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Inspection on 13/12/06 for The Laurels Nursing Home

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

This inspection was carried out on 13th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

The staff collects information about the person before anyone moves into the home. Staff talk with other professionals to ensure residents health care needs are met. The residents said the staff cared for them and comments included"They are good and help me","they are nice staff and always take time to talk to me","I get everything I need", I am very happy here", and "the home has a happy atmosphere". Visitors are made welcome and there are good links with the local community. Relatives said they could visit at any time and help with their relatives care. The residents said they knew who to complain to if they had a complaint and "they sort things out straight away". The recruitment policies are followed. The home is a comfortable, pleasant place to live.

What has improved since the last inspection?

While improvements have been made, further work is needed on the care plans so that they are clear and detailed about the care provided. Medication systems are now being followed. Staff and residents have developed good relationships based on residents` rights to privacy and dignity. Care was given discreetly and with sensitivity. The activities continue to be developed and information is taken from relatives to ensure that residents` social care needs can be met. Further progress has been made with the redecoration and refurbishment of one communal area and a selection of bedrooms upstairs. The use of agency staff has reduced which has improved the care and consistency of service within the home. Quality assurance and quality monitoring systems have been introduced, to promote and improve the quality of the service offered to residents. Formal supervision of staff has started with records kept.

What the care home could do better:

The registered manager must carry out an assessment of residents needs and apply for variation of registration, to ensure that the home can meet all of the residents needs. The assessments need to be completed in detail and include information about religion/beliefs, sexuality and disability. Further work is needed on the care plans so that they are clear and detailed about the care provided. Residents and their representatives need to be involved in the writing of care plans. Information about residents` previous lifestyles and choices need to be written down so that staff can continue to support them. The quality, choices and availability of meals must be reviewed and improved with records kept. All complaints must be written down with the action taken recorded. Improvements to care practice and the environment are needed to prevent cross infection. All staff must receive up to date training in safe working practices and receive specialist training to make sure they can care for residents. All areas of the home that need repair, redecoration and refurbishment must be dealt with according to priority need and within agreed timescales. The Registered Person must continue to support the Registered Manager to develop a strong professional staff team. More frequent internal audits of working practices and documentation may assist in the problems identified with team working. All health and safety issues must be dealt with, records kept and completed within agreed timescales. The registered persons must ensure all requirements in the report are actioned within specified timescales.

CARE HOMES FOR OLDER PEOPLE The Laurels Nursing Home Francis Way Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9EQ Lead Inspector Irene Bowater Key Unannounced Inspection 09:00a 13 & 19th December 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 Nursing Home DS0000018209.V322740.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 Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address Francis Way Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9EQ 0191 517 3763 0191 526 0837 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) www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Barbara Ann Clarke Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (10), Physical disability of places over 65 years of age (40), Sensory Impairment over 65 years of age (10) The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 2006 Brief Description of the Service: The Laurels is a privately owned care home, which is located in the village of Hetton-le-Hole. It is within walking distance of a range of local facilities including shops, public houses, a health centre, library and a Church, and is also near to a bus stop. The home may provide permanent accommodation with personal care support and nursing for up to fifty-five older people, some of whom may have a physical disability or sensory impairment. A limited number of physically disabled adults under the age of sixty-five may also be accommodated within this total number. The home’s entrance is level, and a shaft lift provides access between floors. Accommodation is laid out over both the ground and first floors. Each has selfcontained lounges, dining areas and adequately equipped bathrooms. All bedrooms have en-suite toilet facilities. The building shares it grounds with another care home owned by the same company. The grounds are well kept, there are accessible paved areas for residents and car parking is available. There is a Statement of Purpose and Service User Guide for the home. These are kept in the office and have not been updated for some time. The information is generic in style and does not give clear easy to understand information to existing or potential residents. The weekly fee for this home ranges from £359.00 to £593.00. The nursing care element is extra and is set nationally. There are extra charges for hairdressing, toiletries, newspapers and chiropody services. