Care Home: 4 Laurel Drive

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What the care home does well There have been no new admissions into the home however, there are stringent asssessment processes that would ensure that any future placements would only be offered to those people whose needs could be met. The people who live at Laurel Drive will have their individual care and support needs met and they will be supported to make their own decisions and to experience a fulfilling life. People will have the opportunity to participate in a range of meaningful activities of their own choice. They are supported to develop new skills and to be involved in the local community. People will receive the personal and healthcare support that they need. They will be treated respectfully and in a dignified manner. Medication systems are safe. Good procedures are in place to ensure that each person is able to communicate any concerns or complaints that they may have. The staff team will safeguard each person from harm. Laurel Drive is a comfortable community home, that meets the needs of the people who live there. It is warm, clean, fresh smelling and suitably furnished and equipped. The staff team are well trained and have the necessary skills and competencies to meet their needs. They will have been recruited following safe recruitment practices to ensure that only suitable people are employed to work in the home. Laurel Drive is a well managed home and is run in the best interests of the people who live there. The health, safety and welfare of both the staff and the people who live there is promoted and protected. What has improved since the last inspection? One requirement was made in respects of some repairs that were needed to the home and this had been met. No further repairs were deemed necessary at the time of this inspection. What the care home could do better: No requirements or recommendations were made as a result of this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 4 Laurel Drive 4 Laurel Drive Nailsea North Somerset BS48 1RZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vanessa Carter     Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: 4 Laurel Drive 4 Laurel Drive Nailsea North Somerset BS48 1RZ 01275790073 01179699000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Brandon Trust care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Laurel Drive is a small residential home for up to five people with Learning Disabilities and some additional support needs such as communication difficulties or autism. Laurel Drive is a moderate sized family house situated in a quiet cul de sac in Nailsea. The home is located near local amenities in Nailsea including shops, places to eat and a leisure centre. Laurel Drive does not offer nursing care. Charges vary depending on the needs of the individual and will be determined by the Brandon Trust. 5 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection was unannounced and took place over one day. All key standards were assessed. Evidence to form the report has also been gathered from a number of other resources. The manager provided information about the service in the Annual Quality Assurance Assessment (AQAA). This was very detailed and was backed up by what we saw when we visited the home. We spoke with the support workers on duty and two of the four people who live in the home. Care Homes for Adults (18-65 years) Page 5 of 28 We looked at care planning documentation and other care records for two of the four people. We aslo looked at other homes records and spent some time looking around the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been no new admissions to the home since the last inspection, however there remains a strict procedure and criteria to follow to fill any vacancies. These measures would ensure that any prospective person who came to live at Laurel Drive can be assured that the home will be appropriate for them. Evidence: There are only four people living at Laurel Drive, and each of them have lived in the home for many years. There is one vacant room however there are currently no plans to fill this. The support workers spoken with during the course of the inspection explained the processes that would be followed before any placement is offered. Information would be gathered about the person from the funding authority and a comprehensive assessment of needs would be undertaken by either the home manager or an appointed competent person. If the home felt that the person could be looked after at Laurel Drive, they would be invited to visit the home, meet the other people who live there and maybe stay for a meal. They would then be invited for an Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: overnight or weekend stay and if all this was successful, an admission would be arranged. These measures will ensure that placement is only arranged when the home are confident that they can meet a persons needs. The needs assessment documentation completed for two of the four people who already live at the home were examined and found to be detailed, clear and provide a good insight into each persons specific care and support needs. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Laurel Drive will have their individual care and support needs met because care planning processes are person centred. They will be supported to make their own decisions and to experience a fullfilling life. Evidence: During the inspection visit, two of the occupants were present and therefore their care planning documentation was examined. The care plans had been prepared based upon the information gained during the assessment of care needs process. The plans contained information about each individuals specific care needs and how these were to be met. The plans were person centred. It was evident that the plans had been prepared in consultation with the person involved and that they were based upon an extensive knowledge of their likes and dislikes. Records are maintained of how the care and support needs are met on a daily basis. The care planning documentation is reviewed on a regular basis and formal reviews Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: with the funding authority is arranged on an annual basis. People will be supported to participate in the day to day running of the home, dependent upon their own individual abilities. One person was hoovering the lounge and later on made themselves a cup of tea. Support workers will provide the appropriate level of support and prompting. From observations made during the inspection, and from written records seen, it is obvious that each person is encouraged to make decisions for themselves. One person was assisted to undertake a task that they had communicated to their support worker during the inspection. Robust risk assessments ensure that each persons safety will be maintained, they will not be hampered by any risk management plan and they will be given every opportunity to try new experiences. Examples seen include the plans to manage any risks associated with travelling in a car, or making a hot drink. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live here have the opportunity to participate in a range of meaningful activities of their own choice, will be involved in the local community and will be supported to develop new skills. Evidence: The support workers assist each person to access a range of day care services that have been arranged on an individually determined basis. On the day of the inspection, two people went over the the local Scotch Horn day centre as they would normally do on that weekday, one person was going to go shopping and the other was being supported to go on an outing. Each person has an individual weekly plan. Where appropriate, people will be supported to undertake educational courses and employment. One person had already achieved a number of courses and their Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: certificates were included with their care plans. The support worker discussed future plans and the application for further training that was currently being considered. At least one person has a daycare worker, provided by another care organisation, who will do 1:1 activities with them. Each person is supported to use community facilities and will have a holiday arranged. We were told that for two people a holiday abroad is being planned for later in the year whilst the others would be returning to Weymouth. Meals out and day trips are arranged on a regular basis. One person has been supported to join the local library. Each person has their own room key and can choose to use it or not. The two people who were present in the house were asked if we could visit their room, and gave their agreement. One person participated in part of the tour around the house, evidencing that they have freedom of movement. Meals are generally arranged as a group activity, however meals out and take aways are arranged on an individual basis. One person was still having their breakfast at the start of the inspection, whilst the others had already had theirs and continued on with their days activities. The support workers know the dietary requirements for each person, and their likes and dislikes. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will receive the personal and healthcare and support that they need. They will be treated respectfully and in a dignified manner. Medication systems are safe. Evidence: Both support workers that were spoken with during the inspection demonstrated a very thorough knowledge of each persons specific healthcare and personal care needs, and how these were being met. They knew what actions they were expected to take. This backed up the information that is recorded in each individuals care planning documentation. Each person is supported to attend appointments with their GPs as and when necessary. One person also goes regularly to the dentist and the podiatrist, whilst for one other, the dentist will visit them at the home. Community nurse are consulted for yearly healthcare checks and flu vaccinations are arranged where appropriate. The home keeps a record when healthcare professionals are consulted about health matters, and from those records seen it is evident that each person receives the level of health care support that they require. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Each persons daily routines are based around the events that they have planned on a particular day. For example people will get up earlier if they have day care services to go to, or an outing to go on. The homes medication systems are safe. Daily stock checks are made of some medications and the records kept tallied with what was currently in stock. Most medications are supplied in pre-packed cassettes and no more than a months supply is kept in the home at any time. All support workers will attend safe administration of medications training and both staff confirmed that they had done this. Any new recruits will not be able to administer medications until they have done this training. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good procedures are in place to ensure that each person is able to communicate any concerns or complaints that they may have. The staff team will safeguard each person from harm. Evidence: The home has a comprehensive complaints procedure consisting of symbols, to help people understand how to make a complaint. Although the procedure is in pictoral format they are aware of the need to improve the pictoral prompts available for people who have communication difficulties. Due to the communications difficulties of the two people who were present during the inspection, it was not possible to ask them if they felt able to raise concerns or complaints. However, they both looked contented and at ease with the support workers who were looking after them. Support workers told of the behaviour changes that a person could present with, if they were unhappy about something. All staff will receive training in safeguarding adults procedures and the support workers spoken with confirmed that they had attended training. They demonstrated good awareness of safeguarding issues and the procedures to follow if abuse was suspected, alleged or witnessed. They both knew where the safeguarding policy was located and could therefore refer to it if they had concerns. In the AQAA, the manager explained that they had alerted the authorities and attended protection planning meetings when Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: the behaviours of one person who lives in the home had impacted upon that of another. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Laurel Drive is a comfortable community home, that meets the needs of the people who live there. It is warm, clean, fresh smelling and suitably furnished and equipped. Evidence: The house is located in a residential street in Nailsea. From the outside, it looks no different from any of the other houses. It is a large detached property, that has in the past been extended to provide additional two storey accommodation. It is surrounded by gardens to the front and the rear of the house. The garage is converted into a utility room and storage area. The main entrance into the house is by this garage area, but there are three steps up to the door. A handrail is fitted. There are two entrances to the rear of the property, with ramps that enable people in wheelchairs to have access. The home is near to local facilities. The communal areas of the home consist of a large kitchen and dining room, and two lounges. New lounge furniture has been provided since the last inspection. There is a level access wet room and toilet on the ground floor (this has been converted from a shower room since the last inspection), and a standard bathroom upstairs. The furnishings, fixtures and decorative order of the home are of good quality. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Each person has their own private bedroom, and one is currently unoccupied. Each room is fully furnished and reflects the personality of the occupant. They were clean tidy and fresh smelling. One person had a specialist bed to aid their comfort, plus there were other items of disability equipment located in the house to meet peoples needs. The home was warm and well lit on the day of the inspection. The staff explained that they can over-ride the heating timer system, during cold spells of weather. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home will be cared for by staff who are well trained and who have the necessary skills and competences to meet their needs. They will have been recruited following stringent processes that ensure that only suitable people are employed. Evidence: Both support workers who were on duty on the day of inspection demonstrated their competencies in caring for the people who were in their charge. Both have at least an NVQ Level 2 in Care and have also attended training courses specific to the care needs of the people thay are looking after. One support worker said they had requested particular training so that they had a better understanding of a persons needs. Three other support workers also have at least an NVQ Level 2 in Care. This means that 85 percent of the staff team have at least an NVQ2. There are currently a number of staff vacancies - some shifts will be covered in-house whilst others are covered by bank staff employed by the Brandon Trust. These measures will ensure that people will be cared for by satff who are familiar with their care needs. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Although it was not possible to look at any recruitment files, those support workers on duty confirmed the process that had been followed when they were recruited. An application is completed, and an interview attended. Two written references are obtained plus POVAfirst and CRB disclosures. Brandon Trust have an agreement with us that all recruitment files are held at their headquarters and we are able to examine files as we see necessary. Those staff spoken with also confirmed that they had an induction- training programme to follow when they started working at the home. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Laurel Drive is a well managed care home that is run in the best interest of the people who live there. The policies and procedures ensure that the health, safety and welfare of both the staff team and the people who live there is promoted. Evidence: The registered manager, Mr Norman Birch, was not present during the inspection. He is a registered nurse with over 30 years experience in the care of people with a learning disability, and has already achieved the registered managers award. He is well qulaified to manage a care service. Since the manager was not present during the inspection, it was not possible to make a full assessment of the quality assurance mechanisms used to ensure that the service provided for the people who live in the home, remains appropriate. However information provided by the manager prior to the inspection, in the AQAA, gave clear indications of the importance of achieving this. There is a real committment to providing a service that meets the care needs and expectations of the people who live Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: there. All staff will receive mandatory manual handling training and therefore always follow safe moving and handling procedures. The fire safety log was checked and showed that all the necessary checks had been completed. Staff will receive first aid, food hygiene and infection control training - this was confirmed by those support workers on duty. The house is well maintained and those repairs that were requested at the last inspection had been dealt with promptly. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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