Care Home: Lauriston Christian Nursing Home

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What the care home does well Residents confirmed that they were visited by the manager prior to admission to the home and stated they had been invited to visit the home to see if they liked it enough to live there. ` I chose the home` `My family chose it for me`. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: `Nice people` `Look after us very well` `Its my home` `They are very good and look after my relative very well` `I don`t worry at all about my relative, they always keep me informed`. The menus evidence a well thought out balanced diet with a varied choice of food in line with residents preferences. Comments received `Very good food` `Plenty of choice and its tasty`. Satisfactory arrangements are in place to safeguard residents finances Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. What has improved since the last inspection? The Service Users Guide and Statement of Purpose are given to each resident and provide clear information in respect of the services and facilities the home offer. The care plans and risk assessments are reviewed monthly and were seen to be relevant and person centred. There are robust systems in place for the safe administration and recording of medications that promote and protect the health of residents. There was evidence that a redecoration and refurbishment plan has been commenced. What the care home could do better: Some shortfalls were found in the care plan documentation and risk assessments. The home staff need to ensure that the individual care plans reflect the residents identified need and provides guidance for staff to follow. Medication practices need to be improved to protect the health and well being of the residents. Key inspection report Care homes for older people Name: Address: Lauriston Christian Nursing Home 40 The Green St Leonards On Sea East Sussex TN38 0SY     The quality rating for this care home is:   two star good 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: Deborah Calveley     Date: 0 8 1 0 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 25 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 25 Information about the care home Name of care home: Address: Lauriston Christian Nursing Home 40 The Green St Leonards On Sea East Sussex TN38 0SY 01424-447544 01424447522 lauriston@schealthcare.co.uk www.southerncrosshealthcare.co.uk Trinity Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Fiona Elizabeth Yurteri Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category of service only: Care home with nursing (N) only - 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 (OP) Date of last inspection Brief description of the care home The Lauriston Christian Nursing Home is registered to provide care with nursing for a maximum of sixty clients under the category of elderly care. It is owned by Southern Cross Healthcare Ltd. and situated in a residential area of St. Leonards-On-Sea, near to a main bus route. Lauriston is a large purpose built building with level access to the front door and accommodation set out over two floors. A lift provides access to Care Homes for Older People Page 4 of 25 Over 65 60 0 0 60 1 0 1 0 2 0 0 8 Brief description of the care home each floor. It is surrounded by well maintained grounds that are accessible to wheelchair users. There are six comfortably furnished lounges and three dining areas to provide communal space for clients and their visitors. All the bedrooms are single rooms and all have en-suite facilities. Lauriston has a Christian ethos although clients with other faiths are welcomed. Care Homes for Older People Page 5 of 25 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: two star good 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at The Lauriston Christian Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 8.5 hours on the 08 October 2009. There were fifty three residents living in the home on the day of which eight were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. Care Homes for Older People Page 6 of 25 The purpose of the inspection was to inspect the key standards against the information received from the completed Annual Quality Assurance Assessment,(AQAA) and the Care Quality Commission Surveys. A range of documentation was viewed during this site visit including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Three carers, the administrator, two registered nurses, ancillary workers and the cook were spoken with in addition with the registered manager Mrs Yurteri. Telephone contact was made with health and social care professionals following the visit. The information received verbally has been incorporated into this report, along with the information received from resident surveys staff surveys and the competently completed AQAA. Care Homes for Older People Page 7 of 25 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 8 of 25 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 9 of 25 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 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 prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission ensuring that the home can meet the needs identified. The residents are then assured in writing that the home can meet their identified needs. Evidence: The Statement of Purpose and service users guide has been updated since the last key inspection. These comprehensive documents give prospective residents the information they need to make an informed choice about where to live. It was confirmed whilst talking to residents that the contract arrangements were clear and understood. There is a copy of the terms and conditions of residency included in the homes information documents. Care Homes for Older People Page 10 of 25 Evidence: The registration certificate is displayed prominently in the home and was correct. A review of the care documentation confirmed that pre-admission assessments are completed by a competent person. The latest admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that pre-admission assessments are completed and provide an adequate assessment of prospective residents care needs. Prospective residents are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. It was confirmed verbally that the home now confirms in writing that having regard to the assessment that the home can meet the assessed needs of the prospective resident. Ms Yurteri was knowledgeable regarding the people who live in the home and stated that staff receive training in order to meet the residents differing needs. Trial visits to the home can be arranged. It was confirmed that residents are invited to a trial period to ensure suitability of the home this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate care is not provided at Lauriston Christian Nursing Home. