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Inspection on 09/01/07 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 9th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 were treated with respect and personal care was carried out in private. One resident said, "The staff are lovely. They helped into bed and helped me to walk around with frame. " Another resident said, "The staff are very nice and helpful." One visitor said, "The staff talk to the residents and there`s always staff about especially if someone`s wandering." The daily routine was flexible in order to meet the needs and preferences of the residents. One resident said, "I got up at 10 o`clock, I was asleep until then." Another lady said, "I go to bed when I want, I like getting up early and they know that." All the residents asked said the meals were good. One lady said, "We get well fed." Staff turnover was very low ensuring continuity of care for the residents.

What has improved since the last inspection?

Since the last inspection the home has achieved the nationally accredited Investors in People Award.A registered nurse has become the training co-ordinator and is responsible for planning and arranging appropriate training for all members of staff.

What the care home could do better:

It is of concern that care plans were not in place from the date of admission for all residents. Care plans must state how all the identified needs of each resident are to be met. All care plans must be updated when the needs of the resident change. This ensures that accurate information is available to all members of staff explaining how the needs of each resident are to be met. Urgent action must be taken to ensure all wound care records are up to date and include detailed information about the care and condition of the wound. To promote the safety of residents a risk assessment for the use of bed rails must be in place for all residents who need them. It is important to keep staff attendance records at fire drills to ensure all members of staff regularly receive this training. To prevent injury to residents and staff urgent action must be taken to ensure wheelchairs are used properly and only correct moving and handling techniques are used.

