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Inspection on 14/10/08 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 14th October 2008.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Staff we spoken with indicated that morale in the home was good. The atmosphere in the home was positive and calm. Staff were noted interacting with residents in a caring and friendly manner. The home was found to be clean, warm and free from unpleasant odour. Staff were cheerful and interacting with residents in a positive and caring manner. Residents were calm relaxed and looked well cared for.The recording of people`s fluid and food intake has improved reducing the risk of residents being malnourished or dehydrated. The home ensures that there are adequate numbers of staff to meet the residents` needs. The home ensures that aids and equipment are provided in sufficient quantity to assist staff with meeting the needs of residents. Some positive comments received from residents included: " I`m very happy here and well looked after" and "I am extremely pleased with the care" and " the food and general cleanliness is good".

What has improved since the last inspection?

The requirements made at the last inspection have been met. The company has a good staff-training programme, which should help them, become more skilled. There was evidence that care plans are being written in a more person centred way and in consultation with the resident themselves or their representative and that reviews had been completed appropriately. The supervision process has commenced.

What the care home could do better:

Replace the broken vanity unit and faded carpet in identified residents bedrooms. The Registered person shall ensure that no one works at the home without obtaining suitable references and making sure that any disclosures have recorded risk assessments completed. The registered person shall ensure that hot water temperatures are controlled and monitored to reduce the risk of scalding to residents. The registered provider considers developing a holistic/person centred dependency tool that links to staffing numbers and skill mix to resident numbers and needs. The registered provider consider using dawn and dusk shifts, which span day and night shift hours as these, are the busiest times of each day/night.That intimate photographs are only taken where there is a defined clinical need that cannot be met in another way and where informed consent has been obtained to take the photographs. That at least 50% of care staff achieve NVQ level 2. The registered provider should ensure that end of life planning and personcenteredness is further developed. The registered provider should ensure that registered nurses learning needs are fully recorded and assessed at appraisal and access training for related to the Mental Capacity Act and other identified clinical areas.

CARE HOMES FOR OLDER PEOPLE The Laurels Nursing Home South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER Lead Inspector A Pollard Unannounced Inspection 14 October 2008 09:00 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 DS0000049317.V366846.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 DS0000049317.V366846.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER 01761 470631 01761 471351 Lreuropeancare@aol.com www.europeancare.co.uk European Care (SW) Ltd 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) Vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 36. 7th February 2008 Date of last inspection Brief Description of the Service: The Laurels is a care home operated by European Care, a limited company that operates numerous other care homes registered with the Commission for Social Care Inspection. The company has one other registered care home within Bath and North East Somerset. The home was first registered under The 1984 Registered Homes Act. European Care purchased and took over as the registered providers in May 2003. The home is an older detached property, which has been considerably extended and adapted. It is situated in the village of Timsbury, which is approximately 9 miles from the city of Bath. Accommodation is offered on two floors and there is a passenger lift between floors. There are a total of twenty-eight single bedrooms and five shared rooms. Only one of the single bedrooms offers en-suite facilities. There is extensive parking available to the side of the property. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that the people who use the service experience adequate quality outcomes. Part of this visit was to concentrate on checking whether the home had met the requirements of the last report. No surveys were available prior to this site visit and the ability of many residents to engage in conversations is limited. A number of staff the manager and programme manager were consulted during the visit. The home had submitted an Annual Quality Assurance Assessment prior to the visit which was well completed and gave useful information. There have been a number of improvements in quality of care in the home for residents since the last visit in February 2008. These are described in the sections below. This visit took two days to complete. Information has also been gathered from the Annual Quality Assessment Audit, the last report and notifications sent from the home to the Commission. Discussions were held with resident’s relatives and staff about their opinions of the care and service provided. The home is being managed by Flo chiminyo who has been in post since May but has yet to submit an application for registration to the Commission. She was present for both days of the visit, and was joined by a European Care programme manager on the second day. The key findings of this visit were given to the manager during the two-day visit. What the service does well: Staff we spoken with indicated that morale in the home was good. The atmosphere in the home was positive and calm. Staff were noted interacting with residents in a caring and friendly manner. The home was found to be clean, warm and free from unpleasant odour. Staff were cheerful and interacting with residents in a positive and caring manner. Residents were calm relaxed and looked well cared for. