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 Inspection 26th April 2006 & 8th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 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.V290343.R01.S.doc Version 5.1 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) European Care (SW) Ltd To be appointed 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.V290343.R01.S.doc Version 5.1 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. 15th September 2005 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.V290343.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted over two days. The first day was spent with the acting manager and the regional manager reviewing some management systems and viewing records. The second day was conducted during the afternoon/evening and was spent case tracking and observing the teatime meal. The delay in between the dates was to assess the home after the acting manager had left to ensure that consistency was being maintained. Also the CSCI had received some negative comments in survey forms about aspects of the service in the evenings. This included staffing levels and the choices of food, this second part was unannounced. Since the first day of the inspection the acting manager has resigned and completed her month’s notice at the end of May 2006. Another manager has been employed and is due to start at the home on June 19th 2006. The home has not had a registered manager since European Care purchased the home in May 2003. Managers have been employed but have not completed their registration process with the Commission for Social Care Inspection(CSCI). What the service does well:
The staff respond to residents’ changing health care needs and make sure that they seek specialist advice if they need to. This should reassure the residents that they can still access primary health care professionals while they are living at the home. The home employs a full time activities organiser who is able to share her time within the resident group. She gathers vital information about each person and their interests and how they enjoy activities they participate in. Residents and their families should be confident that there will be efforts made to offer meaningful occupation within the limits of each person’s abilities. Comment cards from residents and relatives included the following: “Generally very caring, friendly staff who try to deal with any problems and difficulties that arise. They co-operate with families requests.” “I never have a problem with the staff”. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
An immediate requirement notice was issued at the first day of this inspection regarding the need for all night staff to be updated in their fire safety training. This is recommended by Avon Fire Brigade as the nights are considered a higher risk due to having less staff on duty. Records seen and discussion during the second day of the inspection showed that this had not been done consistently for all night staff. The notice required that this happened by May 12th 2006. This was a requirement at the last inspection in September 2005 and an enforcement notice will be served if this shortfall is not promptly and fully addressed by the organisation. An immediate requirement notice was also issued on the second day of the inspection for some residents to be given real choices about their daily life. The inspector was told that some residents were being put to bed after tea for their safety, as there were insufficient staff on duty to observe them. This action was in effect creating a type of restraint. Since the immediate requirement letter was sent to the organisation a response has been received stating that the staffing levels have been increased
The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 7 by one care assistant for the evening shift and the night shift. This was implemented from the 9th June 2006 as per the notice. The area of staffing levels will be kept under review by the CSCI to ensure that the resident’s needs are met and choices are available to them. The kitchen was inspected after the teatime meal. It was seen that some plates of food placed in a fridge had not been covered properly and not been dated. This contravenes food hygiene practice. The store cupboard was also not very clean and there was debris in a corner of the room. An immediate requirement notice was issued for these to stop from 08/06/06. In addition to the issues relating to the fire safety training of all night staff and keeping staffing levels under review, other requirements made at the last inspection have not been complied with. These include: Obtaining relevant references and exploring gaps in employment; Ensuring that, where possible, care plans evidence the involvement of the resident in their compilation and review inclusion of the resident themselves; Evidencing an updated Not being able to see the Workplace Risk assessment for Fire Safety. Given the continuing lack of a registered manager and the recent previous history of the service, it is of concern that these had not been complied with. Some comment cards received said the following: “ I am not aware of the complaints procedure and do not know how to access the home’s inspection reports”. “There is not always enough staff on duty particularly in the afternoons. Sometimes there is a problem with the language barrier so things take longer”. “I am not aware of the home’s complaints procedure or how to access the inspection reports .Was frustrated at the management’s response to a concern I had about heating. A fax was sent by myself to head Office and did not hear from them”. “There are not enough staff on duty”. “I am sometimes informed about important matters and sometimes consulted about my relatives care. I am not aware of the complaints procedure but have complained about the food. I am not aware of the inspections and how to access inspection reports.” “The food needs attention, it’s usually very poor, tasteless and of poor quality”. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 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.V290343.R01.S.doc Version 5.1 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 the following standard(s): These standards were not assessed. EVIDENCE: The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 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, 10 The overall quality outcome for these standards is poor. Some care plans did not fully reflect the personal and social care needs of the residents case tracked. Most health care needs are documented and specialist advice sought when necessary. Some residents’ dignity was not being respected, as real choices were not being offered. EVIDENCE: 7. Four care plans were viewed in detail - two for residents who had been in the home for a short time and two who had been at the home for some time. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 12 The two new plans showed that detailed pre-admission assessments had been completed, and that additional information such as social services care plans were present. In the first plan an identified risk had led to instructions in the care plan and nutritional assessment which had not been followed. Staff had not been following the instruction to weigh the resident weekly, and provide an enriched diet. The recording of monthly weights showed a loss of weight. It was unclear what action had been taken as a result of this. There was a plan for confusion identified as a problem and how that should be dealt with. It had not been reviewed to test the effectiveness of the care planned. The health assessments for this resident had also not been reviewed. The inspector met this resident who seemed well and also their relative who had some concerns, but some of these had already been resolved. The second new plan was quite comprehensive and had been reviewed monthly with details of that review and if there had been any changes. There were parameters recorded of blood sugar monitoring so that staff should be clear about any actions they need to take for readings outside those parameters. New problems since admission had been planned for. Inappropriate wording such as “wandersome” had been used. This subjective wording should not be used and the issues behind this description should be assessed and planned for according to best practice in dementia care. Both plans had a social care assessment with significant information about each person and their life and interests before moving into the home. The two older plans had not been reviewed consistently, nor had the relevant health assessments. There was no social care plan for these residents or end of life plan. As one of these residents has become very frail it would be important for staff to try to ascertain their wishes when they die. 8. Observation, reading of documents and discussion with staff demonstrated that most health care needs are assessed and responded to. The inspector met a Consultant at the inspection who was regularly visiting residents at the home. They confirmed that staff offer useful information about the status of the residents they visit. A communication book is kept for doctors visits, which shows that changes are detailed, and the doctors response to that change. Fluid charts, food charts and records of position changes are kept where necessary. It was not possible to verify if the recording of food eaten resulted in actions if that had not been sufficient.
The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 13 10. On the second day of the inspection some residents dignity was not being respected by virtue of the fact that some were being taken to bed against their wishes as a response to inadequate staffing levels. This is described in the summary of the report. The care assistant staffing levels after 2pm are significantly less than during the mornings. Six care staff and one trained nurse are on duty from 8am2pm. The trained nurse is then accompanied by 4 care staff which reduces again from 8pm to 2 care staff and a trained nurse. The home had 26 residents on the first day of the inspection and 30 on the second. At the last inspection on 13/15th September 2005 the manager was asked to review the dependency levels of the home and increase staff according to the needs of the residents. This was done for the morning shift. On the 8th June 2006 the inspector observed that the teatime meal took some time, with some residents sitting to the tables for periods while no meal was served. This was the same after the meal and the last few residents were still sat to the tables at 7.10pm. Some residents were anxious to go to bed so staff were taking them from the table to bed. This delayed the others being taken out from the dining room. One resident had been sitting at the table talking with the inspector, he/she had been quite happy sitting at the table and said it was comfortable and expressed no wish to go to bed. At 7.10pm the inspector left the dining room. The inspector next saw this resident in bed at 7.20pm. When asked he/she said that they did not request to go to bed and did not want to be in bed. This resident’s care plan said that their preferred retiring to bedtime was about 9pm. When staff were questioned about this they said that this resident had to be put in bed for their safety. They were at risk if left in the lounge in the chair. No mention of this risk was in their care plan or risk assessments. As this is in effect restraining a person against their wishes this practice must cease immediately. The staff also stated that they are under pressure to persuade some residents to go to bed earlier than they would wish to due to staffing levels and the night staff being unhappy if many residents are left for them to help to bed. An immediate requirement notice was left for residents to be given real choices about their daily life. If insufficient staff are employed to do this then staffing levels must be increased to achieve this, no later than 09/06/06. Restraint must not be used as a first response to a concern about safety, and only after consultation, and for a short period of time with continual review of its use. The risk must also outweigh the benefit to the person and they also must The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 14 consent to this. This advice follows good practice guidelines from the royal College of Nursing and the Commission for Social Care Inspection. Since the immediate requirement letter was sent to the organisation, a response has been received stating that the staffing levels have been increased by one care assistant for the evening shift and the night shift. This was implemented from the 9th June 2006 as per the notice. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 The overall quality outcome for these standards is adequate. The routine of daily living was not flexible to meet individual needs. Activities are promoted and encouraged. Visitors are able to visit at any reasonable time. Alternative meals are not being fully offered at teatime. EVIDENCE: 12. Residents benefit from an activities co-ordinator who shares her time between individuals as well as groups. Records are kept of time spent with individuals; this includes recording interests and hobbies. The activities coordinator also is involved in the development of the care plan for social care needs. Some of the activities held recently include: A quiz, games & exercise, cooking, bingo, flower arranging, music, making Easter bonnets and a party for the Queen’s birthday. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 16 Residents who commented about activities were fairly positive but some are unable to join in those they would like to because of their physical condition. 13. Relatives were sent comment cards as part of the inspection consultation process. Comments from these have been incorporated into the inspection process and summary of the report. Visitors were present during the inspection. 15. On the first day of the inspection the inspector observed lunch being served. It was noted that residents were sat to the table for some time before the meal was served. Tables were laid with attention to details such as tablecloths, condiments, flowers and drinks. Those residents who needed assistance with their meal were helped discreetly and at their own pace. The acting manager has introduced new menus. Concerns had been expressed to the inspector about there being only soup and sandwiches for tea every day. When asked about this the management team stated that they used to offer a hot alternative, which was chosen then not eaten, leading to a lot of waste. Examples were given of individuals who have a hot meal at teatime. On the second day of the inspection the teatime meal was observed. Soup and sandwiches were served. Those residents who needed a softer diet had mash potato, minced turkey and gravy. It looked unappetising and one resident was being fed this meal despite it being cold. Yogurts were also being given which may not be giving the additional calories some of these residents may need. No alternative meals were given that evening. The kitchen was inspected after the meal was served. Plates of food had been partially covered in the fridge and not dated. In the store cupboard it was noted that there was debris in one corner. An immediate requirement notice was issued to remedy those deficits. Records were being kept of fridge and freezer temperatures and the rest of the kitchen was adequately clean. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The overall quality outcome for these standards is adequate. The complaints procedure is not known to all residents and relatives. There needs to be a local policy for abuse so that staff are aware of what to do if an allegation is made. EVIDENCE: 16. The complaints file was scrutinised. The most recently recorded complaint concerned the heating system. A relative had faxed their concerns to the organisation’s Head Office. The response had come from the regional manager. The inspector was informed that the problem with the heating had been resolved. This will be checked at subsequent inspections. The complaints procedure is simple. However, it does not inform the reader of the procedure to follow within the home and reassure them that they are able to raise concerns with anyone. It could be made more accessible by using a larger font. Comments in the survey forms showed that the complaints procedure is not known and needs to be promoted to residents and relatives. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 18 18. The policy for abuse did not detail the local policies and procedures. It deals generally with recognising abuse and for responding to suspicions. The home does have the BANES inter-agency procedure booklet. As a response to the inspector’s concerns the amendments were made to the home’s policy to refer the reader to the BANES policy. It would be useful for the home to develop their own policy to reflect the local procedures, which can be different in each area of the region. Staff understanding of their role in protecting residents from abuse was not explored at this inspection – it will be a focus of the next inspection. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The quality outcome in this area is good. Residents live in a clean and well maintained home. EVIDENCE: There has been a continuous improvement in the redecoration and refurbishment programme. Bedrooms have been made more homely after being painted and with the use of curtains and matching bedspreads. All bathrooms now have locks. There is only one fully accessible bathroom and one partly accessible. It is recognised by the organisation that they will need to offer another bathing facility in the near future. Bathrooms and toilets would benefit from signs on the doors.
The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 20 None of the home’s radiators have guards fitted to reduce the risk of scalding. Risk assessments have been completed and then a staged programme of covering is to take place. It was noted that during the inspection one radiator in a hallway was very hot to touch. The home has employed a housekeeper and 2 extra cleaners. Comments received from relatives confirmed that the level of cleanliness noticed on the day of the inspection is consistent. New bed rails and bumpers have been purchased. A new bed was purchased following the assessment of a prospective resident so that their needs could be met. This is commended. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality outcome in this area is poor. Staffing levels were not being adapted to meet the resident’s needs. The home has not achieved 50 of their workforce having an NVQ certificate by 2005. The recruitment process is not thorough so does not fully protect the residents. The training programme should enable staff to meet the changing needs of the residents. EVIDENCE: 27. The home does not have full occupancy. The staffing levels consist of 1 registered nurse and 6 care assistants in the morning. Following the second day of the inspection the staffing levels have been increased by one care assistant for the evening and night shift. Consideration will have to be given to future admissions and whether the staffing levels need to be increased to meet those needs.
