Inspection on 10/05/06 for The Orchards

This inspection was carried out on 10th May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Laurels 49 Three Bridges Road Three Bridges Crawley West Sussex RH10 1JJ Lead Inspector Mrs M McCourt Key Unannounced Inspection 10th & 12th May 2006 16.15 The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 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 DS0000066065.V289843.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 Adults 18-65. 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 DS0000066065.V289843.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Laurels Address 49 Three Bridges Road Three Bridges Crawley West Sussex RH10 1JJ 01202 706160 01202 706160 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) Evesleigh Care Homes Limited Post Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: A maximum of 4 service users in the categories listed above may be accommodated at any one time. Date of last inspection New registration Brief Description of the Service: The Laurels is a care home registered to accommodate up to four Service Users with learning disabilities. The Registered Provider is Evesleigh Care Homes Ltd and the Registered Manager’s post is currently vacant. Mr Richard Harris is in day-to-day charge of the home. The current weekly charge is £1,309. This information was provided on the pre-inspection questionnaire. Additional charges are made for personal items, such as; toiletries, clothing and so on. The home is a semi-detached property, situated just outside the centre of Crawley town, and therefore has access to all community facilities and is within easy reach of local rail and bus stations. Accommodation is provided over two floors. Each resident has their own bedroom, with bedrooms located on the first floor. On the ground floor there is a large lounge, kitchen that includes a dining area and a large conservatory. In addition the home has a spacious garden with lawn and patio area to the rear of the property. The Service Users Guide and Statement of Purpose, which incorporates inspection reports, are both located at the home and are accessible to Service Users, staff, relatives and anyone else interested in the service. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection was undertaken by one Inspector over two days on Wednesday 10th and Friday 12th May 2006 and lasted a total of nine hours. Pre-inspection planning took approximately two days. A full tour of the building took place and included the observation of Health and Safety matters, hygiene issues, decorative order and a general overview of the atmosphere created within the home. Five staff members, three resident(s), an NVQ assessor and the Responsible Individual were spoken to at the time of inspection. Case tracking was carried out by examination of relevant records and information held on the staff and residents spoken with during the course of the inspection. What the service does well: What has improved since the last inspection? The Inspector was told during the course of the inspection that the new company is proactive in promoting independence for Service Users. This was evidenced by several examples seen, including travel training, support with personal relationships and encouragement for individuals to attend courses specific to increasing independent living skills. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 6 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 Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The outcome for Service Users was found to be good. Service Users are consulted about where they choose to live prior to moving, and are certain that the home will meet their individual needs. EVIDENCE: The home has an Admissions/Referral Procedure and a Trial Visits Policy in place. The procedure states the process to be followed when considering a Service User’s placement, and includes; tea visits, overnight and weekend stays, followed by reviews to confirm the appropriateness of the placement. Two Service Users spoken with confirmed that they visited the home prior to moving in. The Inspector was told by one Service User how he had chosen the home from three others because it was bigger and he had a friend who already lived in the house. Pre-admissions assessments were contained within individual personal files. Two personal files were examined and found to contain contracts, which had been signed by the Service User. In addition it showed the fee charged, the home’s own needs assessment and which authority funds the placement. Service Users said that they were able to choose colour schemes and bring their own personal belongings into individual bedrooms. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The outcome for Service Users was found to be excellent. Service Users needs and personal goals are reflected in their care plans. Service Users are assisted to make decisions about their own lives, which includes taking responsible risks. EVIDENCE: The Inspector examined two personal files for Service Users. Each file contained a contract of care, financial information, a personal profile, medical notes, dental records, psychiatric reports, funeral wishes, behaviour charts, sleep charts, weight charts, and so on. Monthly reports are comprehensive and have been completed consistently for every single month. Annual review reports are held, with the next one due in June 2006. It was noted that all relevant health professionals, family, care managers and so on are invited to attend. Service Users are involved in the process and were able to tell the The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 10 Inspector about achievements, long-term goals, and their involvement in specific activities. Two Service Users have successfully completed a travel-training course, and are now able to travel independently back and forth from the Acorns day centre, which they have been doing for several weeks now. Staff spoken with said that the new company is proactive at promoting independence for individuals. One Service Users told the Inspector that he is due to start a community course at college in September, for one and a half days each week. He will be studying computer skills and independence skills within the community. The course is a new initiative for people with learning difficulties working towards work experience. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 16 and 17 The outcome for Service Users was found to be excellent. Service Users are able to take part in a range of appropriate activities within the local community. Service Users are supported with family relationships and guided to develop personal friendships. Meals are varied and nutritious. EVIDENCE: The Inspector spoke with several Service Users in order to obtain their views on life at the home. Service Users are supported to make decisions about their lives and to accept risks as part of achieving an independent lifestyle. The Service Users who live at the Laurels are particularly able in their abilities and therefore take part in a wide range of activities and hobbies. The Inspector The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 12 was told that Service Users regularly go out into the community to enjoy various leisure activities, such as; swimming, horse riding, attending college, visiting friends and so on. During the inspection, three of the Service Users returned from attending their workshop programme and told the Inspector what they had been doing that day, this included gardening and living skills. One of the residents said that he goes to Acorns four times each week. He also takes part in Horse-riding, swimming, line dancing and drama, for which he has taken part in some small plays. He has a friend who he calls weekly and he went to a friend’s party last week. The Inspector was told that he will be going on holiday to Great Yarmouth soon which he is looking forward to. Another resident said that he does lots of things in the community, like horseriding, pericles (painting, modelling clay, woodwork and singing), car checks, gardening, cooking and ironing skills. He told the Inspector about several of his personal friends who he sees often. There were positive comments about the food, with residents telling the Inspector that they really like the food at Laurels. The inspector observed one of the Service Users helping to make the evening meal, which the Inspector was invited to eat. Risk assessments are in place for specific and general Health & Safety issues and are reviewed on a regular basis. Discussions with Service Users confirmed that with guidance and support from the staff in some areas they are able to make decisions about their life and to take risks as part of achieving an independent lifestyle. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The outcome for Service Users was found to be adequate. Service Users receive personal support in an appropriate manner and suited to individual need. The home is able to provide physical and emotional care to individuals. A review of medication storage and administration procedures must take place. EVIDENCE: Care Management assessment and other professional assessments were looked at. Medication procedures, care plans, including goal planning documents were looked at within personal files. Two personal files were examined by the Inspector. Personal files for Service Users include information such as; funeral wishes, behaviour charts, sleep charts, weight charts, personal profiles, activity timetables and daily care notes. Risk assessments are in place for activities The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 14 such as; horse-riding, holding money, holidays, road safety and so on. These are also reviewed regularly. Monthly reports are comprehensive and are up to date. Annual reviews are carried out, with staff currently planning for the next one to be held in June 2006. Specific contracts are in place, for example there was one for a Service User to have cable TV installed within his own room. Another contract has been drawn up to enable a Service User to listen to music using headphones, so as not to disturb his fellow housemates. Care plans are in place for various activities and are reviewed three monthly and are all up to date. Medication is stored in a locked cupboard. There were several discrepancies with both the storage and the administration of the medicines. Incorrect quantities were entered on one of the MAR sheets and one medication had not been entered at all. The medicine had been prescribed in January 2005 and had only been used once, although there was no written evidence of this. In addition, Paracetamol was given to a Service User in the presence of the Inspector, from the staff’s homely remedies box. There were no written records for the medications kept in the box, and therefore, no way of knowing when they were bought, who has taken them, etc. The service user was given the tablets from the homely remedy box because he had run out of his own supply. The Inspector was unable to find a policy on Homely Medicines, or the keeping/administering of Paracetamol within the home. All of these issues were discussed with the senior member of staff on duty. On returning to complete the inspection two days later, the senior staff member had worked hard to rectify some of the medication issues. Out of date medication had been returned to the chemist. All of the medication had been audited and a recording sheet for homely remedies had been implemented. A policy and procedure for the use of homely remedies must be put in place at the home, and a regular reviewing system for the storage and administration of all medicines must take place. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The outcome for Service Users was found to be adequate. Improvements could be made in enabling service users to express their concerns or complaints and the home must provide a system for recording any complaints received. Medication policies and procedures must be reviewed on a regular basis. EVIDENCE: The Commission for Social Care Inspection have not received any complaints in respect of this service. Although a policy on complaints is available, it still refers to National Care Standards Commission, and Staff were unable to find a complaints book. Staff and Service Users spoken with confirmed that they would speak to the manager if they had any concerns or problems. It was noted that to enable Service Users to voice concerns or complaints, the complaints procedure needs to be developed into a format suitable for their abilities. Training records looked at during the inspection demonstrated that staff do receive Adult Abuse training and are aware of how to recognise signs of abuse. A missing persons policy is in place. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 16 The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The outcome for Service Users was found to be excellent. The home is clean, bright and in good decorative order throughout. Service Users live in a comfortable and safe environment. EVIDENCE: The Inspector carried out a tour of the premises. The home was found to be in an excellent state of decoration. Fixtures and fittings are in very good order and the environment is very homely and comfortable. Service user rooms are suitable for each service users’ needs and have been personalised with their own belongings and choice of colour schemes. Two out of the four rooms have en-suite facilities. Service users’ privacy is respected and where able service users lock their bedroom doors and hold the keys. Communal areas consist of a large lounge, kitchen with dining table and chairs and a conservatory. There is a large garden at the rear of the property that is The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 18 accessible and safe. The exterior of the property is well maintained. Immediately outside of the conservatory there is a patio area with seating. Records examined demonstrated that safety checks on the property and utilities are regularly undertaken and comply with safety legislation. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The outcome for Service Users was found to be good. A competent and qualified staff team is appropriately trained to meet the individual needs of Service Users. Recruitment policies and procedures have not been sufficient to protect Service Users from potential harm. EVIDENCE: The Inspector examined three sets of staff files. Training records show that staff undertake a wide range of training from induction through to NVQ level 3. Training includes mandatory topics, such as; Health & Safety, Manual Handling, Food Hygiene and so on. In addition, specific training is provided and includes; Physical Intervention, Diabetes, Autism, Adult Protection, Epilepsy and Challenging Behaviour. On commencing work with the company staff start a common induction, followed by the LDAF induction and foundation courses. This will then lead into NVQ. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 20 Staff spoken with confirmed that they had received both mandatory and specific training. Training profiles were looked at by the Inspector and were comprehensive. Supervision is offered regularly and issues such as keyworking, personal and general work matters are discussed. Supervision is held monthly. A keyworker system is in place. Staff told me how they help the Service Users with health appointments, activities and personal and/or family relationships. One member of staff has been working with a Service User to improve his independence. The Service Users has recently started travelling entirely on his own to the day centre and this is a great achievement for him. Recruitment records examined found that procedures were not robust enough to protect Service Users from potential harm. It was evident that references had not been followed up properly. On one file the two references were written by fellow carers and/or a colleague and it was not clear who these people were or where they worked as it had not been recorded. Also the request for references had gone to home addresses, not the place of employment. In addition, the references were not well written, with poor use of language and lack of detail. Another file looked at had inadequate reference material. Only one of three sets of records looked at were complete. The Inspector understands that recruitment procedures looked at on this day had been processed prior to the new company taking on the business. The company should ensure that any future employees are recruited following appropriate guidelines. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The outcome for Service Users was found to be good. Service Users benefit from a well run home, and are confident that their views form the basis for self-monitoring and development by the home. Service Users are protected by Health & Safety policies and procedures. EVIDENCE: Richard Harris is in day-to-day charge of the home, although the Registered Manager’s post is currently vacant. At the time of inspection Mr Harris was on holiday. Staff told the Inspector that they were very happy with their new manager and find him to be supportive and approachable. A survey has just been conducted for Service Users, staff, care managers and next of kin. The results have been compiled and published for the conference The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 22 that was held on 2nd May 2006. A copy of the report is usually forwarded to CSCI. Records examined and staff spoken with confirmed that training in the Health & Safety topics: Moving & Handling, First Aid, Food Hygiene, Fire, Health & safety and so on, is undertaken as part of their induction programme and then updated as required. Health and safety procedures are on display within the home, including the 1st aid appointed person. Records seen on the day of the inspection indicate that annual safety inspections are undertaken on equipment and utility supplies. Maintenance systems are in place to ensure the safety of residents. Risk assessments had been undertaken in respect of potential risks to staff or service users when using kitchen equipment for example and other hazards within the home. Policies and procedures have all been reviewed in April 2006. The accident book showed there to have been four recorded incidents since January 2006. During the inspection it became apparent that the home was having problems with the weekly expenditure cheques not arriving on time. Staff have been told it is because there has been no-one to sign them at head office. On the second day of my inspection the cheque for the weekly allowance still had not arrived. This meant that the senior member of staff would have to return to work on Saturday morning, his scheduled day off, to see if it had then arrived in order to cash it at the bank. Whilst at the home on the second day of inspection, the Responsible Individual, Mr Tony Boyce spoke with the Inspector regarding this matter, along with the issue of telephone bills remaining outstanding. The Inspector was told that the company is in disagreement with their current telecommunications provider, partly due to the change over of the business and the named account holder no longer working for the company. This will be rectified when they change phone provider. It was also acknowledged that there were problems with the weekly allowance not arriving on time. In order to address this problem, cheques will be sent out one day earlier, on Wednesday instead of the Thursday, which was leaving too short a time for them to arrive on Friday morning. In addition Mr Boyce has requested that the home’s manager increases the float to ensure Service Users are not affected by late arrival of cheques. The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 4 x LIFESTYLES Standard No Score 11 x 12 4 13 x 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x The Laurels DS0000066065.V289843.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Timescale for action The registered person shall make 30/06/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Requirement 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 YA22 Good Practice Recommendations The home’s complaints procedure has been given and /or explained to each service user in an appropriate language/format, including information for referring a complaint to the CSCI at any stage should the complainant wish to do so. 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