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Inspection on 07/02/08 for The Laurels Nursing Home

Also see our care home review for The Laurels Nursing Home for more information

This inspection was carried out on 7th February 2008.

CSCI found this care home to be providing an Poor service.

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

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

What the care home does well

The home completes a detailed pre-admission assessment which makes sure that they can decide whether they can meet each person`s needs before a decision is made about their admission. The activities organised continues to fully support many people to participate in the varied group activities. The trained nurses do refer health care problems to the GP.

What has improved since the last inspection?

Plans to reduce the risk of people being scalded had been achieved by all of the radiators in the home having protective covers fitted. Records of what people have eaten are being completed for those people who staff have identified as being at risk of being malnourished. There is now a deep cleaning schedule in the kitchen to hep maintain satisfactory standards of hygiene. Opened packets of food are now being stored in airtight containers.

What the care home could do better:

To ensure the safety and well-being of people living in the home any unexplained bruising must be fully investigated. If the cause is unknown this matter needs to be referred under the safeguarding adults policy to social services. To protect the people living in the home from unsuitable people being employed no one should start working on the home without two suitable references, and POVA first check. To ensure that people`s needs can be met all times staffing levels should meet the dependency levels as well as the numbers of people living in the home. To maintain the quality of care any complaints received whether spoken or written must be taken seriously, fully investigated, and the complainant told that the findings of the investigation (within the Company`s timescale which is in their complaints policy). In order for people to have choices about what they had to eat they need to be asked what they would like before each meal. This is particularly so at teatime when no one has been offered a choice of anything other than sandwiches. In order for staff to be fully informed about what is happening in the home handovers need to be detailed and include all staff, including agency staff. In order for people`s needs to be met in a timely way call bells should be answered as soon as possible. All staff should help to preserve people`s dignity and treat them with respect to all times. This should include that if they have any visitors they should not be left in a compromising position by staff.In order to maintain standards within the home incidents which impact on people living in the home must be fully investigated. In order to foster a culture of people feeling that they can make a complaint without fear of reprisal, staff must not inform the service user that they know the complaint has been made about their conduct. In order to preserve people`s dignity age appropriate course materials should be used for activities, but if used the rationale for using items normally reserved for children under the age of five, should be documented. In order to make sure that staff can fully appreciate anyone`s mental health needs, care plans should be produced for any new problems such as anxiety, depression and dementia. The plans should include any medication for that problem so that staff can monitor its effectiveness.

