Care Home: Laural House

What the care home does well There is a homely and relaxed atmosphere and the home is kept clean and tidy. Members of staff know the residents very well and understand their individual needs and preferences. As a result residents are able to communicate confidently with staff. A high standard of care planning and risk assessment is in place to ensure that people are provided with appropriate support according to the their needs and wishes. A range of activities are available to service users and they are satisfied with the food provision within the home. There is a committed and experienced team of staff at Laural House who work well together. Staff feel well supported by the management team at the home. The staff team has also had a significant amount of training in working with adults with mental health needs, including those with challenging behaviours. Consequently the residents get the benefit of living in a home where they feel understood and supported. Each resident is seen and treated as an individual in their own right. This approach is giving residents the opportunity to build and develop for themselves a more positive lifestyle than they have had previously. One staff member noted that this was the longest placement one person had had, following a long history of placement breakdowns. The home is effective at providing stable placements for people who have been through a number of living situations that have not been able to meet their needs. They are now benefiting from being well supported by staff so that in general their mental heath is stabilising and their level of challenging behaviours is reducing. A number of residents have been able to move on to more independent placements. The management and staff team have worked hard and effectively to achieve this. What has improved since the last inspection? As recommended at the previous inspection, risk assessments had been updated to indicate the degree of risk in each case, so that changes in the assessed level of risk can be more easily identified ensuring that residents are supported appropriately. Staff supervision notes had been updated to indicate timescales applying to action agreed at these meetings. What the care home could do better: Records must be kept of food served in the home, and there is room for improvement in identifying gaps in staff training, and recording financial transactions on behalf of people living at the home, to demonstate that people are supported appropriately. It is recommended that residents be offered the opportunity to go on holiday, that local authority safeguarding training be undertaken, and that further ways be found to involve residents in the running of the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Laural House 15 Fairbourne Road London N17 6TP     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: Susan Shamash     Date: 2 6 0 5 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 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 31 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Laural House 15 Fairbourne Road London N17 6TP 02088010242 02088083748 akwahouseltd@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Akwa House Limited care home 4 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 4 Laural House is a small care home for 4 adults with mental health needs. It is run by Akwa House Ltd which runs 2 other homes for people with mental health needs. The proprietor and registered manager is Alex Kadira who is a qualified mental health nurse. Laural House opened in March 2006. The home is situated in a residential road off Philip Lane in Tottenham. It is close to shops and public transport. Each bedroom has en-suite facilities. There is a lounge and separate kitchen dining area on the ground floor with a small garden at the rear of the property. The homes brochures states the aim of the service is: To build a therapeutic relationship and work in partnership with clients to enhance their quality of life to its optimal level, thus empowering them to live independently within the community. In June 2009 the minimum fees are approximately 800GBP/week, with additional amounts payable for people with particularly high needs. Laural House makes inspection reports and other important information about the home available to Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home residents, their families and professionals. Reports are also available from www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 31 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: This unannounced inspection took place over four and a half hours. I was assisted by the manager and assistant manager during the inspection. I spoke to both residents who were living at the home at the time of the inspection, although only briefly to one of them, in accordance with their choice. Throughout the inspection, the way in which staff communicated with and supported residents was observed. I also spoke to a support worker, the manager and assistant manager. A variety of records, including care plans, staff files, financial records and health and safety documents were inspected, and information provided in the Annual Quality Assurance Assessment for the home was also taken into account. Care Homes for Adults (18-65 years) Page 6 of 31 Written feedback forms were received from two residents, five staff members and one healthcare professional. These were all positive about the home with one resident noting the home keeps me away from trouble, The healthcare professional advised that good communication procedures are in place, noting that their client received a good service, supported as an individual, respected and treated holistically, encouraged to do things for themself and to take part in making decisions abou their care plan. The only improvement suggested was encouraging the client to get up earlier. Staff were positive about the training provided, respect for equal opportunities, food provision and protection of privacy and confidentiality of people living at the home. It was suggested that the service needed to find new ways of encouraging residents who refuse to take part in daily activities. What the care home does well: What has improved since the last inspection? What they could do better: Records must be kept of food served in the home, and there is room for improvement in identifying gaps in staff training, and recording financial transactions on behalf of people living at the home, to demonstate that people are supported appropriately. It is recommended that residents be offered the opportunity to go on holiday, that local authority safeguarding training be undertaken, and that further ways be found to involve residents in the running of the home. Care Homes for Adults (18-65 years) Page 8 of 31 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 Adults (18-65 years) Page 9 of 31 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 10 of 31 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. Residents benefit from living in a home that is able to meet their needs since detailed assessments are made before they move into Laural House. Evidence: I spoke to both residents living at the home, albeit only briefly to one of them. They confirmed that they were well supported within the home, and had choices about how they spent their time. Staff and management confirmed that people have the opportunity to visit the home prior to moving in, and I observed one person visiting the home for this purpose during my visit. One resident confirmed to me that they had also visited the home prior to moving into Laural House, advsing that it was one of the better homes. The files for both residents were inspected and indicated that before they moved in a full mental health assessment had been received by the home. A care plan had then been drawn up by the home showing how the residents needs were to be met. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Reviews with mental health professionals indicated that residents are appropriately placed and their needs are being met. Observation throughout the inspection, together with the care plans, indicated that residents are appropriately placed, following a full assessment of their needs. The manager advised that he meets prospective residents in their current placement so that a detailed assessment can be made of their suitability for Laural House. This is particularly important since the individuals referred to the home have complex mental health needs and may present challenging behaviours. Care Homes for Adults (18-65 years) Page 12 of 31 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. Peoples care plans provide detailed information on how their needs are met. As a result residents continue to feel that they are well supported. Laural House is good at finding ways for residents to make decisions for themselves to increase their independence. People are protected by comprehensive risk assessments clearly indicating how risks to their safety are reduced. Evidence: Feedback from both residents interviewed was generally positive about living at Laural House. Residents thought their needs were being met and that they were getting on well. The records for both residents were looked at, and each had a detailed current care Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: plan setting out the needs of the resident and how they are to be met by the home. These plans include religious and cultural needs of each resident. Throughout the inspection I observed members of staff offering choices to residents. People made choices about when they got up in the morning and when they went out. Residents also said that they could choose when and what they had to eat and what outings or activities they engaged in. Where there are restrictions on peoples choices under the Mental Health Act, this is stated in their care plan and risk assessments. Care plans continue to recognise potential risks to residents and the risks that they may pose to others. Risk assessments outline how these risks can be minimised, for example detailing action to be taken by staff if a resident becomes aggressive or violent within the home. These assessments also highlight what might trigger anger or agitation in particular people, and how these can be avoided or managed. As a result residents feel more relaxed and settled in the home, with fewer incidents of challenging behaviour. Staff interviewed indicated that they understand how to support residents effectively. They do this in line with training they have had on how best to manage the challenging behaviours and unpredictable mental health issues presented by residents. This continues to be a strength of the home, enabling people with complex needs to manage well in a small group living situation. As recommended at the previous inspection, each area of risk detailed in risk assessments includes an assessment of the degree of risk, so that changes in the assessed level of risk can be more easily identified. This makes it easier to determine if any changes are needed in the way people are supported. Care Homes for Adults (18-65 years) Page 14 of 31 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. Residents have the oportunity to have a good quality of life, depending on their choices, with a range of activities available to them. They are helped to be part of their local community so that they do not feel isolated. Staff are aware of diverse cultural needs and lifestyle choices enabling residents to form relationships with others, according to their choices, with as much control over their lives as possible. They choose what they eat and enjoy the food provided within the home. Evidence: Residents decide for themselves what they wish to do and when. Each resident is encouraged to try out new activities by staff within the home and the activities coordinator. A record is kept of activities offered to and taken up by residents. One Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: resident chooses not to participate in the majority of activities on offer. Activities recorded included a barbeque, shopping trips, pub trips, visits to the cinema and lunches out, within the local area, and a trip to the seaside. Feedback from residents and staff showed that residents get out and about in their local community, with and without staff support, although it is recommended that they be supported to go on trips further afield. Residents make use of public transport to get out and about. Records show that staff continue to support residents with behavioural issues, reducing the difficulties caused. Residents have contact with their families if they wish to. One resident has regular contact with a family member, whilst another chooses not to contact their family. Staff advised that residents may negotiate to have guests to stay over on an agreed basis. In this way staff respect and promote personal and sexual relationships for residents. Laural House has a charter of rights for residents which makes clear what they can expect from the home. The home also has house rules which spell out what is expected of residents. As a result everyone living in, or working at, the home knows what is expected of them which is contributing to the generally relaxed atmosphere at Laural House. When a resident does act irresponsibly this is followed up by staff and in conjunction with the Community Mental Health Team if necessary. The foods pretty good here one person told me, and the other resident confirmed that they were satisfied with the quality and variety of meals provided in the home. No residents are currently on a budget to shop for food for themselves, however the home does provide this facility when appropriate (with residents being given money each week so that they can buy and cook their own food so that they are better prepared if they move onto a more independent placement). However there were no current records of food served in the home. Care Homes for Adults (18-65 years) Page 16 of 31 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. Staff are good at meeting the needs residents so that residents feel well supported, and the their physical and emotional health needs are met. Residents are protected by safe and effective arrangements regarding medication in the home. Evidence: One resident told me that staff took time to talk to them when they needed it, so that they felt well supported within the home. The care plans continue to be detailed, setting out clearly how to respond to the needs and wishes of residents, with guidelines about dealing with any challenging behaviours. As a result individuals with challenging behaviours and significant mental health difficulties are less anxious which in turn enables them to have improved relationships both with other residents and with staff. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Health needs are responded to appropriately, with evidence seen of referrals made to other relevant professionals. A Community Psychiatric Nurse is in regular contact with people living at the home. Given the complex needs and histories of each resident there is close contact between the home and the relevant psychiatric team. Regular progress reports are sent to other professionals as part of working in partnership with the Community Mental Health Team. There was also recorded evidence that residents are prompted to attend routine healthcare appointments such as opticians, and dentist appointments. On the day of the inspection, a leaflet was given out to all residents regarding precautions to take against Swine Fever. All staff have undertaken training so that they can administer medication appropriately and safely. Medicines are stored safely within an appropriate facility, with the temperature of storage being recorded. Medication is signed in and out of the home, and signatures on medication administration records indicated that it is signed for at the time of administration as appropriate. However it is recommended that records include administration of nicotine patches prescribed to one resident by their GP. Care Homes for Adults (18-65 years) Page 18 of 31 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. The home deals well with complaints so that residents feel confident their complaints and concerns will be listened to and acted on. The residents are protected by adult protection procedures that make sure that they are safe and secure whilst at Laural House. Evidence: Residents told me that staff listen to their concerns and complaints, and an appropriate record of complaints was maintained within the home detailing actions taken to address any issues raised. Residents spoken to said they felt able to raise their concerns or complaints with staff and managers. This is particularly important at Laural House since some residents behave anti-socially at times within the home. Residents said that they are listened to and staff follow up complaints, for example regarding maintenance issues within the home. The home has policies and procedures in place in relation to reporting and investigating complaints. The complaints book indicated that complaints are recorded, with appropriate follow up action taken. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Staff have attended training courses on how to protect vulnerable adults from abuse and know what to do if they think a resident has been the victim of any form of abuse. The home has procedures and policies on protecting residents from abuse, alongside the local authoritys poclicy and procedures on safeguarding vulnerable adults. There have been no allegations of abuse since the home opened. Records are kept of residents monies that are signed by both the resident and a member of staff. It is recommended that the manager/deputy undertake current Safeguarding of Vulnerable Adults training with the local authority, to further update their knowledge of local procedures. Care Homes for Adults (18-65 years) Page 20 of 31 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. Residents at Laural House enjoy a clean, well decorated, furnished and comfortable living environment that adds to their quality of life. Evidence: Residents were positive about their living environment and throughout the inspection appeared to feel relaxed, and at home at Laural House. Laural House continues to be homely, comfortable and well decorated and furnished. The lounge has a television with cable channels available. There is a small garden at the back of the property, and the home is very close to public transport and shops making it easier for the residents to take advantage of local community facilities. Staff advised that repairs are dealt with promptly since one of the support workers has specific responsibilities to deal with maintenance issues. This was confirmed by records within the home and discussion with residents. On the day of the inspection a staff member was painting the banisters within the home. The manager advised that this was part of a programme of redecoration to decorate other paintwork within the home including the front door. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: On the day of the inspection the home was clean and tidy. Residents are involved in helping out with cleaning the home, however much of this work is undertaken by staff members. Care Homes for Adults (18-65 years) Page 22 of 31 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. Residents benefit from a committed and experienced team of staff who have the skills to meet their needs. They are protected by the home having thorough recruitment procedures for new staff. Residents continue to benefit from their mental health being stabilised and their independence skills increased because of the skills and competence of staff. Evidence: Feedback from the two residents interviewed was positive about how they found living at Laural House and the support provided by staff. Staff interviews showed that there continues to be a committed team of staff at the home who work hard at meeting the complex needs of the current residents. Throughout the inspection staff interacted positively and supportively with residents. Most members of staff have achieved the NVQ Level 2 in care, and have substantial experience in working with people with mental health needs. As a result residents are supported sensitively and effectively, contributing to their improving mental health. Four staff files were looked at and contained the information needed to make sure that Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: all new staff in the home have had the appropriate checks made, including obtaining written references and satisfactory CRB disclosures. As a result residents are protected by the arrangements Laural House has in place when recruiting staff to work at the home. New members of staff have a planned induction into the roles and responsibilities of being a care worker. The staff team has attended a range of relevant courses, including adult protection, administration of medication, challenging behaviours, and mental health awareness. This is in addition to training in essential areas