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection site visit took place over two days in December 2006. Two inspectors visited the home on the first day. One inspector carried out a themed inspection of the home. The other inspector started the key inspection site visit, which was then completed when the registered manager returned from annual leave. The second visit was undertaken to discuss the management of the home and progress made since the last inspection. During the themed inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI is carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. The issues to be addressed from the themed inspection have been incorporated into this report. The inspector looked around and talked to residents and staff, and saw the contact between them. Time was also spent checking the cleanliness, maintenance and decoration of the home. A number of documents were looked at including, training, maintenance, catering, medication, financial, recruitment, health and safety, and complaint records. What the service does well: The staff collects information about the person before anyone moves into the home. Staff talk with other professionals to ensure residents health care needs are met. The residents said the staff cared for them and comments included The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 6 “They are good and help me”,“they are nice staff and always take time to talk to me”,“I get everything I need”, I am very happy here”, and “the home has a happy atmosphere”. Visitors are made welcome and there are good links with the local community. Relatives said they could visit at any time and help with their relatives care. The residents said they knew who to complain to if they had a complaint and “they sort things out straight away”. The recruitment policies are followed. The home is a comfortable, pleasant place to live. What has improved since the last inspection? While improvements have been made, further work is needed on the care plans so that they are clear and detailed about the care provided. Medication systems are now being followed. Staff and residents have developed good relationships based on residents’ rights to privacy and dignity. Care was given discreetly and with sensitivity. The activities continue to be developed and information is taken from relatives to ensure that residents’ social care needs can be met. Further progress has been made with the redecoration and refurbishment of one communal area and a selection of bedrooms upstairs. The use of agency staff has reduced which has improved the care and consistency of service within the home. Quality assurance and quality monitoring systems have been introduced, to promote and improve the quality of the service offered to residents. Formal supervision of staff has started with records kept. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000018209.V322740.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 Nursing Home DS0000018209.V322740.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): 3,4.Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. A basic pre admission assessment is carried out prior to admission. However this information is not always developed into a care plan. Residents holistic care needs therefore may not always be met. Currently the home cannot demonstrate that it can provide specialist care for residents with dementia. EVIDENCE: Before moving into the home residents have an assessment of need, which is completed by, care managers, nurse assessors and the home manager. Should the resident be privately funded the home manager uses the Company’s’ assessment tools. Five residents care plans were case tracked from admission. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 10 Information from the Care Managers and nurse assessors are available and the registered manager confirmed that the home carries out their own assessment prior to anyone being admitted. Although admission assessments and care plans have been produced the detail in all of the care plans varied. Several areas of the assessment tool were incomplete or had a tick next to it, which did not then give the detail of how those residents nursing needs would be met. The social and psychological care needs were not detailed. Through case tracking, discussion and observation throughout the day it was evident that some residents have dementia. Once a resident’s mental health needs become the primary focus of their care, the registered manager needs to carry out an assessment of need and apply to the Commission for a variation of registration. The Laurels Nursing Home DS0000018209.V322740.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The care planning system needs further improvement to provide staff, residents and their representatives with the information they need to meet resident’s needs. The health needs of residents are being met. The systems for the administration of medicines are currently safe and consistent. Personal support is currently promoting residents rights to privacy and dignity. