Care Home: Laurel Lodge Care Home

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What the care home does well The service is close to the centre of Norwich, and residents are encouraged where possible to visit the city. The premises are set in attractive grounds, which are accessible to people living in the home. They offer a personalised service, and the proprietors play an active role in day to day management of the home, supported by a very dedicated manager. Facilities are of a high standard, and the service are always looking at new developments which would benefit the residents and the home, for example they are taking part in the trials of a new laundry tracking system. What has improved since the last inspection? Since we last inspected the service, a new extension has been completed, increasing the capacity of the home, and providing well appointed facilities. They are planning a new brochure which will give prospective new residents more information about the home and the available facilities, and currently reviewing their assessment documentation. Following completion of the extension, they are planning further work on the dining room and conservatory areas, together with ongoing redecoration and re carpeting where required. What the care home could do better: There were no requirements made as a result of our visit, but some change were discussed with the manager at the time, For example the risk assessments in place need to be developed further, and this is now in hand. The AQAA identified a number of areas that the service wish to develop, and this will further enhance the support and facilities available. Key inspection report Care homes for older people Name: Address: Laurel Lodge Care Home 19 Ipswich Road Norwich Norfolk NR2 2LN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alan Buttery     Date: 0 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Laurel Lodge Care Home 19 Ipswich Road Norwich Norfolk NR2 2LN 01603502371 01603443872 brian.jones733@ntlworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Brian Jones,Mrs Linda Jones care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One service user, named in the Commission`s records, with a diagnosis of dementia may be accommodated. Date of last inspection Brief description of the care home Laurel Lodge is located in a residential area close to Norwich city centre. Formerly a large period residence, the premises have been adapted and extended to provide accommodation to a maximum of 27 older people. There are 21 single and 3 double rooms, all having en suite facilities, although only one double room remains in use for two people, the others are now single occupancy rooms. The care home has one spacious TV lounge and a second quiet lounge. There is a conservatory that grants access to a large garden and a private car park at the front of the premises. Fees charged range bewten 450 and 575GBP per week, depending on the room and Care Homes for Older People Page 4 of 24 Over 65 27 0 Brief description of the care home the assessed needs of the perosn. Care Homes for Older People Page 5 of 24 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, carried out over a period of about five hours. During this time, we met with one of the proprietors and with the deputy manager, and looked at a range of documentation and records held by the home including their Statement of Purpose, residents files, staff records and training records. Prior to our visit, the service submitted an Annual Quality Assurance Assessment (AQAA) and we received completed survey forms from ten residents and four staff. During our visit, we spoke with four of the residents over lunch and with two of the staff team working on the day. We also spoke with a visiting professional nurse. The views of all the people we spoke with are reflected in the report. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. detailed assessments are carried out prior to anyone moving into the home, and people thinking of moving to Laurel Lodge can be confident their needs can be met Evidence: The process of any admissions to this home was discussed with the manager of the service, and would normally involve a visit from either the person thinking of moving to the home, or more often a member of their family. Initial enquiries come either directly from the family member, or from the local health or social care teams. During this initial stage a pre admission assessment is carried out, and once the service has a vacancy and the person has decided they want to move to the home, the assessment is re done to ensure information is up to date, and the home can meet the needs identified. During our visit, the four care files we looked at all included the detailed assessment Care Homes for Older People Page 9 of 24 Evidence: information, and clearly showed the identified needs of the person concerned, and how these needs would be met. We also spoke with the four people who live at Laurel Lodge whose files we looked at, and they were all aware of the assessments that had been carried out when they moved into the home. They all felt the care and support they receive was of a high standard. The proprietor advised us that they have been through a relatively stable period, with no current vacancies at the time of the inspection, and have a waiting list of prospective new admissions. Laurel Lodge always tries to provide a home for life, unless the needs of a person living in the home changed to the extent that the home was no longer able to meet them. They ensure that staff are trained to deal with palliative care issues where necessary, and have facilities to support family members during this time. We spoke with two members of the staff team working on the day of our visit, and they were both aware of the process followed for new admissions, and the information gathered, and also confirmed that they had both received training in end of life care. The service does not offer intermediate care. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans show how health and personal support should be given, to ensure that it meets the personal requirements of the individual concerned Evidence: Once the initial assessment process has been completed, and it has been agreed that the identified needs of the person can be met by the service, arrangements for the person to move to the home are made. The manager of the service told us that they always try to arrange admissions early in the week, to give them the time to settle people in and be able to call on GP and district nurse support as required. Wherever possible, a new resident arrives in time to spend lunch at the home, often with their family, and to then complete the required paperwork, arrange required medication, detail any personal effects they have brought with them and to meet some of the other residents. The four residents we spoke to and the two staff members, all confirmed that this process worked well, and that the admissions procedure was unhurried, allowing new Care Homes for Older People Page 11 of 24 Evidence: residents time to settle in. Initial care plans are prepared in readiness for the admission, and these are reviewed and developed over the first few weeks of the persons stay at Laurel Lodge. The plans are prepared by senior staff or the deputy manager, and discussed with the resident concerned, or with their family. We spoke to one of the senior staff on duty at the time of our visit, and discussed the care planning process with them. They clearly understood the processes followed, and told how much better the service was run, compared to another home they previously worked in. We were also told that the service will always say if they do not feel that Laurel Lodge is suited to a prospective admission, or cannot meet the persons needs. Every new admission is reviewed at the end of the first month, to ensure everything is in place, and that the home suits the needs of the person concerned. Evidence of this was seen on the files examined during our visit. Both of the proprietors are actively involved in this process. Most of the residents living in the home are registered with one local GP practice, but if it is possible for a new resident to remain with their existing GP practice, this is always supported. Health care support is provided including specialist dietitian, occupational therapy, physiotherapy and continence support. On the day of our visit, a continence specialist was providing training to staff, and we were able to talk to them about their experiences with the home, which we were told were excellent. They felt the home to be one of the best they visit, with the proprietors and staff very receptive to their role. Medication is administered by senior staff, who all receive training, and this was seen in staff files we examined. Training is provided through the University of East Anglia, and the pharmacy department of the main Norwich hospital have recently carried out a medication audit, with no issues noted. We observed staff administering the lunchtime medications, and ensuring that the correct medication was taken by the person. At the present time, one person is able to manage their own medication, and storage facilities are provided in their room. We looked at the care plan for this person, and although there was an assessment in place, the risk assessment did not contain sufficient information to show the self administering of medication was a safe practice. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of events and activities are available giving residents of the home a choice of how to spend their time, and support is on hand to take them to local community facilities including shops and the library. A good selection of home cooked food is served, and people can make sure they eat foods they like. Evidence: A range of activities and events are provided for people living in the home, and specific activities arranged every afternoon including singalongs, hand massage, quiz and reminiscence sessions, painting, craft sessions, poetry and reading and cooking. The residents we spoke to knew what was arranged for the afternoon, two of them were joining in, two would rather spend the time in their room. All of them felt that they had a good choice of activities available to them, and told us of the regular residents meeting that are held in the home, which give them the chance to discuss anything they may wish to do. At the present time four of the residents are able to go out on their own, and have their own key to the front door, with an agreement that they let a senior member of staff know if they are going out. Care Homes for Older People Page 13 of 24 Evidence: Visitors are welcome at all times, and can spend time with in the lounge or residents own room, or in the conservatory. Family members are issued wither own key to enable them to access the home at all times. Five of the staff team have attended reminiscence training, another life story training, and this has been incorporated within the care plans. Two Chefs are employed by the service together with a teatime assistant, which ensures that a good range of food is available at all times. The chef on duty talks to all residents every morning, telling them what is on the days menu, and arranging for any special requirements they may have. At the present time, two of the residents are on a soft diet, one needing their food mashed, another liquidised. One resident we spoke with during lunch told us they were allergic to fish, and were given an alternative, and this was noted in their care plan which was examined later. The residents that we spoke to told us the food was excellent, and during our visit, we had lunch in the dining room, and were able to observe staff. All the staff we saw provided support where needed, and spoke to the residents in an appropriate manner. Meals are served in the dining room, or in the residents room if that is their wish, and are regarded as a social occasion. The residents we spoke to during our visit told us how good the food is, and that they all had choices everyday, and during lunch we observed staff members asking residents which sauces they wanted and whether they preferred cream or custard with their desert. Main meals are served at lunchtime, but a hot option is available at teatime as well as sandwiches and salads. The deputy manager told us that a higher number of residents now choose to have breakfast in the dining room, and a selection of cereals, toast and cooked breakfasts are available. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure any concerns, complaints or allegations are dealt with, and people living in the home are aware of how to make concerns known, and that they will be dealt with. Evidence: Everyone moving into the home has a copy of the homes complaints procedure, and is aware of who to speak with if they have concerns, and people that we spoke with during our visit confirmed this,. The policy is on display in the homes entrance hall, and is also in their statement of purpose/service user guide. The residents we spoke to during our visit were aware of how to make a complaint and happy that their concerns would be listened to. Two concerns or complaints have been received, but both were resolved in accordance with the procedure. A policy is in place to ensure the safeguarding of the people living in the home. There have been no safeguarding incidents since the last inspection and all staff receive training in safeguarding matters, and regular updates, and supervision includes discussion on safeguarding issues with individual staff members. The manager and deputy manager have both undertaken Mental Capacity Act and Deprivation of Liberty training, and although there are no current concerns, one Care Homes for Older People Page 15 of 24 Evidence: resident living in the home is supported by the local authority with an advocate to ensure that their views are represented.. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a clean and well equipped home for the people living here who can personalise their own rooms if they wish. Evidence: Since the last key inspection, a new extension has been built, providing further en suite bedrooms which we were able to look at during our visit. Along with the existing rooms, they provide a good level of comfort together with aids and adaptations needed to meet the needs of people living in the home. The home provides a good level of communal space, with two large lounges and a dining area with attached conservatory. Individual rooms are well equipped and during a tour round the home, it was clear that people are encouraged to bring in personal items and possessions. Suitable toilet and bathing facilities are available. The home is set in pleasant grounds, close to the centre of Norwich. Some of the residents of the home are still able to access the city centre on their own, others with support, and the home use of local facilities including shops, theatres and libraries. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by staff who are well trained and have been subject to suitable recruitment checks. Evidence: On the day of our visit, there were clearly sufficient staff to meet the needs of the people living in the home. There are normally at least four care staff available at busy times, with three during the afternoon, two in the evening, and in addition, domestic and catering staff are working. The service has a detailed recruitment policy in place, and four staff records were examined which all contained information in accordance with the regulations, and details of the training provided. In addition we spoke to two of the staff working on the day of our visit. We looked at the recruitment and training records held for four members of the staff team, and these demonstrated that the procedures in place were being followed, and all required documentation was in place. Training records showed a range of mandatory and more resident specific training was provided including Fire Safety, moving and Handling, First aid, Dementia care, Diabetes awareness and Palliative care. Care Homes for Older People Page 18 of 24 Evidence: As already indicated, a Continence adviser was providing training on the day of our visit, the first in a series of sessions which will ensure all staff are aware of the importance of promoting continence. We spoke with two of the staff team, who were both generally happy, and told us that training in the home was excellent. They felt at times, staffing levels are low, especially when two staff members are attending to the needs of a resident home. This was relayed to the deputy manager and proprietor, and will be discussed further at a forthcoming team meeting Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, and people living in the home know how they can make their views known, and be part of decisions that affect their day to day lives. Evidence: An experienced management team is in place providing consistent support to both residents and staff. People living in the home commented favourably on the surroundings and the support they receive, one person saying how at home they felt, another resident that we spoke with said that the home provided a fantastic service which they did not feel could be bettered. As already mentioned, the continence adviser felt the home to be one of the best in the area. A quality assurance process has been introduced to ensure that the views of people Care Homes for Older People Page 20 of 24 Evidence: living in the home are obtained, and those of families, and these views are taken into account when planning future changes support provided. A detailed report has been produced and a copy of this provided to the inspector. The service is taking part in a pilot scheme with Age Concern, who will assist residents in completing quality assurance questionnaires, to ensure an unbiased view in gained. We received six completed surveys from people living in the home, and four staff questionnaires. All ten questionnaires were positive, comments included The best home in Norwich If you are unhappy at Laurel Lodge, you will not be happy anywhere A family atmosphere The current deputy manager has already achieved their Registered Managers award, and will be registering as the manager of the home in the coming weeks. This will not have any impact on the care and support delivered, and the management team appears to have a strong working relationship, and the interests of people living in the home clearly important to all of them. The deputy manager told us that staff are regularly supervised, but often on an informal basis, and records were not available to demonstrate this. At the present time the deputy manager supervises all staff. During our visit we were also able to spend time with one of the two proprietors, and were shown a new initiative the service is testing, where small electronic buttons are fixed to people clothing, which log their name and room, and avoid some of the issues of lost laundry many care homes suffer. This is being trialled in the home in partnership with the manufactures, with a view to it becoming available to all homes, and appears to be working very successfully. The proprietor takes responsibility for all maintenance in the home, and the required fire and water checks, and details of the checks made to equipment were recorded in the AQAA. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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