CARE HOMES FOR OLDER PEOPLE The Laurels Care and Nursing Home Bankside Lane Bacup Rossendale OL13 8HG Lead Inspector Mrs Susan Hargreaves Unannounced Inspection 9th January 2007 10:10 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.V319943.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.V319943.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 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.V319943.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 28th February 2006 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 current fees charged at The Laurels are £315 to £510 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.V319943.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 on the 9th January 2007. No additional visits have been made since the last inspection. However, the home’s manager and a senior manager have investigated a complaint about a member of staff made to the Commission for Social Care Inspection. Nine residents had completed questionnaires and the relatives of seven residents had completed comment cards stating their overall satisfaction with the care provided. Comments included, ‘staff are friendly, patient and understanding of the needs of the people in their care’ and ‘we have been impressed by the caring and professional attitude of the staff’. At the time of this inspection 27 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 home manager and a senior manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? Since the last inspection the home has achieved the nationally accredited Investors in People Award. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 6 A registered nurse has become the training co-ordinator and is responsible for planning and arranging appropriate training for all members of staff. 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.V319943.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.V319943.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. Admission procedures were thorough. Standard 6 is not applicable to this service. EVIDENCE: Individual records of three 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.V319943.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. Privacy and dignity was promoted for all residents. Care plans did not contain detailed information relating to all aspects of care. Medication was managed efficiently promoting good health. EVIDENCE: The individual care plans of three residents were inspected. These plans did not clearly identify and address all the care needs of each resident. The care plan relating to nutrition for one resident stated ‘cater for likes and dislikes’ but did not explain what these were. A care plan about spiritual needs was generic and did not explain if the resident practised a particular faith and the name of the clergyman or woman to contact. Another care plan had not been up dated to provide details of how to manage incontinence when this became a problem. The wound care records for one resident provided insufficient information about the treatment and condition of the wound. The care plan had not been up dated when the type of dressing used was changed. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 10 Care plans had not been written for a resident admitted for respite care. Although some risk assessments had been carried out for this resident one for the safe use of bed rails was not in place. 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. At the time of the inspection none of the residents were self-medicating. Registered nurses were responsible for administering all medication. 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. However, a record of the times a prescribed cream was used for one resident was not kept. 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 nice.” Personal care was carried out in the privacy of the resident’s own room. Privacy and dignity was discussed with two 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.V319943.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure activities were organised for residents. Visitors were welcomed into the home at anytime. The daily routine met the needs and preferences of residents. The meals were wholesome and menus offered variety and choice. EVIDENCE: Leisure activities were advertised in the home. These included dominoes, pamper sessions, watching videos and listening to music. An outside entertainer visited the home every month. Resident’s interests and hobbies were recorded in their individual care plans. A visitor said, “Staff talk to 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. Residents were encouraged to make decisions about their lifestyle and daily routine. One resident said, “They take me to bed when I want and I got up at 10 o’clock because I was asleep until then.” The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 12 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.V319943.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. Complaints were taken seriously and investigated. Appropriate policies and 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 home’s manager and a senior manager have investigated a complaint about a member of staff made to the Commission for Social Care Inspection. Policies and procedures about safeguarding vulnerable adults were in place. This issue was discussed with three members of staff. They said they would report concerns to a senior member of staff. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, 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 free from offensive odours. Residents were encouraged to personalise their rooms with photographs, ornaments small items of furniture etc. Communal rooms were spacious and suitable for a variety of activities. The decorations in some communal areas were looking tired and the manager said they were due to be redecorated. The grounds and gardens were well kept and accessible to all residents. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 15 The laundry was well equipped and appropriate for the size of the size of the home. An infection control policy was available. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. Staffing levels were appropriate to meet the assessed needs of the residents Recruitment procedures were thorough. Training for 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. The files of four 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. It was evident from discussion with the manager and members of staff that training was encouraged. This included, ‘skills for care’ induction training for anew employees, moving and handling, fire safety, first aid and dementia care. Nine members of staff had obtained qualifications in care including one at level 4. A further five member of staff were working towards NVQ level 2. A designated member of staff was responsible for arranging training and maintaining records. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 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 ISO 9001 and Investors in People. Anonymous service user satisfaction questionnaires were distributed The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 18 annually. An annual development plan to help monitor the quality of the service and improve outcomes for residents was available. Records of transactions involving resident’s money were seen to up to date. Fire alarms were checked weekly. Emergency lighting and smoke alarms were serviced annually. Fire drills were held but staff attendance records need to be kept to ensure all members of staff regularly receive this training. A fire risk assessment was in place. Records of the routine servicing of equipment were seen. These included the testing of small electrical appliances, an electrical installation certificate and the servicing of gas appliances. Although records of the servicing of gas appliances were seen 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 a member of staff was observed using a wheelchair without footplates and tipping it backwards to prevent the resident’s feet from touching the floor. Members of staff were also observed using an inappropriate moving and handling technique when assisting a resident in the lounge. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 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.V319943.R01.S.doc Version 5.2 Page 20 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(1) Requirement A care plan must be in place for all residents from the date of admission. This will ensure members of staff know how the care needs of each resident are to be met. Care plans must accurately address all identified needs including dietary preferences, and spiritual needs. This will make sure staff know how to provide effective care for each resident. Care plans must be updated when the needs of the resident change. This makes sure members of staff have up to date information about how to care for each resident. Timescale of 28/10/05 and 28/04/06 not met. Records relating to wound care must be up to date and include details of the size and condition of the wound, the treatment and how often the dressing must be changed. Records must also be kept of each dressing change. This will ensure members of staff DS0000056864.V319943.R01.S.doc Timescale for action 09/01/07 2. OP7 15(1) 23/02/07 3. OP7 15(2)(b) 23/02/07 4. OP8 17(1)(a) Schedule 3(k) 09/02/07 The Laurels Care and Nursing Home Version 5.2 Page 21 5. OP8 13(4)(c) 6. 7. OP38 OP38 13(4)(a) 13(5) are treating the wound correctly and can quickly identify when medical attention is needed. Timescale of 07/04/06 not met. A risk assessment must be 09/01/07 carried out for a resident before bed rails are used. This will identify the risks associated with the use of bed rails and enable a care plan to be developed explaining how members of staff will manage the risks. A gas safety certificate must be 30/03/07 obtained. Wheelchairs must always be 09/01/07 used properly and correct moving and handling techniques used in order to prevent injury to the residents and staff. 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. Refer to Standard OP9 OP38 Good Practice Recommendations A record of when prescribed creams and ointments are used for individual residents should be kept. To ensure all members of staff regularly attend fire drills attendance records should be kept. The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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. Extracts may not be used or reproduced without the express permission of CSCI The Laurels Care and Nursing Home DS0000056864.V319943.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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