Inspection on 29/08/06 for The Laurels, Huntley

This inspection was carried out on 29th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

The Laurels, Huntley 09/05/07

The Laurels, Huntley 30/11/05

The Laurels, Huntley 08/06/05

The Laurels, Huntley 17/11/04

The Laurels, Huntley 08/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Laurels Main Road Huntley Glos GL19 3EA Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 29th August 2006 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Laurels DS0000016615.V307927.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 DS0000016615.V307927.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address Main Road Huntley Glos GL19 3EA 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) 01452 831484 Mrs Patricia Alice McCreery Mrs Patricia Alice McCreery Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: The Laurels is a comfortable well-maintained Care Home providing personal care for eight service users who are aged 65 years and over. The house is situated on the A40 in the village of Huntley, approximately 6 miles from the City of Gloucester. The eight single bedrooms, five with en suite facilities, are located on the ground floor, with toilets, shower and assisted bathing facilities within easy access. A lounge/dining room is provided for the service users use. They also have the benefit of a small private garden at the rear of the house. The proprietor and her family live in the property; the Registered Manager provides overnight cover for the Home. All the bedrooms are equipped with emergency call facilities. The fees range from £325 to £425. Extras to this include hairdressing and chiropody. The home does not display copies of their Statement of Purpose or Service Users Guide. The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection on one day in August 2006. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The Registered Manager/Provider was available during the inspection as were other members of the home team. A total of 24 standards were inspected. Several residents were spoken with to ascertain their views on the care and services provided. A number of surveys were left for service users, staff and visitors to the home. Of these, two service users returned theirs and both were complimentary about the home as was two staff surveys received. One visitor’s survey was received and this commented that the member of staff on duty is often ‘stretched’ trying to assist all service users. The comments received from service users during the inspection all indicated they are very happy living at the home. The Registered Manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feed back on the inspection findings were given on completion and were received in a constructive and positive way by the Registered Manager. Two requirements had not been complied with since the last inspection. On this occasion the timescales have been extended as indicated in the requirements made. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale may lead the Commission for Social Care Inspection to considering enforcement action to secure compliance. What the service does well: The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 6 The home is a small family run home that all service users said is very homely and a comfortable place to live. The service users have a good relationship with the staff in the home and the staff demonstrated good awareness of the needs of the service users. Service users have a lot of input into the meals provided allowing both choice and variety and the home is able to cater for service users who require a special diet. What has improved since the last inspection? What they could do better: The home needs to write to any proposed service user detailing how the home will meet their needs. A written plan of care needs to be produced for each service user detailing how their needs will be met. Training needs to be provided for staff to ensure they can undertake their job roles effectively and safely. The home needs to review their policies and procedure to ensure they are updated with the latest legislation. The home needs to review their medication procedures to ensure service users are not put at risk. The Pharmacy inspector from the Commission is going to visit the home and assist them with this. The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 7 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 DS0000016615.V307927.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 DS0000016615.V307927.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The homes’ Statement of Purpose and Service Users Guide provide service users with information about the services offered, however further additions are needed to ensure all the required information is available. Arrangements for admission procedures are now in place, although further improvement could be achieved by the home confirming in writing that the needs of the service user can be met. EVIDENCE: A copy of the homes Statement of Purpose and Service Users Guide was given to the inspector during the site visit. A few minor additions are needed to the Service Users Guide to meet the regulations. These are: To add a copy of the homes terms and conditions To add a copy of the homes contract To add a summary of the homes complaints procedure The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 10 To add the address and telephone number of the Commission. Consideration should be given to making an amendment to the wording of a section in the Statement of Purpose that says “we welcome applications from anyone” as the home is only able to accept proposed admissions from service users within their category of care. The home should also consider documenting about the night staffing arrangements to ensure prospective service users receive all the information they need to make an informed choice about admission to the home. Since the last inspection the home has only had one new admission. A pre admission assessment was completed, however their was no evidence to suggest that the home has written to the service user informing them that the home is suitable to meet their needs. Intermediate care is not offered at this home. The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The care planning systems in place still do not fully provide the staff with the information they require to care for all service users needs. The health needs of service users are being met. The arrangements for administration of medication can potentially place service users at risk. Service users