Inspection on 19/04/07 for The Laurels Nursing Home

This inspection was carried out on 19th April 2007.

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

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

Other inspections for this house

The Laurels Nursing Home 14/10/08

The Laurels Nursing Home 07/02/08

The Laurels Nursing Home 04/12/07

The Laurels Nursing Home 05/01/07

The Laurels Nursing Home 26/04/06

The Laurels Nursing Home 15/09/05

The Laurels Nursing Home 21/06/05

The Laurels Nursing Home 10/09/04

The Laurels Nursing Home 07/05/04

The Laurels Nursing Home 25/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Laurels Nursing Home South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER Lead Inspector Kathy Marshalsea Key Unannounced Inspection 19th & 20th April 2007 09:30 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.V335161.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.V335161.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 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.europeancare.co.uk European Care (SW) Ltd To be registered-Mrs Lesley Weir Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (4) of places The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 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. May continue to accommodate named persons who require dementia care. Any further admissions of service users with a definitive diagnosis of Dementia or Alzheimer’s disease is prohibited until an application to change the category of registration to DE(E) has been approved by the CSCI. From the 12th July 2005 until the 5th December 2005, European Care (SW) Ltd shall not admit any service user to the Home unless it has given a representative of the Avon Office of the Commission for Social Care Inspection prior notification of the proposed admission of that service user to the Home. 28th February 2007 7. 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 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 DS0000049317.V335161.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was part of the homes key inspection and was conducted over 2 days. The inspector was joined on the first day of the inspection by her line manager. The manager of the home, Mrs Lesley Weir, was present for both days of the inspection. The programme manager, Chris Ashton, was also present for part of the first day of the inspection. In order to gain as much information as possible about life within the home, survey forms had been sent to the home for completion by service users (residents), relatives, and visiting healthcare professionals. While only a few of these were returned to the Commission, information in these was used as part of the inspection process. There were 28 residents in the home during the visit, with one resident being in hospital. Mrs Lesley Weir has been managing the home since September 2006. This is her second inspection with the Commission. It was evident during this visit that there had been many positive changes made by her, which has had a significant impact on the quality of life of the residents living in the home. All of the requirements made at the last inspection related to the care of the residents, which Mrs Weir has direct control over, have been met. This is commended. The home is currently going through a difficult period of having enough permanent staff to provide a consistent quality of care for the residents. There has been a history of poor retention of permanent staff in this home over the last few years. This will be explored further in the relevant section of the report. Despite these difficulties, there has still been progress made from the last inspection and this has meant that the quality rating of the home has improved from a home that was of concern to a home that is now adequate in it’s standard of care. There was only one immediate requirement made at this inspection, and this was in relation to the care of one particular resident. This concern was addressed by the manager of the home and actioned within the timescales given. The three enforcement notices served upon the home in March 2007 were checked for compliance during this inspection. The two notices related to accident after care and care planning have been met. The other notice related to reviewing the quality of care by the home and organisation are to be discussed at a meeting arranged for 10th May 2007. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 7 Any residents that have been identified as being at risk nutritionally now have actions set in place to minimise that risk. These include these residents being weighed regularly, referrals being made to the dietician by the GP, supplements provided, and an enriched diet. Regular weights recorded prove that resident’s weights are now being kept stable. The home now uses a recognised induction programme and also new staff are sent on an external induction programme, this should mean that staff are competent. Most staff in the home have now been enrolled on their National Vocational Qualification (NVQ) course, and indeed their induction was on the second day of the inspection. The systems for recording fluid and food intake again have been kept up since the last inspection. This should make sure that residents have enough to eat and drink, when they don’t this is reported to the nurses. The majority of the staff have now received training in the care of dementia, this was a two-day course. One member of staff gave the inspector examples of how this has changed the way she looked after the residents. This should lead to staff generally having a better understanding of the care of older people and the concept of person centred care. Staff