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has a care plan which is based on the preadmission assessments which are carried out by care managers, home manager and when necessary the nurse assessor. The assessment tools include pressure sore risk assessments, dependency, moving and handling, nutritional, continence and fall risk assessments. Three care plans examined showed that they were not fully completed, dated and signed. This means accurate information that residents care needs are met is not available. Risk assessments and evaluations of care were not carried out at least monthly. There was evidence that tippex was being used to correct errors instead of a single cross line with initials. One care plan had recently been reviewed and up dated. It was, comprehensive and jargon free and included a social assessment and plan. One care plan relating to wound care was comprehensive and detailed. The care and treatment given by the nursing staff showed clear guidance for the type of treatment needed to improve the wound. There is limited information about resident’s previous lifestyles and social care needs. Residents who have dementia or display challenging behaviours also need to have detailed care plans in place so that all staff can respond to their needs in a consistent manner. The use of meaningless phrases such as “slept well”, “diet and fluids taken”, “is stable” and “settled day” do not inform staff that individual care needs are being met. Staff have a good knowledge of individual residents needs. They were able to describe how individual needs and risks would be managed. The residents spoken to were complimentary about the staff and how well they were looked after. The residents have access to all NHS facilities. There are regular visits from GP’s and other health professionals including dentists, opticians and chiropody services. Advice is sought from tissue viability specialists, speech therapists and continence advisors. Visits from them are recorded in individual care plans. The home has medication policies and procedures for staff to use. Records are in place for all medicines received, administered and disposed of. An audit of Controlled Drugs and the Medicine Administration Records (M.A.R.) showed no discrepancies. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 13 The treatment room was clean, tidy and medicines were safely stored. The treatment room was very warm and the room temperature should be recorded to make sure a temperature of 25 C is not exceeded. Residents spoken to felt that they are treated with respect and their right to privacy is upheld. Residents spoke about their personal wishes and preferences, which are respected by staff. Examples include locking their bedroom doors, knocking on doors and waiting for permission before entering, receiving their mail unopened and being addressed by their preferred name. Other comments from residents included: “They are good and help me”, “they are nice staff and always take time to talk to me” and “I get everything I need”. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Social activities provide stimulation and interest for residents living in the home. Support from relatives and representatives provide residents with opportunities to maintain their previous lifestyles. Residents are supported to make choices and take control over their lives but this is not evidenced in the care plans. Dietary needs of residents are not catered for. There is not a balance or choice of wholesome food. EVIDENCE: The home has a designated activities organiser. Social events are displayed and include a “bonus ball” competition, bingo, exercises and board games. The home was pleasantly decorated for the Christmas period. There was evidence of a range of activities taking place over the Christmas period including visits from the church singers, gift sale, Christmas party and in house entertainment. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 15 Relatives are also invited to join their relative for Christmas lunch. One relative said, “lunch is booked and I am really looking forward to it”. Relatives and residents receive a newsletter telling them of events and activities in the home. All activities are recorded and show if residents have joined in or not. However these records are not cross-referenced to the care plans. The residents confirmed that family and friends are welcomed and can visit at any time. The staff took time to talk to visitors and share information with the residents consent. Relatives said that they are always welcome and can stay and have a meal and join in any event should they wish to do so. Residents have been encouraged to bring small items of furniture and other belongings with them, making their rooms highly individualised and reflective of their lifestyles. They are encouraged to take responsibility for their own financial affairs for as long as possible. Information about advocacy is available in the home. The home does not have a menu displayed. Residents did not know what was for lunch until they sat down in the dining room. The inspector asked the cook what was for lunch and was told it was lamb chops, mashed potatoes, carrots, cauliflower and gravy followed by rice pudding with jam. When they were informed that lamb and rice were not liked the only alternative on offer was a sandwich. Residents confirmed that alternatives are not readily available .One resident said, “It doesn’t matter as I am not fussy what I eat” and another said “I don’t like milk pudding but I haven’t asked for anything else as I don’t want to make a fuss”. The only records of food served were in a diary that did not specify choices, alternatives or availability of snacks. This makes assessment of residents’ nutritional status difficult to measure. Hot drinks with a biscuit are offered midmorning and in the afternoon. The practices observed at lunchtime were appropriate with staff being sensitive to residents needs. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Residents and relatives are sure that their views are listened to and acted upon. However without comprehensive records there is little evidence to show that they have been dealt with appropriately. Further Safeguarding Adults protected. training for all staff will ensure residents are EVIDENCE: The Company have a complaints policy, which is on display at the entrance to the home. Residents said they would be able to use the procedure if needed but “didn’t have anything to complain about”, “they sort things out” “the girls see to anything I am concerned about”. The records show that no complaints have been received since 2005. All concerns raised are not routinely recorded with actions and outcomes. Detailed recording of all issues raised by residents and relatives would show if similar concerns were being made and assist in the quality assurance monitoring. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 17 There are policies and procedures in place to safeguard vulnerable adults. The company has a workbook to complete to evidence that the service understands what constitutes abuse. The registered manager confirmed that care staff have completed the training and ancillary staff were to attend training in the near future. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 18 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): 19,20,21,24,26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Recent financial investment has improved the appearance of the home. This is creating a comfortable pleasant place to live. Good working practices ensures that the home is kept free from infection and safe for residents. EVIDENCE: The home is purpose-built and is accessible to residents and their visitors. On both days of inspection the home was nicely decorated for the Christmas festivities. All of the communal areas are nicely decorated and furnished .The large entrance area has plenty of comfortable seating and residents were choosing to spend a lot of time there chatting to each other and visitors. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 19 One area upstairs has been refurbished and redecorated to a high standard and it was confirmed that the refurbishment and redecoration would continue. There are sufficient bathrooms and shower facilities close to resident areas. These areas are in need of maintenance as there is wheelchair damage to walls, damage to flooring and to the tiling in the shower room upstairs. On the first visit there were black bags, two slide boards and flower planters stored in one bathroom. These items had been removed by the second visit. All of the bedrooms have an en suite facility. The residents have brought small items with them making their own rooms individualised and reflective of their lifestyles. As stated in the last reports dental tablets were still not being securely stored or risk assessed. On both days of inspection the home was clean and tidy. There was only one area of odour in the upstairs sluice. All other areas were fresh and pleasant. As at the last inspection, sluice doors were again found unlocked. This is a health hazard and staff must take better care to prevent unauthorised persons accessing areas where they may come to harm. The sluices were untidy with old commodes, rusty catheter stands being stored. On the second visit these items had been removed. All of the light cords are grimy and need to be replaced. In order to reduce the risk of infection staff need to have access to liquid soap and paper towels in all resident areas including en suites. The laundry was clean and organised with infection control procedures being followed. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 Quality in this outcome is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The current staffing levels ensures the residents’ needs are met. A training programme needs to be implemented to ensure staff have the competence to care for the residents needs. The residents are kept safe and supported by comprehensive recruitment procedures to prevent unsuitable people from working in the home. EVIDENCE: The current staffing levels for thirty-four residents are as follows: Two qualified nurses throughout the day; one qualified nurse during the night; Five care staff in the morning; four care staff during the afternoon and evening; three care staff overnight. These levels should be constantly reviewed to make sure there is sufficient staff on duty especially at peak times to meet the residents assessed needs. There are sufficient ancillary staff including domestic, laundry, chef, kitchen assistants, activities person, maintenance and an administrator. The manager is supernumerary to make sure that there is a consistent care and general management provision. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 21 As a positive development the use of agency staff has reduced since the last inspection. This makes sure that the staff give consistent, safe care to residents. On both days of inspection the staff worked fairly well together and there was evidence of appropriate communication between them. The staff are completing NVQ level 2 training. However the 50 target has not been reached. Five staff files showed that recruitment policies and procedures are being followed. There was evidence of completed application forms, two written references, Criminal Record Bureau checks and proof of identity. Personal Identification Numbers (P.I.N.) numbers of qualified nurses are checked with the Nursing and Midwifery Council to make sure nurses are registered. Staff are now given a “Staff Handbook” which covers all aspects of employment matters and care practice. Induction and mentorship for staff is underway and some progress is being made. There is still an outstanding requirement that all staff receive mandatory training in safe working practices. Not all night staff has completed fire training every three months. Other staff are not up to date with moving and handling, infection control or first aid. Safeguarding Adults training is underway although none of the ancillary staff have completed this training. Some specialist training has been completed including would care, nutrition, customer care and venapucture. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36,38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The manager is appropriately qualified to manage the home. However she requires further support from her line manager to ensure that there is a strong effective staff team. The systems for consultation and quality monitoring to improve the service are now in place, with evidence that views of residents and their representatives are being sought. Residents personal accounts are safeguarded, however they do not have access to individual accounts and their money at all times. Some facilities in the home, and health and safety practices carried out do not fully promote and safeguard the health, safety and welfare of the people living there. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager is a qualified first level nurse who has considerable experience working with older people. She is very aware of the issues raised in the last two inspection reports about the management style and attitudes of some of the staff. Given that this is a long-standing problem it is acknowledged that the plans that have been put in place will take time to put right. Some of the staff in the home try to overturn or disregard management decisions, which then leads to poor communication of care and may reflect in unsatisfactory standards of service provision. Supervisions are now in place and they are comprehensive. Progress is being made to try and complete them at least six times a year. Relative resident and staff meetings are being held with minutes recorded. The Company has put a quality monitoring system in place and the results are collated nationally. They show that “there has been a rolling programme for refurbishment, so some areas are very good and some need attention. The staff are very good. The Laurels is a wonderful care home, it has been superb for my relative. The family are very satisfied with the care in the Home, all the staff are friendly, caring and hard working.” The information also shows that there is sometimes a lack of consistent communication between staff and relatives. Comments received at the time of inspection were generally positive and included the following: “It is a happy home and staff are good” “I am satisfied with the care given and the staff work hard”. “Some work is needed to the rooms” All residents have an individual balance record that is reconciled every week if any transactions have taken place. Monies are held in one joint non- interest making account. This should be reviewed as some banks are now offering individual account facilities so that residents will then be able to gain interest on their money. The home holds an appropriate float and two staff signatures; receipts are available for all transactions. Staff supervision has started and progress is being made to complete the records so that the member of staff and the line manager are clear about the ethos of the home, training and individual career development. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 24 The training records show that not all staff have completed up to date training in safe working practices. Night staff have not completed fire training every three months, manual handling training and infection control training is not up to date. In house weekly maintenance checks are not being carried out .The maintenance person has been off sick for some time but alternative arrangements for checking fire, emergency lighting and water temperatures have not been put in place. The fire risk assessment needs to be updated and the Health and Safety risk assessment although available was not dated or signed. External maintenance certificates are up to date. The accident recording was being appropriately documented with monthly analysis being completed. The analysis does not track trends to produce an action plan to reduce further risks if possible. Staff were still unaware of the high risk associated with the use of dental cleaning tablets. These were still easily accessible throughout many of the bedrooms. The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 25 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 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 17 X 18 2 2 3 2 X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 2 X 2 The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 26 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 4 Requirement The statement of purpose must be reviewed and where necessary changed so it becomes user-friendly. The service users guide must be developed and issued to all residents. The residents’ must also be issued with the most recent inspection report. The owners must review the draft contracts and terms and conditions to make sure they are fair and give sufficient detail about the peoples’ rights. Residents or their relatives must be given the opportunity to agree to changes in fee levels. The home must demonstrate that nursing needs have been assessed. Service users or their representatives must be involved in the writing of assessments. Residents must be informed in The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 27 Timescale for action 01/04/07 2. OP1 5 01/04/07 3. OP2 5 01/03/07 4. OP3 14 