Care Home: Laurel House

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What the care home does well `I believe Laurel House offers an excellent standard of care to their clients. I have no concerns.` This was the written feedback from one of the psychiatrists for the residents at Laurel House, and was typical of the feedback from professionals involved with the home and relatives. `I like living here,` and `the food is really nice` was the view of one of the residents when interviewed. Residents feel at home and relaxed at Laurel House because staff pay close attention to meeting their individual needs and wishes. They benefit from being supported by a consistent team of staff with whom they have formed trusting relationships. The stability of the staff team is especially valuable since each of the residents has complex needs and it takes longer for staff to get to know their needs and wishes. The home has an experienced manager and deputy manager who are in close touch with residents, relatives and outside agencies. Residents benefit from regular contact with their families.Laurel House has become very good at meeting the needs of people with a variety of challenging behaviours. As a result residents with a history of placement breakdowns now feel at home at Laurel House. The home is particularly commended for enabling residents to reduce the amount of medication they take in a safe environment, so that they are able to express themselves without the need for a chemical restraint. What has improved since the last inspection? As this is a newly registered service, this section is not relevant. What the care home could do better: Contracts for each person living at the home should be updated to reflect their new home. It is recommended that more use be made of picture or photograph formats to help residents make choices about food or activities etc. The recording of fire drills could also be improved. CARE HOME ADULTS 18-65 Laurel House Laurel House 25 Heene Road Enfield Middlesex EN2 0QQ Lead Inspector Susan Shamash Unannounced Inspection 1st April 2008 2:00 Laurel House DS0000070790.V361265.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 House DS0000070790.V361265.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 House DS0000070790.V361265.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurel House Address Laurel House 25 Heene Road Enfield Middlesex EN2 0QQ 020 8366 2957 020 8366 2957 nlcareservices@yahoo.co.uk 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) North London Care Services Ltd Angela Marie Delaney Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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: 4 N/A Date of last inspection Brief Description of the Service: Laurel House is a four-bedroom detached house in a residential street in Enfield, within walking distance of Enfield Town and is well served with local transport, shops, parks etc. Rooms are bright, and decorated and furnished to a high standard. There is one bedroom on the ground floor and three on the first floor. The room on the ground floor has a separate shower room with toilet. One room on the first floor has an en suite facility consisting of a shower, toilet and sink. The other two rooms have sinks and share a shower room and toilet. There is a quiet room on the first floor with a sofa and television. The kitchen is at the front of the house, and the lounge is at the back of the house and leads to a newly built conservatory that serves as a dining area. The staff office is accessed off the lounge and there is a separate laundry room. The rear garden is private and overlooks school playing fields. Laurel House believes that: People with learning disabilities have individual needs whatever the degree of their disabilities or for others the degree of their challenging behaviour and aims to meet these needs. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the manager or at www.csci.org.uk. The current scales of charges are from: £1,200-£2,000/week. There are no other additional charges. Laurel House DS0000070790.V361265.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 3 stars. This means the people who use this service experience excellent quality outcomes. This unannounced inspection took place over one day and lasted approximately five and a half hours. It was the first inspection of this service since it moved to new premises. The owner, Angela Delaney, who is also the manager, was available throughout the inspection. I looked around the home and spent time with all four people living at the home (although only briefly with some of them). I spoke to two residents who were able to indicate their views about the home and the care they were getting. Written comments by residents, relatives, and professionals involved with the home were also looked at. I spoke to two members of care staff on duty during the inspection and one new staff member who was attending for induction training. A variety of records, including care plans, staff files, menus and health & safety documents, were also looked at. The overall impression is that despite being a newly registered home (following the change of premises) the service continues to provide an excellent standard of care to people with complex needs within a homely and supportive environment. The staff and management at the home have worked very hard to reach this high standard and are to be commended for this achievement. What the service does well: ‘I believe Laurel House offers an excellent standard of care to their clients. I have no concerns.’ This was the written feedback from one of the psychiatrists for the residents at Laurel House, and was typical of the feedback from professionals involved with the home and relatives. ’I like living here,’ and ‘the food is really nice’ was the view of one of the residents when interviewed. Residents feel at home and relaxed at Laurel House because staff pay close attention to meeting their individual needs and wishes. They benefit from being supported by a consistent team of staff with whom they have formed trusting relationships. The stability of the staff team is especially valuable since each of the residents has complex needs and it takes longer for staff to get to know their needs and wishes. The home has an experienced manager and deputy manager who are in close touch with residents, relatives and outside agencies. Residents benefit from regular contact with their families. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 6 Laurel House has become very good at meeting the needs of people with a variety of challenging behaviours. As a result residents with a history of placement breakdowns now feel at home at Laurel House. The home is particularly commended for enabling residents to reduce the amount of medication they take in a safe environment, so that they are able to express themselves without the need for a chemical restraint. What has improved since the last inspection? 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 House DS0000070790.V361265.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have the information about Laurel House they need to make an informed choice including details of terms and conditions to ensure that their rights are protected. They have their needs and wishes assessed so that the home can be sure that it can meet these needs and wishes, and they have the opportunity to visit and stay at the home on a trial basis before deciding whether to move in. EVIDENCE: The home has a detailed and informative service user’s guide and statement of purpose so that relatives of prospective residents and professionals know what they can expect from Laurel House. The information emphasises respect for people from different cultural backgrounds, and that people living at the home are treated as individuals. I provided the manager with some advice about further information to be provided in the Statement of Purpose in line with the Care Homes Regulations 2001. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 9 The manager advised that the home continues to explore different techniques to ensure that information about the home is as accessible as possible to existing and prospective residents. Observation of people living at the home indicated that they felt relaxed and at home at Laurel House. The case file for each resident contains a community care assessment that sets out their needs and wishes. Care plans are very comprehensive and set out how each person’s needs and wishes will be met by the home. Staff and the manager advised that residents themselves contribute as much as possible to this process in order to ensure that plans reflect their wishes. As a result a very high standard has been achieved in this area. The manager advised that in addition to community care assessments, existing support plans are also obtained for prospective residents so that their success can be evaluated. Where necessary she has identified when people users require more specialist support in certain areas such as speech and language therapy. They are visited at home and the manager undertakes her own assessment, utilising information provided by professionals, the prospective service user, relatives and advocates prior to a decision being made about the home’s ability to meet their needs. In the Annual Quality Assurance Assessment the manager indicated that she intended to produce this assessment in a pictorial format for future use. Prior to the move detailed transition plans are produced for individual service users. Records within each persons case file and in particular the file for the service user most recently admitted to the home, confirmed that the above procedures had been carried out. Records also indicated that this person had had the opportunity to visit Laurel House and stay for visits of increasing length to become accustomed to the home prior to moving in. The manager advised that issues of consent were taken account of, in the recent move to the new home by residents and their families agreeing and signing a consent form about the move. Where people were unable to consent, family members consented on their behalf and a letter was provided by the psychiatrist with their opinion on the move on behalf of some of the service users. This process was in compliance with the Mental Capacity Act 2005 and the home is commended for the high standard of practice in this area. Although people living at the home had statements of terms and conditions with the home, for the three people who had moved from the home’s previous location these still contained details of the previous home. It is therefore required that these be updated to reflect the current place of abode and the bedrooms that they occupy. Laurel House DS0000070790.V361265.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. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from care plans that set out how their needs are to be met and respond to changes in their needs and wishes. They are supported by staff so that wherever possible they make decisions for themselves, and the each resident has risk assessments in place in order to keep them as safe as possible. EVIDENCE: The care plans are very detailed and appear to cover all the key aspects of people’s lives. The home attains community care assessments of needs and care plan areas prior to admission and the home conducts its own assessment of need. Each resident has specialised needs and in each case referrals had been made by the home to appropriate agencies for support. These have included getting support from the speech and language service for a person Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 11 with specific communication needs, and from the psychology service for an individual needing support with emotional and behavioural issues. Staff advised that residents are involved in drawing up care plans as far as possible, and sign to indicate they agree with them. Recording and discussion with staff indicated that care plans are reviewed on an ongoing basis, as well as more formally every three months. On a six-monthly basis the home conducts review meetings in which residents’ families and professionals are involved in the review and further planning, including some Person Centred Planning meetings. Monthly key worker meetings are also held with residents to ensure that they are as involved as much as possible in the planning and review of their own care and support needs. Minutes of all these meetings were available within each person’s care file. People living at the home have high needs and staff need to be skilful at finding opportunities for them to make decisions and have choices. Residents’ meetings, one-to-one meetings with their key workers and questionnaires (completed with support from their family members) are used to obtain the people’s comments and wishes in relation to their life at Laurel House. Records showed that residents had been informed and consulted about the move to their new home, activities that they would like to engage in and food served at the home. There is a support plan section on decision making and choices which identifies areas of people’s lives where they have the ability to make decisions and choices and how they can be supported to make decisions e.g. with the use of pictures or giving a few options at a time to make the process attainable, based on their individual communication needs. Where residents had expressed concerns e.g. about noise levels at the home, actions had been taken to address this issue, and the issue was being monitored on an ongoing basis by staff and management at the home. The homes risk management policy outlines the importance of risk assessments not impeding individuals’ lifestyles so long as the risks are calculated and there are contingency plans in place. The manager has completed detailed risk assessments for each resident to ensure that any risks identified can be managed by the home. These risk assessments are regularly reviewed and updated at least three-monthly. For one person who occasionally exhibited challenging behaviour, extremely detailed evaluation had been undertaken of each risk including areas such as access to fluids, walking around at speed and support needed in different areas of the house. As a result residents benefit from being supported to be as independent as possible whilst minimising risks to their welfare. In the case of all residents, liaison with medical professionals alongside rigorous risk assessment had enabled them to reduce, and in some cases come off all the medication that they had previously been taking regularly. The home is commended for its successful practice in this important area. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 12 The manager advised that all but one staff member had completed risk assessment training and this was confirmed by staff files examined. Future areas that the home intends to address include producing all day to day documents such as residents meetings and support plans in simpler language, and pictorial formats. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 13 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. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have a good quality of life because they take part in a range of stimulating activities, getting out and about in their local community. They feel secure and happy at Laurel House whilst being able to maintain close contact with their family and friends. People benefit by having support from staff to make choices for themselves and to have as much control over their lives as possible. They are provided with good quality meals that they enjoy and which ensure they have a healthy diet. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 14 EVIDENCE: People take part in a variety of daytime activities. Two residents go to an outreach service where they go bowling, ice skating, swimming, shopping, or to cafes and pubs and are assisted to get out and about in the community. One person has an individualised programme consisting of college, day centre, clubs, community outings and helping at a local charity shop. As a result residents feel more fulfilled by having a range of stimulating activities to take part in. The most recently admitted person has not yet joined an external programme of activities, and therefore is supported for day activities by members of the staff team. Staff told me that residents go out to the local shops and cafes, and one resident told me that they had recently been to the cinema. One resident chooses to go to a local church. A minibus is available to help people go out locally or on outings so that people get to know and feel part of their local community. Resident’s diaries and activity timetables provided further evidence that all residents engage in varied daytime activities. Staff told me that one resident had only recently returned from a weekend at his relative’s home, and this was confirmed by recording. Support plans indicated that people valued the regular contact they had with their family members and friends, both at the home and elsewhere. The manager advised that staff support residents in the area of personal and sexual relationships. One person who had expressed a wish to have a girlfriend had been assisted to make contact with a local dating agency for adults with learning disabilities. Another support plan included a detailed risk assessment regarding supporting a resident appropriately in this sensitive area. Staff interviews and the care plans indicated that Laurel House takes the empowerment of residents seriously, and continues to look at ways of increasing the choices they can make over how they live their lives. Staff and manager have attended person-centred training in order to promote this area and each resident has someone independent of the home to help them complete their feedback forms about life at Laurel House. I observed staff and residents interacting in the evening at the home and noted that the atmosphere was relaxed and people ate a healthy snack on returning from day activities and then appeared to enjoy eating their evening meals. Given the behavioural issues that some of the people living at the home had shown prior to moving in, it is clear that staff had worked hard to achieve such a relaxed atmosphere, and they are commended for this. One person told me when I asked about the food in general: ‘the food is really nice here.’ Support plans included people’s preferences and dislikes and feedback forms from residents and relatives were positive about the food Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 15 served. I was impressed to learn from the manager that staff had supported one person, who needed to lose weight for medical reasons, to lose a significant amount of weight, through encouragement, promotion of physical exercises and provision of a varied healthy eating diet. This is a significant achievement. The home was well stocked with fresh fruit and vegetables, and a variety of meat, fish etc and dairy products which were stored appropriately. Records of food served to residents confirmed that they all receive a balanced diet in the home. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 16 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): 18, 19 and 20. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents like living at Laurel House and are supported by staff in a way that they are happy with. Their physical and emotional health needs are met effectively and they benefit from safe and effective arrangements for medication in the home. EVIDENCE: Discussion with two support workers indicated that they were very well informed about the physical and emotional needs of all people living at the home. In case files large amounts of information is written in the first person, starting with ‘I like…’ or ‘I need… ’ so that the home provides an individual service to each client. One resident told me ‘the staff are good’ and when I asked who they would speak to if they were unhappy about something they identified their key worker or the manager of the home. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 17 People’s support plans indicate how they prefer to be supported with their personal care and these are now reviewed at least on a three-monthly basis. Those inspected included information such as people’s preferred times for getting up and going to bed, when they choose to eat their meals etc. Each resident has a comprehensive person-centred ‘Personal Health Record’ folder that helps to ensure that their health needs are addressed appropriately by themselves, staff and professionals. Records indicated that all residents have had at least annual health checks and each has a health action plan. Feedback from the last quality survey for the home indicated that residents, relatives and professionals were impressed by the high standard of care provided in the home. The manager advised that the home continues to develop close and effective working relationships with other professionals, such as social workers, psychologist, psychiatrist and speech and language therapists. In several cases the home had worked closely with members of the local community learning disabilities team and medical professionals on carefully managed, programmes to reduce significantly the level of people’s medication. The home is to be commended for the high standard it has achieved in this area. The manager noted that she had liaised with a new GP surgery for the home, and the GP had visited the home to complete all four new registrations. She also noted that home requested a private second opinion for one person for a thorough consultation which resulted in a recommendation to enhance their quality of life and prevent their condition from deteriorating. Evidence of this was seen in correspondence within this person’s care file. In the Annual Quality Assurance Assessment she advised that she planned to build up a bank of photographs of the local community, including medical centre/blood taking clinic etc to improve the knowledge of residents in relation to attending healthcare appointments. The medication cabinet and medication records were looked at and were satisfactory. Staff records showed that all relevant staff members have had training in the administration of medication. The homes medication policy incorporates the collection , administration and storage of medication as well as covert medication guidelines. During the inspection I recommended to the manager that a risk assessment be recorded for a particular person whose medication was being reduced, even though the process was being overseen by a particular person’s psychiatrist. She contacted me shortly after the inspection to advise that this had been undertaken as recommended. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 18 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. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home deals with complaints and concerns effectively so that residents and their relatives feel confident their views are listened to and acted on. Residents benefit from effective adult protection measures that make sure that residents are safe and secure. EVIDENCE: The home has an appropriate complaints procedure, including a user-friendly version which makes use of pictures and symbols. The procedure contains clear and detailed guidelines for staff. Throughout the inspection there was an open environment in the home, with support given to residents to enable them to express their views and any concerns that they had. People living at the home also have family members to support them in expressing their views and wishes. Comments made by residents and families in feedback questionnaires had been noted by the management and followed up. One complaint had been made about the home, and I saw evidence that this was addressed appropriately. In addition an adult protection issue concerning a person outside of the home was investigated appropriately, and the CSCI was informed as required. I was also impressed to see that any concerns noted had been addressed seriously e.g. concerns about noise levels and support provided during mealtimes. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 19 The home has an adult protection policy which clearly outlines action to be taken by staff and timescales to be followed. As appropriate, an adult protection investigation had been undertaken in response to information provided about an external service. Service user plans contain detailed and comprehensive risk assessments, including appropriate guidelines for staff on managing challenging behaviours presented by people living at the home. All staff in the home have attended training on adult protection. Staff spoken to felt confident about actions to take in relation to adult protection issues such as a resident making an allegation. Records relating to residents’ monies were accurate and up to date with a system of daily checks in place. As a result of the efficient procedures in place residents are protected from financial abuse. In the Annual Quality Assurance Assessment the manager advised that she was arranging for all staff to access training in complying with the Mental Capacity Act (2005). She noted that monthly key worker meetings will continue to be held with each resident, so that they have the opportunity to express their views about care provision in the home and express concerns or make complaints. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 20 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 and 30. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at Laurel House enjoy a homely, attractive and comfortable living environment which adds considerably to their quality of life. They benefit from a home that is kept clean and hygienic. EVIDENCE: The service had recently moved to new premises which staff and a resident described as larger and more comfortable than the previous house. Laurel House is spacious and comfortable but homely with communal areas both downstairs and on the first floor so that people living at the home can choose which area to sit in. One person told me ‘I like living here’ and was happy to show me their bedroom which they had personalised as appropriate. I received permission from two other people living at the home, to look at their bedrooms. Each Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 21 contained lots of personalised items, such as picture, DVDs and CDs, so that people felt at home in their bedrooms. The home is a four-bedroom detached house in a residential street within walking distance of Enfield Town and is well served with local transport, shops, parks etc. Rooms were bright, and decorated and furnished to a high standard. There is one bedroom on the ground floor and three on the first floor. The room on the ground floor has a separate shower room with toilet and washbasin. The manager advised that this room was being occupied by a person who had some mobility problems, and that use of a separate shower room was easier for them than attempting to use an en suite room. One room on the first floor has an en-suite facility consisting of a shower, toilet and washbasin. The other two rooms have wash basins and share a shower room with toilet and wash basin. There is a quiet room on the first floor with a settee and TV. All bedrooms and the lounge have access to Sky TV. The kitchen is at the front of the house, and the lounge is at the back of the house and leads to a newly built conservatory that serves as a dining area. The staff office is accessed off the lounge and there is a separate laundry room. The rear garden is private and overlooks school playing fields. All residents and families had made positive comments about the home environment in feedback forms as part of the last quality assurance audit. The home was clean and hygienic to a high standard. Feedback forms received, confirmed that this was generally the case. Staff files indicated that they had been trained in infection control measures, food hygiene and health and safety, to ensure that there is a hygienic environment at Laurel House at all times. The manager advised that further training was being planned this year to update staff in infection control measures. The home has an infection control policy and risk assessments to prevent the spreading of infection. Infection control policies include MRSA, Legionnaires, hand washing and general infection control procedures. Staff members told me that they check for the safety of the environment on every shift. Health and safety risk assessments, environment checklists and servicing certificates provided evidence of the premises being well maintained. I recommended that further use might be made of pictorial or photograph formats as communication aids for choices about menus, activities etc. within the home. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 22 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, 34, 35 and 36. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a committed and experienced team of staff who have the skills to meet their needs. They are also protected by the home having thorough recruitment procedures for new staff. Residents are supported by staff who have the skills and training to meet their needs. EVIDENCE: ‘I like the staff’ one resident told me. They went on to say ‘if I am unhappy about anything I can talk to my key worker.’ All care staff at Laurel House are experienced in working with adults with learning disabilities and have done further training in managing challenging behaviour. As well as in-house training, staff undertake external training, including training to NVQ level 2 in Health & Social Care. NVQ training for care Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 23 staff is currently at 37.5 however another staff member is due to undertake relevant NVQ training shortly. Interviews with two staff members and observation of interactions between staff and residents in the home showed that they had a very good understanding of the needs and wishes of each people living at the home and how to support them effectively. I sampled three staff records and these contained all the necessary documentation, including references and CRB disclosures. The home had obtained new CRB disclosures for all staff as part of its policy of asking for fresh checks every 3 years. This is seen as good practice and indicates the home’s commitment to safeguarding residents. On the day of the inspection one new staff member was attending to undertake part of their induction training. All necessary recruitment checks had been completed for this staff member as appropriate. Examination of the rota, and discussion with staff and residents as well as observation of staff interactions with residents indicated that staffing levels are sufficient to ensure residents’ needs are met at all times. In addition the manager is generally on duty and available to support as needed. The staff team have considerable experience of working with adults with learning disabilities and challenging behaviour. A detailed induction procedure is in place, in line with the General Social Care Council induction standards. Staff had attended all mandatory training, such as safeguarding adults, health and safety, food hygiene, first aid, fire safety etc. Training had recently been provided on medication administration, and other courses undertaken by staff included training on diversity issues, challenging behaviour, epilepsy, breakaway techniques, communication, risk assessment, and support plans. There is a training plan in place, with training for staff in the Mental Capacity Act 2004 planned later in the year. In the Annual Quality Assurance Assessment the manager noted that the home has retained the core staff team for a long time. She advised that all staff are given copies of the GSCC code of conduct. Records of individual staff supervision sessions indicated that these meet the required minimum frequency of approximately six times annually, and that a range of issues are covered at each session. The manager advised that annual performance appraisals were due to be carried out on all staff members shortly, and that it was he intention to discuss one of the home’s policies at each staff meeting. Staff meeting minutes also indicated that staff are instructed and consulted regarding key ways in which the home is run. Feedback from staff members showed that they felt sufficiently supported by management and worked well as a team. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 24 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. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The views and wishes of people living at the home are taken into account so that the home is run in their best interests. The home is run efficiently so that residents receive continuity of care with minimal disruptions. A very high standard of health and safety is in place to ensure that people living at the home are as safe and secure as possible. EVIDENCE: One resident was able to tell me that they felt well supported and enjoyed living at the home. Observation of other residents indicated that they felt confident and comfortable at the home and were able to express their wishes Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 25 to staff as appropriate. Two staff members spoken to indicated that they felt well supported by the home’s manager. The manager advised that she is undertaking the Registered Manager’s Award at NVQ level 4, to further improve her skills in managing a care home. Discussion with the manager confirmed she has a good understanding and commitment to meeting the needs and wishes of each resident. Efficient policies and procedures are in place within the home so that residents benefit from living in a well run home. She advised that she had recently purchased a symbol package for the home’s computer, to provide further information in an accessible format for residents. It was notable that residents who had transferred from the previous site of the home had made the transition to the new home with relative ease. This is in no small way due to the careful management of the transition, and staff input in making this transition a positive experience for residents. Two residents that I spoke to were in no doubt that they preferred living at the new home. The manager has arranged for an external monthly report on the standard of care provided by the home, copies of which are sent to the CSCI. These reports are not required by law, but are useful in identifying areas of practice in need of improvement at Laurel House. The manager is commended for this practice. Written feedback from people living at the home (completed with support from their relatives) and direct feedback from relatives is very positive about the home. Questionnaires are used to obtain the views and comments of residents, their families and professionals involved with Laurel House on a six-monthly basis. Evidence was available that feedback provided is then acted on by the staff team. For example one person wanted more support available at mealtimes, and the manager had taken action to ensure that this was provided. Records confirmed that staff meetings and resident meetings are held regularly to get feedback and suggestions about the running of the home, including activities and outings people would like to have. In addition key workers meet with individual residents on a one-to-one basis at least monthly, to ascertain there views and wishes. Records of these meetings indicated that these are especially valuable for some residents who are less able to speak up in the group meetings. A range of health and safety records were examined including fire safety logs, satisfactory gas and electrical safety certificates, and detailed routine temperature checks. Health and safety records were detailed, up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 26 The home has risk assessments for all areas of health and safety as specified in the national minimum standards and there is a rolling training programme which incorporates all mandatory staff training to ensure that staff are adequately trained to ensure the safety of people living at the home. Fire drills were being held regularly as required, however because the time of each drill was not recorded it was difficult to ascertain if these were being undertaken at varied times. It is recommended that records of each fire drill should include the time at which the drill was held and that the requirement for at least one ‘night time’ drill can be undertaken silently if this is deemed necessary, for the safety of people living at the home. In the Annual Quality Assurance Assessment the manager indicated her intention to provide health and safety records for people living at the home in a pictorial format where possible. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 27 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 3 2 4 3 X 4 4 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 X X 3 X Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1bc) Requirement The registered person must ensure that each person living at the home had a current statement of terms and conditions to reflect their new place of abode and the bedroom that they occupy, so that their rights are protected. Timescale for action 16/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA24 YA42 Good Practice Recommendations It is recommended that further use should be made of pictorial or photograph formats as communication aids for choices about menus, activities etc. It is recommended that records of each fire drill should include the time at which the drill was held and that the requirement for at least one ‘night time’ drill can be undertaken silently if this is deemed necessary, for the safety of people living at the home. Laurel House DS0000070790.V361265.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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