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 6 The recording of people’s fluid and food intake has improved reducing the risk of residents being malnourished or dehydrated. The home ensures that there are adequate numbers of staff to meet the residents’ needs. The home ensures that aids and equipment are provided in sufficient quantity to assist staff with meeting the needs of residents. Some positive comments received from residents included: I’m very happy here and well looked after” and “I am extremely pleased with the care” and “ the food and general cleanliness is good”. What has improved since the last inspection? What they could do better: Replace the broken vanity unit and faded carpet in identified residents bedrooms. The Registered person shall ensure that no one works at the home without obtaining suitable references and making sure that any disclosures have recorded risk assessments completed. The registered person shall ensure that hot water temperatures are controlled and monitored to reduce the risk of scalding to residents. The registered provider considers developing a holistic/person centred dependency tool that links to staffing numbers and skill mix to resident numbers and needs. The registered provider consider using dawn and dusk shifts, which span day and night shift hours as these, are the busiest times of each day/night. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 7 That intimate photographs are only taken where there is a defined clinical need that cannot be met in another way and where informed consent has been obtained to take the photographs. That at least 50 of care staff achieve NVQ level 2. The registered provider should ensure that end of life planning and personcenteredness is further developed. The registered provider should ensure that registered nurses learning needs are fully recorded and assessed at appraisal and access training for related to the Mental Capacity Act and other identified clinical areas. 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 DS0000049317.V366846.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 DS0000049317.V366846.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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients and their families are given relevant information and terms and conditions in written or verbal form about the home to assist them in deciding if the home is suitable for their purpose. As a result of effective assessment of needs prospective residents can be confident that needs will be met in a manner to suit the individual. EVIDENCE: A statement of purpose and service user guide is made available at the initial stage of enquiry to prospective residents/families. This provides useful information about the services available and includes the terms and conditions. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 10 There is a document giving additional information to prospective residents about how the company/home operates. The Statement of Purpose will need to be amended to show the change of manager and new activity organiser. We discussed the fact that they should include the categories of people they were able to care for in the home and the admission criteria. Visits by prospective residents to the home are encouraged either for the day or perhaps for lunch dependent on their wishes. The home has an admission procedure and pre-admission assessments based on the activities of daily living are completed. Post admission a more detailed assessment is carried out which along with the Social Services care plan (where appropriate) informs the care plan. All residents have Waterlow, handling, nutritional, falls and continence risk assessments. The assessments were fully completed and gave useful information to staff. The manager is committed to the full introduction of person centred planning to enhance resident’s quality of life. In support of this the senior staff will need training in the application of the “Mental Capacity Act” as a number of resident s have varying levels of dementia. A dependency assessment is also made which is regularly repeated although the relationship between this tool and staff skill mix and numbers was not clear. All of the residents are older people and are of white UK ethnic origin. The AQAA does not indicate any residents with particular needs related to sexuality. Individual assessments ensure that any specific needs i.e. spiritual/cultural are identified and included in the care support plans. The Laurels Nursing Home DS0000049317.V366846.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): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans detail residents care needs they are clearly written and give directions to staff. End of life planning and a person-centeredness approach needs further development to enhance quality of care for residents Appropriate personal and nursing care is offered to residents to maintain residents’ health, well being and dignity and residents are treated with respect and given choice in how needs are met. Proper arrangements are in place for residents to access healthcare services and for the administration of their medication to maintain or improve their quality of life. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 12 EVIDENCE: Several residents files were looked at, including assessments, care plans personal history profiles and risk assessments. The records showed consistency and were detailed and up to date. Where possible residents/relatives sign care plans and consents if the resident is unable to do so. It is accepted that the intention is to develop care plans with greater emphasis on developing a more person centred, holistic approach in the coming year. There is a stated aim to better involve family/advocates more comprehensively in the care planning and review process, which will support this. The intention is that each resident has a biography written and a person centred assessment of their wishes, likes and dislikes which will be at the centre of the service offered to provided more focus on the holistic and social model of care. This will supports people’s health and social needs including, psychological, emotional, and cultural needs and can demonstrate that the home takes a holistic approach to the provision of care putting resident wishes first. There is evidence of this approach being introduced in care plans reviewed. Regular evaluation of resident’s care plans was taking place although this generally seems to be a list of dated entries indicating” no change”. We discussed the value of an annual reassessment and care plan re-write (where indicated), which could be linked to Social services, review and involve residents or advocates. Risk assessments were in place with information to ensure safe procedures including, manual handling, and the correct use of bed rails and how to reduce the risk of falls. The accident policy requires that the risk must be reviewed after any accident or unexplained injury. Nutritional assessments are completed for each person and weights recorded monthly. Information about people who are having difficulty in eating or who will need a special diet is written in their care plan. However the are two different assessments being completed which in a number of cases give contradictory outcomes. The manager is to decide which is most appropriate. Wound care plans were present and were accompanied by wound assessment forms, which allow an assessment of the size and condition of the wound. These gave sufficient information to gauge any improvement or deterioration in the wound. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 13 The suction apparatus requires a ridged catheter to be available as well as a flexible type. The validity of taking photographs of resident’s pressure sores was discussed with the manager, as they seemed to serve no clinical purpose and are not researched based practice. The manager is to cease doing this unless directed by the Tissue viability nurse and should be done under controlled and repeatable conditions where consents had been given by the resident or their representative to take photographs. Formal end of life Care Plans are to be established in the home whereby residents/relatives are encouraged to think ahead about the care they would like to receive if their health deteriorates. Documents relating to advanced directions will require a mental capacity assessment to be carried out which supported the direction. The manager was to make enquiries about accessing training in this field. The home is considering the Liverpool care pathway training and documentation in the near future, which will further enhance this aspect of care. Each resident was referred to a GP on admission to the home and an initial first visit was then set up. The majority of residents are registered with a local surgery Policies and arrangements are in place for the storage administration, disposal and recording of drugs. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were up to date and in order. The storage and recording of controlled drugs was in order. None of the residents is self-medicating at the present time; appropriate procedures are in place to support this if need be. After reading the last report there appears to have been has been a general improvement in staff treating people with respect and upholding their dignity. Residents and staff spoken with supported this view. There was a warm cheerful atmosphere in the home. The staff/resident interactions were respectful and caring. Staff showed a positive attitude to their roles and responsibilities ensuring they provide quality of care to the residents. The Laurels Nursing Home DS0000049317.V366846.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 using available evidence including a visit to this service. There is some provision of meaningful recreation for residents but require a structured approach to have a more enhanced effect on individual’s quality of life. Mealtimes are sociable and pleasant time with food that residents enjoy and they are supported to eat their food if need be. EVIDENCE: It has been possible to recruit an activity organiser who will be taking post in the near future. Staff spend time with people in small groups doing activities although in an adhoc manner. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 15 There is an effort being made to offer social engagement with residents who are at risk of being socially isolated if they cannot or do not enjoy group activities. With no activity organiser residents are not assessed on an individual basis on admission to enable the staff to plan suitable activities relevant to their cognitive function and preferences. The staff have made a good effort to arrange social activities and a small committee formed to facilitate this. Activities programmes are displayed in public areas. Additional staff have been allocated in the absence of the activity organiser to enhance recreational and social activities. There is a record of activities that residents have participated in are recorded. The records go back to 2002 so can be thinned out. Special events including: harvest, Halloween, fireworks, Remembrance Day and a games evening are planned for the coming month. Various entertainers visit the home and various outing have taken place. The home shares a minibus with Rosewell nearby. A quarterly newsletter has been instituted recently. Resident’s benefit from services run by the local churches including weekly hymn singing and Holy Communion each month. A resident spoken with enjoys the service. At present there are no residents with specific cultural or religious needs other than those of a Christian background. A suggestion was made that the resident relative forum be combined, as there may be a limited number of residents who can fully participate. The manager is going to ask the activity organiser to chair most of these meetings. The menus are provided are four week rotational with seasonal variation. The menus are based on the outcome of a survey of resident’s preferences; there is choice for each meal. People are asked for their choices the day before and a record made of what they have eaten, although these were filled out inconsistently. Staff were seen to be assisting some residents on a one to one basis in a dignified manner. The cook is not always given information about people special needs in regards to their diet or preferences however she knows many of the residents and keeps her own record. Residents spoken with said enjoyed their meals and said the portions were sufficient. The Laurels Nursing Home DS0000049317.V366846.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 good. This judgement has been made using available evidence including a visit to this service. There are policies in place to protect residents, investigate complaints or manage allegations of abuse. Arrangements are in place for staff training in these matters so residents can feel safe and have their concerns dealt with. EVIDENCE: A copy of the complaints procedure is on display in the main foyer and bedrooms. The correct information is included in the Service User Guide provided to people on admission. The complaints policy and procedure is clear and contains the required information. No formal complaints have been received by the home since the last inspection. Two minor concerns have been recorded in the log one incident had recorded the action and the outcomes the other did not, however the manager stated it had been resolved to the satisfaction of the complainant. There have been no complaints received by the Commission since the last inspection. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 17 Several thank you/complimentary letters were seen from relatives on the notice board. The home has written procedures for managing adult protection and whistle blowing. The Local Authority ‘No Secrets’ document was available. Abuse and adult protection training is included in the induction workbook for all staff. Local Authority (LA) alerter training is being arranged for all home staff in adult protection procedures. The deputy manager has undergone higher-level training in adult protection and runs the house programme. Staff spoken with were aware of the basic procedures and none had seen any thing that gave them cause for concern. There have been no allegations of abuse. The Laurels Nursing Home DS0000049317.V366846.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): 19,20,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a safe and well maintained clean environment with good furnishing and décor, their needs are met by having bedrooms and communal rooms and facilities which are suitable for their purpose and meet the resident’s needs. EVIDENCE: It is planned to install a new shower in the home to offer more flexibility to residents, there is in addition a parker bath. One room has an en-suite bathroom. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 19 The maintenance man regularly tests and records hot water outlet temperatures, however these are often well below 40 degrees and the boiler has recently been repaired and services to raise water temperatures for heating and hot water. It is intended to install safety valves to all hot water taps in the communal baths, showers throughout the home if they are not already in place. The residents sitting in the communal areas appeared relaxed in their environment. Suitable dining room seating and table facilities are provided so that residents can enjoy their meal times comfortably and in a congenial setting. The home was found clean, warm, well lit and free from unpleasant odours. There is ongoing redecoration of rooms. Resident’s rooms were well furnished and had been personalised. Verbal comments were happy with the cleanliness of the environment and its upkeep. One bedroom required the replacement of a vanity unit and one had a very badly faded carpet that required replacement. The rooms were identified to the manager. Resident areas are fitted with appropriate aids such as grab rails, suitably equipped bathrooms and there are fixed and mobile hoists and stand aids. All rooms have a nurse call system with audible alarm facility. A range of pressure relieving equipment is in use and kept in stock. A passenger lift ensures level access throughout the home. The kitchen was cleaned to a high standard. However the cook had run out of the proper hot food probe wipes used to reduce the risk of cross contamination. Milton was being used as a temporary measure. The cook was hoping to have the food mixer replaced soon. The most recent Environmental Health report found all to be in good order. Sluice areas included a washer disinfector. The laundry has sufficient washing machines and tumble dryers. There are infection control, policies and procedures in place. Alcohol hand wash is available at the front door for all visitors to clean their hands. The clinical waste is correctly disposed of to prevent the spread of infections. The Laurels Nursing Home DS0000049317.V366846.