Inspection on 23/06/06 for The Laurels Nursing Home

This inspection was carried out on 23rd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

The Laurels Nursing Home 23/09/09

The Laurels Nursing Home 24/09/08

The Laurels Nursing Home 06/11/07

The Laurels Nursing Home 13/12/06

The Laurels Nursing Home 20/03/06

The Laurels Nursing Home 20/12/05

The Laurels Nursing Home 23/03/05

The Laurels Nursing Home 24/09/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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 Francis Way Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9EQ Lead Inspector Mary Blake Key Unannounced Inspection 10:00 23 and 27th June 2006 rd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address Francis Way Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9EQ 0191 517 3763 0191 526 0837 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Barbara Ann Clarke Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (10), Physical disability of places over 65 years of age (40), Sensory Impairment over 65 years of age (10) The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20th March 2006 Brief Description of the Service: The Laurels is a privately owned care home, which is located in the village of Hetton-le-Hole. It is within walking distance of a range of local facilities including shops, public houses, a health centre, library and a Church, and is also near to a bus stop. The home may provide permanent accommodation with personal care support and nursing for up to fifty-five older people, some of whom may have a physical disability or sensory impairment. A limited number of physically disabled adults under the age of sixty-five may also be accommodated within this total number. The home’s entrance is level, and a shaft lift provides access between floors. Accommodation is laid out over both the ground and first floors. Each has selfcontained lounges, dining areas and adequately equipped bathrooms. All bedrooms have en-suite toilet facilities. The building shares it grounds with another care home owned by the same company. The grounds are well kept, there are accessible paved areas for residents and car parking is available. The weekly fee for this home ranges from £359.00 to £593.00. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection and took place over two days and involved two inspectors. A full tour of the building, residents care records, staff rota, recruitment /training files plus additional statutory records were examined. The Registered Manager, deputy, three nurses, five care staff, six ancillary and support staff, sixteen residents and eight relatives were spoken to during the inspection. What the service does well: What has improved since the last inspection? Individual care plans have continued to make improvements. Staff were more involved in planning and evaluating care and the plans this helps staff give residents the care they need. The social activities coordinator continues to develop the range and type of activities; information is being provided to residents and relatives and this enables residents to be more aware and involved. Further progress has also been made to improve the home’s physical environment. Some redecoration has taken place and some new furnishings have been bought making improved and pleasant surroundings for residents. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 6 Staff training is progressing enabling them to develop their skills, which should improve care for residents. What they could do better: If resident’s physical and mental health needs are to be properly met, the Registered Manager and nursing staff must make sure that relevant assessment, care-planning and risk-management tools are used and records kept to guide care staff in their work. Although assessments look at religious/beliefs they do not consistently look at the full range of diversity issues relating to race, religion, age, gender, sexuality and disability. Medication systems and staff awareness must be reviewed to ensure that all medications are safely administered. Staff must treat residents with respect and dignity and communicate with residents when giving personal care. The quality and presentation of the meals, the choices to residents and the organisation of the dining arrangements must be improved so that residents can enjoy good food in pleasant surroundings. An audit of control of infection practices and equipment must be undertaken with an action plan developed to ensure that improvement is made to protect resident from cross infection. The cleaning and records of cleaning in the kitchen must be completed at the timescales detailed, to confirm that the kitchen is adequately cleaned to protect the health of residents. The Registered Manager must undertake a review of the dependency of residents, current staffing levels and use of agency staff to ensure that residents receive consistent care. Staff must be supervised within the recommended timescales of six times per year as this provides the management overview of staffs ability to provide satisfactory care for residents. The Registered Manager must have further support and formal supervision from the Registered Person to improve her supervisory and management practices and improve the staff working practices and poor attitudes, so that the home can be run in the best interests of the people who live there. Satisfactory testing of the fire alarm system and risk assessments for dental cleaning products must be in place in order to protect the safety of residents, staff and visitors. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 7 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 DS0000018209.V298090.