have also been enrolled onto a course for Bath and North East Somerset Social Services – Protection of Vulnerable Adults. There continues to be a consistent and firm approach to any disciplinary matters resulting in the home. This has also led to some staff having to leave the home because of their poor practices. Recruitment procedures are now robust and should protect the residents from any unsuitable staff being recruited. What they could do better: Ensure that any instructions in the care plan are communicated to all care staff and that the registered nurses ensure that these instructions have been actioned. Record any spontaneous social time spent with any residents by any member of the staff. This should also go hand in hand with ensuring that the key workers are able to spend quality time with the residents in their care. This should be particularly so for those residents at risk of being socially isolated in their rooms. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 8 The retention of staff could be improved by members of the existing staff team accepting new members of staff into the team. This has been an ongoing issue within the home; this includes the accepting of agency staff, and has led to the current situation of their being an inadequate number of permanent staff within the home. This is having a negative impact on the quality of life for the residents, and for the consistency of care in some instances. The registered nurses need to have some training in the delivery of constructive supervisions. Staff need to receive regular structured supervision sessions to support them in their job. Clear goals need to be set for poor practices and these goals checked regularly. Now that staff are working days as well as nights, they will need to receive a 3 monthly update in fire safety training to keep all those in the building safe in the event of a fire. The information given in the monthly provider reports of visits in line with Regulation 26 reports, need to include progress with requirements and recommendations made at the previous inspection. The results of any quality assurance monitoring needs to have an action plan produced, and this needs to be communicated to all those interested parties. 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.V335161.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good use of pre-admission assessments makes sure peoples needs are picked up and met. EVIDENCE: Two pre-admission assessments were checked to ensure that people were being admitted to the home only on the basis of a full assessment. Both assessments were comprehensive and in one instance had been signed by the resident themselves. Particular attention had been paid to highlight any risks identified at this stage. There was also in both instances, a comprehensive assessment on admission to the home. These gave clear instructions to staff to be able to meet the person’s needs while a longer term assessment takes place. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 11 Since the last inspection the manager has not admitted any resident who has a primary diagnosis of dementia, as was agreed at a multi-disciplinary meeting. She had arranged for most of the staff group to have training in a two-day course of dementia care which happened prior to the inspection visit. Two members of staff who had attended that training spoke to the inspector about their experience of this training. Both stated that they found this training very useful and had been able to discuss residents in their care during this process. This has enabled them to have more understanding of the way some residents behave when they develop dementia. They also stated that it improved the empathy they are able to feel towards residents generally. At the last inspection it was identified that one resident had particular communication difficulties that had not been recently assessed. A requirement was made for this to be done. Although this referral has been made, the Manger was told that due to shortages in the NHS this assessment has not taken place. However, staff are now using word and picture charts to enhance the way they communicate with this particular resident. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are looked after well in respect of health and personal care needs and are in the main, treated with dignity and respect. EVIDENCE: Six care plans were checked to ensure that resident’s health, personal and social care needs are set out clearly in individual care plans. As mentioned previously new residents have a plan of care which is generated from a comprehensive assessment, which is drawn up with the resident and now provides the basis for the care to be delivered. Plans are reviewed by the staff at least once a month, and where changes take place. This means that they reflect changing needs. In most instances the plans are written in the first person giving a very clear and powerful message to the staff about how the resident prefers their care to be delivered. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 13 It was also evident from the care plans where resident’s condition had changed, for one fairly new resident this had shown an improvement to their condition since admission. This was reflected by this person’s relative who spoke with the inspector. They said how delighted they were with the positive changes and was very happy with the care given by the staff. Relevant healthcare assessments were also present and checked regularly. Where necessary these were developed into risk assessments of their own for example for the risk of the resident developing a pressure sore or the risk of them falling. In all instances there was also a detailed social care assessment which includes a life history and significant events within the person’s life before they came into the care home. There was more specific details for example which particular music the person might like to listen to and which TV programmes they preferred. People’s religious beliefs were also described. The registered nurses as well as the care assistant write daily notes to record their interactions with residents. In most instances there is also now an end of life plan which also is signed by the resident themselves or their relative. This means that staff are aware of the persons wishes when they die. The care plans are now kept in each resident’s bedroom, this should enable staff to be fully informed of the residents needs. Unfortunately in one instance this had not been the case, as one resident identified as being at high risk of falls had in their care plans that they would have a crash mattress by the bed at night, and have one to two hourly checks by staff day and night. On the day of the inspection the crash mattress had not been used the night before, nor was there any evidence of staff going in to regularly check this resident for their safety. Staff spoken with who were caring for that resident on that particular day did not convey any sense of urgency about the regular checks for this resident, nor were they recording these checks. The manager was asked to find out why the crash mattress hadn’t been used, and to instigate a chart to enable staff to evidence that they were regularly checking this resident. It was also requested that there is some recording of the trigger for this resident to actually try to get up. This will be checked at the next inspection. It was noted that consent forms were being used for any form of restraint; this includes the use of bed rails and also wheelchair or armchair straps. The use of consent should be checked regularly to make sure that it is still suitable. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 14 The home had recently received a visit from the pharmacy inspector who thoroughly checked medication systems. The inspector observed the administration of medicines on the second day of the visit at lunchtime. Two trained nurses with two drug trolleys did these separately. In one instance although the registered nurse locked part of the trolley, she left the ring binder of medicines on top of the trolley. This was in the corridor of the home near the dining room and front door. The second nurse did not do this. One resident’s medication was not able to be given due to the fact that it was not available. It had not been administered for two days. The nurse was not clear about whether this had been ordered or not but was prompted to check by the inspector. Otherwise the administration of medicines was done satisfactorily. It was noted during the visit that residents were treated with respect and that their dignity was upheld. This had improved since the last inspection. There is also an improvement in the way staff talk to the resident before they commencing any sort of task, for example while moving them from a chair to a wheelchair. It was also noted that residents were being assisted with their meals, at the resident’s own pace, and the communication had improved. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most residents are benefiting from the attention of an Activities Coordinator who is developing a programme of individual and group activities. EVIDENCE: Since the last inspection an Activities Coordinator has been appointed. This person undertook training specific to his role at the organisation’s other home in the area. Regular activities include music, bingo, playing cards and ‘making friends’ as part of the weekly programme. On the first day of the visit there were residents observed watching television in their rooms, listening to music and playing games. The Activities Coordinator offered foot massage to residents during the latter part of the first visit day. Religious services are held within the home on a monthly basis for those of the Church of England faith and two weekly for those who are of the Roman Catholic Church. The Activities Coordinator is negotiating the celebration of Holy Communion within the home. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 16 On touring the premises it was disappointing to note that several residents’ Christmas gifts were left in bedrooms unused. It was recommended that there needs to be more attention to individualised activity by care staff, for example by spending time with residents, to encourage them to open and make use of their gifts. The Activities Coordinator does offer residents the opportunity for individual time in their room and this was observed during the visit. The Coordinator advised of a relatives meeting that had been held and of how one resident, who had previously refused, was now participating in activities. A weekly record of activities is maintained and attendance/participation of individuals is recorded. Further development of recording of individual engagement with residents and activity is needed. The home has several communal areas. The larger of these are designated either as lounge space or for dining and there is a smaller area that is used as a quiet area, for when relatives visit and when the hairdresser is at the home. During the last inspection a two tier/sitting for meals was introduced due to the mealtime being chaotic. During this visit there was feedback from one service user about the lounge area being cramped and this was observed to be the case by the Inspector. It was suggested that each of the two larger communal areas could be used for both lounge and dining