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Inspection on 15/09/05 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 15th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

8 residents were spoken with in depth on 15th September. They all praised the atmosphere in the home. They found the staff kind, friendly and approachable. They were especially positive about the activities provided. They also said contact with friends and family was supported. The following is typical of the comments made: "very happy in here, looked after well, I have company when I want it." The three comment cards from service users did not contain any additional comments but made positive responses to the questions posed on the questionnaire. Some comments on the relatives comment cards included: " we are very satisfied with the care she is receiving" "the staff work very well and hard but they need more help" "when we made a complaint it was looked into and the matter has been put right"

What has improved since the last inspection?

The following comments are based upon sustained improvements noticed during the inspection on 21/06/05: The staff team have been maintained as far as the senior carers are concerned. This has had a positive impact on the continuity of care. They remain very clear about their responsibilities, which is very reassuring. Activities continue to be a major part of the daily life of the home. Whilst the activities programme was not examined it was evident throughout the inspection that the programme continues. Heath care needs continue to be closely monitored and safety checks requested are still being maintained. The recruitment of staff has been done in a measured way so that their introduction has not been disruptive to the running of the home. Trained staff competency is being assessed and recorded; this will continue to be monitored by the CSCI. Care plans are being still being reviewed monthly. Appropriate Manual Handling techniques were observed during the inspection.

CARE HOMES FOR OLDER PEOPLE The Laurels Nursing Home South Road Timsbury Nr Bath BA2 0ER Lead Inspector Kathy Marshalsea Announced 13 and 15 September 2005 th th 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 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 D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address South Road Timsbury Nr Bath BA2 0ER 01761 470631 01761 471351 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) European Care (SW) Ltd To be appointed Care Home with Nursing 36 Category(ies) of PD Physical disability,4 registration, with number OP Old age,36 of places The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 36 persons aged 50 years and over requiring Nursing Care. May accommodate up to 4 persons aged 18-64 years with Physical Disabilities. Staffing Notice dated 22/08/2001 applies. Manager must be a RN on parts 1 or 12 of the NMC register. Date of last inspection 21-Jun-2005 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 Laurels is registered to accommodate up to 36 older people who require nursing care. Additional conditions of registration enable the home to offer accommodation to four younger adults with a physical disability. 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 D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and conducted as part of the annual inspection process. It was conducted over two days. The home was served with 8 enforcement notices on 19th May 2005 and compliance with these notices has been checked at monitoring visits since then. The last notice to be complied with was for all staff to receive supervision; the date this should have been achieved by was 19th August 2005. There has been a change in the manager’s position as Mrs Honey left the home on 1/9/05. Mrs Sharon Read who was the deputy manager at the home has taken her position. The evidence for this inspection was collected in various ways: A review of various records, consultation with residents and staff, discussion with the management representatives, a tour of the premises, and observation of the interaction between the residents and the staff team. Six comment cards were received as part of the inspection consultation. Three from service users and three from relatives. Three immediate requirement notices were served at the completion of this inspection. These were with regard to: 1.Ensuring that all accidents/falls/incidents are recorded in the resident’s notes and that the care plans and risk assessments are reviewed in such circumstances. 2.Ensuring that the application by Mrs Read for registration as manager is received by CSCI no later than 23rd September 2005. 3.Staffing levels on 13th September 2005 were not sufficient to meet the needs of residents. It was required that 6 care staff are deployed on the morning shift, that this be kept under review and be increased if the dependency or occupancy levels increase. A further meeting is being held on 27th September 2005 between European Care, CSCI, Bath & North East Somerset Social Services and Bath & North East Somerset PCT. This is to discuss concerns that the previous manager left before she could be registered with the CSCI and to check upon the progress made now that the enforcement notices timescales have expired. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? The following comments are based upon sustained improvements noticed during the inspection on 21/06/05: The staff team have been maintained as far as the senior carers are concerned. This has had a positive impact on the continuity of care. They remain very clear about their responsibilities, which is very reassuring. Activities continue to be a major part of the daily life of the home. Whilst the activities programme was not examined it was evident throughout the inspection that the programme continues. Heath care needs continue to be closely monitored and safety checks requested are still being maintained. The recruitment of staff has been done in a measured way so that their introduction has not been disruptive to the running of the home. Trained staff competency is being assessed and recorded; this will continue to be monitored by the CSCI. