Care Home: Laurieston House

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What the care home does well Mrs Jobbins and members of staff are well known to people who use the service. Initial care plans are in place on the day that people move in. Efforts are being made to include more detail about people`s care and support needs during the day and at night. People`s family are involved in the pre-admission assessment process. People have good access to healthcare professionals. Pressure relieving equipment is available when people are assessed as being at risk of developing pressure damage. The home makes sure that people`s diet is improved if they are assessed as at risk of developing pressure damage. People benefit from comfortable, clean and well maintained surroundings. People who live upstairs can now use the passenger lift to go to their bedrooms.People who live upstairs are now able to open the windows to enjoy fresh air without the risk of falling out. People are protected by a robust recruitment procedure. What the care home could do better: The home must carry out and record assessments with people who are considering moving in. So that people know that the home can meet their needs. Pressure area care plans must have information that is specific to the individual needs of the person. So that people are receiving more person centred care. Immediate care charts must be filled out according to the instructions in people`s care plans. To make sure that people receive the care that they need. The home should continue to review whether a portable hoist is needed. Body maps should record size, colour and date of any wounds or marks, together with whether the skin is broken. Members of staff must always give first aid to save life. The home has a duty of care to save life. Consideration should be given to whether there is a medical need for everyone to have their blood pressure and pulse taken regularly. Consideration should be given as to whether monitoring people`s continence would be recorded in a more person centred way in their own care plan rather than in a `toileting book`. Care plans should give more detail about medicine administered via an adhesive patch. So that staff know the correct prescribing instructions. Care plans should give more information about medicine prescribed to be taken only when required. So that staff know when to give the medicine. A balance column and numbering of receipts would mean that the home has a better audit trail of transactions with people`s money. Random inspection report Care homes for older people Name: Address: Laurieston House 78 Bristol Road Chippenham Wiltshire SN15 1NS one star adequate service 11/09/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Walker Date: 1 6 0 6 2 0 1 0 Information about the care home Name of care home: Address: Laurieston House 78 Bristol Road Chippenham Wiltshire SN15 1NS 01249444722 FP01249444722 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jennifer Jobbins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Jennifer Jobbins care home 9 Number of places (if applicable): Under 65 Over 65 3 9 dementia old age, not falling within any other category Conditions of registration: 3 0 The maximum number of service users who can be accomodated is 9 The Registered Provider may provide the following category of service only: Care Home only (Code PC) to service users of either gender whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) - maximum of 3 places Date of last inspection Brief description of the care home Laurieston House is a care home for up to nine older people, three of whom may have a dementia. The home is a two storey, detached property in a residential area of Care Homes for Older People Page 2 of 12 1 1 0 9 2 0 0 9 Brief description of the care home Chippenham. There is a large garden at the rear of the home and a parking area at the front. Laurieston House is owned by Mrs J. Jobbins, who is also the registered manager. There is a staff team which includes a deputy manager, senior carers and carers. Other staff members are deployed to carry out domestic work. Peoples accommodation is on the ground and first floors. There are three double bedrooms and three single bedrooms. There is a staircase, and a newly installed passenger lift, to those rooms on the first floor. The communal areas consist of a sitting room and a dining room. Information about Laurieston House is available in the homes Statement of Purpose. The fees for the home are between 440.00 and 510.00 pounds a week. Copies of inspection reports can be obtained from the home. These are also available through the Commissions website at: www.cqc.org.uk Care Homes for Older People Page 3 of 12 What we found: This unannounced Random inspection took place on 16th June 2010 between 9.35am and 1.20pm. Mrs Jobbins, the registered provider and manager was present during the inspection and assisted us with access to records. We spoke with two people who used the service. We looked at peoples care plans, one persons medicines, staff recruitment files, accident records and the arrangements for people to hold small amounts of money at the home. Mrs Jobbins showed us round the home and introduced us to the people who lived there. The last Key inspection was on 9th and 11th September 2009. We did not look at all the requirements from the last inspection during this visit. When we arrived at the home people were having their breakfast in the dining room. One person told us its nice, I like it here. The staff are very good. Another person told us about their experience of attending a local hospital for a healthcare appointment. The care plans had been reviewed and revised to include more details about how people preferred their care to be provided. Each person had a separate document with details about specific needs for personal care. There was a separate document with clear information about peoples night care needs. We looked at the records of one person who recently moved in. There was information about the persons care and support needs written by the family. The homes preadmission assessment gave little information about what information the home had gathered about the persons care and support needs. However there was an initial care plan dated for the day that the person moved in, a moving and handling assessment and an assessment of the persons risk of developing pressure sores. There was evidence that the person and their family had agreed to them sharing a bedroom. Some action had been taken to address the requirement we made that care plans must identify