CARE HOMES FOR OLDER PEOPLE The Laurels Nursing Home South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER Lead Inspector Kathy Marshalsea Unannounced Inspection 7th February 2008 11:00 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.V359420.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER 01761 470631 01761 471351 lreuropeancare@aol.com www.europeancare.co.uk European Care (SW) Ltd 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) Mrs Lesley Weir Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (4) of places The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 36. 4th December 2007 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.V359420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. This inspection visit was initially an unannounced inspection done jointly with the Contracts and Commissioning manager from Bath and North East Somerset Social Services. The visit was arranged to investigate several complaints which were received by Social Services in January 2008.The Commission for Social Care Inspection also received a complaint about the service, part of that was about the conduct of the manager; this part was referred to the provider to investigate. During the course of the visit both departments decided that due to the poor response to our concerns that the following actions would be taken: The Commission for Social Care Inspection would make this inspection a key (main) inspection visit so that the key standards could be inspected, giving us a better indication of the outcomes for people living in the home. The commissioning manager stated that she would be recommending an embargo on admissions to the home until a meeting was held with the homes acting manager and line manager on the 14th of February 2008. We also requested that in the managers absence someone else was seconded to oversee the home. This was done immediately and the manager from one of the company’s sister homes came to assist the inspector and commissioning manager, and also received the feedback from our visit. The second day of the key inspection took place on the 12th of February 2008, which concentrated on looking at the health and personal care, social care and provision of meals for people living in the home. What the service does well: The home completes a detailed pre-admission assessment which makes sure that they can decide whether they can meet each person’s needs before a decision is made about their admission. The activities organised continues to fully support many people to participate in the varied group activities. The trained nurses do refer health care problems to the GP. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To ensure the safety and well-being of people living in the home any unexplained bruising must be fully investigated. If the cause is unknown this matter needs to be referred under the safeguarding adults policy to social services. To protect the people living in the home from unsuitable people being employed no one should start working on the home without two suitable references, and POVA first check. To ensure that peoples needs can be met all times staffing levels should meet the dependency levels as well as the numbers of people living in the home. To maintain the quality of care any complaints received whether spoken or written must be taken seriously, fully investigated, and the complainant told that the findings of the investigation (within the Companys timescale which is in their complaints policy). In order for people to have choices about what they had to eat they need to be asked what they would like before each meal. This is particularly so at teatime when no one has been offered a choice of anything other than sandwiches. In order for staff to be fully informed about what is happening in the home handovers need to be detailed and include all staff, including agency staff. In order for peoples needs to be met in a timely way call bells should be answered as soon as possible. All staff should help to preserve peoples dignity and treat them with respect to all times. This should include that if they have any visitors they should not be left in a compromising position by staff. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 7 In order to maintain standards within the home incidents which impact on people living in the home must be fully investigated. In order to foster a culture of people feeling that they can make a complaint without fear of reprisal, staff must not inform the service user that they know the complaint has been made about their conduct. In order to preserve peoples dignity age appropriate course materials should be used for activities, but if used the rationale for using items normally reserved for children under the age of five, should be documented. In order to make sure that staff can fully appreciate anyones mental health needs, care plans should be produced for any new problems such as anxiety, depression and dementia. The plans should include any medication for that problem so that staff can monitor its effectiveness. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Laurels Nursing Home DS0000049317.V359420.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 DS0000049317.V359420.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. No one moves into the home without having their needs fully assessed so that staff can decide whether they can meet their needs. The care of people with dementia is not based upon best practice guidelines and so they are not supported to make the most of their abilities and preferences. EVIDENCE: We looked at the pre- admission assessments and records for two people had moved into the home, one recently and one last summer. Both assessments were comprehensive and had looked at issues which would be of importance for staff in the home to know, such as peoples personal details, their care The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 10 needs and any previously identified risks to their health and well-being. In both instances the person moving into the home had not been able to make a choice about whether they moved there or not due to their condition. We checked the care records and talked with staff about some of the people living in the home who had symptoms or a diagnosis of