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 The Laurels does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home undertakes a detailed pre admission assessment and liaises with the residents and family prior to admission. Satisfactory pre-admission assessments are undertaken but this is not always developed further in the care plan. The home is not registered for and therefore does not provide intermediate care. EVIDENCE: Assessments and detailed information are obtained prior to admission to ensure that the home can meet the needs of the prospective resident. This is a comprehensive tool which guides staff to look at a range of needs such as religion/cultural needs, social interests/hobbies, pyschological needs as well as physical health needs. However, in a couple of the cases tracked some identified needs such as the section relating to ‘religious/cultural needs’ would identified someone’s religion, which was then repeated in the ‘social The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 10 assessment’ without any follow up in the care plan. The assessment does not cover all aspects of equality and diversity, although Four Seasons have a policy relating to this. Conversely, some cases tracked showed that staff worked with residents and/or their families to discuss areas of need/or wishes, for example hobbies/lifestyle choices were recorded, such as ‘reading the paper’ or ‘doing the crossword’, as well as past interests and important life events. Much of this is currently being reviewed to ensure a more consistent approach. Pre admission assessments are obtained from other professionals such as social workers, psychiatrists and previous care providers. The manager acts as gatekeeper for admissions and to ensure that the home operates within the categories of registration; and that the home can continue to meet the needs of those people already living at the home. Residents and their families explained a comprehensive admission process; this includes a gradual introduction to the home and a detailed pre-admission assessment. They felt that this helps new residents adjust and settle into living in the home. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence gathered both during and before the visit to this service The care plans are not consistently completed to sufficient standard to ensure that staff can deliver care to meet the needs of residents. The health and social care needs of service users are being met but the records do not consistenly support this, which may result in residents needs not being fully met. The home is not ensuring residents receive their medication safely as prescribed and in line with safe practice guidance. Not all staff treat residents with respect and their right to privacy is not always upheld, this compromises their dignity. EVIDENCE: Four care plans were case tracked which showed a degree of inconsistency in the amount of information recorded. There are a number of assessment tools in place around pressure care, nutrition, moving and handling, mental health The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 12 and dependency. These tools were not consistently completed or up to date but did in the main link into the care plan. Some details were brief for example, ‘can display challenging or aggressive behaviour’ , without specifying how that behaviour manifests itself, or how staff should consistenly deal with it. Another plan used words that made it difficult to follow for example, ‘ensure named nurse has a well structured therapeutic relationship, particularly empathy and truct with X’. This does not explain a consistent approach to meeting this persons challenging behaviour, and could result in the wrong approach being used and the resident becoming distressed. However, where the care plan related specifically to the management of wounds, this was detailed and up to date. For example staff were given clear guidance around skin integrity and the type of treatment for each individual specific wound care needs. In addition, some plans gave detailed guidance to staff around more physical needs around safety of mobility, and guided staff to ensure that footwear is checked and fits properly and supports the foot etc. The most recent admission was not in the admissions book. Policies and procedures are available for safe receipt, recording, storage, handling, disposal and administration of medicines. These were being followed for ordering medicines and recording their handling once in the home. The treatment room and medicine store cupboards were tidy, organised and the treatment room was clean and contained the necessary safe storage cupboards. All medicine records detailed the resident’s allergies and had up to date photographs to ensure identification was possible even for agency staff. Medications receipt administration and disposal are generally recorded effectively but where hand written additions have been made to the administration chart they have not been signed by two persons, resulting in the possibility of an error occurring. Medicines for disposal are now being removed using an nominated waste management supplier. During the first visit to the home a Qualified Nurse was administering four residents’ medicines, which had been decanted into separate medicine pots. This is unsafe practice. The Manager was informed and action taken to prevent it re-occurring. During both of the visits staff were seen to provide care to the residents on at least four occasions without explanation or attempting to have a conversation with them. One carer was openly disrespectful to a resident in their presence saying “its her own fault that she feels sick because she wont eat”. This was inappropriate and suggests that staff are not aware or respectful of the resident’s health care needs on some occasions. Although there was some positive comments by two residents that the care staff were “really helpful” and “you get all the help you need”. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 13 The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence gathered both during and before the visit to this service Resident’s social activity needs are being addressed and are documented, which ensures residents lead meaningful lives. Residents maintain contact with family/friends/representatives and the local community as they wish. Residents are helped to exercise choice and control over their lives but this is not always evidenced in care plans. The mealtime experience was poorly organised and residents do not receive an adequately wholesome or balanced diet. This could compromise the nutritional status of individuals living at the home. EVIDENCE: Social activities are varied, there is a weekly “bonus ball” competition that both staff and residents take part in. On birthdays residents have a cake, party and receive a present from the home of usually smellies or chocolate. The The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 15 relatives and residents are sent a “newsletter” telling them of upcoming events and activities. All resident have an individual activities record sheet. Arrangements for residents to maintain contact with their family and friends and the local community are suited to each individual’s needs and vary accordingly. The residents are encouraged to go to places in the local area and families are encouraged and supported to take residents out and about. The residents’ bedrooms were personalised reflecting individual choices and preferences. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives were very positive about the welcome they receive and the good communication between the home and families. The home does not have the menu displayed very visibly although one was displayed at the entrance and a copy was provided on request. The menu was not being followed. Residents are asked for their choice for lunch and tea daily, which is recorded and given to the kitchen staff. The food being served on the first visit was poorly presented, cold and not properly cooked. A number of residents expressed their dissatisfaction with the dining arrangements, that the quality of the food served is often poor and cold, that they can go for long periods from early evening to breakfast without snacks, that long waits are normal and that they have raised their concerns about the repetitiveness of the high tea. The dining room was very crowded with most residents remaining in their wheelchairs, the residents sat and waited over 1 hour and 30 minutes before their food arrived. Several staff served the food and drinks to residents without any communication or acknowledgement of their needs and residents stated this often happens. On the second visit the dining room was better organised, with minimal waiting, the food was better and staff were pleasant and supportive this again suggests that there is inconsistency in a number of practices in the home. The Registered Manager was aware of these inconsistencies. The kitchen was clean and well organised but the records to support this could be better organised to ensure that the staff can evidence the work they are doing. The record of food actually served was inaccurate making it difficult to assess if residents were receiving a varied and balanced diet. Hot drinks were offered at midmorning, and the residents are given a biscuit or fruit at this time, with similar being offered in the afternoon. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence gathered both during and before the visit to this service. Displayed in a variety of places makes the residents and relatives aware of the complaints policy. Complaints are managed satisfactorily and the necessary action taken, which helps to safeguard residents and promotes continued autonomy over their own lives. Staff have or are to complete training in the Protection of Vulnerable adults and this is necessary to ensure that residents are protected. EVIDENCE: The complaints procedure is in the service users guide and copies are displayed in the home. The records of the complaints made to the home were examined. There have been no complaints since 2005. Six of the residents said they knew problems were dealt with and how this would be done. Three relatives were aware of the complaints procedure but had not needed to use it and would raise their concerns at the regular relatives meetings. The Registered Manager stated that all staff were aware of the whistle blowing policy and informing the Manager of any incidents or issues of which there are concern. Staff confirmed this. Staff had completed or were about to attend Protection of Vulnerable Adults training. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence gathered both during and before the visit to this service The home is very clean and pleasant, but some unsafe storage of equipment and hygiene practices found may compromise resident safety. The home is spacious with several communal areas, which offers a choice of environment for residents. Sufficient numbers of toilets and bathrooms are provided although not all of these are in use. The bedroom areas are personalised according to the individual’s own taste, which promotes the autonomy of the individual. EVIDENCE: The home has a large entrance area, which has comfortable seating in which residents were choosing to spend time on both visits. The home is generally The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 18 were decorated and has appropriate furniture which is in keeping with the style of the home. There is a programme in place for redecoration and good progress was being made. The residents bedrooms were pleasantly arranged and were personalised to the taste of the occupant with memorabelia and religious artifacts, where they choose. One commented that she was “happy with her room and had brought in her own things to make it more like home”. Throughout the building there was clutter and inappropriate storage of equipment, this impeded