CARE HOMES FOR OLDER PEOPLE
The Laurels Nursing Home South Road Timsbury Nr Bath BA2 0ER
Lead Inspector Kathy Marshalsea Announced 21st June,22nd June & 3rd July 2005 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service The Laurels Nursing Home Address South Road Timsbury Nr Bath BA2 0ER 01761 470631 01761 470631 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 Mrs Nicola Honey-Acting Manager CRH 36 Category(ies) of PD,4 registration, with number OP,36 of places The Laurels Nursing Home Version 1.10 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. 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 NCSC. Date of last inspection 10-Sep-2004 Brief Description of the Service: The home is a care home operated by European Care,a limited company that operates several other care homes registered with the Commission for Social Care Inspection.The company has one other registered care home within Bath & North East Somerset.The Laurels is registered to accomodate up to 36 older people who require nursing care.Additional conditions enable the home to offer accomadation to four younger adults with a physical disability. The home is an older detached property which has been considerabley extended and adapted.It is situated in the village of Timsbury,which is approximately 9 miles from Bath.Accomadation is offered over two flors and there is a passenegerr lift between floors.There are a total of 28 single bedrooms and five shared rooms.Only one of the single bedrooms offers ensuite facilities.There is extensive parking available to the side of the property. The Laurels Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an inspection conducted both as part of the annual inspection process and also to monitor the progress in relation to a 14-point agreement made with European Care to dramatically improve standards within the home. This agreement was made after very serious concerns about the home, by the Commission for Social Care Inspection (CSCI) and other health and social care professionals. A meeting was held on 27th April 2005 with representatives from European Care, the CSCI and legal representation from both parties. The Commission has checked compliance with this agreement since this meeting in a variety of ways and the organisation and staff team have worked hard to successfully improve standards in every area. Enforcement notices dated 19th May 2005 were served upon the home in the following areas: Pre-admission assessment and review Care planning Risk assessments Medication practices Fitness of workers Competency of staff Staff supervision The inspection took place over three days. The first day was spent looking at records; the second day was spent on an early shift to assess the effectiveness of the systems in place, for example communication and the after care of accidents. The third day was unannounced and conducted to monitor progress with the enforcement notices, which will be detailed further in this report. On all three days opportunities were taken to speak with residents, staff and relatives. care practice and interactions were also observed. The following records were examined: A sample of care files and assessments Risk assessments Accident book Staff files Staff supervision notes Training records and plan Fluid and diet charts Fire safety log Medication records
The Laurels Nursing Home Version 1.10 Page 6 Activities records At the conclusion of the second day of the inspection an immediate requirement notice was issued in regards to medication practice and care plan reviews and appropriate after care of accidents/incidents. The enforcement notices were served after non-compliance with requirements from more than one previous inspection. Compliance with these notices was checked at the unannounced inspection on 3rd July 2005. The notice for pre-admission assessments has not been possible to assess due to the fact that the home has not been taking admissions since 27th April 2005.This will be checked at subsequent inspections. The supervision process is making very good progress towards completing sessions for all staff by 19th August 2005. Regulation 37 notices are now being sent to the CSCI for all incidents in the home which could adversely affect service users. Care plans have been reviewed for June 2005 and are now current and meaningful. Risk assessments have also been reviewed for June 2005. Risks are explored within the care plan. Medication systems were checked and in order. The immediate requirements had also been met. Staff competency has been assessed by ensuring that staff are aware of preventive care and responding to warning triggers. European Care assessed all staff in the home during May 2005 and had not kept any staff who were deemed to be competent. Two registered nurses have been referred to their governing body, the NMC, for concerns about their practice. Staff recruitment has improved dramatically and new staff are being slowly inducted at the home. All of these areas will continue to be checked in particular at subsequent inspections. What the service does well:
The home caters mainly for those who are elderly and need nursing care. The home is now clean and has no offensive odours. The staff looked relaxed and were polite and helpful during the inspection process. The service users (residents) also wore clean clothing and it was evident that their hair and nails were attended to. The Laurels Nursing Home Version 1.10 Page 7 The home has employed an activities organiser. During the inspection the activities organiser was involved with individuals and groups. The records she kept showed a varied and individualised programme. After advice given at previous monitoring visits the home now records fluid and diet intake accurately. It was observed that all staff were informed of special needs for fluid and diet intake. Staff were seen encouraging all residents with extra fluids due to the hot weather. Staff used appropriate Manual Handling techniques during the inspection. Care staff spoken with were knowledgeable about those residents that they were caring for during their shift. It was also evident after observation and talking to staff that the recent training provided informally and formally has had a positive outcome. At the unannounced inspection staff were observed to being pro-active with one service user who had previously been nursed in bed. This person was sat out in a comfortable chair and was also brought to the dining room for lunch. The notes for this person showed an improvement in their general condition due to an increase in their diet and fluid intake. This is to be commended particularly as at the unannounced inspection no managers were present to prompt these actions. What has improved since the last inspection?
