Care Home: Laughton Croft Nursing Home

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What the care home does well The home has a relaxed atmosphere and staff are welcoming, with a friendly manner. People said that they were happy with the care provided and that the acting manager and staff team were helpful and supportive. Comments included, `the care is very good` and `they have been wonderful with my wife, and they are great with me as well`. There is a robust recruitment system in place to make sure that staff are suitable to work with vulnerable people before they start working at the home. Staff are well trained and supported What has improved since the last inspection? Care plans reflect peoples likes. dislikes and preferences in more detail, so that staff know what care they need and their role in supporting them. Risk assessment documentation has been improved and the content incorporated into care plans. People told us that the provision of activities was much better and residents now have a social care plan which highlights what they like to do and how staff can support them to follow their interests. The addition of a decked patio area for each unit has given people a pleasant, safe area for them to sit. What the care home could do better: The company must maintain the environment of the home at a good standard. This includes the decoration, carpets and furnishings. The owners have however told us that a full refurbishment programme is due to start in October 2009 which will address any shortfalls. Other areas that would benefit from some attention include the following. Care plans should be developed further so that they reflect how decisions about peoples care have been made and who was involved in the process. They should also contain information about recent legislation that is designed to protect people`s rights and choices. Staff should receive training regarding this subject as this will help them to understand their role in assessing, recording and supporting the people they care for. The provider should complete his monthly visit reports consistently making sure that the content reflects how the home is operating and any actions to be taken to address any shortfalls. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Laughton Croft Nursing Home Gainsborough Road Scotter Common Gainsborough Lincs DN21 3JF     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: Dawn Podmore     Date: 0 3 0 9 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. that people have said are important to them: They reflect the things 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 Older People 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 Older People Page 2 of 26 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Laughton Croft Nursing Home Gainsborough Road Scotter Common Gainsborough Lincs DN21 3JF 01724762678 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Croft Carehomes Limited care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following categories of service only :- Care Home with Nursing - code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Laughton Croft is a single storey building situated about a mile from the village of Scotter, half way between Scunthorpe and Gainsborough. Accommodation is provided in thirty-four single rooms and one double room each with en-suite facilities. The home 36 0 Over 65 0 36 Care Homes for Older People Page 4 of 26 Brief description of the care home is set in a rural location surrounded by wooded and grassy areas. There are carparking facilities to the front of the building. Since the last inspection the Registered Manager has left the home, however an acting manager Mr Kesh Ramsurn has recently been appointed. At the time of the inspection the home confirmed that the weekly fees ranged from £408 - £552.30 depending on the residents assessed needs. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report, is available from the main office. Care Homes for Older People Page 5 of 26 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took any previous information held by C.Q.C about the home into account. Throughout this report the terms we and us refers to the care Quality Commission (CQC). Before the the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next twelve months. We also sent out surveys to residents and staff, 12 of which were returned in time to be included in this report. The main method of inspection used was called case tracking. This involved selecting a proportion of residents and tracking the care they received through the checking of records, discussions with them and the staff who care for them, and observation of Care Homes for Older People Page 6 of 26 care practices. A partial tour of the home was also conducted, which included looking at some bedrooms, communal areas and bathing and toilet facilities. Documentation was sampled and the care records of the four people being tracked were examined. We spoke with 8 residents, 4 relatives and 5 members of staff. They shared their views about how the home operated on a day to day basis and the care and facilities provided. The acting manager and Mr Cregan, one of the owners, were also present during the visit. A second inspector spent just over an hour observing the care given to a small group of people in one of the lounge areas. All observations were followed up by discussions with staff and examination of records. On the day of the visit 28 people were living at 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. A satisfactory admissions procedure helps to ensure that the home can meet the needs of the people who come to live there. Evidence: The home provides people with various information to help them decide if it is the right place for them to live. This includes a Statement of Purpose and Service Users Guide. The home does not admit people without a comprehensive assessment of their needs being completed. In the case of emergency admissions they told us that they gather as much information as possible so that they can help to make sure that the home is suitable for the person concerned. The people we spoke to confirmed that assessments had taken place and said that they had been encouraged to be involved in the