CARE HOMES FOR OLDER PEOPLE
The Laurels Care and Nursing Home Bankside Lane Bacup Rossendale OL13 8HG Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 10:00 15 March 2006
th 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.V269773.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.V269773.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.V269773.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 16th September 2005 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.V269773.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 seven hours. No additional visits have been made since the last unannounced inspection. 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 and residents 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?
The falls risk assessment has improved and clearly indicates how the overall risk has been determined. Since the last inspection new curtains have been fitted in all the bedrooms and new bedside lamps purchased. The connecting door between the lounge and dining room has been repaired and can be opened from both rooms. This ensures the home is well maintained and provides a homely environment for the residents. The Laurels Care and Nursing Home DS0000056864.V269773.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.V269773.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.V269773.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): EVIDENCE: None of these standards were assessed. Standard 3 was assessed and met at the last inspection. Standard 6 is not applicable to this service. The Laurels Care and Nursing Home DS0000056864.V269773.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 and 9 Detailed care plans were in place for all residents. Not all care plans had been up dated when the needs of the resident had changed. This meant there was the potential for some healthcare needs not to be fully met. Medication was managed efficiently promoting good health. EVIDENCE: The individual care plans of three residents were inspected. These identified the needs of each resident and explained how these needs were met. Appropriate risk assessments had been carried out. Care plans gave clear instructions about how identified risks were managed. However, the wound care chart for one resident was not up to date. Although care plans were reviewed monthly several had not been up dated when the needs of the resident had changed. A written report about the care given to individual residents was completed during each shift. Where possible residents or their relatives were involved in care planning. Residents were registered with a GP and had access to other healthcare professionals. Records 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
The Laurels Care and Nursing Home DS0000056864.V269773.R01.S.doc Version 5.0 Page 10 instructions stating when medication prescribed ‘when required’ should be given to individual residents. Medication was stored correctly in a locked trolley and cupboards inside a locked utility room. The temperature of this room was checked and recorded daily. Controlled drugs were appropriately stored and a stock was satisfactory. The Laurels Care and Nursing Home DS0000056864.V269773.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): 14 and 15 The daily routine was flexible to meet the needs of the residents. The meals were wholesome and menus offered variety and choice. EVIDENCE: Residents were encouraged to make decisions about their lifestyle and daily routine. One resident said, “I like getting up early and go to bed when I want.” 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. One resident said, “I can’t fault the meals.” The Laurels Care and Nursing Home DS0000056864.V269773.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 were taken seriously and investigated. Appropriate procedures were in place to ensure the protection of residents at the home. EVIDENCE: A copy of the complaints procedure was included in the service user guide and displayed in the home. The registered person has investigated one complaint since the last inspection. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was 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.V269773.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): 19, 20 and 26 The home was clean and comfortable and provided a safe environment for residents. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy and well maintained. This provided a safe and comfortable environment for the residents. Improvements to the environment have been made since the last inspection. These included, new curtains in all the bedrooms and new bedside lamps. The grounds and gardens were well kept and accessible to all residents. Communal rooms were spacious and suitable for a variety of social activities. The laundry was well equipped and appropriate for the size of the size of the home. The Laurels Care and Nursing Home DS0000056864.V269773.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, 28 and 29 Staffing levels were appropriate to meet the assessed needs of the residents Recruitment procedures were thorough. Care staff were encouraged to obtain NVQ qualifications. 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. It was evident from discussion with the manager and members of staff that training was encouraged. Six members of staff had an NVQ level 2 in care and two had level 3. One senior care assistant was working towards NVQ level 4. Arrangements were being made for care assistants to do vocational training in dementia care. 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 had been completed. The Laurels Care and Nursing Home DS0000056864.V269773.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): 31, 33, 35 and 38 The home has an experienced and competent manager. Residents were consulted about the quality of the care and services provided at the home. Appropriate procedures were in place to safeguard the health, safety and welfare of residents. EVIDENCE: The registered manager is an experienced nurse and has an NVQ level 4 in management. She maintains an up to date knowledge of current practice by reading articles in the nursing press and various care publications. The home has achieved the nationally accredited quality management system ISO 9001. The company is also aiming to obtain the Investors in People award by September this year. Audits covering all aspects of the care and services provided were carried out at regular intervals. Anonymous service user satisfaction questionnaires were distributed annually. An annual development plan to help monitor the quality of the service and improve outcomes for residents was available.
The Laurels Care and Nursing Home DS0000056864.V269773.R01.S.doc Version 5.0 Page 16 Records of transactions involving resident’s money were seen to up to date. At the time of the inspection several wheelchairs without footplates were in use. However, the manager addressed this issue during the inspection and explained that she would monitor the problem. The Laurels Care and Nursing Home DS0000056864.V269773.R01.S.doc Version 5.0 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Laurels Care and Nursing Home DS0000056864.V269773.R01.S.doc Version 5.0 Page 18 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 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. Timescale of 28/10/05 not met The registered person shall - (a) 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. Records relating to wound care must be kept up to date. Timescale for action 28/04/06 2. OP8 17(1)(a) Schedule 3 07/04/06 The Laurels Care and Nursing Home DS0000056864.V269773.R01.S.doc Version 5.0 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Written instructions should be in place for individual residents stating when medication prescribed when required should be given. The Laurels Care and Nursing Home DS0000056864.V269773.R01.S.doc Version 5.0 Page 20 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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