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 7 Care plans are being still being reviewed monthly. Appropriate Manual Handling techniques were observed during the inspection. What they could do better: Maintain staffing according to dependency levels as well as occupancy levels. Improve the standard of cleaning Improve the records kept of residents’ monies and valuables Keep to a programme of re-decoration and refurbishment Risk assessments should be reviewed for the house, done for fire risk and all radiators and kept under review. Provide evidence of registering staff for their NVQ training Ensure recruitment procedures are robust Ensure staff are adequately inducted Put in place quality assurance monitoring Provide evidence of fire safety training at the recommended intervals Include the residents and/or their representative in the writing and reviewing of their care plan Record evidence of individual alternatives to the menu to show a true record of the food provided. Review the adequacy of current bathrooms. Consult the Health Protection Agency re prevention of legionella in unused showerheads. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 8 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 Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 10 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 standard(s) 1,3 Information for potential residents about the service needs to be brought up to date and more accessible. A thorough pre-admission process is now in place. EVIDENCE: The Service user guide was examined. It did not hold service user (residents) views, or the staffing structure within the home, it also did not give up to date information about staffing changes and the activities programme. Thought could also be given to making it user friendly for those residents who may have cognitive and sensory impairments. Pre-admission assessments have been sent to the Commission as part of the agreement made in July 2005. These have been comprehensive documents facilitating a decision about the suitability of a prospective placement. In one instance this information had not been used to ensure that equipment was in The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 11 place before the admission took place. When this was brought to the attention of the management team they ordered the piece of equipment immediately. Once an assessment of needs has taken place the home needs to write to the prospective residents confirming that they can meet those needs. This will be checked at the next inspection. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 12 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 standard(s) 7, 8, 9, 10 Residents need to be involved in the care planning process so that there are individualised goals and actions. Plans need to be reviewed after accidents to show that any risk is being minimised. Health care needs are well documented and specialist advice sought when necessary. Medication systems are well organised and comply with guidelines ensuring safe practice. After care of accidents is not well documented and auditing has not been analysed. This auditing could help reduce some accidents. EVIDENCE: Four care plans and relevant assessments were viewed as part of the case tracking process. Three were existing residents who are highly dependent; the other was for a recent admission. The first plan contained 6 elements of daily living that this resident needed assistance with. All had been reviewed monthly. The August review was completed by a new member of staff and did not give an accurate reflection of the risk of falls, which were tracked through the accident reporting. This was of The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 13 concern and pointed out to the acting manager. The risk assessments for this resident had also been reviewed; safety checks, which were prescribed in the care plan, were being completed. The social care assessment contained comprehensive information which is commended. Regular checks of this resident’s weight, blood pressure, and nutritional status were recorded. Other assessments were also present for determining any risk from Manual Handling and developing pressure sores. The plan for the newest resident was adequate. Comprehensive information was recorded on the day of admission on the admission form. This gave important information about a variety of holistic needs including previous hospital acquired infections. The Social Services plan (CM4) gave relevant information about the family history and previous interests of this person. This is vitally important for this resident who cannot communicate effectively. The plan was dated the day after admission to the home. This contained confusing information about the status of a hospital acquired infection. This needs to be clarified. It also requested hourly checks for this resident’s safety which were being recorded. Weekly tests of blood sugar were not; this was to be checked by the acting manager who was unaware of this request. There also had been some additional risks after admission, which had not been risk assessed. These were pointed out to the management team. The third plan was satisfactory. This had been checked at previous visits and had been kept up to date. This was the same situation for the fourth plan. There is still no evidence that the resident themselves and/or their representative are becoming directly involved in the plan of their care. There was plenty of evidence of health care needs being met. Records were kept of any visits by the GP and any actions needed to be taken as a result of the visit. The records for accidents within the home were checked. One resident had an unwitnessed incident where they were found in their room having come out of their bed. It was noted that