The agreement reached on 27th April 2005 has caused a new management team and an almost entirely new staff team.There is now a culture of individual responsibility across the staff team which was not present before. Meeting all care needs Pro-active nursing Regular monitoring Activities Staff competency Recruitment Prevention of pressure sores Diet and fluid intake Effective systems Communication Response to health care advice and instruction Staff accountability
The Laurels Nursing Home Version 1.10 Page 8 Medication systems What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Laurels Nursing Home Version 1.10 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 Version 1.10 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) EVIDENCE: These standards were not inspected as the home has not been having admissions since 27th April 2005.This situation will be re-assessed in time for a decision to be made about re-admitting to the home at the next meeting between the CSCI and European Care on 12th July 2005. The Laurels Nursing Home Version 1.10 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10. There has been a great improvement in recording interventions relating to the health care needs of the residents. The home is now meeting the health care needs of the residents in an individual and sensitive way. Care provided to meet health care needs is now easy to track within the documentation. Residents spoken with confirmed that they are treated with respect and dignity. Choices are being given to residents in all aspects of their life within the home. Staff spoken with were very clear about their role and responsibilities. EVIDENCE: Examination of care files and associated assessments, for example Daily observation records Risk assessments Care plans
The Laurels Nursing Home Version 1.10 Page 12 Fluid and diet charts The inspector attended a handover from night to day staff. Care staff on duty confirmed that they understood their priorities for that shift and paperwork checked by the inspector at the end of that shift confirmed that. Care plans do not yet reflect the resident’s and/or their representatives contribution to the development of their plan. The manager of the home confirmed that this is the direction that they wish to head for care planning. As part of the 14 point agreement the home had to re-write all the care plans within the home to a tight schedule. This did not allow time for them to be done in consultation. The Laurels Nursing Home Version 1.10 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14.15 Social activities are well organised, creative and provide stimulation and interest for people living in the home. Meals are nutritious and balanced and show a consideration for the special needs of the elderly. EVIDENCE: Visitors were seen and gave a mixed response to the recent changes in the home. There were positive comments about the cleanliness and about the friendliness and kindness of some of the transitional staff brought in from other homes within the organisation. Some visitors still felt that communication from some staff could be more proactive, which they would find reassuring. The records for the activities organiser demonstrated that her time is spent with those residents who choose to spend time in their rooms as well as those who join in group activities. A weekly programme is displayed and adhered to. On one of the inspection days an entertainer was at the home which was enjoyed by a large group of residents. The Laurels Nursing Home Version 1.10 Page 14 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) 18 Residents have benefited from the fact that staff have been updated in the prevention and detection from abuse. EVIDENCE: The inspectors spoke with existing staff members who said that they found the recent abuse training useful and after reflecting on the day had changed the way that they deliver care. This has been because they no longer assume that care needs stay the same. This has had a positive impact for residents by offering a flexible care programme. The Laurels Nursing Home Version 1.10 Page 15 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) 26 The home is clean, pleasant and hygienic. EVIDENCE: Since the date of the agreement an organised cleaning schedule has been implemented. This has made a significant difference to the atmosphere of the home making it pleasant and free from offensive odours. The lounge and dining room have been changed around which has also made an improvement to the smooth running of the home. The Laurels Nursing Home Version 1.10 Page 16 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) 27,28,29,30. The transitional staff have provided a stable staff group but the true measure of this will not be seen until the new staff team is fully established and functioning. EVIDENCE: There is a stable staff group at the home which have been transferred temporarily for other homes within the organisation. They have integrated well with existing members of staff. New staff are being recruited and will be assessed at subsequent inspections. A review of supervision notes showed that regular sessions are taking place. Staff spoken with confirmed this. It was also evident from observation that informal supervision is taking place and tasks delegated are accompanied by an explanation of why that task is necessary. The home have a comprehensive training programme which will be monitored for its effectiveness at future visits. Staffing levels have exceeded the normal expectation due to the need to dramatically improve standards with staff who were competent and experienced. This has had a positive outcome for the residents and visitors. The home are now able to start to reduce staffing levels following a meeting on 24th June 2005 between European Care and the Commission for Social Care Inspection This will mean a permanent staff group, with realistic numbers, should be in place by the end of July 2005.
The Laurels Nursing Home Version 1.10 Page 17 At the unannounced inspection on 3rd July 2005 the staffing numbers had returned to their normal levels. This did not have a detrimental effect on care delivery. The Laurels Nursing Home Version 1.10 Page 18 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) 31,36,38 The acting manager has been well supported by senior managers providing a full time presence in the home since the end of April 2005. EVIDENCE: Nicola Honey has been in post since 21st April 2005 and is going through the process of being registered with the Commission as part of her fitness to be the registered manager. The meeting mentioned above also decided that the extra management in the home could begin a gradual withdrawal to allow Nicola Honey to manage the home with reduced and normal support. This proposal for this withdrawal has been received by the CSCI and is satisfactory. Fire log records were generally kept up to date apart form a 2 week gap while the staff member who is responsible for doing the tests was on leave. The tests need to be completed at all times.
The Laurels Nursing Home Version 1.10 Page 19 The Laurels Nursing Home Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x 3 2 3 The Laurels Nursing Home Version 1.10 Page 21 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. 2. 3. 4. Standard 9 9 7 8 Regulation 13(2) 13(2) 15(2) 13(4) Requirement Medication charts must reflect the prescription that is currently being used. Record parameters prescribed by the GP on the MAR charts. The reviews of the care plans must reflect the current status of each service user. There must be appropriate after care and auditing of accidents/incidents for service users. Fire safety tests must be conducted at the recommended intervals even when the person normally responsible for doing them is away. Timescale for action From 22/6/05 From 22/6/05 From 24/6/05 From 22/6/05 From 30/6/05 5. 38 23(4) 6. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 8 12 Good Practice Recommendations Ensure all assessments are dated and signed Ensure that radios and televisions are tuned in to the station preferred by the service user and not the staff.
Version 1.10 Page 22 The Laurels Nursing Home The Laurels Nursing Home Version 1.10 Page 23 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
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