Care Home: Laurel Villas

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What the care home does well The home is well run with a family atmosphere and the staff work well together as a team under the leadership of the registered manager who is well supported by the owner of the home. Any new person considering entering the home can be sure the home is suitable for them by the decisions reached at the initial assessment. The assessment is a gradual process with several overnight stays until the person is confident that the home is suitable. There are a high percentage of trained staff with 18 out of 20 care staff obtaining a National Vocational Qualification (NVQ) in Care at level 2 or above. Staff are empowered and encouraged to attend training and assist in the running of the home and 3 out of the 4 senior staff have an NVQ at level 4 in Care. Both the registered manager and the owner of the home have an NVQ at level 5 in Management and lengthy experience in the provision of care. There are sufficient staff for the number and needs of the current people cared for and there are excellent handovers between staff three times a day as shifts are changed. The routines of daily living are relaxed and the home is run in the best interests of the people cared for. There were several positive comments from the people living at the home as well as a relative and staff. Comments included: `It is a friendly happy care home for both residents and staff.` `Takes care of all the residents on and individual basis.` `The home is a happy and friendly environment for both staff and residents. We all work well and communicate as a team.` What has improved since the last inspection? The home has improved the information available about the home by ensuring the Service User Guide and Statement of Purpose are in large print and are in the process of putting the details on an audio tape. Equality and Diversity are promoted and the assessment process and format for recording has been changed to ensure that it incorporates Dignity in Care requirements. The manager has also been on a training course with regard to the Deprivation of Liberty (DOL)Safeguards. The manager has already begun to determine which persons residing at the home need to be assessed under the DOL Safeguards and taken measures to ensure their rights to liberty are maintained as much as possible.A new format is in use including `life books` that ensure the previous background and social history of the person is recorded as much as possible. A major upgrading has taken place with regard to the electrical systems to meet the current legal requirements. A new 42 inch television and DVD player has been purchased. New blinds have been fitted in the dining room and communal lounges to ensure safety from direct sunlight. New commodes have been purchased to assist with personal care in the bedrooms even where there are en-suite facilities. This is following reviews that have established that it was helpful to have a commode nearer to the bed. New procedures are in place to assist with food safety and protective head wear and disposable aprons have been purchased for any staff member entering the kitchen. There are plans to upgrade some of the chairs and dining furniture. Funding has been granted for two of the catering staff and four care staff to attend a course on nutrition for the elderly and both have completed Food Hygiene certificates at levels 1 and 2. Staff handbooks and management guide books have been devised and awaiting publication. What the care home could do better: There are no concerns found at this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Laurel Villas 170/172 Tulketh Rd Ashton Preston Lancashire PR2 1ER     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Dale     Date: 2 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Laurel Villas 170/172 Tulketh Rd Ashton Preston Lancashire PR2 1ER 01772720609 01772768908 laurel1702003@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Laurel Villas Limited care home 24 Number of places (if applicable): Under 65 Over 65 24 0 old age, not falling within any other category physical disability Additional conditions: 0 24 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: Old age, not falling within any other category - Code OP, Physical disability - Code PD. The maximum number of service users who can be accommodated is: 24. Date of last inspection Brief description of the care home Laurel Villas is registered as a care home that provides personal care and accommodation for up to 24 older persons, both male and female. The home is located near to the centre of Preston in a residential area of Ashton close to shops and various local amenities. The home is not purpose built and arranged over two floors with access provided to all parts of the home via a lift. Accommodation is provided in single rooms and one room is available for use as a double room if required. The accommodation provides a homely atmosphere with plenty of communal space including a large lounge that overlooks a very attractive garden that can be easily Care Homes for Older People Page 4 of 26 Brief description of the care home accessed. The current fees are from £386:50 to £435:00; further information about fees can be obtained from the homes manager. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The site visit was unannounced and focused on key standards. The inspector was able to speak to the persons cared for in the home, a relative, staff and the registered manager and owner of the home. Various documents were examined belonging to the people cared for and staff. The registered manager completed the Annual Quality Assurance Assessment prior to the site visit that provided some statistical information and how well the home was meeting the standards of care. The last key inspection was on the 25th April 2007 and an Annual Service Review was carried out on the 29th April 2008. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The home has improved the information available about the home by ensuring the Service User Guide and Statement of Purpose are in large print and are in the process of putting the details on an audio tape. Equality and Diversity are promoted and the assessment process and format for recording has been changed to ensure that it incorporates Dignity in Care requirements. The manager has also been on a training course with regard to the Deprivation of Liberty (DOL)Safeguards. The manager has already begun to determine which persons residing at the home need to be assessed under the DOL Safeguards and taken measures to ensure their rights to liberty are maintained as much as possible. Care Homes for Older People Page 8 of 26 A new format is in use including life books that ensure the previous background and social history of the person is recorded as much as possible. A major upgrading has taken place with regard to the electrical systems to meet the current legal requirements. A new 42 inch television and DVD player has been purchased. New blinds have been fitted in the dining room and communal lounges to ensure safety from direct sunlight. New commodes have been purchased to assist with personal care in the bedrooms even where there are en-suite facilities. This is following reviews that have established that it was helpful to have a commode nearer to the bed. New procedures are in place to assist with food safety and protective head wear and disposable aprons have been purchased for any staff member entering the kitchen. There are plans to upgrade some of the chairs and dining furniture. Funding has been granted for two of the catering staff and four care staff to attend a course on nutrition for the elderly and both have completed Food Hygiene certificates at levels 1 and 2. Staff handbooks and management guide books have been devised and awaiting publication. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Any new person admitted to the home has a comprehensive assessment process that ensures the persons needs are met and they are comfortable and confident about moving into the home. The home does not provide intermediate care. Evidence: There have been improvements to the information available about the home by ensuring the Service User Guide and Statement of Purpose are in large print and are in the process of putting the details on an audio tape. Any new person considering entering the home can be sure the home is suitable for them by the decisions reached at the initial assessment. The assessment is a gradual process with a half day, full day, or overnight stay at the home, this can then be Care Homes for Older People Page 11 of 26 Evidence: extended to two nights. This ensures that the person involved is able to sample the services provided and also ensures that the homes facilities are suitable for the individual requirements both physically and socially. Equality and Diversity are promoted and the assessment process and format for recording has been changed to ensure that it incorporates Dignity in Care requirements. The home has signed up to the Dignity in Care Charter which is a joint initiative between Lancashire County Council and the Lancashire Social Care Partnership. The charter is a public statement that all providers and commissioners of services have agreed to. There are five standards to be met with regard to Dignity in Care and the assessment process includes new questions to ensure that the standards are covered and met with regard to dignity. The manager has also been on a training course with regard to the Deprivation of Liberty (DOL) Safeguards which is an amendment to the Mental Capacity Act and was implemented on the 1st April 2009. The manager has already begun to determine which persons residing at the home need to be assessed under the DOL Safeguards and taken measures to ensure their rights to liberty are maintained as much as possible. The assessment process takes place at either the persons own home or hospital and is generally carried out by the registered manager and her deputy as well as senior staff. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A care plan is devised and delivered in a sensitive way that ensures individual requirements are met with regard to physical, health and emotional needs. Evidence: Several care plans were examined. A new format is in use including life books that ensure the previous background and social history of the person is recorded as much as possible. The care plans seen were clear and included aims and objectives to ensure that improvement is maintained as much as possible. There are three handovers a day and each person cared for in the home is discussed verbally and senior staff members complete the day and night records. There was an example recorded and discussed with the manager whereby staff were taught to recognise the symptoms of nicotine withdrawal and how to help the individual concerned. Care Homes for Older People Page 13 of 26 Evidence: A Malnutrition Screening Tool is in operation for all persons cared for and includes five steps that take into account height, weight and Body Mass Index (BMI). Staff had recorded the nutritional intake on all the care plans seen. The care plans were up to date and a signature had been obtained where possible from either the individual concerned or their representative. A specialised care plan is devised according to the homes End of Life policies and staff have been on a Care of the Dying training course. Charts are maintained to maximise the comfort of the person concerned and their families wishes are taken into account as the person nears the end of their life. The manager is in the process of devising a system for all care plans to be done by senior staff and to have immediate access to a computer for reviewing and reassessing. As previously mentioned, privacy and dignity is maintained at all times to ensure the requirements of the Dignity in Care Charter are met. There was evidence of liaison with Health professionals including General Practitioners, District Nurses, Dentists and Opticians. The medication is stored appropriately and the medication record was examined and found to be up to date. Any person assessed as capable of self medicating is assisted to do so and any risks are taken into account. Several of the persons cared for were spoken with and they all confirmed that they feel well cared for by the staff and their needs were being met. A relative also confirmed that the care provided was excellent. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate activities are in place according to needs and capabilities. Meals meet dietary requirements and offer choice. Contact is maintained with family, friends and the local community ensuring that the persons cared for in the home are provided with a lifestyle of their choice. Evidence: At the initial assessment a recording is made of individual wishes with regard to hobbies and interests and any cultural or religious requirements. Activities include arts and crafts, dominoes, bingo, karaoke, quizzes and playing cards. Activities have been structured and posters are put up in the home to let family, friends and relatives know what is going on, keep them up to date and invite them to any of the social events. Shopping trips are undertaken with staff members, clothing parties, handbags and glad rags parties and sing a longs. Fund raising activities are arranged to help raise funds for trips out. There have been theatre trips to the Guild Hall, the Bond Hotel cabaret afternoons, St Annes Hotel meal and bingo evenings, trips to Blackpool with a fish and chip supper. An entertainer visits Care Homes for Older People Page 15 of 26 Evidence: the home on a regular basis. There are photos throughout the home of activities and trips undertaken. A company came in at Christmas to provide large cinema screen entertainment of White Christmas. A relative spoken with confirmed that she is made to feel welcome by the staff and is provided with refreshments. Ministers from local churches are welcomed and one person received Holy Communion each week. Catering staff speak individually with the persons cared for in the home and discuss the menu with them. Special diets are provided and there is plenty of choice; one person has been provided with a rice dish once a week by special request. A recording is made of nutritional and fluid intake particularly for those persons at risk of losing weight. Menus are varied with a different menu during the summer and winter and there are special menus for example on Valentines Day. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to ensure that the persons living at the home are protected and any complaints or concerns are recognised and acted upon. Evidence: There is a suitable complaints procedure in place and the home has not received any complaints in the last twelve months. No concerns have been raised with the Care Quality Commission. The home has Adult Safeguarding and Whistle Blowing procedures in place and all staff have received training in safeguarding procedures. Staff from the home have attended a Deprivation of Liberties (DOLS) workshop and the manager of the home intends to complete the DOLS standards to ensure that all the persons living in the home are protected from a deprivation of their liberties. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides comfortable safe surroundings that are well maintained and provide a suitable environment for the persons living at the home. Evidence: Bedrooms are refurbished and decorated as rooms become vacant. The home has ample communal space, which provides a variety of recreational lounges and dining space. The home is entirely non-smoking and the few persons who smoke have been provided with an area outside and are accompanied by staff to ensure their safety. All areas of the home seen were clean, tidy and hygienic; two housekeepers are employed. The people living at the home are encouraged to bring personal possessions with them dependant on the space available. Policies and procedures are in place with regard to Infection Control and staff have received training in Food Hygiene. A major upgrading has taken place with regard to the electrical systems to meet the current legal requirements. Care Homes for Older People Page 18 of 26 Evidence: A new 42 inch television and DVD player has been purchased. New blinds have been fitted in the dining room and communal lounges to ensure safety from direct sunlight. New commodes have been purchased to assist with personal care in the bedrooms even where there are en-suite facilities. This is following reviews that have established that it was helpful to have a commode nearer to the bed. New procedures are in place to assist with food safety and protective head wear and disposable aprons have been purchased for any staff member entering the kitchen. There are plans to upgrade some of the chairs and dining furniture. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of highly trained staff on duty at all times for the number and needs of the current people cared for in the home. Evidence: There were sufficient staff on duty for the number and needs of the current people cared for in the home. Staff spoken with confirmed that they have sufficient time to complete their duties and that there are always sufficient staff on duty. The home has a suitable recruitment procedure and several staff records were examined. The records showed appropriate references had been obtained and clearance had been obtained from the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) Register. All staff receive a contract of employment and are expected to abide by the code of conduct set by the General Social Care Council. The staff application form has been reviewed and and revised. An employee handbook has been devised and is awaiting publication. There was evidence of Induction training and a high percentage of staff have received appropriate training including five DVDs on Choice, Dignity and Diversity, Fire Safety, Nutrition, Health and Safety, Pandemic Flu and Infection Control. Following the DVDs Care Homes for Older People Page 20 of 26 Evidence: a training pack tests the knowledge gained with extensive questions and a certificate provided to staff upon a successful completion. There are currently 20 care staff and 18 have a National Vocational Qualification at level 2 or above in Care. Two out of three senior staff have achieved NVQ level 4 in Care and a further two staff have now received funding to undertake NVQ level 4 in Care. Funding has been granted for two of the catering staff and four care staff to attend a course on nutrition for the elderly and both have completed Food Hygiene certificates at levels 1 and 2. Staff have attended end of life courses. A new senior member of staff has been trained in physiotherapy. A good relationship has been formed with a training company who provide the training at the home and are provided with a buffet lunch in return. There were a number of complementary staff comments: It is a friendly happy care home for both residents and staff. Takes care of all the residents on and individual basis. The home is a happy and friendly environment for both staff and residents. We all work well and communicate as a team. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Persons cared for and staff, benefit from the competency and leadership of the manager, registered provider and senior staff; they are given every opportunity to participate in the running of the home. Evidence: The registered manager and registered provider both have an NVQ at level 5 in operational management and have extensive experience in the provision of Care. A new deputy manager has been employed. The manager trained as a nurse and so has acquired good observational and basic nursing skills that assists in the process of providing care. The manager has an open door policy and encourages staff by empowering them in their role and by teaching people to empower others. The result of this is shown by the high number of staff with a qualification including the two senior carers who have achieved an NVQ at level 4 plus two others due to commence the training. Care Homes for Older People Page 22 of 26 Evidence: A management guide book has been devised and the home is awaiting its publication. The registered provider provides constant support and completes a written report under Regulation 26 of the Care Home Regulations about the conduct of the home and this is retained by the manager for any future reference by the Care Quality Commission. As well as an annual appraisal, there was evidence that staff are provided with one to one formal supervision and staff spoken with confirmed that the support from management was excellent and they all work as one happy team. Team meetings take place on a regular basis and minutes are taken. Questionnaires are provided to the people cared for every six months and there is also a suggestion box. A senior collates the details and the results are fed back to staff at team meetings. Each person cared for in the home has their own personal account for any finances and records are maintained. The home has Investors in People status since September 2005. Compliance with relevant health and safety legislation was provided and staff are kept up to date on health and safety topics. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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