this accident had not been recorded in their daily notes, nor had the risk assessment for falls been reviewed. This is of concern as it does not show that the home is taking steps to minimise any risk for this resident and so an immediate requirement notice was issued to prevent this happening again. It was noted that although accidents were being audited monthly there was no action plan produced as a result of this audit. This would be in line with best practice and show a commitment to the reduction of risk. Medication systems were examined. The home is working in accordance with its own policies, which includes the homely remedies policy. The records of those residents who are taking Warfarin were greatly improved since the last The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 14 inspection. It is now clear which is the current dose and has supporting evidence of that prescription. There were also parameters for when a tablet may not be given, for example Digoxin. There were two gaps on the administration charts making it difficult to determine if that medication had been given or just not signed for. The inspector was concerned that one resident had not been taking medication prescribed to them. It was stated that their GP had been informed of this persistent refusal. The home is using safe disposal for waste medicines. This is in accordance with new procedures and legislation. The home has a contract with Pharmacy Plus who are licensed for this arrangement. Any controlled medicines are being “de-natured” before being handed to the waste disposal company in line with correct procedures. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 15 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 standard(s) 13, 15 Residents maintain contact with friends and family as they wish. Residents are being provided with meals which meet their dietary needs and are thoughtfully prepared and presented. EVIDENCE: Residents spoken with said contact with friends and family was supported and several gave examples of when they would be seeing friends or family members that day or in the near future. Whilst the activities programme was not looked at in depth, residents spoken with made very positive comments about the activities they have and especially about the Activities Co-ordinator. Since the previous inspection, the chef has left. The longstanding part-time cook has stepped in to work full-time on and interim basis until a new cook or chef is appointed. Other staff are cooking on her day off. All kitchen staff have updated their food hygiene awareness training. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 16 A number of residents have a diabetic diet and one resident has a gluten-free diet. Appropriate ingredients for these meals were present. Stocks of food and delivery schedules for fresh produce adequately reflected the size of the home. The record of meals showed nutritional balance. Evidence of individual alternatives to the menu need to be recorded to show a true record of the food provided. Residents’ comments about the meals ranged from “not too bad” to “good”. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 17 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 standard(s) 16, 18 No complaints had been received since the last inspection. Staff have received training in abuse and should be able to be confident in taking appropriate actions if need be. EVIDENCE: There were no recorded complaints since the last inspection. The Commission has not received any complaints about the home. It was noted that the home did not have a copy of the organisation’s updated Protection Of Vulnerable Adults policy. This was requested during the inspection and a copy given to the inspector. It was noted at the last inspection that staff and changed their practice after attending training about Abuse. This training is ongoing and had been offered to staff in August 2005. This had been attended by 10 staff over days. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 The age and layout of the property causes particular problems which are not easy to solve, but a lot of thought is being given to make the most of the indoor and outdoor communal facilities given these limitations. A systematic and comprehensive programme of re-decoration and refurbishment needs to be reactivated and then sustained. Bedrooms are personalised and comfortable. Most current bathrooms are no longer suitable to meet the needs of current residents and there needs to be a fundamental review of these facilties, including their décor. They would benefit from being made more homely and promoting a relaxing and enjoyable experience rather than just being functional. The standard of cleaning again needs to improve and be sustained at that improved level. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 19 EVIDENCE: It was evident after touring the building that the programme of re-decoration is not keeping up with need. A number of bedrooms on the ground and first floors of the older part of the building are in need of re-decoration. Routine maintenance records showed a prompt response to requests and where this was not possible a referral made to the relevant specialist for help. On the second day of the inspection, damp ingress caused by recent wet weather was noted in one bedroom: this was brought to the attention of the onsite maintenance person who undertook to arrange for the roofer to attend the next day. If this problem is not able to be remedied promptly, a risk assessment as to the health and safety of that room for the occupant will need to be done and its outcome actioned. There are few signs on doors to promote orientation and independence. It was noticed that there were also no orientation aids in communal areas. Pictorials signs would be a useful aid on bathroom and toilet doors. Décor remains essentially clinical i.e. no borders/ornaments/softening colour schemes. There is only one bathroom which is fully accessible i.e. can