16/04/07 4 OP4 18 5 OP3 4,12,14 6 OP7 15 7 OP9 13,23 8 OP12 14,16 9 OP15 14,15,16 10 OP16 22 writing that the home can meet their assessed needs. The registered person must ensure that nursing and care staff receive specialist training to equip them to meet service users’ physical and mental health needs. Outstanding as of 20/06/06 Timescale of 01/09/06 not met. The registered persons must ensure that an assessment of residents needs is completed and application made to the Commission to vary conditions of registration. The registered manager must ensure that resident care plans are specific to the needs of individuals, and be regularly updated to reflect changing needs. Outstanding 20/03/06. Timescale 01/09/06 not met. The registered persons must ensure that the treatment room ambient temperature does not exceed 25 C. The registered persons must ensure that resident’ interests and life styles are assessed and care plans formulated. The registered manager must review the quality of the meals, choices to residents and the organisation of the dining arrangements. Timescale of 01/08/06 not met. The complaints procedure must be reviewed and issued to all residents or representatives. The manager must keep accurate records of complaints and the action taken to address them. The registered person must ensure that all staff complete DS0000018209.V322740.R01.S.doc 01/06/07 01/02/07 01/04/07 01/04/07 01/04/07 01/04/07 01/03/07 11 OP18 13(6) 18(1) 01/04/07 Page 28 The Laurels Nursing Home Version 5.2 training in the Local Authority’s multi-agency procedures for the protection of vulnerable adults (MAPPVA). The company’s procedural guidance in the is respect also needs to be amended, to clearly show that wherever a criminal offence is suspected, such as physical, sexual or financial abuse, the Police must be contacted as a matter of urgency. Outstanding 20/06/06.Timescale of 01/09/06 not met. The programme of ongoing redecoration and refurbishment planned by the manager must continue. The provision of a designated smoking area for staff must not impinge on the rights of service users and non-smoking workers. Timescale of 20/06/06 not met. The registered persons must ensure that the damage to the walls, floors and tiling in bathrooms and shower rooms is repaired and replaced. The registered persons must ensure that all light and call cords are easily cleanable. Liquid soap and paper towels must be made available in all resident areas to enable effective hand washing. All bins must have suitable foot operated lids. The registered persons must ensure that the sluice doors are kept locked when not in use. Timescale of 20/06/06 not met The registered persons must make sure that 50 of care staff complete training to NVQ level 2. The registered person must DS0000018209.V322740.R01.S.doc 12 OP19 13(4) 23(2,3) 01/07/07 13 OP21 23 01/09/07 14 OP26 23 01/04/07 15 OP26 23 01/02/07 16 17 OP28 OP30 18 13(1) 01/06/07 01/04/07 Page 29 The Laurels Nursing Home Version 5.2 18(1) 23(4) 18 OP31 12(1,5) ensure that all staff undertakes mandatory health and safety training, including first aid and fire safety training, within the prescribed timescales. Outstanding as of 20/06/06. Timescale of 01/09/06 not met. The registered person must supervise the registered manager to develop good supervisory and team working practices at the home. Outstanding as of 18/02/06 and 20/06/06. Limited progress made from 01/09/06. The registered manager must review the leadership style and ethos within the staff team. Timescale of 01/09/06 not met. The registered persons must continue to develop internal and Company quality assurance systems in order to develop all aspects of service provision. The registered manager must ensure that all staff receives supervision at least six times per year. Timescale of 20/12/06 not yet met. The registered person must ensure that staff fire drills and fire alarm tests are undertaken at the given timescales and records kept. Timescale of 01/09/06 not met. The registered manager must ensure that dental cleaning tablets are safely stored and risk assessments are undertaken. Timescale of 01/08/06 not met. The registered persons must ensure that the fire risk assessment and the health and safety risk assessment are reviewed, signed and dated. All staff must sign to confirm DS0000018209.V322740.R01.S.doc 01/04/07 19 OP32 10, 18,24 01/04/07 20 OP33 24 01/06/07 21 OP36 17(2) 18(2) Schedule 4 23 (4) 01/04/07 22 OP38 01/03/07 23 OP38 13 (4)(c) 01/02/07 24 OP38 13,23 01/02/07 The Laurels Nursing Home Version 5.2 Page 30 they have completed fire training three and six monthly. All in house maintenance records must be completed weekly including checking water temperatures. 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 OP1 OP2 Good Practice Recommendations Staff should on admission confirm with residents that they understand the purpose of the service and what are services are available. On admission residents or their representatives should be made aware of what the maximum weekly contribution will be and that this will be back dated to the day they moved in. The laundry staff may benefit from a rotary iron to deal with the large quantity of bed lines laundered. It is highly recommended that the staffing levels and dependency levels are constantly reviewed to make sure there are sufficient staff on duty at all times The Registered Manager to review the accident records and identify preventative actions. 3 4 5 OP26 OP27 OP38 The Laurels Nursing Home DS0000018209.V322740.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South of Tyne Area Office St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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