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures and evidencing Criminal Records Bureau (CRB) disclosures require improvement to make sure suitable staff are recruited to care for residents and their protection. There are sufficient numbers of staff to meet resident’s needs. Progress is being made training care staff but Registered Nurse training needs more fully need to be addressed for the benefit of residents. EVIDENCE: At the time of the visit there were 30 people living in the home. In the morning 6 care staff and 1 Registered Nurse (RN) are on duty and an additional carer who takes responsibility for activities. In the afternoons there are 5 care staff and 1 RN and an additional carer as above. At night there is 2 carers and 1 RN, all are waking. The manager role is supernumerary Monday to Friday. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 21 We discussed changing the way staffing is determined. The manager stated that the dependency levels are reviewed to ensure appropriate skill mix and staff numbers although the direct correlation was not clear. A holistic/person centred dependency tool that links to staffing numbers and skill mix to resident numbers and needs could be researched and piloted. We also discussed using dawn and dusk shifts, which span day and night shift hours as these, are the busiest times of each day/night. The manager intends to consider these options in conjunction with a programme manager. All staff indicated that in the main there were sufficient staff on duty to meet residents needs and that morale was improved. There are satisfactory staffing arrangements for housekeeping, laundry, catering and maintenance. Some comments from residents about staff included, “the staff are very friendly” and “I’m happy here and well looked after”. The organisation has an equal opportunities policy and conducts diversity monitoring of staff. The recruitment records seen were generally satisfactory and met the requirements of the Care Home Regulations. Completed application forms, two written references, a statement of health and fitness to work, proof of identity and the persons qualifications are on file. However for those staff recruited through a student programme from outside the EU the references had been brought in with the staff rather than sent for by the home. In discussion with a Human Resources manager it was stated that this practice will no longer be carried on and all references will be collected by the home. Those existing references will be validated as need be. There has been successful recruitment of an activity organiser who starts in the near future. There was evidence that the home seeks confirmation from the CRB of the persons suitability to work with vulnerable people. The original disclosure form was kept until signed off during the inspection by a Commission inspector. A formal log has been created which records all the relevant details. The company policy is to renew the disclosures triennially. Three disclosure contained information and there was no evidence of a clear procedure for carrying out risk assessments where disclosures revealed convictions. The HR manager is to create a clear procedure to this and delegate responsibility for this to home managers with appropriate support if need be. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 22 The home uses a comprehensive induction booklet, which is given to new staff to work through when they start. The book contains sections on principles of care, safeguarding adults, person centred care and safe systems of working among others. It was accepted that less than 50 of care staff have achieved at least level 2 National Vocational Qualification (NVQ). The home is working towards improving the percentage of staff that have an NVQ level 2 in care. There are 15 care staff with at least NVQ level 2. We discussed the need to enhance the clinical updating for RN’s at a professional level in areas relevant to caring for older people. It was recommended that RN learning needs be fully assessed at appraisal and supervision and individual nurses equipped to have some expertise in various areas of clinical practise. Individual training records for RN will be updated to evidence they are meeting minimum registration standards for clinical updating. NMC qualification confirmations are checked for all RN’s annually. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36,37,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A manager is in post pending CSCI assessment. The home is making good progress in consulting with and getting the views of residents about the quality of care provided in the home so that they have their say in how the home is run. Staff supervision is taking place and appraisal is planned, which should lead to improvements in residents quality of life and development of staff skills in care. The health and safety of those who live and work in the home is essentially managed and promoted well. However there was one area of concern related to water temperatures. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 24 EVIDENCE: There has been a high turnover in registered managers. Ms Chimonyo has been in post since May but has yet to submit an application to the Commission. An application is expected to be submitted in the coming week. This continuing difficulty has inhibited progress in uplifting and maintaining quality in all aspects of the service and it’s rating. Ms Chimonyo is a registered nurse who was able to demonstrate an understanding of the needs of the individuals living in the home and considers she has a good team who are working to raise standards of care and quality of life for the residents. A deputy manager is in post to support Ms Chimonyo. The programme manager has been visiting the home regularly and is responsible for monitoring the home and carrying out monthly Regulation 26 visits and writing a report. The deputy manager and programme manager were present for some parts of this visit. Most staff had received supervision on a one to one basis, which has been delegated to RN team leaders and is now properly established. A Process is in place to conduct annual appraisals for all staff although this has not yet commenced but is expected to start in December. The procedure for safekeeping of resident’s money was examined. Each person has a ledger sheet, which accounts for all transactions and receipts for purchases are kept. The records were clear in good order and up to date. Valuables taken into safekeeping are to be returned to relatives if the resident does not wish to or is unable to keep it himself or herself. The fire alarm system is checked weekly and the maintenance checks of the fire fighting equipment and alarms are done regularly and relevant invoices seen. Staff are updated with fire safety training, the night staff having three monthly and the day staff six monthly updates. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 25 The home has appropriate moving and handling and pressure relieving equipment and that staff have attended updates on safe handling of residents and further training is planned The home employs a maintenance man who works full time; he completes weekly and monthly maintenance checklists. Records showed that relevant inspections and maintenance has been carried out at the required intervals for the fire alarms and equipment, electrical services, water, wheelchairs, hoists and lifts. The gas safety certificate was not available but the manager stated the inspection had taken place and will forward a copy of the certificate. It was not clear if communal baths and showers have thermostatic mixer valves as required. The monitoring of hot water outlet temperatures takes place but the records showed that in general temperatures were quite low often between 33 and 38 degrees centigrade. This was the result of a fault with the boiler which has now been resolved and hot water is now circulating at 50 degrees to stop growth of the legionella bacteria but creates a risk of scalding in baths, showers and basins. A pluming company has been contracted to review the provision and function of mixer valves to reduce risk to the residents. The company has appropriate Health and Safety (H&S) policies and procedures. The manager who has a degree in H&S management oversees General Health and Safety management. There is a process for accidents recording, however there have been none to residents or staff since the last inspection, the manager puts this down to improvements in care plans staff training and accountability through allocation. A discussion took place about accidents and the need to inform the All residents have risk assessments including tools for assessing and reducing the risk of falls. A Quality Care audit, looking at: strengths, weaknesses, opportunities and threats has been undertaken by the manager. The response to the questionnaire has resulted in creation of an action plan and a review will take place in January to assess the results. Weekly meetings are held between the manager and heads of departments and weekly trained staff meetings take place. There is a monthly SW manager group meeting with the programme managers. The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X x 3 3 3 3 3 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 2 x 3 x 3 3 3 2 The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP24 Regulation 16.2 (c) Requirement Replace the broken vanity unit and faded carpet in identified residents bedrooms. The Registered person shall ensure that no one works at the home without obtaining suitable references and making sure that any disclosures have recorded risk assessments completed. The registered person shall ensure that hot water temperatures are controlled and monitored to reduce the risk of scalding to residents. Timescale for action 19/11/08 2. OP29 19 (4) 01/11/08 3. OP38 13.4 05/11/08 The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations The registered provider considers developing a holistic/person centred dependency tool that links to staffing numbers and skill mix to resident numbers and needs. That intimate photographs are only taken where there is a defined clinical need that cannot be met in another way and where informed consent has been obtained to take the photographs. The registered provider consider using dawn and dusk shifts, which span day and night shift hours as these, are the busiest times of each day/night. That at least 50 of care staff achieve NVQ level 2. The registered provider should ensure that end of life planning and person-centeredness is further developed. The registered provider should ensure that registered nurses learning needs are fully recorded and assessed at appraisal and access training for related to the Mental Capacity Act and other identified clinical areas. 2. OP8 3. OP27 4. 5. 6. OP30 OP7 OP30 The Laurels Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Nursing Home DS0000049317.V366846.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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