath or a shower. The Commission for Social Care Inspection has been informed of any important events that have happened at the home.

What the care home could do better:

Prompt action must be taken to ensure care plans accurately identify and address all the care needs of each resident. It is essential that detailed records relating to the treatment and condition of all wounds be kept. It is also important to make sure care plans are more person centred and include information about the personal preferences of individual residents. Prompt action must also be taken to improve the management of medication in order to prevent mistakes being made. A record of all medication received into the home must be kept. If medication is omitted a reason for this must be recorded. When medication prescribed for a resident is no longer needed this must be disposed of correctly and not kept in the home. Prescribed medication must not be given to a resident unless a pharmacist has dispensed a supply for that resident. Handwritten instructions on medication administration records should be signed and witnessed. Clear written instructions should be in place for staff to follow to ensure medication prescribed `when required` is given correctly. To promote the safe handling of medication a system must be put in place to regularly audit all aspects of the management of medication including staff competence. To promote the wellbeing of all residents the range of leisure activities should be increased and offered on a more regular basis. To ensure residents in the large dining room eat their meals in a pleasant and sociable environment the dining tables should be set at all mealtimes. It is essential that all areas of the home be properly maintained in order to prevent injury to residents and staff. The broken lock to a bedroom door must be repaired or replaced, the door to the bathroom used for storage must be locked and the damaged doors must be repaired or replaced. Staffing levels should be reviewed to ensure residents are not having breakfast late in the morning and then lunch soon after midday. To ensure the needs of residents with mental health problems are identified and met a nurse with the relevant competence and experience should be employed.It is strongly recommended that additional supernumerary hours be allocated for the deputy manager to enable her to effectively fulfil her managerial responsibilities.

CARE HOMES FOR OLDER PEOPLE The Laurels Care and Nursing Home Bankside Lane Bacup Rossendale OL13 8GT Lead Inspector Mrs Susan Hargreaves Unannounced Inspection 2nd September 2008 9:30 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 Care and Nursing Home DS0000056864.V367109.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.V367109.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 8GT 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) 01706 877171 01706 870106 Regency Healthcare Ltd Mrs Claire Tighe Care Home (N) 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.V367109.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 17th October 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 £329 to £675 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.V367109.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at The Laurels Care and Nursing Home on the 2 September 2008. No additional visits have been made since the last inspection. An expert by experience assisted with this inspection and her comments are included in this report. An expert by experience is someone who has had direct involvement in care services either as a service user or the relative or friend of a service user. Five completed surveys were received from residents and one from a member of staff. The deputy manager completed an annual quality assurance assessment several weeks before the visit to the home. This document provided important information about how the home is being managed. At the time of this inspection twenty-six 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 acting manager and the provider regarding issues raised during the inspection. What the service does well: Residents praised the staff for their care and kindness. One resident said, “They look after you and if you ask for something they will do it if they possibly can.” Another resident said, “The staff are always about if you need some help.” One resident wrote on a survey, ‘staff are very nice.’ The relative of a resident said, “The staff are very good, they’re always helpful and available.” Residents said the daily routine was flexible and they could get up and go to bed when they wanted to do. One gentleman said, “ I get up and go to bed when I want.” Visitors were welcomed into the home at any time and offered refreshments. All the residents asked said the meals were good. The relative of one resident said, “They have a well balanced diet.” The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Prompt action must be taken to ensure care plans accurately identify and address all the care needs of each resident. It is essential that detailed records relating to the treatment and condition of all wounds be kept. It is also important to make sure care plans are more person centred and include information about the personal preferences of individual residents. Prompt action must also be taken to improve the management of medication in order to prevent mistakes being made. A record of all medication received into the home must be kept. If medication is omitted a reason for this must be recorded. When medication prescribed for a resident is no longer needed this must be disposed of correctly and not kept in the home. Prescribed medication must not be given to a resident unless a pharmacist has dispensed a supply for that resident. Handwritten instructions on medication administration records should be signed and witnessed. Clear written instructions should be in place for staff to follow to ensure medication prescribed ‘when required’ is given correctly. To promote the safe handling of medication a system must be put in place to regularly audit all aspects of the management of medication including staff competence. To promote the wellbeing of all residents the range of leisure activities should be increased and offered on a more regular basis. To ensure residents in the large dining room eat their meals in a pleasant and sociable environment the dining tables should be set at all mealtimes. It is essential that all areas of the home be properly maintained in order to prevent injury to residents and staff. The broken lock to a bedroom door must be repaired or replaced, the door to the bathroom used for storage must be locked and the damaged doors must be repaired or replaced. Staffing levels should be reviewed to ensure residents are not having breakfast late in the morning and then lunch soon after midday. To ensure the needs of residents with mental health problems are identified and met a nurse with the relevant competence and experience should be employed. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 7 It is strongly recommended that additional supernumerary hours be allocated for the deputy manager to enable her to effectively fulfil her managerial responsibilities. 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.V367109.R01.S.doc Version 5.2 Page 8 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.V367109.R01.S.doc Version 5.2 Page 9 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 copy of the statement of purpose and service user guide is available to prospective residents and their relatives on request. These supply information about the care and facilities provided at the home. The deputy manager or senior member of staff visited and assessed prospective residents in hospital or their own home prior to admission. The care records of two residents were inspected. These records contained a detailed pre-admission assessment. This information was important for the development of the care plans. Standard 6 is not applicable to this service. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning and the management of medications could affect the health and wellbeing of some residents. Privacy and dignity was promoted for all residents. EVIDENCE: The individual care plans of two residents were inspected. These plans did not accurately identify and address the health and personal care needs of each resident in order to ensure they received person centred care. The only care plans in place for a resident admitted several days before this inspection were for personal hygiene and mobility. The daily report for this resident frequently referred to aggressive and agitated behaviour but there was no guidance for staff to follow about how to manage this problem. The daily report also suggested that advice and reassessment by mental health care professionals was needed but there was no evidence of a referral having been made. Another entry in the daily report indicated that this resident should be observed for leaving the building but a detailed risk assessment and a care The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 11 plan about how to manage this problem was not in place. After lunch on the day of this inspection the resident left the building independently and was found near a main road. Risk assessments relating to falls, nutrition, mobility and the development of pressure sores were in place for this resident. However, there was a lack of guidance for staff to follow about how to manage the risk of falling and the high risk of developing pressure sores. The other care plan inspected indicated that the resident had a very high risk of developing pressure sores. However, a care plan giving clear directions for staff to follow about the care needed to help prevent the formation of pressure sores was not in place. The care plan about mobility provided some information about the level of risk this resident had of developing pressure sores but had not been up dated when this risk had increased. The care plan about spiritual needs advised staff to make arrangements for this resident to be visited by a minister. There was no information about which religion this resident practised or the name and contact details of the minister or if such a visit had been requested by the resident. A wound care plan for this resident did not provide detailed information about the size and condition of the wounds. Moreover, clear instructions for staff to follow to ensure the wounds were treated correctly were not included in this care plan. The wound assessment and monitoring charts lacked detail about the size and precise location of the wounds. Medication was stored correctly and administered by registered nurses. Records relating to the management of medication were in place. However, a record of the receipt of medication for one resident had not been made. Handwritten instructions on medication administration records were not signed or witnessed. It was impossible to accurately audit the medication for several residents because boxes of medication had not been dated on opening and the amount of medication remaining from the previous prescription had not been recorded on the medication administration records. On a number of occasions a medication administration record had not been signed to indicate medication had been given to the resident and a reason for its omission was not recorded. Failure to keep accurate records of the management and administration of medication can result in mistakes being made. There were no written instructions for staff to follow about the administration of medication prescribed ‘when required’ for individual residents in order to ensure they received their medication when it was needed. One medication administration record was signed to indicate that medication had been given to the resident on a number of occasions. However, there was no evidence to suggest that the pharmacist had dispensed a supply of this The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 12 medication. Therefore, it was impossible to determine how a supply of this medication had been obtained. Medication dispensed for a resident in September 2007 and no longer prescribed was stored in the medicine trolley. Keeping unwanted medication increases the risk of mistakes being made. There was no evidence that the deputy manager or a senior member of staff audited the management of medication in order to identify poor practice, any mistakes and check the competence of staff responsible for the administration of medication. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Members of staff were observed attending to residents in a polite and friendly manner. One resident said, “The staff look after you, they’re very patient.” The relative of a resident explained that she frequently discussed her mother’s care plan with senior staff and said, “The staff are always helpful.” The expert by experience reported as follows; ‘The staff interacted with the residents when they gave them a drink or they needed moving and they appeared very caring with the residents. I spoke to a relative and she said that the family were happy with the care the resident was getting. The food was always good with plenty of vegetables. Plenty of drinks were available and a good choice of menu. She said that the resident was always clean and tidy.’ The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 13 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 the limited range of leisure activities means some residents do not have the opportunity to participate in meaningful activities of their choice. Meals were wholesome and appetising and residents enjoyed them. EVIDENCE: A senior member of staff was responsible for organising activities at the home. She explained that she had attended a short training course to enable her to further develop the range of activities provided for residents. During the inspection the activities organiser was observed helping a resident to complete a reminiscence diary. Activities currently offered included, listening to music, nail care and hand massage, reminiscence and quoits. Special events were celebrated e.g. birthdays, St George’s day and five residents had recently enjoyed a trip to Blackpool. The expert by experience reported; ‘having asked the residents what they would be doing in the afternoon and they said nothing. There appears to be very little social activity for the residents apart from a Hi-fi playing old time music that the residents would have heard during the war or the early 50’s. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 14 There appeared to be little stimulation during the day for the residents. A hairdresser comes into the home once a week. Perhaps some of the more able residents could help the staff set the tables at mealtimes to stimulate them. There is a wonderful garden around the home, which appears to be under used. Residents who are not able to go to church have a priest coming in but that does not cater for the residents who are of a different religion. A resident said that the staffs are always courteous and is happy in the home. The resident said that they had never been out. In the larger of the lounges the television was on but no one seemed to be looking at it and the chairs were around the walls of he room and so far apart that it would be difficult to have conversation with other residents. Some of the chairs in this lounge were like ordinary lounge chairs and some seemed much too low for the residents to get out off unaided. Some residents were being hoisted out of chairs into wheel chairs, as they were unable to walk.’ Discussion with residents and members of staff confirmed that the daily routine was flexible. One resident said, “I get up and go to bed when I want.” Regular contact for residents with their family and friends was considered to be an important part of their life. Residents said their visitors were welcomed into the home at anytime. The expert by experience ate lunch with the residents and reported as follows; ‘In the small dinning room the tables were set with cloths, knives, forks and spoons. Cups were on coasters with a spoon in them none of the crockery was matching. In the large dining room/lounge tables were not set or cloths on the table and residents were being helped to eat their meal. This is in stark contrast to the other dinning room. The staff again were very attentive to these residents needs. All the residents asked said the meals were good. The relative of one resident said, “They have a well balanced diet.” The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 15 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 felt able to express their concerns. Staff had a good understanding of protection issues. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in the service user guide. The five residents who completed surveys all ticked yes in answer to the question do you know how to make a complaint. No complaints have been made to the provider or directly to the Commission since the last inspection. 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 three members of staff. They were aware of the procedure and said they would report any concerns immediately. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Communal areas were clean and well maintained. Some areas of the home require attention in order to prevent injury to residents and staff. EVIDENCE: At the time of the inspection the home was clean and tidy and provided a comfortable environment for the residents. However, a number of internal doors were badly scraped and had holes in them. Apart from their appearance they would not offer the level of protection required in the event of a fire. The lock on one bedroom door was broken and a sharp piece of metal was protruding through to the inside of the bedroom putting the resident and staff at risk of injury. One bathroom, with a bath unsuitable for residents, had an unguarded very hot radiator and was being used for storage. The deputy manager was advised to keep this door locked to prevent injury to any resident who mistakenly entered this room. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 17 The expert by experience reported as follows; ‘I was shown around the home by a member of staff, on the ground floor there are 3 lounges one of which was a smoking lounge, one doubles up as a dinning room and the last one was very large and had a portioned off area that residents and their families could have a meal in and have it in “private” off this room there was a separate dining room for the residential clients. On the first floor there were bedrooms and toilets for the use of he residents. The bedrooms were single or double occupancy. Residents can take their own furniture into the home if they so wished. On each floor there are storage rooms for the cleaning equipment and the residents incontinence pads.’ The grounds and gardens were well kept and accessible to residents if they wished to sit outside when the weather permitted. All the laundry was done at the home. A suitably equipped laundry room ensured clothes were washed promptly and returned to the residents. Gloves and plastic aprons were available for staff to use in order to protect them and the residents from infection. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 18 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 adequate. 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. However, staffing levels in the mornings may not be sufficient to ensure residents receive person centred care. EVIDENCE: The duty rota provided information about the grades and numbers of staff on duty for each shift. The relative of a resident said, “Staff are always helpful and available.” One resident said, “ staff are always about if you need some help.” Discussion with several members of staff revealed that staffing levels had been reduced to five care workers in the mornings. Two care workers said this meant that residents were getting up later and it was not unusual for them to be having breakfast at 11.30am. At the time of the inspection three residents were observed eating breakfast at 11.00am. The expert by experience reported; ‘The residents were still having breakfast at 11.45am, plenty of drinks were given to the residents and they can have a jug of water if they require it’. However, it is not beneficial for the health and wellbeing of residents to have breakfast late in the morning and then lunch soon after midday. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 19 The care of a small number of residents suffering from mental health problems had until recently been supervised by a qualified mental health nurse. This nurse has left which means that the mental health needs of these residents might not be identified and met. The files of two members of staff appointed since the last inspection were examined. These files indicated that all the required pre-employment checks to ensure protection of the residents from unsuitable staff had been completed prior to appointment. It was evident from discussion with members of staff and the deputy manager that training was encouraged. This included induction training for new employees, moving & handling, fire safety, health and safety, first aid, adult protection, food hygiene and infection control. Eight members of staff have NVQ qualifications at level 2 or above. In addition to this a further four members of staff were working towards NVQ level 2. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The views of residents were considered when decisions about the care and facilities provided are made. Management arrangements do not ensure all residents receive person centered care nor do they ensure the national minimum standards are met. EVIDENCE: Following the resignation of the registered manager at the end of June the deputy manager supported by company directors has been responsible for managing the home. She has started training for the NVQ ‘registered Manager’s Award’. Members of staff said the deputy manager was approachable and listened to what they had to say. However, management systems were not in place to ensure that care plans provided sufficient detailed information about the individual care needs of each resident. Care plans also The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 21 needed to explain clearly how these needs were to be met in order for residents to receive person centred care. It is also the responsibility of management to ensure that care plans and risk assessments are developed from the day of admission for residents new to the home. This ensures members of staff have the information needed to provide effective care for new residents and manage any immediate problems. Audits to ensure medication was managed correctly were not carried out by the acting manager or a senior member of staff. These audits would enable management to identify poor practice, any mistakes and check the competence of staff responsible for the administration of medication. Management would then be able to take the necessary action in order to prevent residents being put at risk from poor practice. It is of concern that senior members of staff said they did not have time to write care plans. Reduced staffing levels and the lack of a nurse with the specialist knowledge of mental health makes it difficult for staff to provide person centred care for all residents. The home has achieved the nationally accredited ISO 9001 and the Investors in People award. Anonymous satisfaction questionnaires were distributed to residents and their relatives annually and to residents admitted for respite care. The Annual Quality Assurance Assessment stated that as a result of the most recent survey they were going to continue refurbishing the home and develop the area to the side of the building to make it into a seating area for residents during nice weather. The deputy manager said she was always willing to talk to residents and their relatives. Policies and procedures for safe working practices were in place. These help to ensure the home is a safe place for residents to live. Fire alarms were tested weekly. Fire drills also took place regularly and a fire risk assessment was in place. Records of the routine servicing of equipment were seen. These included the testing of small electrical appliances and up to date gas safety and electrical installation certificates. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 22 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 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 23 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 OP7 Standard Regulation 15(1) Requirement To ensure the care needs of all residents are met care plans must be person centred and accurately identify and address all the care needs of each resident. To ensure members of staff have the information necessary in order to meet the individual needs of each resident care plans must be up dated when the needs of the resident change. To ensure residents receive effective wound care detailed records must be kept about the care and condition of the wound at each dressing change. To ensure medication is managed safely a record of all medication received into the home must be kept. If medication is omitted a reason for this must be recorded. (Timescale of 30/11/07 not met.) Unwanted medication must not be kept in the home. Prescribed medication must not DS0000056864.V367109.R01.S.doc Timescale for action 31/10/08 2 OP7 15(2)(b) 31/10/08 3 OP8 12(1)(a) 10/10/08 4 OP9 13(2) 10/10/08 The Laurels Care and Nursing Home Version 5.2 Page 24 5 OP9 24(1) 6 OP19 13(4) be given to a resident unless a pharmacist has dispensed a supply for that resident. To ensure medication is managed correctly a system must be put in place to regularly audit all aspects of the management of medication including staff competence. To prevent injury to residents and staff the broken lock to one bedroom door must be repaired, the door to the bathroom used for storage must be locked and the damaged doors must be repaired or replaced. 31/10/08 14/11/08 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 OP9 Refer to Standard Good Practice Recommendations Handwritten instructions on medication administration records should be signed and witnessed. Clear written instructions should be in place for staff to follow to ensure medication prescribed ‘when required’ is given correctly. To enable residents to have a fulfilling lifestyle the range of leisure activities provided should be increased and offered on a more regular basis. The dining tables should be set at all meal times in the large dining room so that residents can eat their meals in a pleasant and sociable environment. It is strongly recommended that staffing levels be reviewed to ensure residents are not having breakfast late in the morning and then lunch soon after midday. To ensure the needs of residents with mental health problems are identified and met a nurse with the relevant experience and competence should be employed. 2 OP12 3 OP15 4 OP27 The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 25 5 OP31 To ensure all residents receive person centred care it is strongly recommended that the deputy manager be allocated sufficient supernumerary time in order to effectively fulfil all managerial responsibilities. The Laurels Care and Nursing Home DS0000056864.V367109.R01.S.doc Version 5.2 Page 26 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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