dementia. We then checked their records and found that there was not a definitive care plan for the effects that dementia was having upon them as individuals. One person had been living in the home for quite some time, one of their assessments had alot of subjective and negative comments about their abilities, and assumptions made about their capacity. For example they dont have the ability to continue with any hobbies and expresses no feelings so it is not possible to know. There was no social care plan this person despite the fact that the social assessment informed staff about things that they used to be interested in. This person had also been prescribed an antidepressant at some time but this was not mentioned in the care plan. It was evident from talking with care staff that people accepted the limitations they saw of this persons condition, and had not attempted to promote their remaining abilities, or attempt to help them maintain their self-esteem. However, it was pleasing to see that the activities co-ordinator had included this person in the various activity sessions, which took place in the communal lounge. While this is commended this should be complemented by meaningful activities for that individual person. We met this person’s relatives who said that they bring in a local newspaper when they visit and read it to their relative. They said that the staff would not have the time to do this. They had also developed a photo album of the person’s previous life including their family when they were growing up. They said that their relative would read the labels next to photos and recognise members of their family. None of these abilities had been recognised by the staff. We also discussed the fact that this person had been sat in a recliner chair for some time, and this had been done to keep them safe as they had previously tried to get out of their armchair. They wished that they could sit up to the table when eating their meal, but couldn’t because of the size of the chair. This was discussed with the staff who agreed that this person’s condition had changed so that they may be able to re-assess the use of the recliner chair. As using a chair of this type restricts the person’s ability to get up it should be assessed as a from of restraint and regularly re-assessed to see if it still a necessity. The second person had also been living at home for some time. There was no information in their actual care records about a diagnosis of dementia, this was found in the notes of a review held with social services. I spoke to 2 care staff who did not know that this person had a diagnosis of dementia. The Laurels Nursing Home DS0000049317.V359420.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mental health problems such as depression, dementia and anxiety are either not recorded in care plans or do not contain sufficient detail for staff to be given direction in meeting their needs. People living in the home are not always treated with respect and in some cases infantilised. EVIDENCE: We noticed in an accident form dated the 16th of January 2008 that someone living in the home had bruises on both hands and one arm. The person stated that this had happened while they were being given a bath on that day. The section of the accident form about whether this had been investigated or not was blank. I spoke the deputy manager who stated that this incident had not The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 12 been investigated, and nor had it been referred to under the safeguarding adults (abuse) policy to social services. The acting manager was asked to do this straightaway. We read the care records of this person and saw in their ongoing notes that there they had been diagnosed recently with a mental health problem, and had been prescribed medication for that problem. These facts were not in their care plan. The care records of three of the people who live in the home were checked to see if they gave sufficient and up-to-date information to staff about how to meet all of their needs. The first person was someone whose records I had checked at the previous inspection visit, and while there was some good detail of this persons physical care needs, was no plan for this persons mental health needs. There was no mention in the night-time care plan about the previous problems with hallucinations and dellusions, and the fact that they were having tablets at night to help them sleep. The second person’s care plan gave some good detail to staff about how to meet the persons physical needs. It was evident that the care plan was not entirely accurate, and that staff were not using the plan as a working document. For example in the pressure area care plan staff were asked to change the persons position every hour. Staff spoken with said that they actually do this every three to four hours. The plan for the person’s continence needs did not describe the actions that staff take during the day to meet this need. The care plan for their nutritional needs was quite detailed. However care and kitchen staff said that some of the things in the plan are not done. There was no mention of this persons remaining abilities or any encouragement to try and promote their abilities. There was a good risk assessment and care plan for possible non-verbal signs of this person either being unwell or being in pain. This person was also prescribed an antidepressant, which was not mentioned in their care plan. The third persons plan had adequate detail for staff to follow to meet their care needs. Some of this had been taken from the original admission assessment which was detailed. There were some instructions which were not being followed, for example in their eating and drinking plan. The care plan for sleeping did not mention the fact the person had been put on night sedation. Upon talking to the deputy manager we were told that this had been due to them being resistive to care intervention at night. We were told that no other type of management of this problem had been tried. There was no evidence in the care plan or daily statements of well-being that this had been a problem. This decision to use night sedation does not seem appropriate, and medication prescribed for a behavioural problem, should be a last resort and time limited. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 13 This persons family had completed a detailed social assessment including lots of important information about their interests and hobbies when they were well, and their spiritual preferences. The social care plan review did not show that these interests have been promoted or tried. There was a good risk assessment and care plan for the problem of communication, with useful information to staff about why the person might be feeling frustrated, and how staff should respond to that. Some health care assessments such as the risk assessment for the possible development of a pressure sore and taking the persons blood pressure regularly had not been done for some time. This person had also been prescribed antidepressants, which was not mentioned in their care plan at all. We met one person who had moved to the home about six weeks before our visit. Despite the fact that they been very unwell when they arrived, and continued to have a serious health problem, there was no care plan for staff to follow. The deputy manager stated that they had had not time to do this, or any of the health care assessments. On observing the staff interacting with people living in the home it was evident that people are not always offered choices or treated with dignity and respect that they should be. We were told about and witnessed people not being offered a choice of meal, being moved in a wheelchair without any warning from staff, clothes being tweaked without any conversation at all, staff making patronising remarks such as good girl when someone finished a meal or a drink, and inappropriate use of coercion such as eat your meal for me. The Laurels Nursing Home DS0000049317.V359420.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social care is not woven into the daily care of people living in the home so that it depends upon the activities organiser providing social care. Some people’s abilities and interests are not recognised and promoted. People living in the home are not being offered choices of meals. EVIDENCE: It was a recommendation at the last inspection visit that only age appropriate material should be used for craftwork. We noticed that one person living in the home had been given a very young child’s puzzle to do; it was hard to see how this was appropriate. There was nothing in this persons notes to suggest that this had been assessed as being necessary or wanted. One person complained to us that staff are so busy they do not seem to have the time just to sit and talk. Staff also said how busy it had been at the home, The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 15 records seen verified the fact that there had been occasions when there have not been enough staff on duty. One family we met were very complimentary about the activities organiser who they thought was very good, and tried to do things individually with people which they had not seen done before. On checking the records of the activities it was evident that the organiser make every effort to see each person regularly. However a lot of the entries covered the main activities programme in the communal lounge. We did not see any evidence of peoples individual interests and preferences being accommodated. In order for this to happen staff would need to have the time and willingness to spend quality time with people. This is usually done using the key worker system, a key worker is a care assistant who would be particularly interested in the welfare of a small group of people. Part of this role would be to spend one-to-one social time with each person on a regular basis. One of the complaints social services received was about the quality of the food, in particular at teatime. The homes menu shows that this should be a choice of hot or cold food at this meal. One person told us that they are not given a choice and are just given sandwiches every night. There was no evidence in any records to show the people were being offered or given the hot alternative at teatime. One member of staff did confirm that people were just being given sandwiches. We observed two meals, breakfast and lunch on the second day of the inspection. Both meals were fairly chaotic and seemed poorly organised. There were roughly 6 people having breakfast in the dining room. One care assistant was allocated just to help people in this room. While they were trying to do this other care staff were dashing in and out of the room, periodically standing by someone and attempting to encourage them with a spoonful of food, or to take more of a drink. However, one persons cup of tea sat untouched for approximately 20 minutes before someone came to prompt them. The lunchtime meal extended over two hours, from the bringing up of the first person from the lounge to the dining room, to the last person being taken out of the dining room and back to the lounge. There are quite a lot of people who needed help to eat their meal, as some staff were not available one person was helping two people at the same time with their meal. One persons meal was only partially eaten and they were left for considerable time, leaving the meal to go cold, before they were helped again. No offer was made of giving them more hot food or another alternative. Some staff who were trying to assist someone with their meal did not really speak to the person they were helping, or explain what meal they were helping them with. After telling the deputy manager on the first day of the inspection about people not being given a choice of meals, we checked whether they had been on the second day. Staff said that they asked everyone the day before what they The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 16 would like to eat for the next day. People had an entry of choice next to their name. For those people who suffer from dementia this would not be appropriate, so staff were making that choice for them. A much better solution would be to offer these people a visual choice of the alternatives at each meal. During our visit staff told us about four people whom they recognised as being of risk of being malnourished and dehydrated. All four records of the food and fluid intake charts were checked. None of the fluid charts were totalled over a 24-hour period making it difficult to see how much people were drinking and whether this was enough. There was no clear record in their care plans on instructions for the amount of fluid fluids and food they should be having. As was found at the last inspection the cook and kitchen assistant were not informed about any special diets. Following recommendations at the last inspection visit the kitchen now has a deep cleaning schedule, and all packets of food are being stored in airtight containers. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People could not be assured that their complaints will be taken seriously and that they will be informed about any outcomes as a result of their complaint. The culture of institutional abuse has begun to be evident again, this was seen when we observed staff. EVIDENCE: As mentioned in the summary this visit was done to look at the four complaints received by Social Services in January 2008, and the one complaint received by the Commission for Social Care Inspection in January 2008. There was a common theme over the five complaints from different sources regarding inadequate staffing levels, a language barrier, the poor quality of food, and from one person the inadequate cleanliness in the home. Two people also felt that the management of the home had been inadequate at times. We were able to verify that staffing levels had been inadequate for at least 6 days from the 24th of December to the 13th of January this also included two Sundays.we experienced a difficulty in communicating as we were not sure if our concerns had been understood and could verify about the problems with The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 18 food provision. We also felt that while our complaints and concerns were listened to, no action would have been taken to investigate or resolve these concerns. We met one person living in the home who told us since their admission to the home theyve made a number of complaints. These have included their dissatisfaction with the food and there was an incident recently when one of her relatives had complained about the small size and quality of their tea-time meal to one of the registered nurses. Despite this has not been an improvement in the teatime meal. They also informed us that they felt was no point in complaining as the staff all stuck together. They told us about one incident where they had complained to one of the nurses about the conduct of one of the care assistants. They were very distressed and upset when the carer came to tell them that they knew a complaint had been made about them. They said that this was not the first time this had happened. As a result of us commenting about this incident this member of staff had received a supervision session with the deputy manager to discuss their behaviour, instigated by us. We saw the record of this supervision session, which was inadequate and did not cover the significant intimidation that the person living in the home suffered. This form of intimidation is considered to be abusive behaviour and needs to be dealt with in this manner. It was evident during this inspection visit that elements of institutional abuse have crept back into the culture of the home over the past two months. (See Standard 10) Senior staff did not appear to recognise that this form of behaviour is abusive. This was also evident in them not recognising that unexplained bruising needs to be investigated, both to make sure that it was unintentional and to make sure the steps are taken to make this less likely to happen. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to make improvements to its décor. EVIDENCE: While these standards were not assessed at this inspection visit we saw that there was a decorator at the home freshening the paintwork. We noticed as we walked around the building that there were no offensive odours and that all areas we saw looked clean. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home have at times not had enough staff on duty to meet their needs, or been protected from unsuitable people being employed. EVIDENCE: One of the complaints we received had been about inadequate staffing levels. We checked the records of hours that have been worked by staff, including agency staff from the 17th of December 2007 to the third of February 2008. The home’s records of actual hours worked showed that were some days when there was an insufficient amount of staff on duty, even with agency staff. Record showed that the week of the 24th of December 2007 had three days when there was not enough staff on duty and from the seventh of January till the 28th of January 2008 nine days was not enough staff on duty, the following two weeks there was two days with not enough care staff. We are informed that the deputy manager that two new care staff had started working their induction and another was about to start their employment. We were told that this should fill the vacancies. We discovered during our visit that one member of the care staff team was about to go on maternity leave and another was moving to another home within the group. This would appear to The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 21 leave another two vacancies so the home will still not be fully staffed with permanent employees. We spoke with some of the care staff team who said that it had been a very busy time and that it could be very frustrating when not enough staff were on duty. This was also verified by the deputy manager who said that some things which should be kept up-to-date like the care plans and healthcare records had not been done because of them being short staffed. They included the fact that someone was living in the home without a care plan and risk assessments because of their having to work as an extra pair of hands, while the care staff numbers were insufficient. It was evident that even since the previous visit to the beginning of December the dependency levels of the people living in the home has increased. This seemed particularly so for those people who need assistance with their meal. The staffing levels have to be adjusted to meet the needs of the people living in the home and should not be calculated just upon the numbers of people living in the home. We checked the employment records of the last three people