Inspection on 09/11/06 for The Laurels Nursing Home

This inspection was carried out on 9th November 2006.

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

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

Other inspections for this house

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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 71 Old London Road Hastings East Sussex TN35 5NB Lead Inspector Liz Daniels Unannounced Inspection 12:30 9 November 2006 th 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 DS0000066577.V317256.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 DS0000066577.V317256.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address 71 Old London Road Hastings East Sussex TN35 5NB 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) 01424 714258 The Laurels Nursing Home (Hastings) Ltd Vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty-nine (29). Service users must be older people aged sixty-five (65) years or over on admission. Service users requiring nursing care only to be accommodated. Can accommodate one specific person under the age of sixty-five (65) years. New Service Date of last inspection Brief Description of the Service: The Laurels Nursing Home is a large detached property set back from the road at the end of a small cul-de-sac in a residential area of Hastings. It changed ownership in June 2006 and provides nursing and personal care for up to 29 residents of an older age. The accommodation is arranged over two floors: a passenger lift enables access to all parts of the building and all areas are accessible for those with limited mobility. Hoists and bath hoists, as well as grab rails and disability aids are in the bathrooms and toilets. There are 21 single rooms, eight of which have en-suite facilities and four double rooms, all with en-suites. The lounge on the ground floor looks out onto a small garden area. The Home is set in large well-maintained gardens, which can be accessed from some of the bedrooms on the ground floor and enjoyed through large picture windows on the first floor. At the front of the Home there is parking space for approximately ten cars. A main bus route is nearby, enabling access to the shops and sea. The home welcomes prospective residents or their representatives to look around and discuss their needs with the Manager as well as spend time with the staff and residents. Weekly fees range from £525 - £735 as at 3/11/06, for full nursing care. Hairdressing, chiropody, manicures and any sundries such as newspapers, or personal shopping are charged as extras. Information about the service is available at the home and can be obtained by contacting the Manager. The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. It included a visit to the home by an Inspector that began at 12.30pm and lasted for just under eleven hours. A senior member of staff, who is currently mentoring the recently appointed Manager, facilitated the visit. The Deputy Manager was on leave but the visit also provided the opportunity to meet with the home’s new owners, the Manager and four other members of staff, before spending time with several of the residents. No visitors were available to meet with the Inspector during the visit. The Inspector also toured the premises and examined records that included resident’s files, staff files, training records, policies and procedures, the accident log and the complaints log. Evidence contributing to this inspection has also been gathered from surveys circulated to residents and their relatives (seven of which had been returned to the Inspector) and from data provided by the Manager of The Laurels. All of the key standards and several others were inspected. What the service does well: What has improved since the last inspection? This is the first inspection of The Laurels since its change of ownership. A senior member of staff who has previously worked at the home and has management experience has been working alongside the proprietors and the new Manager on a short-term basis. Her role has been to audit the environment and the service being provided and to support with updating the policies and procedures. This has assisted in enabling a smooth transition for the staff and residents. As a result of an extensive audit, a more structured activity programme is being developed and the specific interests of individuals The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 6 are being explored whereby the lifestyle experienced by the residents matches their expectations. An addition to the call system in the home ensures it is now safer for residents and information about The Laurels is being updated whereby prospective residents can make an informed choice about the home What they could do better: 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 DS0000066577.V317256.R01.S.doc Version 5.2 Page 7 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 DS0000066577.V317256.R01.S.doc Version 5.2 Page 8 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): 1, 3 and 6 Quality in this outcome area is good. Good information about the service provided at The Laurels is being produced although it has not yet been circulated and publicised. A thorough assessment of prospective residents takes place to ensure a resident’s individual needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose for The Laurels has been re-written to reflect that the home is under new ownership. Similarly the Resident’s Guide is being amended and the proprietor confirmed that they will soon be ready for printing and publicising. The aim is to then provide each of the residents with a copy. The new information was viewed and discussed. It does not include the views of service users but the proprietor aims to summarise the feedback from a survey that has been circulated recently and include it as an appendix to the guide. Similarly it is anticipated that a copy of the Commission for Social Care The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 9 Inspection (CSCI) report will be included. It is practice that a Residents Guide is sent out to enquirers and given to any prospective residents who look around the home. There was also discussion about the benefits of ensuring copies are on display in the main entrance of the home and it was agreed this would be explored. The practice for the assessment of prospective residents was discussed. Following an