such as first aid, food hygiene, fire safety, and health and safety. As a result staff are more effective in how they manage challenging behaviours reducing the need for psychiatric admissions. Staff training in the Mental Capacity Act 2005, had also been commenced. However their is room for improvement in identifying gaps in staff training and targetting these staff members for training in particular areas e.g. two staff members identified had not undertaken food hygiene training since 2001, although they remain involved in food preparation within the home, and not all staff members had undertaken training in addressing challenging behaviour. Staff records showed that members of staff have regular supervision session so that their care practice develops and any difficulties can be addressed. Staff interviewed said they felt well supported by management at the home. As recommended at the previous inspection, supervision files now have timescales for action needed to meet the identified staff needs e.g. for staff undertaking specific training. Staff should also be provided with annual apprasals to facilitate their further professional development. Care Homes for Adults (18-65 years) Page 24 of 31 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. Residents benefit from living at Laural House because the home provides a personalised service to each of the residents in order to meet their needs. The home is run in the best interests of the residents with their views and wishes shaping how the home is run. The home is good at making sure residents are kept safe and secure whilst living at Laural House. Evidence: Laural House has a good track record of preparing people to move into more independent accommodation. Residents are confident about the management of the home, and feel that their views are taken into account. The home is run with priority given to meeting the needs of residents. The management team and staff have a good understanding of the needs and wishes of Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: each resident. Residents were seen to be relaxed in the presence of staff and confident about interacting with them. The home uses feedback forms and questionnaires to get the comments and views of residents, families and professionals about the service provided by Laural House. Suggestions for meals to be cooked, or activities provided, are followed up by staff or the activities coordinator. Historically residents were provided with double beds where they requested this. It remains recommended that staff find further ways to increase the involvement of residents in the running of the home, given difficulties involved in holding residents meetings. The manager had completed the AQAA (Annual Quality Assurance Assessment) providing detailed information about the running of the home. Information on the form was checked at the inspection and indicates that Laural House continues to be able to critically assess the quality of the service provided and work towards improving the standard of care further. Inspection of financial records for monies held on behalf of residents for safekeeping, indicated that staff had access to the pin number for one persons bank card. This practice must cease, as it places both staff and residents at risk. No pin numbers should be shared with staff, and where this is the case, a new pin number should be requested from the bank in question. This should not be opened by staff, but returned unopened to the bank if the resident in question is unable to memorise the number independently. Instead the resident will need to sign for money taken out of the bank on each occassion. Property held for their safekeeping e.g. bank books also need to be signed in and out of the safe. Staff advised that on buying cigarrettes for an identified resident each day, they frequently top up the money with their own money, hence there is no change recorded for monies taken out for this purpose. This practice must stop. When purchasing items on behalf of residents, change given must be recorded on the financial records, and staff should not be spending any of their own money on purchases for residents, for the further protection of staff and residents from financial abuse. A range of health and safety records were inspected, including gas and electrical installation certificates, portable appliances testing, temperature checks, and fire safety records. These records were up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. An independent company had carried out a fire safety risk assessment of the premises. The home had followed this up with a timetabled action plan to implement all the action required. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 17 16 The registered persons must 17/07/2009 ensure that records are maintained of meals served within the home, to evidence that residents are provided with a varied and nutritious diet. . 2 35 18 The registered persons must 14/08/2009 ensure that training profiles are used to identify any gaps in staff training, so that these can be targetted effectively, and that all staff have annual appraisals to promote their further professional development. . 3 41 17 The registered person must ensure that no pin numbers are kept on behalf of residents, and property held for their safekeeping e.g. bank books are signed in and out of the safe. When purchasing items on behalf 17/07/2009 Care Homes for Adults (18-65 years) Page 29 of 31 of residents, change given must be recorded on the financial records, and staff should not be spending any of their own money on purchases for residents, for the further protection of staff and residents from financial abuse. . 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 12 It is recommended that residents be provided with the opportunity to go on holiday each year, and to go on trips to places of interest further afield, to increase the variety of opportunities available to them. It is recommended that medication records include administration of nicotine patches prescribed to one resident, to evidence that these are administered appropriately. It is recommended that the manager/deputy undertake current Safeguarding of Vulnerable Adults training with the local authority, to further update their knowledge of local procedures, for the protection of people living in the home. It remains recommended that staff find further ways to increase the involvement of residents in the running of the home, given difficulties involved in holding residents meetings. It is recommended that the record of fire alarm call point checks undertaken each week should include the zones tested on each occasion, to ensure that they are all tested regularly, and that the record of fire drills undertaken includes the time of the drill, to evidence that this is varied, for the further protection of people living and working at the home. 2 20 3 23 4 39 5 42 Care Homes for Adults (18-65 years) Page 30 of 31 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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