The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 22 28. Records showed that 5 care assistants had started their NVQ 2 course this year. Two staff already have that qualification. This was not discussed with staff during this inspection. 29. The recruitment records for four new staff were checked. Three had been recruited from Poland and one locally. It was of concern that the references sought by Head Office were addressed “to whom it may concern” in some instances. Otherwise the references were written in poor English and did not refer to this particular role. The locally recruited member of staff’s file did not contain any interview notes. This was of concern as there were two areas of concern which could not be verified. This could not be done verbally as the person who conducted the interview has left. The concerns have been passed on to the acting manager and regional manager. 30. Training records were examined. These showed that Hygea (training provider) had updated staff in subjects relevant to their role this year. These included: Fire Safety, Nutrition, Care planning, Communication, Role of the care assistant, Abuse, Manual Handling, First Aid. Evidence of staff reflection on the study days was not present – such evidence was present at the organisation’s other care home locally in relation to their staff who attended the same sessions. The learning outcome of staff attending these sessions will be assessed at future inspections. It was not possible to tell from the records if the night staff had all been updated in Fire safety which had been required by the 12th May 2006 at the first day of the inspection. The administrator gave the inspector the name and number of the trainer to check if they had all been updated. The trainer was contacted and stated that they would e-mail the inspector with those details. To the date of writing this report on 22nd June 2006 this had not been received. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The quality outcome for this area is adequate. A consistent approach to develop standards and provide staff with continuous leadership is not possible due to the poor retention of managers. Quality assurance surveys must have the results/action plan published so that the home shows it is running in the best interest of the residents. Staff are receiving regular supervision. Although Health and Safety issues are in the main being addressed well, the safety of residents and staff is being compromised insofar as night staff are not receiving their 3 monthly fire safety update. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 24 EVIDENCE: 31. Unfortunately the Acting manager has given in her notice and will be leaving at the end of May 2006.The home now has a different regional manager who visits the home very two weeks. 33. A quality assurance questionnaire was distributed in January 2006. 9 forms stated that they were satisfied or more with aspects of the home. Three forms detailed areas of dissatisfaction, which the manager stated had been addressed. The results of this survey need to be published and made available to residents and other interested parties. Relatives meetings are held. Unfortunately the last meeting was poorly attended. Requests were made which are going to be actioned such as a new TV for the lounge, new tables in the lounge and more chairs for visitors in the bedrooms. 36. Staff confirmed and records showed that staff are receiving regular supervision. This was not discussed with the staff at this inspection to determine if this has a positive outcome for them. 38. Health & Safety audits had been completed in October and December 2005. These revealed that some actions needed to be taken such as requiring COSHH data and risk assessing water temperatures. Most generic risk assessments have been completed. The Fire Log showed regulars tests of alarms, extinguishers, and emergency lighting. Advice was given about conducting a prolonged emergency lighting test as is recommended in the log. It was not possible to ascertain whether night staff are receiving a three monthly update in fire safety training. The last recorded sessions were June 2005 and March 2006. Only 13 staff attended the last session and only 2 of those were night staff. An immediate requirement notice was issued to ensure that resident’s safety is promoted by all night staff being updated in fire safety no later than the 12th May 2006. The inspector was told that a Workplace Risk assessment had been done. This was not available during the inspection. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 25 The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 X 2 The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 27 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 OP27 Regulation 12(1)(a), 12(2) Requirement Timescale for action 09/06/06 31/07/06 26/07/06 2. 3. OP31 OP27 4. OP29 5. OP38 6. OP15 Ensure service users are offered real choices about their daily life and increase staffing levels if necessary for this to happen. CSA 11(1) Ensure a completed application form is submitted by the Acting Manager. 18(1)(a) Keep the adequacy of the staff numbers under review, and increase if either the dependency or occupancy levels increase. This is a repeated requirement 19(4) Ensure that gaps in employment histories are explored and relevant references sought. This is a repeated requirement 23(4)d Ensure all staff attend suitable fire safety training at the timescales set out by Avon Fire Brigade. This is a repeated requirement 23(2)(d) Ensure food placed in the fridge is fully covered and dated. Ensure all areas of the kitchen are kept clean and free from debris.
DS0000049317.V290343.R01.S.doc 30/06/06 30/06/06 08/06/06 The Laurels Nursing Home Version 5.1 Page 28 7. OP7 15 8. OP8 12(1)(a) 7 OP30 17(3)(b) Ensure that, where possible, the resident and/or representative signs care plans to evidence their involvement in the process of planning their care in the home. This is a repeated requirement Instructions in assessments such as nutritional assessments must be transferred into a care plan and followed and reviewed for its effectiveness. Maintain records of training 30/08/06 30/06/06 30/06/06 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. 3. 4. 5 6 8 9 10 Refer to Standard OP21 OP22 OP24 OP11 OP16 OP18 OP33 OP38 OP7 Good Practice Recommendations Use clear signs on bathroom and toilet doors. Use orientation aids in communal areas. Provide comfortable seating for 2 people in bedrooms. Draw up end of life plans for all service users. Make the complaints procedure more accessible. For the home to produce its local policy for abuse. Publish results of quality assurance surveys. Send a copy of the Workplace Risk Assessment to the CSCI. Review care plans monthly with the service user, where possible. The Laurels Nursing Home DS0000049317.V290343.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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