how pressure area care is to be delivered to those people assessed as at risk of developing pressure sores. A generic plan had been produced with space to add the persons name. Some information was written at the end of the risk assessment for pressure damage. Some people had pressure relieving mattresses on their beds and cushions in their chairs. The generic care plan identified that people must be supported with a healthy diet and some people had been prescribed food supplement drinks. Mrs Jobbins told us that the district nurse visited twice a week to treat one persons wound. One persons care plan recorded that they had a wound on their ankle. There was no record of the size of the wound or whether the wound was healing. Another person was described as having a sacral sore with no record of the size, colour of the wound and whether the skin was broken. Mrs Jobbins showed us some body maps detailing location of different wounds or marks. The body maps gave no indication of the dates when marks were noted. One body map white and black to two marks. We looked at the immediate care chart of one person who was described as very poorly. Their pressure area care plan stated that they were to be turned every two hours. The Care Homes for Older People Page 4 of 12 chart did not record that this was being carried out. For the morning we visited the date was recorded with 8.30am pressure care. The previous night record stated that the person was turned at 1.00am to their right side and at 5.15am to their left side. The record did not record the fact that the person was sitting in their chair. Other dates recorded more detail of the person being turned, but not as often as required in their care plan. The home had equipment for taking peoples blood pressure. The care plans had a list of each persons blood pressure and pulse results. We asked why this was being carried out with everyone, who was doing the tests and whether they had up to date training. Mrs Jobbins told us that she and the deputy had been trained to use blood pressure monitoring equipment when they were respectively an Auxiliary Nurse and a State Enrolled Nurse at the hospital over twenty years ago. She went on to say that this had always been carried out and one of the GPs had recently asked for this to be done for one person. We asked whether other tests were carried out. Mrs Jobbins told us they would collect urine samples for the practice nurse to test for infection. She told us that no one had diabetes, so no injections were given, or blood glucose testing carried out. Action had been taken to address the requirement we made that people must never be locked alone in bathrooms. The lock to the upstairs bathroom had been removed. Mrs Jobbins told us that she was looking at fitting a suitable lock to the bathroom door so that people could have privacy but members of staff could still access the room in an emergency. Action had been taken to address the requirement we made that there must be clear written guidance on the use of listening devices for peoples privacy. Mrs Jobbins told us that the devices were no longer used. The outstanding requirement from the last two inspections that bathing risk assessments must identify how long people were left unattended had been met. We saw one persons bathing risk assessment identified that they were never to be left alone in the bath. One person had a detailed assessment about their risk of choking. One person had a detailed care plan about supporting the person if they wanted to go out of the front door. Members of staff were instructed to go with the person rather than prevent them going out alone. At the last inspection we recommended that not everyones name should be included in the toileting book if they were described as self caring. Mrs Jobbins told us that everyones name was put in the book because they may need support at some time. She said it was a means for staff to record when peoples needs changed. We said that a more person centred approach would be to record the information when needed in the persons individual care plan. Mrs Jobbins told us that the Pharmacist from the Primary Care Trust had carried out an inspection of the arrangements for safe handling of peoples medicines, so we did not look at the medicines in any detail. We looked at one persons medicine. They were prescribed a controlled drug administered via a patch. Their care plan did not give details about what the medicine was, where on the body it was to be administered; only that it was for pain. The guidance was for members of staff to read information kept elsewhere in the home. The controlled drug record was being properly recorded. The deputy manager told us that a record was kept of the return of the used patches to the Care Homes for Older People Page 5 of 12 pharmacy. The person was also prescribed medicine to be taken only when required. There was no record of when it was to be taken. The deputy manager told us the medicine was prescribed for anxiety. We were shown the GP record where the medicine had been reduced to only when required, as other medicines were prescribed. We said this information must be in the care plan. Mrs Jobbins told us that members of staff knew that they could only give medicine prescribed to be taken only when required following discussion with her or the deputy manger. The persons care plan and daily records showed that the behaviour was being managed through explanation and positive behaviour from members of staff. Mrs Jobbins or the deputy manager trained members of staff in the administration of peoples medicines. The supplying pharmacy also gave training sessions. Some action had been taken to address the requirement we made that records of all transactions for money kept on peoples behalf must show a balance after each transaction and be regularly audited. We looked at two peoples money. The balances were correct according to the records. The deputy manager told us that the homes accountant regularly checked the arrangements. A passenger lift had been installed to the front of the building. The extension had provided a bigger entrance area, an extension to the sitting room and further office space. New carpet had been fitted to the sitting room, stairs and two bedrooms. Mrs Jobbins showed us the downstairs bathroom which could not be used as the bath hoist was broken and needed replacement. She went on to say that people could now go up in the lift to use the upstairs bathroom. The outstanding requirements from the last two inspections about restricting the opening of the upstairs windows had