process. Care Homes for Older People Page 10 of 26 Evidence: The acting manager confirmed that the home does not provide intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Care plans provide a person centred approach to providing the right level of support while acknowledging that people can take responsible risks. Evidence: We looked at the care records of 4 people living at the home choosing people with different needs. They were concise and contained detailed information about what care and support people needed and their individual preferences and abilities. This included assessments regarding peoples nutritional status and their likes and dislikes. Files also contained social profiles about their past history, hobbies and interests. Assessments for potential risk areas, such as manual handling and risk of pressure damage, had been carried out. This information had then been used to formulate care plans to guide staff as to how to minimise these risks. However the decision making process about the use of a lap belt to stop one residents from falling out of their wheelchair had not been documented in enough detail to show that its use was in their best interest. Care Homes for Older People Page 12 of 26 Evidence: A daily record of how people were progressing had been maintained and care plans had been evaluated regularly. Mental capacity assessments had been carried out for some people, but another file contained a blank form. The Mental Capacity Act and Deprivation of Liberties is new legislation that is aimed at protecting peoples rights and choices. Residents have access to outside health professionals such as doctors and specialist nurses. Peoples health care was being monitored and equipment, such as pressure relieving mattresses, was in use. During the observation period one carer was seen speaking to residents with respect and coming down to their level so that she could make eye contact and thereby communicate better with them. Another carer was observed not communicating with people in such a positive way, this was highlighted to the manager. Staff were knowledgeable about the people they supported and how they preferred their care delivering. They also demonstrated a good understanding of how to maintain peoples privacy and dignity. Residents and relatives we spoke to, as well as the people who returned surveys to us, said that they were happy with the level of care and support provided. One relative told us, I dont want her to leave here, they are so concerned about my wife, they have had the doctor out and are so good with her. The home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. Internal audits have been undertaken and any areas needing attention addressed. Although currently no outside audits have been undertaken the provider is addressing this issue with the Primary Care Trust to arrange for an independent pharmacist to visit the home. Care Homes for Older People Page 13 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. The home provides a varied activities programme which people enjoy. People have access to a nutritious and varied diet that meets their individual preferences and health requirements. Evidence: The home employs an activities coordinator to provide activities and stimulation for the residents. The programme includes, arts and crafts, floor games, one to one sessions and memory games. The home also aims to have an outside entertainer visit on a monthly basis. The activities person said that residents enjoyed going on walks around the grounds and to see the horses at the top of the road. People said that they had enjoyed a recent fete and that they loved the new patio areas. These are raised decked patios, one for each unit, where people can sit and look out over the countryside. A vegetable garden has also been started and tomatoes were growing in pots around the patios. The people who returned surveys told us that on the whole they were happy with the activities that took place, although one person said that they were not. Care Homes for Older People Page 14 of 26 Evidence: Relatives can visit at anytime and people said that they were always made very welcome by the staff. At lunchtime the atmosphere in the dining room was calm and relaxed, with staff assisting some people to eat. Two main choices were offered and people said that other alternatives to the main menu and special diets were also available. Residents told us that they enjoyed the meals at the home. Comments included, it suits me and the food is very good. However this was an area that 2 people who returned surveys felt could improve. At the last visit by the Environmental Health Officer the kitchen was awarded a 4 star rating for the cleanliness and organisation of the kitchen, the highest rating being 5 Star. Care Homes for Older People Page 15 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Residents are protected by clear policies and procedures for handling complaints and allegations of abuse. Evidence: The home has a complaints procedure, which is displayed in the home and included in the Service User Guide. The AQAA said that four concerns had been raised over the last year, these had been recorded and addressed appropriately. Most people said that they knew how to make a complaint and would be comfortable highlighting any issues. During the visit residents and relatives told us that they had no complaints. Concerns highlighted to us over the last year were looked at as part of the inspection. The home has procedures concerning the protection of vulnerable adults from abuse. Two alerts made to the Lincolnshire safeguarding team are still being looked into and the home has worked with them to make sure that people are kept safe. Staff demonstrated a satisfactory knowledge of what to do if they suspected abuse could be occurring and confirmed that they had received training in this subject. Care Homes for Older People Page 16 of 26 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a spacious and comfortable home, but some areas are not adequately maintained and decorated. Evidence: We took a partial tour of the home looking at the bedrooms of the people being case tracked, communal areas and bathing facilities. Bedrooms had been personalised by