be accessed by carers from both sides. There are still no locks on bathroom and toilet doors or residents’ bedrooms. This has been subject to requirement at previous inspections. The home are trialling a new lock and if successful will be fitting it throughout the home. Grab rails are present in toilets. There are also hoists and a stand aid. Some pole hoist seats in baths showed signs of flaking paint: this needs prompt attention. Call bells were heard during the inspection and records showed that they are all checked monthly. Some carpets in bedrooms are looking worn now. There are plans to begin replacing those and providing curtains as the home just has blinds in the bedrooms. It was noted that there were not always easy chairs in bedrooms. The inspectors were told that this is due to some being removed and not yet being replaced. The home does not have guards on any radiators. It was agreed that these needed to be risk assessed and any covered where deemed necessary. A representative stated that the intention was to cover all radiators. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 20 Water temperatures are checked monthly to ensure that they comply with recommended temperatures. Bathroom hot water taps were tested by the inspector and found to be satisfactory. In one bathroom, there was a showerhead which had not been used for some weeks if not months. The Health Protection Agency must be consulted to advise on the prevention of legionella in such outlets. The standard of cleanliness was noticed to be unsatisfactory on the first day of the inspection. The inspector was told that two domestics have left and are yet to be replaced. The standard of cleanliness had improved noticeably by the second day of the inspection although some high cleaning is needed. The laundry was checked and found to be working to control the spread of infection and within professional guidelines. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 21 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29, 30 The carers have provided a stable team who have ensured that there is effective communication and continuity of care. The home is not on target to have 50 staff trained in NVQ by the end of 2005. Recent recruitment did not follow robust procedures. There is a training programme but staff cannot always attend. Induction programmes had not been signed off to reflect a staged induction. EVIDENCE: Two staff currently have a certificate in NVQ. Two carers are registering to do theirs. With the recent departure of the previous manager Mrs Honey, the home does not have an assessor within the staff group. The home is not on track to meet the target of 50 of their staff having achieved their NVQ by the end of this year. The recruitment records of recently employed staff were examined. The exmanager had employed two staff. These records showed an inconsistent approach and records were not completed according to strict guidelines. This was of concern; one did not show that gaps in employment had been explored. The application form was also not fully completed and relied upon a C.V. References were fax copies, no original copies were present. The second staff member has also not completed their application form adequately. There were no dates for employment and a christian name only given for one referee. The character reference was from a colleague working The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 22 at the home. This staff member had worked at the home previously and there was no evidence of any discussion about why they wanted to return. This lax approach does not show that the recruitment process is protecting the residents. These deficits were passed onto the management team. Staff have all been given copies of the GSCC Code of Conduct. This was verified in their files. There is a training programme supplied by Hygea. Monthly sessions are held and staff from the organisation’s 3 care homes locally are invited to attend. Since May 2005 the following sessions have been arranged: Manual Handling Treat me right Essential Dementia care Fire safety, Health & Safety, COSHH First Aid Understanding abuse Individual records showed that staff have been able to attend some sessions. However, the uptake for fire safety in July 2005 was very poor, only 2 staff attended from the Laurels. The home’s regional manager stated that some fire training had been organised in June 2005 but no staff had taken the opportunity to attend. There was no evidence that night staff are receiving their 3 monthly fire safety update according to recommended timescales for training. Induction records were also examined. One programme had been signed off all in one go. This does not demonstrate a systematic approach to an individualised induction, which should be conducted over several weeks. Another member of staff had no record of induction. It is thought that they may have taken it home. This could not be evidenced as the member of staff was on sick leave. The clinical assessment of a registered nurse showed some deficits in cultural and regulation knowledge. This is to be addressed by the new manager. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 38 The home does not have a manager who is registered with the CSCI.This is of concern as this registration has not been achieved for some time. Records of monies and valuables held must be improved to satisfy the auditing system. There has been formal supervision of staff; this must be sustained to satisfy the enforcement notice issued in May 2005 regarding this matter. Health & Safety issues need to be managed to ensure the safety of staff and residents. EVIDENCE: The acting manager, Sharon Read, is now managing the home. This commenced on 5th September 2005. The previous manager had left before completing her fit persons process with the Commission. An immediate requirement notice was issued for an application to be received from her no later than 23rd September 2005. The line management for the home is due to be changed from the end of September. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 24 The new manager had already held a staff and residents meeting. She stated that she wanted to reassure everyone that she planned to stay at the home and shared her plans for the home with them. The home has not yet undertaken internal audits to ensure that they are delivering quality care and meeting the residents’ expectations. The management team were asked to produce an annual plan for the home, which should include a business and financial plan. This will be checked at the next inspection. The home’s policies and procedures were not examined: it was suggested that the commission’s provider relationship manager assess the company’s policies and procedures. The records for residents’ money were checked. There was no balance sheet for two new residents despite the fact that they both had money being held for them. The inspector required that this was corrected immediately and this was done. It was not possible to check the amount of money held in relation to the balance sheets as the money was kept in sealed envelopes. It is recommended that more information is given on the balance sheets e.g. when cash is given. The records and amounts held tallied for two residents whose money was kept in a purse. It was noticed that money and a building society book was still being held for two residents who no longer live at the home. It is required that these items are returned. Supervision sheets were seen for four members of staff. This area was subject to an enforcement notice in May 2005. These sessions were completed in June 2005 and the commission have requested evidence that all staff have received supervision and that they will continue to do so at the recommended timescales. Health and safety records were checked. Generic risk assessments for the house had been completed in May 2004. It is required that these are reviewed. The fire log showed that safety tests are checked at the recommended timescales: the records of fire safety inductions for new staff had not been completed since 1/8/04. There were also no training records in the fire log. Also absent was a Workplace Risk assessment. Records show that safety tests are conducted for equipment in the home. Regular inspections of fixed and portable hoists are due. The Commission receive Regulation 37 reports from the home when an incident adversely affecting the residents occurs. They also receive reports following the organisation’s monthly visits to the home. It was noticed that The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 25 these reports were a shorter version than the home has, which do not contain an action plan. It was requested that the detailed reports are sent to the Commission and the senior management representative present agreed to do this. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 2 2 2 2 2 1 STAFFING Standard No Score 27 x 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 1 2 2 x 1 2 x 2 The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 27 YES Are there any outstanding requirements from the last inspection? 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 8 Regulation 13(4)C Requirement To record all accidents/falls/incidents in the residents notes and for the care plan and relevant assessments to be reviewed.. To receive a completed application form from the acting manager. For staffing levels to be maintained at 6 carers in the mornings, and keep the adequacy of the staff numbers under review, and increase if either the dependency or occupancy levels increase. For a good standard of cleanliness to be achieved and maintained. For monies received for safe keeping to be recorded and the purpose of the transaction kept. Valuables kept need to be returned and a written acknowledgement kept. Provide evidence of the intention to provide NVQ training for staff. Ensure that gaps in employment histories are explored and relevant references sought. Ensure that staff are adequately Timescale for action From 15/09/05 2. 3. 31 27 CSA !!.! 18(1)(a) No later than 23/09/05 From 15/09/05 4. 5. 6. 7. 8. 9. 27 35 35 28 29 30 16(2)(j) Sch..4.9 Sch.4.9 18(1)(a) 19(4) 18(1)ci Form 13/09/05 From 13/09/05 By 30/09/05 No later than 07/10/05 From 15/09/05 From Page 28 The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 10. 11. 33 38 24(1)ab 23(4)d inducted and records kept.This includes agency staff. Put in place effective quality assurance monitoring. Suitable fire safety training must be provided,with records kept, at the timescales recommended by Avon Fire Brigade. Risk assessments must be completed for all radiators in the home.Also a Workplace Risk assessment for fire safety. Care plans should be signed by the resident and/or representative. The Service User Guide needs to be amended and updated. Confirm in writing to any prospective service user that the home can meet their needs. 15/09/05 No later than 15/12/05 No later than No later than 15/12/05 from 30/09/05 Noj later than 15/10/05 From 30/09/05 12. 38 13(4)c 13. 14. 15. 16. 7 1 3 15 5 14(1)d 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. 7. 8. Refer to Standard 21.2 22.6 24.2 24.5 30.4 33.2 35.6 Good Practice Recommendations To use clear signs on bathroom and toilet doors. To use orientation aids in communal areas. To provide comfortable seating for 2 people in bedrooms. To offer the installation of keys for bedrooms To keep individual staff training development assessments and profiles. For to be an annual development plan for the home. To keep a receipt of possessions handed over for safe keeping. The Laurels Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 29 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG 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 Nursing Home D56_D05_S349317_TheLaurels_V242499_130905_Stage4.doc Version 1.40 Page 30 - 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. 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