are treated with respect and dignity. EVIDENCE: The care of two service users was examined in detail and one additional care plan was examined. All had an assessment of need that had evidence of regular reviews, however when a need is identified a plan of how to address it was not in place. One service user did have brief plan in place for a medical condition but it did not contain enough detail on how staff would manage this need. Reviews were being undertaken of this plan but it was difficult to The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 12 ascertain when they were done as a date was not always visible. Detailed daily records are maintained and a member of staff spoken with had a good understanding of the needs of the service users. One care plan seen had evidence of service user involvement. Moving and handling assessments were in place but on one service user’s assessment had no reviews were seen. In another care plan a copy of the health professional’s care plans was in place but again no evidence of reviews. During the inspection two health professionals’ were visiting service users. The systems for medication were examined in detail. A number of issues were identified that could potentially place service users at risk. A specialist inspection is going to take place to assist the home in meeting good practice guidelines within their environment. A risk assessment must be undertaken to determine the safety of the system used by the home. Service users confirmed that their privacy and dignity are maintained. The Laurels DS0000016615.V307927.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users are able to exercise control and make choices about their daily lives. Dietary needs are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The home does not have a structured activities programme as service users are able to plan their own. Service users spoken with said they are happy to provide their own activities and are free to choose how they spend their time each day, however one service user said they are bored at times and this was fed back to the Registered Manager during the inspection. During the inspection a small number of service users were sat in the lounge enjoying each other’s company. Other service users were in their rooms. Several service users said that their families come and take them out regularly. The homes’ Service Users Guide lists the services available to them and these include hairdressing and a mobile library that visits the home. Service users said visiting to the home is not restricted and a number of visitors were at the home during the inspection. Service users said they could The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 14 see their visitors in their own room or communal areas. The homes’ Statement of Purpose and Service Users Guide do not make any reference to visiting. Service users are able to bring in their own possessions and this was seen during a tour of the home, giving each room an individual feel. The Registered Manager confirmed that one service user’s family deal with their finances. From discussions with both the Registered Manager and service users they have input into the menus, and they operate on a three weekly rota with alternatives offered if needed. Both cooks are aware of service users likes and dislikes. Lunchtime was a sociable event and all comments received about the food provided were very complimentary. Service users confirmed that drinks are offered at regular times throughout the day. Records were seen in the kitchen of food provided and the health and safety checks undertaken by the home. The Laurels DS0000016615.V307927.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home has a complaints procedure in place but to date this has not been tested. Arrangements for protecting service users from possible risk of harm and abuse are satisfactory, however this can be improved with the provision of training. EVIDENCE: A copy of the homes complaints policy is on display by the main entrance to the home. The Registered Manager said the home has not received any complaints. From talking to service users they all said they could approach a member of staff or the Registered Manager if they had any concerns. The home has adult protection policies in place and as part of the induction programme staff have to read them. The Registered Manager said these need updating. No training has been provided for staff in this subject and to ensure that staff are aware of best practice guidelines consideration must be given to obtaining training. Details of where to access local training was given to the Registered Manager. Staff said they would inform the Registered Manager if they had any concerns. Copies of the local procedure for reporting abuse ‘The Alerters’ guide were sent to the home following the inspection. The Laurels DS0000016615.V307927.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The standard of the environment within this home is good providing service users with an attractive and homely place to live. EVIDENCE: A tour of the environment took place with a number of service users room inspected. No maintenance issues were identified and the damp problem in room one has been addressed. The home appears to be well maintained and a very pleasant outside seating area is provided for service users when the weather is warm. Service users spoken with all said they are happy with the cleanliness of the home and that the domestic does a very good job. The home must ensure that all chemicals hazardous to service users are either locked away or kept with a member of staff at all times. Staff were seen wearing protective clothing when required. The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 17 The laundry appeared to be well organised and service users said they are very happy with how their clothes are looked after. The Laurels DS0000016615.V307927.