the resident or their relatives with photographs, mementos and small items of furniture. The home is in general need of redecoration and refurbishment. We were told that a refurbishment programme would start in October and should be completed by Christmas 2009. The provider said that this will include redecoration, new carpets, curtains and furniture. During the visit and in surveys returned to us people told us that in general they were happy with the facilities. However concerns have been raised recently be relatives which included the cleanliness of the environment and the need for repairs and redecoration. When asked what the home did well one person said that it was clean. Another person said it could do with some TLC (tender loving care) outside. The grounds are well maintained. Two new decked patio areas provide residents with Care Homes for Older People Page 17 of 26 Evidence: somewhere to sit in warm weather. A vegetable garden and potted tomato plants have also been added. Ramps are in place to enable easy access to all areas. Separate housekeeping and laundry staff are employed. One person said that sometimes clothing is mixed up even through it is labeled, this was discussed with the acting manager. There were no unpleasant odours detected during the visit and most areas looked clean and tidy. Care Homes for Older People Page 18 of 26 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. People benefit from a well trained staff team, and are protected by current recruitment procedures. Evidence: The atmosphere of the home seemed relaxed and unhurried with staff having time to talk to people. People raised no concerns about the staff and in the main felt that there were enough staff available to meet their needs. They told us, the caring is very good, the staff are very helpful, they are great and the staff are lovely. One person highlighted that they felt that the home was very busy which meant that sometimes the staff did not have enough time to talk to people for a long time. We checked the files of 2 new staff and these showed that their recruitment had been carried out correctly with essential checks, such as written references and C.R.B. (Criminal Records Bureau) checks, being undertaken. Records and staff comments also demonstrated that new staff had received a satisfactory induction to the home, which included essential training. On the day of the visit some staff were undertaking manual handling training in one of the lounges. The home has a training programme which includes essential subjects such as manual handling, protection of vulnerable adults from abuse, fire safety, medications and infection control. Specialist training such as, the Gold Standards end of life care, Care Homes for Older People Page 19 of 26 Evidence: dementia awareness and challenging behaviour had also taken place. There had been no training provided regarding the Mental Capacity Act and Deprivation of Liberties, which are aimed at protecting people rights and choices. The owner and acting manager said that this was being addressed. The company encourage staff to complete an N.V.Q (National Vocational Qualification) in care and currently 9 care staff have attained this award. Staff said that they felt well trained and supported and they demonstrated a good knowledge of the people they were caring for. Care Homes for Older People Page 20 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 management systems in place help to ensure the health and welfare of people who live at the home. Evidence: The home currently does not have a Registered Manager, but an acting manager Mr Kesh Ramsurn has been appointed. Mr Ramsurn is a qualified nurse with experience working in the care sector. People told us that he was approachable and listened to what they had to say. When we asked what the home did well comments included,they look after us well, the caring is very good, the food is very good and clean, nice and friendly staff. Some people highlighted areas that could be improved. These included, better food, a better service for patients, more organised trips to different places and provide more one to one care and attention. The home has a quality assurance system so that they can gain the views of the Care Homes for Older People Page 21 of 26 Evidence: people who use the service and check that staff are following the correct procedures, this included meeting, surveys and internal audits. There is a system in place for residents monies to be held in safe keeping by the home. This includes keeping a running total of all transactions and obtaining receipts and two signatures. The home has health and safety polices and procedures to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis. Information provided in the AQAA demonstrated that regular checks on equipment, such as fire equipment and hoists, had taken place as scheduled. Care Homes for Older People Page 22 of 26 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 Older People Page 23 of 26 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 1 24 23 All areas of the home must be decorated, furnished and maintained to a satisfactory standard. This will enable people to live in a suitable environment which is decorated and furnished to suit their needs 01/02/2010 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 1 7 It is strongly recommended that the decision making regarding the use of any restraints, such as lap belts are appropriately recorded and include the outcome of best interest meetings. This will help to demonstrate that peoples rights and choices are being respected. It is recommended that support plans include reference to the Mental Capacity Act, 2007 and the effects it has on residents lives. This is to help to make sure that their rights and choices are protected. All staff should be provided with training regarding the Mental Capacity Act and Deprivation of Liberties. This will Page 24 of 26 2 7 3 30 Care Homes for Older People 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 help to make sure that they are aware of the content of this legislation and their part in protecting people rights and choices. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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