Care Home: Laurel Gardens, 14

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What the care home does well The service is able to meet the needs of people with different cultural and religious backgrounds and this is reflected in the diverse staff group. The needs and aspirations of prospective residents are assessed comprehensively prior to admission. The changing personal, healthcare and social needs of residents are being identified within care plans and are regularly reviewed. People who use the service are able to make decisions regarding their daily living routines and receive support while participating in shared and/or individual activity within the local community. The physical and emotional healthcare needs of residents are being met satisfactorily and their safety and welfare are being protected. A long standing permanent staff group has been maintained and appropriate training and refreshers have been delivered. Support workers were observed being competent and attentive in meeting the needs of residents. People who use the service have benefited from receiving consistent support from regular carers with whom they relate in a friendly and spontaneous manner. They were appropriately dressed, appeared settled and content, and reported being happy at the home. Overall, the service was clean, hygienic and reasonably well maintained. The environment was safe, calm and homely. What has improved since the last inspection? One requirement relating to medication had been complied with.Specifically, dates on which bottled medication were opened were recorded on labels and signed. CARE HOME ADULTS 18-65 Laurel Gardens, 14 Hanwell London W7 3JG Lead Inspector Jean Bovell Key Unannounced Inspection 23rd September 2008 11:00 Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurel Gardens, 14 Address Hanwell London W7 3JG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8579 6869 hm14laurel@ealing.org.uk www.supportforliving.org.uk Support for Living Mrs Ursula McGinty Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 2nd October 2006 Date of last inspection Brief Description of the Service: 14 Laurel Gardens is a residential home for three service users with learning disabilities. The home was registered in 1991. Acton Housing Association owns the home and the care provider is Ealing Consortium Limited. The home is located in Hanwell and is within walking distance to the local shops and cafes. West Ealing and Ealing Broadway shopping centres can be accessed by public transport facilities. Hanwell mainline station is located nearby. The lounge, kitchen/dining area, a laundry room, an en suite shower room and one of the three service users bedrooms are situated on the ground floor. There is small rear garden with wood covered patio. Two service users bedrooms, a staff sleeping-in room, an office and an en suite bathroom are on the first floor. The home is not accessible to wheelchair users. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is three stars. This means the people who use the service experience excellent quality outcomes. This inspection was carried out between 11:00 am and 4:00 pm on 23rd September 2008. Two residents and two support staff were on duty. We were informed by a support worker that the Acting Manager was on annual leave and one resident was at work. During the course of the inspection, the home’s records, documents, policies and procedures were viewed. A tour of the building was undertaken and observations were made. We spoke to three support workers and three residents. A telephone discussion was held with the Acting Manager subsequent to the inspection. A requirement made at the last inspection and all key standards were examined. A completed annual quality assurance assessment – self assessment document was considered. We received co-operation and appropriate assistance for a support worker throughout the inspection. What the service does well: The service is able to meet the needs of people with different cultural and religious backgrounds and this is reflected in the diverse staff group. The needs and aspirations of prospective residents are assessed comprehensively prior to admission. The changing personal, healthcare and social needs of residents are being identified within care plans and are regularly reviewed. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 6 People who use the service are able to make decisions regarding their daily living routines and receive support while participating in shared and/or individual activity within the local community. The physical and emotional healthcare needs of residents are being met satisfactorily and their safety and welfare are being protected. A long standing permanent staff group has been maintained and appropriate training and refreshers have been delivered. Support workers were observed being competent and attentive in meeting the needs of residents. People who use the service have benefited from receiving consistent support from regular carers with whom they relate in a friendly and spontaneous manner. They were appropriately dressed, appeared settled and content, and reported being happy at the home. Overall, the service was clean, hygienic and reasonably well maintained. The environment was safe, calm and homely. What has improved since the last inspection? One requirement relating to medication had been complied with. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 7 Specifically, dates on which bottled medication were opened were recorded on labels and signed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and aspirations of prospective residents are comprehensively assessed prior to admission. EVIDENCE: The personal files of three residents were inspected. It was evidenced that initial assessments relating to prospective residents which included family history were submitted to the home by the placing authority at the point of referral. It was indicated also, that a subsequent assessment was carried out by the home and that social workers, relatives, friends and/or advocates participated in the process of determining the capacity of the home to meet separate identified needs and aspirations. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and related risk assessments are being appropriately undertaken and regularly reviewed. People who use the service are able to make decisions regarding their daily living routines. EVIDENCE: The changing personal, healthcare and social needs of residents were appropriately assessed within separate care plans viewed, and action plans and set goals were in place. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 11 Risk assessments associated with specific activities identified within care plans had been carried out. These included going out in the community, using the toilet at night, eating and drinking, and risks in the bath, shower and kitchen. All care plans and risk assessments viewed were clearly detailed and regularly reviewed. A care worker confirmed that people received choice regarding their daily living routines such as meals, activities, what they wore each day, when they got up on mornings/retired at night and personal purchases. Those with capacity were able to be independent within the local community. People were observed freely moving around the house and an individual was offered a late cooked breakfast of his/her choice at the time of the inspection. Separate choices and interests were also reflected in residents’ bedrooms which were lockable and contained lockable facilities. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The religious needs of residents are being met and they are able to participate in separate and/or joint activities within the community. Contact with relatives and/or friends are encouraged and facilitated. People undertake appropriate housekeeping tasks while being supervised. Varied and nutritional meals are provided. EVIDENCE: Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 13 The religious needs, social interests and aspirations of residents were identified within individual care plans. An activities programme which listed separate activities, appointments and family visits were on display and included photographs of individuals and specific support workers in relation to each activity. There were indicators that people received support or independently attended Church services on a Sunday. Residents were also supported while participating in a variety of individual or joint activity within the community and annual holidays were arranged. People were encouraged to pursue separate interests and received opportunities for realising aspirations. Those with capacity were able to maintain and travel to and from part-time employment. People were observed participating in separate activity such as copy writing and watching television. Others attended day resource centres or work placements, at the time of the inspection. We were informed by a support worker that residents received regular visits from relatives and/or friends and were often taken out by them. Support workers confirmed that people were supervised while undertaking housekeeping tasks such as tidying individual bedrooms. Sufficient stocks of fresh, dried and frozen foods were appropriately stored in the home’s kitchen. Meals were prepared by care staff and varied and wholesome meal options were listed on menus. Snacks and drinks were readily available. People were observed enjoying a cooked breakfast and nutritional lunch at the time of the inspection. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. 18, 19 and 20. This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of residents are being met satisfactorily. Policies and procedures on medication are appropriately detailed. EVIDENCE: The personal care needs of residents were identified within separate care plans and reflected that residents required assistance or supervision with their personal care routines. Support workers confirmed that people’s privacy and dignity were at all times respected and they were able to choose what they wore each day, hairstyles and makeup. People who used the service were observed to have individual hairstyles and were appropriately dressed in separate outfits. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 15 The individual healthcare needs of residents were also identified within care plans. It was indicated that they received access to healthcare professionals as required and were accompanied to medical appointments. Annual health checks were arranged and people received regular therapies such as music and drama. Support workers have been particularly observant in recognising specific changes in people which gave cause for concern. Medical opinion was sought and serious conditions were discovered at early stages. Hospital admissions, procedures and regular appointments for specific therapies followed. Ongoing medication requirements have been managed satisfactorily by care staff resulting in marked improvements to the health and wellbeing residents. Support workers are also attentive to residents with chronic conditions and ensure that their specific needs are at all times met. Separate health records including seizure charts were up-to-date and clearly detailed. Weight charts were in place. Prescribed medication was safely stored, accurately documented and appropriately signed after being administered. Medicines received and returned to the Pharmacist were recorded. Dates of opening bottled medicines were entered on labels and signed. Records were indicative of staff training on medication being delivered and support workers appeared competent, attentive and committed to meeting the health care needs of residents. The home’s policy and procedures on medication were in place. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedures is appropriately detailed and residents are being protected from abuse and neglect. EVIDENCE: The complaints procedure is concise, clearly detailed and written and illustrated in a format suitable to meeting the needs of people who use the service. A support worker confirmed that complaints had not been received at the home following the last inspection. This was indicated in the complaints book. We were informed by a support worker that weekly benefits were paid directly into residents’ bank accounts and cash allowances were held in safekeeping at by care staff. Financial records relating to three residents were examined and no discrepancies were identified. People in part-time employment were able to secure earned cash in lockable facilities placed within separate bedrooms. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 17 Accidents and incidents that occurred within the home were appropriately recorded and regulation 37 forms are being submitted to the CSCI as required. The records indicated that refresher staff training on the Protection of Vulnerable Adults had been delivered. Policies and procedures on the protection of vulnerable adults were in place. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being adequately maintained. Residents’ bedrooms are personalised and the bathroom and toilet facilities are sufficiengt for meeting individual personal needs. Overall, the service is clean and hygienic. The environment is safe and homely. EVIDENCE: Communal areas within the premises are spacious and suitable for shared and/or individual activity. All furnishings are comfortable and of good quality. The kitchen and laundry rooms contained the required fittings and equipment. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 19 The garden was adequately maintained and accessible to residents. All bedrooms were freshly painted, suitably furnished and fitted, and reflected individual choices and interests. Bathroom/toilet facilities were clean and hygienic, in good order and sufficient for meeting the personal needs of residents. Although bedrooms and communal areas had been repainted, carpets in hallways and stairwells were worn and/or stained and were not firmly secured onto the floor on bottom steps. This was discussed with the Acting Manager on the telephone and it was confirmed that a programme of refurbishment was in place and included replacement of all floor coverings. Overall, the home was clean, hygienic and adequately maintained. The environment was safe, calm and homely. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support workers are suitably trained and qualified for meeting the needs of residents. Policies and procedures on recruitment are satisfactory. EVIDENCE: The staff rotas were viewed and reflected that two support workers were on duty during waking hours and one support worker covered sleeping duty at night. It was indicated on the completed annual quality assurance assessment document that of four permanent care staff, two had achieved NVQ level 2 or above. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 21 Training programmes were in place and reflected that care staff received induction training. Subsequent training and refreshers delivered, included choking and resuscitation and epilepsy. Support workers were observed being attentive and competent in meeting the needs of residents. Staff recruitment files were not accessible at the time of the inspection as the Acting Manager was on annual leave. However, a telephone discussion was held with the Acting Manager on her return and it was confirmed that copies of all required recruitment documents were within individual staff files. This was also evidenced at the last inspection. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Acting Manager is suitably qualified and experienced. An annual quality assurance assessment has been undertaken satisfactorily. The health and safety of residents are protected. EVIDENCE: The Registered Manager of the service was on maternity leave and is being temporarily replaced by an Acting Manager. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 23 The Acting Manager was not at the home during the inspection but was subsequently spoken with on the telephone. She confirmed being a Deputy Manager for several years at another service within the organisation and had enrolled for training on NVQ level 4 in Health and Social Care. Support workers who covered duty at the time of the inspection reported that the Acting Manager was approachable and supportive. An annual quality assurance assessment document had been completed and returned to the CSCI at the required time. Areas in which the service did well, what could be done better and how they had improved were identified. Numerical information was also provided. All health and safety records were up-to-date. These included fire safety and water temperature checks, portable appliances tests and gas maintenance. Fire drills were being undertaken at regular intervals. Separate fire and environmental risk assessments were in place. Records were indicative of staff training and refreshers being delivered on Health and Safety, Moving and Handling, Infection Control, First Aid, Food Hygiene and Fire Safety. Policies and procedures on health and safety were in place. Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 3 X 3 X X 3 X Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laurel Gardens, 14 DS0000027734.V372321.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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