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home is confident that the numbers of staff on duty meet the needs of the service users, however the processes for staff training need improving to ensure staff receive the appropriate training. The standard of vetting and recruitment practices need improving to ensure the appropriate checks are being carried out and not potentially leaving service users at risk. EVIDENCE: Four care staff work at the home and one of these has completed their NVQ 2 and another is undertaking it at the moment. The home also employs two cooks and a domestic. The staffing levels provide one carer on each shift except for nighttime when the Registered Manager provides cover as she lives on site. The Registered Manager is also available during the day. Staff spoken with and from the surveys returned following the inspection all said it is a nice friendly place to work and that service users are free to make choices about their daily lives. Service users all complimented the staff and one comment received was that “the staff are our friends”. The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 19 A survey completed by a visitor to the home following the site visit said that at times the staff member on duty is often ‘stretched’ trying to fit in all the tasks they have to complete by the end of their shift, including assisting service users with personal care. One new member of staff has started at the home since the last inspection. Evidence was seen of all the required checks except for a full employment history, therefore any gaps in employment could not be explored. The home has an induction checklist but this was not filled in for the new member of staff. However evidence was seen of a completed induction form for another member of staff. As the Criminal Records Bureau disclosure has not been returned for the new member of staff they must be supervised and a supervisor appointed. The Registered Manager said the home has a training programme in place but it was difficult to establish if all staff had received training. Consideration should be given to devising a matrix for ease when determining what training each staff member has undertaken. A member of staff spoken with said they have not received any training in the year they have been at the home. The home must ensure that staff receive the training needed to meet their job role. The Laurels DS0000016615.V307927.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The Manager has a supportive, open approach to running the home, which benefits the service users, staff and relatives. There are systems in place to obtain service users views and evidence that they are acted upon. The home ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. EVIDENCE: There have been no changes to the management of the home since the last inspection. The Registered Manager has completed the Registered Managers The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 21 award. She is a qualified nurse and is aware of the importance of keeping herself updated. Service users and staff all said the Registered Manager is approachable and friendly. Service users meetings take place and minutes of these were examined. As the Registered Manager lives on site she is available to see staff when they are on duty and at each shift there is a handover and a communication book is available for staff. The home sent out questionnaires to service users and their relatives in November 2005 and the Registered Manager said these are sent out yearly. The Registered Manager said she undertakes monitoring of the home but does not record the checks undertaken. The Home is to review their policies and procedures, as a number of them were out of date as far back as 2001. The home does not manage any service users monies. Evidence was seen of staff supervision sessions and staff spoken to confirm this. Evidence was seen of servicing of equipment and boilers. The home does not have any hoists. A fire risk assessment has been completed by the home but needs to be reviewed as last done in 2004. The Laurels DS0000016615.V307927.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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X N/A 3 X 2 The Laurels DS0000016615.V307927.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. Standard OP1 Regulation 5 Requirement The registered person must add the additions to their Service Users Guide as mentioned in this standard. The registered person must confirm in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of their health and welfare. A written plan of care must be produced for each service user. This requirement has been repeated from the last two inspections. The registered person must complete a risk assessment to determine if the medications used are not potentially placing service users at risk. The registered person must ensure that all receive training about abuse. The registered person must ensure that all chemicals hazardous to service users must be stored securely at all times. DS0000016615.V307927.R01.S.doc Timescale for action 10/11/06 2. OP3 14(1d) 10/11/06 3. OP7 15 01/12/06 4. OP9 13(2) & (4c) 30/09/06 5. 6. OP18 OP26 13(6) 13(4a) 31/12/06 20/09/06 The Laurels Version 5.2 Page 24 7. OP29 19 8. OP30 18(2) 9. OP30 19(11) 10. OP30 18(1)(ci) All members of staff must be subject to full recruitment procedures. This requirement has been repeated from the last two inspections. The registered person must ensure that for the duration of the new workers induction training: i) a member of staff (“the staff member”) is appropriately qualified and experienced, is appointed to supervise the new worker; ii) as far as is practicable, the staff member is on duty at the same time as the new worker; and iii) the new worker does not escort any service user away from the care home premises unless accompanied by the staff member. Where a registered person permits a new worker to start work as defined in this regulation the registered person shalla) appoint a member of staff (“the staff member”) who is appropriately qualified and experienced, to supervise the new worker pending receipt of, and satisfying himself with regard to, the outstanding information in relation to a criminal record certificate. The registered person must ensure that all staff receives training appropriate to the work they are to perform. 01/11/06 01/11/06 01/11/06 31/12/06 The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP1 OP8 OP30 OP33 OP33 OP38 Good Practice Recommendations The home should consider making the changes to their Statement of Purpose as described in this standard. The home should review service users moving and handling assessments on a frequent basis depending on the needs of the service user. The home should consider devising a training matrix for easy recognition of what training staff have undertaken and when they are due. The registered manager should record all monitoring systems used as part of their quality assurance systems. The home should review all their policies and procedures. The home should review their fire risk assessment. The Laurels DS0000016615.V307927.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 DS0000016615.V307927.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!