space. The system for meal delivery could remain as two sittings with the serving of meals being at different times for each dining area. It was noted that many of the residents struggle to walk from the current lounge to the dining room and this may help to alleviate difficulties. Some residents commented that they spend long periods in the dining room before they are served and after they have eaten their meal. Reviewing these arrangements may have a positive effect on the participation of residents in group activities. The home provides meals according to menus provided by the organisation however, steps are being taken to accommodate ‘local’ preferences. On the first day of the visit the lunch comprised of broccoli soup followed by a choice of chicken casserole or ham and egg salad. To follow there was a choice of banana with custard, ice cream or yoghurt. Where service users expressed a wish for an alternative this was provided. Food samples are retained and dated in line with food safety legislation. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good management of complaints and safeguarding of people who use the service from abuse keeps them protected. EVIDENCE: Complaints received since the last inspection were looked at to ensure that complaints were taken seriously and acted upon. One complaint had been received recently from a relative, which came in while the manager was on holiday. At the moment she is in the process of investigating this. This therefore will need to be looked at during the next inspection. One of the roles of the two appointed dignity champions is to ensure that those residents that may not be able to communicate fully are given the chance to make their complaints known. The inspector spoke with one of these dignity champions; they have been given some literature from the manager to enable her to fully understand her role. As this process is still ongoing this will be checked in full during the next inspection for its effectiveness. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 18 Since the last inspection the manager had received two allegations of abusive practice by staff. She responded positively to these incidents, and informed all the appropriate agencies. In both these instances the staff were dismissed due to either misconduct or abusive practices. Both members of staff were also referred to the Protection of Vulnerable Adults List. This should protect residents in other homes from being cared for by these two unsuitable people. The manager and senior staff have booked to attend the BANES Social Services Alerters training course, and other staff are also going to be going to the same course. The inspector spoke with one care assistant about her reactions to a possible abusive incident. The carer was very clear with her own responsibility in ensuring that this was reported to the appropriate people, even if this meant contacting the line manager if it wasn’t dealt with sufficiently in house, or the Commission for Social Care Inspection. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home that is generally clean and tidy with attention needed to upgrading and refurbishment for their comfort and protection. EVIDENCE: During the inspection visit the home was noted to be generally clean and tidy and the ‘special’ efforts of the staff team to maintain the environment was noted. For example there was carpet cleaning during the evening before the visit and a member of staff was observed cleaning a furniture item. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 20 In spite of this the tour of the premises highlighted some areas in need of cleaning. These were specifically a bath hoist, chair, WC and commode as pointed out during the tour. There were some commode chairs that were in need of repair or replacement and the door to a WC on the first floor would not close properly. A trip hazard noted on the ground floor on the first day of the visit was subsequently repaired. The organisation is in the process of replacing beds, as appropriate, to enable residents the use of equipment more suited to their needs. For some these are equipped with side rails to offer protection from falls for others, so that poorly fitted rails are being replaced. The manager pointed out that good progress has been made in this area, and is hoping that the other 10 ordered beds will arrive shortly. There is also an ongoing programme for the installation of protective covers to radiators. Progress in this area has been slow and whilst it might appear not to be a priority during warmer weather this is not the case as some radiators both within residents’ room and in corridors were very hot to touch. There are new windows (sixteen) being installed to one area of the building. The manager advised that there are plans to convert the bathroom on the first floor into a ‘wet room’. This will enable residents to shower and possibly alleviate some of the demand for the ground floor bathroom where staff reported some water temperature problems. A further ground floor bathroom is to have a specialist bath installed and this is dependant on the installation of new flooring and suitable electricity supply. The kitchen was viewed and it was pointed out that new flooring has been laid. The food stores were orderly however it was felt by staff that there is a lack of space for items that require refrigeration. During inspection of the kitchen, after lunch on the first day of the visit, it was noted that there were 74 litres of milk being stored. The cook advised that the delivery for the next day had been cancelled. Better organisation of milk deliveries should resolve this issue. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are adversely affected by the fact that there are not enough staff working at the home so agency staff are used alot. EVIDENCE: It was confirmed during the inspection visit that residents do not always receive a consistent quality of care, this is partly dependant on which staff are on duty, and partly due to the fact that so many agency staff are being used in the home at the moment. This was also mentioned in several of the survey forms received, and from residents and relatives spoken with during the inspection days. The Manager confirmed that on most days during March and April there were at least six hours of agency staff needed both day and night. While the home does endeavour to book the same agency staff it is not always possible. There are only six permanent care staff at the moment with one new carer just started in post. However this number does contain three senior carers that have been at the home for some time. Now that there is internal rotation, the registered nurses also do nights as well as days. There are only four permanent trained nurses working in the home at the moment. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 22 Residents spoken with during the inspection visit expressed their displeasure at having two full days of agency staff in the home, with the manager also present. This was in order to allow all of the staff to attend the dementia training previously mentioned in this report. It was not possible to look at some old rotas, so the inspector tracked the number of staff on duty by looking at timesheets. The manager was requested to keep old rotas certainly between inspections. As mentioned previously there were only 28 residents in the home during the inspection visit. Where possible there are two trained nurses on duty in the morning and at the moment there are five care assistants in the morning and four in the afternoon. It was evident again that while there are sufficient numbers of staff on duty the quality of the care delivered is not always as it should be. The manager of the home is addressing this. Ideally this should be a process that is dealt with through supervisions with clear goals set for improvements of poor practice. Due to all of the demands on the manager it has not been possible for her to do the supervisions and the trained nurses are not yet competent to do supervisions in a way that would be useful in this instance. In order to help the manager with this situation some representatives from the Human Resources department of the organisation, are coming to the home after the inspection to try and deal with these performance issues. This also includes the problem of some staff bullying new and agency staff. Since the last inspection, most of the care staff have now been enrolled for undertaking a qualification in NVQ for care. On the second day of the inspection visit a representative from the training body came to carry out the care staff’s induction for their NVQ. It was also seen in training files that the domestic staff have completed their NVQ level 2 in cleaning. The recruitment process was checked to ensure that this was based on equal opportunities and protects the service users from unsuitable staff being employed. Three members of staff recruited since the last inspection had their records checked. Two written professional references were taken up for two members of staff and one for the third member of staff prior to being offered work in the home. The manager stated that a second reference had been received but couldn’t be found. In addition all staff signed to declare that they have not a criminal offence prior to employment. They also have a Criminal Records Bureau Check completed before employment starts which includes a POVA “first” check is done. These checks are a further safeguard to protect vulnerable residents. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 23 To enhance the information gained before employment, there was also a completed medical questionnaire and evidence of qualifications, this was particularly so for the registered nurse employed. There were also job descriptions and contracts in place. Unfortunately due to the demands on the manager she has not been able to continue the monthly training sessions that she was holding previously. A copy of the training matrix was given to the inspector in some mandatory topics such as moving and handling, fire safety, food hygiene, and control of substances hazardous to health. A check needs to be done of this matrix to ensure when staff need to do their next update in each topic, and for those staff that had missed sessions such as moving and handling that they are actually booked on another course in the near future. Some individual training records were checked. Three members of staff attended the Mental Capacity Act in 2007.There has also been training in infection control, moving and handling, the dementia training mentioned previously, some fire training and some first aid training. This topic will be looked at in more detail during the next inspection. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has shown her competency at running the home but needs to have practical support to be able to continue improving the quality of life for the residents. EVIDENCE: The acting manager has been in post since 28 August 2006. She has now submitted her application to be the registered manager of the home with the Commission. Mrs Weir has been able to demonstrate her commitment to improving standards within the home and meeting the requirements and recommendations made at inspections. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 25 She is supported by a programme manager who visits the home fortnightly and completes a Regulation 26 report as a result of that visit. These reports are now being sent to the Commission. Most of the comments made about Mrs Weir’s leadership were very positive. Two survey forms received from relatives stated that they felt the home was improving under her care and that generally standards were improving. They also commented how pleased they were that she had stayed when so many managers over the last couple of years haven’t. Some positive comments on survey forms included, “Under the leadership of Mrs Weir the home is now doing most things well and very much better than before.” “Communication between nursing staff and relatives has improved since the current manager has been in post. She is very approachable and very positive and has made considerable progress with the problem areas since she took up her post.” Staff spoken with appreciated her commitment to the home and the fact that she sets high standards. She also communicates these standards clearly to staff, so that they know what is expected of them. Regular staff meetings are now being held for each discipline of staff, but there are also general staff meetings. Staff spoken with commented that these are useful meetings where they feel that they can participate and they feel that they can be listened to. A residents meeting was also held in March 2007 in which 20 residents attended. The purpose of that meeting was to talk about the home and their daily life and seeing if there was anything that could be done to improve the care they receive. Mrs Weir also explained to the residents about the importance of completing an end of life plan which some thought was a very good idea. Some residents expressed their approval of the care plans being in their rooms although none had actually read them. They did not comment in that meeting about the frequent use of agency staff. At the most recent general staff meeting the new dignity champion’s role was explained and staff were told about the new Mental Capacity Act and the impact it may have on them. Following a requirement made at the last inspection, the home has done their own quality assurance monitoring. 29 survey forms were sent to residents and 14 were returned. Head Office is doing an analysis of these results and the inspector requested that the results of this are forwarded to the Commission when available. Other quality assurance monitoring takes place in the form of care audits for example the manager aims to audit six care plans per week, however she is not always able to do this depending on staffing problems. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 26 Health and Safety issues detailed in the last report had all been actioned. It was noted during the visit that there was a tripping hazard from a carpet strip on the second day of the inspection this was removed and replaced. The only health and safety record checked during this inspection was the fire log. It was noted that fire alarms are checked weekly as per recommendation by Avon Fire brigade and other safety checks are done monthly in accordance with those recommendations. There are also details of the location and cause of the fire alarm being activated spontaneously. It was noted that training is not up to date as the recent session had to be cancelled. It was of concern that some staff who are rotating on to nights and one example was tracked had not had any fire training since August 2006. This needs to be addressed as a matter of urgency and the manager was requested to remedy this within a week of the inspection. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X 2 X 2 The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 13(4)(c) Requirement The registered person must ensure that safety checks and measures, described in the care plan for a service user identified during the inspection to reduce the risk of falls, are put in place. The registered person must ensure that staff receive regular training in fire safety, ensuring that attention is given to the night staff being given more regular updates. (see Avon Fire Brigade guidance) The registered person must ensure that the remaining electric beds are delivered. The registered person must ensure that there is a consistent level of cleanliness, paying particular to commodes and toilets. The registered provider must ensure that the Regulation 26 reports reflect the state of the service and any progression with requirements made. Timescale for action 25/04/07 2 OP38 23(4)(d) 20/05/07 3 OP24 23(2)(n) 30/04/07 4 OP26 23(2)(d) 30/04/07 5 OP33 24 30/05/07 The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 29 6 OP38 12 7 OP27 18(1)(b) The Registered person shall ensure that the radiators are 31/07/07 covered in a staged programme according to the risk assessments already completed. The registered person shall ensure that the temporary use of 31/05/07 staff (agency staff) does not stop service users receiving continuity of care. 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 Refer to Standard OP24 OP36 OP33 OP7 OP12 Good Practice Recommendations Comfortable seating should be provided in the bedrooms for two people. Also seats for visitors in the communal areas. Provide supervision training for trained staff. The results of survey forms received by the home should be published and made available to current and prospective service users. The care staff need to be aware of the content of the care plans. Social care needs to be recorded even when it is not part of the organised activities. The Laurels Nursing Home DS0000049317.V335161.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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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