enquiry, prospective residents or their relatives are invited to visit The Laurels if at all possible, to spend time with the Manager and staff, view available rooms and discuss the home’s suitability. If it is then appropriate to pursue an admission, the Manager, her deputy or the home’s trainer undertakes an assessment in the person’s own home or if they are in hospital, they visit them there. A comprehensive pro-forma is completed. The Manager confirmed that she also asks for information from the prospective resident’s Care Manager, or from nursing and medical staff if the person is in hospital. Their written assessment if available then helps underpin the home’s preadmission assessment. If the home is suitable the Manager writes to confirm and once funding has been agreed (if it is needed), the resident is then admitted for a trial period. They are provided with a contract that identifies the room they occupy, the fees payable and the services provided. Six of the seven surveys returned to the Inspector, prior to the inspection, stated that they had received a contract and they all said that they had received enough information prior to moving in, to enable them to make an informed choice about the home. The care files for four residents were viewed during the inspection. Three had been assessed prior to admission and the information gathered had been used to underpin their plan of care. The fourth resident had been admitted for respite care as an emergency. Each of the other residents had also had physical and social assessments, as well as various Risk Assessments. The Laurels does not provide ‘Intermediate Care’ although residents are admitted for planned respite care. Emergency respite care is also provided very occasionally. The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 10 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, 8, 9 and 10 Quality in this outcome area is good. The care plans for some residents need to be more specific. However, in general individualised health and personal care for the residents is promoted and the practises in place encourage residents to be cared for with respect and dignity. Good practise is in place for the administration, storage and disposal of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four resident’s files were reviewed. Two residents were receiving respite and two had been admitted for permanent care. Those residents receiving respite care had a modified plan detailing the nursing care required to meet their medical needs. Other needs had been identified in the assessment although the care required to meet those needs had not been outlined. The other two residents both had comprehensive risk assessments and individualised care plans that had been reviewed monthly and there was evidence that they had been updated. Each day, the staff also complete a daily record for each The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 11 resident, documenting care provided and any significant events. Any changes in care are also passed on verbally in the handover between each shift. The Manager confirmed that the staff explain to each resident on admission that they will have a care plan, discussing the care that is required with them and their relatives. Any care given is explained and any new care introduced is discussed with them and/or their relative. The resident or their relative does not currently sign the care plan to demonstrate their involvement with it. The condition of residents’ skin is assessed and monitored, any pressure areas are recorded and if a sore develops the treatment and outcome is documented. The Manager confirmed that in general, staff within the home manage any wounds but advice may also be sought from a nurse specialising in tissue viability. There are various types of pressure relieving mattresses and cushions to support the management of pressure areas at The Laurels. Resident’s dependency is also assessed and the risk of falling is identified. If appropriate, residents are assessed as to the suitability of bed rails and consent is obtained. The home has electric hoists and hoist-assisted baths for those with reduced mobility. Grab rails are fitted in the toilets and raised seats are available; there are also adjustable beds. If appropriate, residents have a continence assessment and continence advice is sought if needed. Nutritional screening is also undertaken and resident’s weights are monitored. The chiropodist visits the home and arrangements are made for residents to see a dentist or optician as needed. When possible residents remain registered with their own GP or they register with a GP of their choice. One care plan seen by the Inspector demonstrated a community matron and physiotherapist had also seen the resident. One resident receiving respite care currently self medicates. If a prospective resident asks to self medicate at the pre-admission assessment the Manager assesses whether it is appropriate, recording it as a Risk Assessment. If they are assessed as safe, the Manager records agreement from the prescriber, the resident and the next of kin. A lockable space is provided in each of the rooms, for the storage of medication. A policy is in place outlining the details of the procedure undertaken. The medication for the remaining residents is kept in one of the two ‘Drug Rooms’ either on the ground floor or the first floor. The majority is dispensed in blister packs, providing one months supply (the NOMAD system). Other medication not dispensed in the NOMADS is named for each individual and stored in a drug trolley. Each resident has his or her own Medication Administration Record (MAR chart) of medicines prescribed. The MAR charts were not examined in detail during this inspection, as there has recently been an internal review of medications by the Manager and senior staff. A record of medication for disposal is maintained and signed by two staff: the Home uses a The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 12 Waste Management Company for disposal. There is a locked wall cupboard that is used for ‘Controlled Drugs’. There is a fridge which is used for medication: the temperature is monitored daily. The trained nurses at the home administer medications; they have all had in-house training. Carers assist in the administration of medication although they are not involved in the administration of Controlled Drugs (CDs). Staff