the accessibility of the bathroom. In addition, communal toiletries, boxes of pad and used pads inappropriately disposed amongst the dirty linen. Individual bedrooms had inappropriate or out of date creams and dental tablets were not securely stored or risk assessed. The Registered Manager had addressed these issues by the second visit. Staff were not taking necessary precautions to prevent cross infection. The sluice was not locked when not in use. Staff were not using the sluice but using a communal toilet to store the laundry skip and deposit clinical waste. This was the only place where an odour was evident and a qualified nurse was witnessed carrying used incontinence pads from a bedroom, unbagged and then disposed of them without double bagging. The ensuites are not equipped with disposable paper towels, liquid soap, and waste bins with lids, which would assist in the control of infection. An audit of control of infection practices and equipment has not been undertaken which together with an action plan would ensure that improvement is made to protect residents from cross infection. The laundry and domestic staff appeared well organised with good hygiene systems being followed. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence gathered both during and before the visit to this service. The Registered Manager ensures there are adequate numbers of staff on duty however these are not effectively managed or deployed to provide safe and consistent care for residents. The recruitment processes in place protect residents and follow equality legislation, which prevents discriminatory practice of staff during the process. Progress is being made on the external and internal training taking place to enable staff to meet the needs of residents EVIDENCE: Staffing rota and observation during the day indicated that the home is adequately staffed but vacancies have resulted in a high use of agency staff, residents and relative commented upon this “we don’t know the staff” “they don’t know what I need”, this has made some residents feel anxious and makes it difficult to provide consistent care. The home has 2 RGN and 5 carers during the day and 1 RGN and 3 carers during the night. The care staff are generally experienced but were given inconsistent leadership, care staff and nursing staff had minimal communication throughout the day and unsafe, poor care and hygiene practices were evident from nurses and carers. An action plan was agreed with The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 20 CSCI to tackle these issues and some progress has been made but further work needs to be carried out with the Regional Manager to ensure a change of attitude and a more cohesive senior team are established. There is good ancillary support. Three staff recruitment files, across all grades, were inspected and were satisfactory. Appropriate applications are completed which ask for evidence of qualifications, experience and work history and appropriate references and checks are completed. Training files examined clearly detailed that progress was being made and that staff had completed induction, foundation, mandatory and NVQ training. Planned training events include: customer care, record keeping, infection control, care planning, nutrition, venapuncture and POVA. Some of these are already underway. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence gathered both during and before the visit to this service The Registered Manager has had difficulties providing sufficiently strong leadership, which has been exacerbated by a lack of support from the deputy manager and the nursing team. This has a negative impact on the quality of care that residents receive. Quality systems are being established and developed, which will contribute to a better quality of life for residents. Resident’s financial interests are safeguarded, but residents do not have access to individual accounts or their monies at all times. A system of staff supervision has recently been put into place to develop and support nursing and care practices, but these shortfalls are not readily identified and dealt with. This means that the home is not always run in the best interests of the people who live there. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 22 The health, safety and welfare of residents are not always promoted or protected. EVIDENCE: The Registered Manager was aware that care staff lacked effective management and of the general staffing issues and attitudes raised at this and at previous inspection. She has taken some steps to address this, minutes of a staff meeting identified similar issues raised in April 2006 but she felt that no progress has been made. Staff supervisions have recently been undertaken, with more planned, these do not highlight areas of difficulty with staff attitude but show only positive elements of practice. However, whilst the Regestered Person has provided weekly input to support the manager, formal supervision has not been undertaken. The Registered Manager was aware of the difficulties within the team but stated she feels that her decisions are overtunred by specific individuals within the nursing team during her absence. These issues are not tackled within the supervision and disciplinary procedures that four Seasons operates and therefore, impact on the quality of care provided. The accident record was being kept in line with current guidance. They were being recoded in the appropriate format and in sufficient detail to allow the Registered Manager to audit them in line with company policy. However the section Action taken / recommendation was being used to describe the incident and not to detail the follow up action taken or risk reduction action. For example, ‘X was found lying on the floor’ or ‘heard noise from X’s room and found them on the floor’. This does not outline the follow up action taken by the nurse in charge. However, some were accurately recorded and showed the action taken by staff, albeit very briefly. For example, ‘full examination from head to the limbs and assisted back into her chair’. There has been monthly accident analysis / audit but this is a numerical overview and does not suggest any proactive action has been taken to reduce risk to residents. The system for checking resident’s monies was satisfactory, however all of the monies are pooled into a central account and residents do not have access to their money at weekends/evenings, this reduces independence and choice for residents. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 23 Maintenance of equipment was satisfactory. Fire maintenance and testing of equipment was in place but fire alarm testing was not undertaken on a weekly basis, this is a potential a safety risk to residents, staff and visitors. Dental cleaning tablets were easily accessible throughout many of the bedrooms, the Registered Manager was not aware of the high risk associated with this product and has not undertaken risk assessments and safe storage, this again is a potential risk to some residents. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 24 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X 2 1 1 2 The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered manager must ensure that resident care plans are specific to the needs of individuals, and be regularly updated to reflect changing needs. Outstanding 20/03/06 but progress being made The registered person must ensure the safe receipt, storage, administration and disposal of medicines at the home. Outstanding 20/03/06 further issues identified at this inspection 3. OP18 13(6) 18(1) The registered person must ensure that all staff complete training in the Local Authority’s multi-agency procedures for the protection of vulnerable adults (MAPPVA). The company’s procedural guidance in the is respect also needs to be amended, to clearly show that wherever a criminal offence is suspected, such as physical, sexual or financial The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 26 Timescale for action 01/09/06 2. OP9 13(2) 17(1)Sch 3 01/08/06 01/09/06 4. OP19 13(4) 23(2,3) abuse, the Police must be contacted as a matter of urgency. Outstanding 20/06/06 but progress being made All areas of the home must be kept clean and better steps taken to control the possible spread of infection. Sluice doors must be kept locked. Not met The programme of ongoing redecoration and refurbishment planned by the manager must incorporate the home’s bathrooms. Progress being made with redecoration The provision of a designated smoking area for staff must not impinge on the rights of service users and non-smoking workers. Not met The registered person must ensure that nursing and care staff receive specialist training to equip them to meet service users’ physical and mental health needs. Outstanding as of 20/06/06 The registered person must ensure that all staff undertake mandatory health and safety training, including first aid and fire safety training, within the prescribed timescales. Outstanding as of 20/06/06 but progress being made The registered person must supervise the registered manager to develop good supervisory and team working practices at the home. DS0000018209.V298090.R01.S.doc 01/07/06 5. OP4 18(1) 01/09/06 6. OP30 13(1) 18(1) 23(4) 01/09/06 7. OP31 12(1,5) 01/09/06 The Laurels Nursing Home Version 5.2 Page 27 Outstanding as of 18/02/06 and 20/06/06 and limited progress. 8. OP33 24 The registered person must demonstrate that quality assurance systems are in place and used to identify and remedy shortfalls in worker practice and service provision. Outstanding as of 17/03/06, 20/06/06 but progress being made. 9. OP36 17(2) 18(2) Schedule 4 12 (4)(a) 12 (5)(b) 16 (2) (i) The registered manager must ensure that all staff receive supervision at least six times per year. Limited progress The registered manager must address the shortfalls in staff attitudes and approaches when working with residents. The registered manager must review the quality of the meals, choices to residents and the organisation of the dining arrangements. The registered manager must ensure that care staff appropriately and safely store all equipment. The registered manager must undertake a review of staff hygiene practices and control of infection. The registered person must undertake a review of the current staffing levels and use of agency staff. The registered person must address their lack of management and review the leadership of the registered manager. DS0000018209.V298090.R01.S.doc 01/09/06 20/12/06 10 OP10 01/08/06 11 OP15 01/08/06 12 OP19 13 (4)(a) 01/09/06 13 OP26 13 (3) 01/09/06 14 OP27 18(1) 01/09/06 15 OP31 10(1) 01/09/06 The Laurels Nursing Home Version 5.2 Page 28 16 OP32 18(1) 17 OP35 16 (l) 18 OP38 23 (4) 19 OP38 13 (4)(c) The registered manager must address their lack of leadership and review the senior staff management of care staff. The registered person must ensure that residents have access to their personal monies at all times. The registered person must ensure that staff fire drills and fire alarm tests are undertaken at the given timescales and records kept. The registered manager must ensure that dental cleaning tablets are safely stored and risk assessments are undertaken. 01/09/06 01/09/06 01/09/06 01/08/06 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 OP26 OP38 Good Practice Recommendations The laundry staff may benefit from a rotary iron to deal with the large quantity of bed lines laundered. The Registered Manager to review the accident records and identify preventative actions. The Laurels Nursing Home DS0000018209.V298090.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 DS0000018209.V298090.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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