been met. We saw that Mrs Jobbins had fitted suitable restrictors to the windows. This meant that people could open the windows for fresh air without the risk of falling out. Action had been taken to address the good practice recommendation we made that records were kept of discussions with people about whether they have made a positive choice to share the double bedrooms. One persons file had a record of discussions with family which concluded that the person was not to be resuscitated. There was no evidence of a living will or formal best interest meeting, given that they were assessed as not always having capacity. We discussed our recommendation that a hoist be considered to safeguard everyones health and safety. Mrs Jobbins told us that a hoist was currently not needed as those people who needed help with moving could bear their own weight. She went on to say that there were slide sheets to move people in their beds if needed. This recommendation should be kept under review as peoples needs change and to ensure that members of staff have the right equipment to protect their health when moving people. Mrs Jobbins told us that external moving and handling training was provided. Mrs Jobbins was working with the deputy manager when we arrived. Another member of staff arrived a little later. Mrs Jobbins told us that there were two members of staff on Care Homes for Older People Page 6 of 12 duty at night. She went on to say that they take turns to be awake and sleep in the sitting room. We asked about the arrangements for hearing the call alarm system. Mrs Jobbins demonstrated how the call alarm system operated and how members of staff monitored the calls, to ensure the safety of people living at the home. Many members of staff have worked at the home since it opened. We asked about the employment of children and members of staff under twenty. Mrs Jobbins told us that children from the local school come in the evenings for two hours; up to six hours in the school holidays to help with turning down beds, washing up and providing some activities and games. Mrs Jobbins showed us the form for recording when new members of staff had undertaken instruction in hand washing. We examined the staff recruitment records of two members of staff who had commenced work at the home since our last inspection. Records demonstrated that safe recruitment practices were being followed. Staff had received a Criminal Records Bureau clearance (Criminal Records Bureau certificates), two written references and proof of identity prior to commencing work. This was considered good practice and helped to protect people living at the home. Mrs Jobbins told us that two members of staff had NVQ Level 3, the deputy manager and another member of staff had NVQ Level 4 and four members of staff had NVQ Level 2. Mrs Jobbins told us that she had arranged for an external training provider to provide a session to senior staff about supervision. A computer had been ordered so that members of staff could access e-learning from Skills for Care and other providers. Mrs Jobbins told us she was nearing completion of the Leadership and Management Award. She told us that the deputy manager and one of the senior staff were also completing the award. We looked at the accident book. The last two entries related to people falling. Mrs Jobbins had reviewed the records and recorded in red that she had done so. What the care home does well: Mrs Jobbins and members of staff are well known to people who use the service. Initial care plans are in place on the day that people move in. Efforts are being made to include more detail about peoples care and support needs during the day and at night. Peoples family are involved in the pre-admission assessment process. People have good access to healthcare professionals. Pressure relieving equipment is available when people are assessed as being at risk of developing pressure damage. The home makes sure that peoples diet is improved if they are assessed as at risk of developing pressure damage. People benefit from comfortable, clean and well maintained surroundings. People who live upstairs can now use the passenger lift to go to their bedrooms. Care Homes for Older People Page 7 of 12 People who live upstairs are now able to open the windows to enjoy fresh air without the risk of falling out. People are protected by a robust recruitment procedure. 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 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 Care plans must identify how 30/11/2009 pressure area care is to be delivered to those people who are assessed as at risk of developing pressure sores. A referral to the policy document is insufficient. So that peoples individual care needs are met and monitored. Care Homes for Older People Page 9 of 12 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The home must carry out 30/06/2010 and record assessments with people who are considering moving in. So that people know that the home can meet their needs. 2 8 12 Pressure area care plans must have information that is specific to the individual needs of the person. So that people are receiving more person centred care. 30/06/2010 3 8 12 Members of staff must always give first aid to save life. The home has a duty of care to save life. 30/06/2010 4 8 12 Immediate care charts must 30/06/2010 be filled out according to the instructions in peoples care plans. To make sure that people receive the care that they need. Care Homes for Older People Page 10 of 12 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Consideration should be given to whether there is a medical need for everyone to have their blood pressure and pulse taken regularly. Consideration should be given as to whether monitoring peoples continence would be recorded in a more person centred way in their own care plan rather than in a toileting book. Body maps should record size, colour and date of any wounds or marks, together with whether the skin is broken. Care plans should give more detail about medicine administered via an adhesive patch. So that staff know the correct prescribing directions. Care plans should give more information about medicine prescribed to be taken only when required. So that staff know when to give the medicine. The home should continue to review whether a portable hoist is needed. A balance column and numbering of receipts would mean that the home has a better audit trail of transactions with peoples money. 2 8 3 4 8 9 5 9 6 7 22 37 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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