who met with the Inspector confirmed that the ethos of the Home is to support residents in caring for themselves as far as they are able but also to provide privacy and show respect when residents are undergoing examinations or personal care. During the inspection, staff were observed to be attentive and courteous to the residents. One resident who met with the Inspector commented that ‘I am very happy here’ and another confirmed that ‘there’s no other group of staff to match this lot. The nurses are so qualified and empathetic’. Of the seven surveys returned prior to the visit, three residents responded that they ‘always’ receive the care and support they need and four said ‘usually’. One person commented ‘the nurses are very good’ and another that ‘the care is very good’. The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Resident’s interests and preferences are not always clearly recorded. However the selections of activities that are available are improving, whereby the lifestyle experienced by the residents matches their expectations. Autonomy and choice are upheld and the residents benefit from varied and nutritious meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A small lounge on the ground floor at The Laurels enables residents to sit together and watch television, read or meet with their visitors. Videos, books and games are available. One resident has a budgie that spends time either with them in the lounge or in their room. One of the staff works part time as a receptionist and part time as the Activity Co-ordinator. Another member of staff who is currently a carer is also helping with developing a programme of activities, particularly over the Christmas period. Music and movement sessions are starting soon and a coffee morning is planned for relatives. The Manager has contacted local churches to ask if the vicar or some of the congregation could visit the home and the care staff have recently been The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 14 accompanying some of the residents for walks. Of the seven service user surveys returned to the Inspector prior to the visit, four said there are ‘sometimes’ activities for them to take part in, one said ‘never’ and two did not respond to that question. One resident who spoke with the Inspector said they prefer not to go into the lounge and join in but were happy to read the newspaper or a book and to watch television in their room. Another commented that they sometimes find it difficult in the lounge as it is small but they prefer that to sitting alone in their room. Friends and relatives can visit anytime that the resident wishes and staff rearrange meals for any resident who wishes to go out. Residents can meet with their visitors in the lounge, if they prefer not to meet with them in their own room. Although hobbies, likes and dislikes were not well recorded in those care plans seen by the Inspector, the Manager confirmed that, where possible, residents are encouraged to maintain links with the local community. None of the current residents belong to a local club or join in with any community activities. However, arrangements are made if residents wish to receive Communion and the home currently celebrates the Christian festivals. There are currently no residents from an alternative cultural background although some of the staff at The Laurels are employed from overseas. Although there have not been celebrations for other festivals the Manager confirmed that the staff and residents share stories about their own homes and different cultural backgrounds. The Manager is therefore confident that the home could meet the needs of residents with varying social and cultural needs. It is not known how many of the residents manage their own financial affairs and how many have a relative or solicitor who acts on their behalf. The home acts as the appointee for one resident. The remaining residents or their representatives are invoiced by the home and any sundries are separated out on the invoice. Residents are encouraged to bring in personal possessions with them. Whilst walking around the home the Inspector met with several of the residents informally in their bedrooms. Those who spoke with the Inspector said they liked their rooms and had chosen some of their own furniture and belongings to bring with them to make them feel more homely. Staff were seen to be respecting residents’ privacy by knocking before entering. The Manager confirmed that staff always endeavour to ensure residents have a voice and that they access advocacy services or ensure there is always someone available to speak on their behalf. There have not been resident’s meetings held but the Manager aims to start them. Although The Laurels is now under new ownership, the catering team remains as at previous inspections, when it has been found that the food provided is varied and enjoyed by the residents. Meals can be eaten in the lounge or alternatively some residents prefer to eat in their own rooms. The menu seen by the Inspector was nutritious and varied. Two choices of meal are available for lunch, with one usually a vegetarian or fish alternative. There is a cooked supper (usually jacket potato with filling) or soup and sandwiches, followed by The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 15 a dessert. One resident who met with the Inspector described the food as ‘very good’ whilst in the surveys returned, four people responded that they ‘always’ like the food and three said ‘usually’. The Laurels Nursing Home DS0000066577.V317256.