employed. These included two care staff and an administrator. The first file was in good order and contained all of the necessary documents to show that the person was suitable to work in care. The second file was less reassuring as there was a gap in employment from August 2007 to when the person started work at this home at the end of January 2008.Also the references seen did not match the referees recorded on the application form. There were the necessary police and protection of vulnerable adults checks done before the person started work. The third person was not involved in care work and was on their induction on the first day of our visit. There were no references in the file, the interview form was incomplete and identified two areas of weakness, and no checks been done to make sure that they were not on a list of unsuitable people to be working in care (POVA list). The acting manager was informed about this and immediately sent the person home. The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the manager’s absence the home was not being managed effectively. EVIDENCE: The manager had been absent from the home for approximately 3 weeks at the time of our visit. On the first day of our visit we discussed our concerns and findings with deputy manager. While we found them to be very pleasant and apologetic for the shortfalls, will not given any reassurance that would be an investigation is all actions taken as a result of these concerns. It was difficult to gauge whether they understood the seriousness of our concerns. We did not find this reassuring so contacted the companys program manager The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 23 responsible for overseeing this home. We asked for someone to come and care take the home in the manager’s absence. The manager from the company sister home nearby came over straight away and took control of the situation. Once theyd listen to our concerns they immediately understood to the potential seriousness, and were able to state what investigations and actions they were going to take. They informed us that they would be staying at home until the registered manager returned. One family that we met commended the registered manager, Mrs Lesley Weir’s efforts at improving standards in the home. They stated that that they had noticed changes for the better in a lot of aspects in the home under her leadership. Another person living in the home stated, she calls a spade a spade and said that while initially they werent sure about that they actually appreciated that direct approach. We received mixed comments about Mrs Weirs management style both from staff, people living in the home and relatives. It may be that her direct approach is not easy for some people to accept. However it must be recognised that this home needed strong leadership skills to improve the standards. Before Mrs Weir the home had a succession of managers who for various reasons were not able to cope with managing this home. Mrs Weir was the first registered manager with the Commission for Social Care Inspection for three years. She achieved many improvements in the life of the home including the promotion of activities, safer health care, minimising the risk of people falling, more accountability among the staff group and having the strength to tackle the insidious institutional abuse which was evident in 2005. The Laurels Nursing Home DS0000049317.V359420.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 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 X X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X X The Laurels Nursing Home DS0000049317.V359420.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 91) Requirement The Registered person shall ensure that a care plan is written for the service user identified within this report as not having one. Immediate Requirement The Registered person shall ensure that new health problems, including mental health problems are recorded in the care plans. Any restrictions of liberty must be recorded and reviewed regularly. Instructions in the care plans for the frequency of interventions must be followed or changed. Repeated Requirement The Registered person shall ensure that all service users are treated with respect at all times. Repeated Requirement The Registered person shall ensure that no one works at the home without obtaining suitable references and making sure that they are not on the Protection of Vulnerable Adults list. Timescale for action 19/02/08 2. OP7 15(2)(b) (c) 29/02/08 4. OP10 12(4)(a) 28/02/08 5 OP29 19 (4) (b) 28/02/08 The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 26 6 OP27 18(1)(a) 7 OP18 13(6) 8 OP12 16(2)(m) 9 10 OP15 OP16 16 (2)(i) 22(3)(4) 11 OP9 13(7) The Registered person shall ensure that at all times sufficient numbers of staff are on duty to meet the dependency levels of the service users. The Registered person shall ensure that any unexplained bruising is investigated and reported under the safe guarding adults policy. The Registered person shall ensure that service users are supported to pursue their previous interests and hobbies. The Registered person shall ensure that service users are offered a choice of meals. The Registered person shall ensure that complaints are fully investigated and inform the complainant is informed of the outcome. The Registered person shall ensure that medication is used as a last resort when dealing with any behaviour which challenges the staff. 09/02/08 09/02/08 30/04/08 29/02/08 29/02/08 29/02/08 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 Refer to Standard OP4 Good Practice Recommendations Subjective comments should not be made in care plans or assessments. Any assumption about a person not having capacity should be done following guidance from the Mental Capacity Act. Age appropriate materials should be used for craftwork. The home should continue to strive to consult relatives and service users about life in the home so it is run in their best interests. DS0000049317.V359420.R01.S.doc Version 5.2 Page 27 2. 3. OP12 OP33 The Laurels Nursing Home The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Laurels Nursing Home DS0000049317.V359420.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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