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. The home has a satisfactory complaints procedure and residents are confident that their views are listened to and acted upon. Safe measures are in place to ensure residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure at The Laurels was updated in October 2006 and is on display in the entrance to the home. It is also publicised in the Statement of Purpose and Resident’s Guide. Residents seen during this site visit expressed confidence in the Manager with one describing her as ‘wonderful’. Although she is new to her post they confirmed that they feel they can raise anything with her. They also said they know she listens and feel reassured that she will follow through their concerns. One resident also commented that ‘Mrs. Thind (the owner) is so superb’. Of the seven surveys received by the Inspector, five identified that they ‘always’ know who to speak to if not happy, and two that they ‘usually’ do. Of the seven, five also said they ‘always’ know how to make a complaint and two said ‘sometimes’. The Commission has not received any complaints about the service since the change of ownership, although the home has received two complaints. Details of complaints, their investigation and the outcome reached are documented in the home’s complaints log. The Manager confirmed that the outcome is discussed with the complainant to ensure they agree, although this had not been recorded. There The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 17 were also no dates as to when the investigations had been undertaken or the outcome reached. The benefits of recording these were discussed and agreed. Adult Protection policies and procedures are in place and have been updated to reflect Social Services as the lead agency to lead an investigation in the event of an allegation of Adult Abuse. Criminal Record Bureau (CRB) Disclosures are applied for as part of the recruitment process. A Protection of Vulnerable Adults First (POVA First) check is also applied for. All staff receive a basic introduction into Adult Protection as part of their induction training. All staff that met with the Inspector could explain the action to take if they had any concerns about a resident’s welfare. The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 18 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): 19, 22 and 26 Quality in this outcome area is good. The Laurels provides a comfortable environment that is clean and satisfactorily maintained. The addition to the call system ensures the home is safer for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Laurels is situated in a residential part of Hastings but is convenient to local shops and bus services. It is a large detached property that provides accommodation over two floors, both of which can be accessed by stairs or a lift. There is a good size garden to the rear and side, which can be reached via some resident’s rooms, or by steps from the front of the building on the ground floor. On the ground floor there is a lounge that overlooks a small area of garden. The home is comfortably furnished: radiator guards are in place throughout the Home and windows are restricted. The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 19 The fire alarm has just had its annual service (in October 2006) and is tested weekly. Records show that alarms on both floors are activated on a rotational basis to ensure they sound and the fire doors close. Random fire drills also occur, the last being in September 2006. All attendances are recorded and the Manager plans to monitor that all staff attend the required number of drills each year. The call bell system at The Laurels remains as it has been previously. The system to alert for an emergency in a resident’s room is to ring three times; as the bell has to be re-set outside the room, this necessitates the alerter going outside the room between each ring. The emergency call cannot be identified against any other call bell ringing at the same time. However two ‘walkietalkies’ have recently been purchased, enabling two staff to talk directly to each other. This is particularly beneficial at night as the night staff can summon each other for assistance: the proprietor agreed that there needs to be further discussion with the day staff to clarify what other steps can be taken during the day to summon assistance in an emergency. The proprietor is currently meeting with representatives of different companies with a view to installing a safer, more comprehensive, call system as soon as possible. The laundry facilities were not fully inspected on this occasion as the same staff and arrangements have continued through the home’s change of ownership. The Manager confirmed that good measures are in place to prevent the spread of infection and that the home is cleaned and well maintained. At this inspection it was found to be clean and free from odours. One resident who met with the Inspector praised the cleanliness and was pleased at the flexibility of the domestic staff in fitting around her routine when cleaning her room for her. All the respondents in the survey returned to the Inspector confirmed that the home is ‘always’ fresh and clean. The Laurels Nursing Home DS0000066577.V317256.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, 28, 29 and 30 Quality in this outcome area is adequate. There is a planned approach to staff training and development, ensuring that the staff who care for the residents are skilled and competent. However robust recruitment procedures must be implemented to ensure the residents are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At least one registered nurse is on duty at The Laurels at all times during the 24-hour period. Four carers support him/her during the morning, three in the afternoon and evening and one at night. The Manager works some shifts as the nurse in charge and some shifts as an extra, enabling her to provide staff support and to complete administrative work. There have been some recent staff vacancies and absences whereby considerable agency staff have been used over the last two months. The home uses two agencies and asks for evidence that staff have had a Criminal Records Bureau (CRB) Disclosure. The Personal Identification Number (PIN) for any trained nurse booked to work, is also requested, as an assurance that they are registered with the Nursing and Midwifery Council (NMC). However the Manager confirmed that the home is building up a ‘bank’ of staff that will provide flexible cover for any absences and that permanent staff are also being recruited. She anticipates a full The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 21 complement of staff within one month of this inspection. Catering and cleaning staff, maintenance and gardening staff are also employed. Of the seventeen care staff, ten (60 ) have or are currently studying for the National Vocational Qualification (NVQ) level 2 and the home’s trainer has also recently become an NVQ assessor. All staff that are employed undertake an induction with the home’s trainer and a foundation programme is then put in place, which is tailored to individual need. Two staff files were inspected during the visit. Both members of staff had been employed during October 2006. A ‘Protection of Vulnerable Adults First’ (POVA First) check and an enhanced CRB disclosure is applied for, for all new recruits. Confirmation of clear POVA First checks for both staff had not been received until after their start of employment. The Manager explained that the induction for new staff is held in a separate building and that staff do not have contact with any residents until their POVA First clearance has been received. They then work with the residents under the supervision of another member of staff until the CRB Disclosure is received. The CRB disclosures had not been received for the two staff members whose files were viewed. References are requested as part of the recruitment procedure. One file seen had two references that had been received after the start of employment. The other had a verbal reference taken prior to the start of employment but no record of written references. A completed application form containing all the appropriate information was in each file and copies of passports are held. An annual training programme is in place for both the trained nurses and the care staff. The mandatory training including fire training, ‘Moving and Handling’ and ‘First Aid’ are scheduled, but there is also specialist training, specific for the needs of the residents accommodated at The Laurels. The trainer is also made aware of any areas for development that are identified in supervision or appraisals: appropriate training is then arranged. All training is held in work time whereby staff have a minimum of three paid training days per year. The Laurels Nursing Home DS0000066577.V317256.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, 33, 35 and 38 Quality in this outcome area is good. The Laurels is being well managed during the mentorship of the new Manager and robust processes are being put in place to ensure the home is run in the best interests of residents and that they are kept safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager at The Laurels has recently been appointed. She is a registered nurse with a background of experience in acute health, both in this country and abroad, before transferring into community care and working within a variety of care settings. Supported by a Deputy Manager she leads a team of ancillary and care staff. A senior member of staff who has previously worked at the home and has management experience is also working alongside the The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 23 Manager on a fixed term contract, to provide mentorship. The aim is that the Manager will commence training for the Registered Manager’s Award (RMA) within the next six months and apply for registration with the CSCI. Those staff and residents who met with the Inspector expressed confidence in the new proprietors and management team. One resident commented that ‘Matron is wonderful’ and a member of staff commented ‘I can go to the Manager at any time if I have any concerns. I know she’ll follow things up’. As part of their quality assurance, The Laurels aims to undertake annual service user surveys. A survey had just been circulated at the time of this inspection. The proprietor confirmed that this will be analysed and summarised. The benefits of ensuring the information is available to staff, residents and stakeholders was discussed and agreed. The proprietors have developed an Annual Development Plan for the home although this was not available in paper format to be seen by the Inspector on the day of the visit. Discussions demonstrated that already the plan has changed to include the needs of the residents and the proprietors explained that they anticipate the plan will be moulded and changed, depending on the views of residents and needs of the service. The management team has recently undertaken a full internal audit of the property and home’s operation and the proprietor also undertakes a monthly, unannounced visit to inspect the premises and speak with residents and staff. The home acts as the appointee for one resident but the remaining either manage their own financial affairs or relatives or solicitors act on their behalf. Residents are encouraged to keep small amounts of personal money with them if they wish, but the home buys sundries on behalf of the residents as necessary and they are then invoiced retrospectively. The fees and any sundry items or services are separated out on the invoice. Prior to the site visit the Manager returned data to be considered as part of the inspection. The training information included within that, shows that there is a comprehensive programme of training for the year that includes the annual mandatory training in fire procedures, ‘Moving and Handling’ and ‘First Aid’. The home’s trainer maintains a matrix to monitor that all staff have their mandatory updates. The information returned prior to the inspection demonstrates that the home is well maintained and this was borne out on the day of the inspection. The maintenance manager undertakes monthly water checks to check the water temperature and fire records were examined. The Accident Log for the home was viewed: slips, trips and falls have been recorded and appropriate action taken. The Manager explained that she is monitoring all the accidents and therefore aims to identify if there are any trends and the action needed to reduce that trend. The Laurels Nursing Home DS0000066577.V317256.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 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP12 Regulation 15 (1) 16 (2)(n) Schedule 1(9) 13 (4)(a)(c) 19 Schedule 2 (1-7) 8 (2)(a)(b) Timescale for action Resident’s Care Plans must detail 31/12/06 how specific health and personal needs can be met A structured activity programme 30/11/06 must be available for residents and information about them must be circulated. There must be an emergency 31/12/06 Call System whereby staff or residents can summon assistance as soon as possible. Legislative requirements must be 09/11/06 in place when recruiting staff. The Manager must apply to be registered with the Commission. 31/03/07 Requirement 3. OP22 4. 5. OP29 OP31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Laurels Nursing Home DS0000066577.V317256.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 DS0000066577.V317256.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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