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was found to be meeting residents health and general needs with accessed additional specialist support when needed. The medication practices at present do not promote and protect the health needs of residents. The privacy and dignity of residents are promoted and protected. Evidence: The care documentation pertaining to five residents was reviewed in depth as part of the inspection process. It was confirmed that all residents have their health personal and social care needs set out in an individual plan of care. It is acknowledged that the staff have worked hard on the care plans to ensure they are person centred and specific to the individual. There was evidence of regular review and resident/representative involvement in the majority of those viewed. As discussed there are some areas that need to be further developed and these included: ensuring that there is sufficient guidance in respect of infection control measures when needed and ensuring that the documentation is signed and dated. Care Homes for Older People Page 12 of 25 Evidence: The care plans include a wide range of risk assessments to monitor the health needs of the residents. These are reviewed regularly and cross referenced within the care plan ensuring that the residents health needs are met competently and consistently. Again there were some minor shortfalls identified however as stated by Ms Yurteri, the care plans and risk assessments are being constantly reviewed and improved. The home need to seek professional advice regarding the documentation of resuscitation status. Residents are registered with a GP from local surgeries. The home support and enable residents to access services from other health care professionals in order to promote their health and well being. The Medication Administration Charts (MAR) were viewed, gaps were identified and these need to be followed up by the senior staff. It was noted that some medications for individual residents were out of stock for up to 3 days which does affect the outcomes for residents. The home need to investigate the reason for this and approach the medication provider for advice and further training. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication and as discussed these need to be adhered to ensure that the health and well being of the residents are protected and promoted. The management team stated that they have identified these shortfalls and are taking appropriate action with the staff concerned. Staff were seen to be respectful and considerate to all residents whilst attending to their needs. The residents spoken with confirmed that they were treated with dignity and respect and that their right to privacy was respected. Staff were seen to knock on doors before entering the residents bedroom and the staff addressed them by their preferred name. Residents were seen to be dressed appropriately and attention had been taken with their appearance. Care Homes for Older People Page 13 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. Evidence: As at the last key inspection there is a full time activity co ordinator. She is supported by a group of volunteers that visit on a regular basis and help facilitate in house socialising, events, activities. this team of people aim to enhance the quality of life for residents. It was confirmed that the co ordinators hours are flexible and include the occasional weekends. The activity programme is displayed in the home and showed the weeks planned activities and also publicizes the forthcoming special events and visiting entertainers. Every morning there is a non denomination session with one of four people who take the group. This was seen to be popular with the residents. Every afternoon at 2 pm there is a group activity, these include bingo and quiz sessions and craft sessions. The Statement of Purpose states that residents and their families are involved in devising the activity programme. Feedback from surveys received were in the main positive from residents, family and staff regarding the provision of activities. Two comments included Trips out would really be beneficial More stimulation for the Care Homes for Older People Page 14 of 25 Evidence: residents who remain in their room. It is acknowledged in the AQAA that the documentation in respect of activities still needs to be improved. From direct observation during the site visit and from meeting residents staff and family, it is identified that the more physically and mentally frail residents would benefit from more individual and personalized one to one sessions. This is acknowledged by Mrs Yurteri. Residents confirmed that they joined in activities only if they chose to do so. Some residents prefer their own company and choose to spend time in their own rooms. Residents are encouraged to personalize their bedroom with their own possessions. During the site visit residents were being consulted and invited to choose new curtains, lampshades and matching bedspreads. Residents are supported to exercise choice and control over their lives. Visitors spoken to were all happy with the visiting arrangements and how staff who were said to be very welcoming received them. The reception area is manned during the day and all visitors are greeted and offered assistance should they need it. There was a choice of meal available on the day of the inspection and the food was seen to be well prepared and attractively presented. The feedback in respect of the meals included Good food Plenty of choice and tasty. The menus are displayed in the home and rotate 4 weekly and change according to the season. The communication between the kitchen staff and caring staff was said to have improved. Records are kept for individual residents in respect of fluids and food intake. The Environmental Health Organisation have visited the home recently and the home are acting on their recommendations. Care Homes for Older People Page 15 of 25 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. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. Evidence: There is a comprehensive complaint policy and procedure in place and it is displayed in the home. It is also in the Service Users Guide and Statement of Purpose documentation. The AQAA stated that there have been 7 complaints received in the last twelve months. There is a complaints book that now shows the process and outcomes of a complaint along with any correspondence related to the complaint. All incidents that impact on the health, welfare and well being of residents are documented. Residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the safeguarding of vulnerable adults and staff have all received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Care Homes for Older People Page 16 of 25 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. Lauriston Christian Nursing Home provides a comfortable, clean and safe environment for those living in the home and visiting. Residents are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests. Evidence: Lauriston Christian Nursing Home is well maintained and safe and meets its stated purpose and the aims and objectives of the home. There is now a refurbishment and redecoration plan in process that has attended to the shortfalls found at the last key inspection. The residents have been involved in choosing their preferred colour scheme for their bedroom and furnishings. The home have a choice of various communal areas which are attractive and allow for different uses ensuring residents have choice where they spend their time. There are adequate communal bathrooms and shower rooms in the home with specialist equipment to ensure all residents can have a bath or shower. The home has specialised equipment available throughout the home to promote health and encourage independence. Care Homes for Older People Page 17 of 25 Evidence: In relation to fire safety all records are current and in place to protect the safety of those living and visiting the home. All of the staff team attend regular fire safety training. It was confirmed that all staff receive training in infection control and that the policies and procedures are updated regularly. They are easily accessible to staff thus protecting those living and visiting the home from risk of cross infection. Good practice in respect of infection control measures by staff was observed during the inspection visit and there were gloves and aprons freely available in the home. All areas of the home were found to be clean and free from offensive odours. Care Homes for Older People Page 18 of 25 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. Robust recruitment procedures are in place to protect residents and staff training ensures they are aware of their roles and are able to provide the support and care the residents need. Evidence: From direct observation and from viewing the staffing rota, it evidenced that there were appropriate numbers of trained and competent staff on duty over a 24 hour period to care for the residents. The fire safety risk assessments and resident dependency levels are taken into consideration when reviewing staffing levels at night. It was confirmed by the manager that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents. Residents confirmed that the home had enough staff to give the level of care they expect and need. In addition to care staff, separate staff are employed for ancillary roles. A selection of staff recruitment files were viewed and demonstrated that there is a thorough and robust recruitment process in place to protect their residents. The documentation in the files supported the information supplied in the AQAA that all staff receive a thorough induction to the home. All new staff complete a trial period to ensure that the job is suitable for them. Staff spoken with said that training opportunities are good and interesting. There is a Care Homes for Older People Page 19 of 25 Evidence: training matrix in placer, which enables the management team to track the training needs. This ensures that all staff receive the training required to perform their job competently and therefore promoting the health and well being of the residents living in the home. The induction programme has been introduced for all staff. The induction and foundation training is in line with the Skills for Care guidance. This leads into foundation training in preparation of National Vocational Qualification (NVQ) training. At present 15 of the 28 staff have a NVQ qualification. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of this home is good with effective systems in place to protect residents. Evidence: The registered manager, Mrs Yurteri commenced employment on the 11/11/08 and was registered in June 2009. She is an experienced manager and has experience of managing large care homes. She is a level one registered nurse and has the necessary experience to run a home. The manager and staff have worked hard over the past year to meet the requirements made at the last key inspection. They have improved the outcomes for the people who use the service. There are systems in place to monitor the quality in the home and include the use of questionnaires. It was confirmed that these are audited reported on and responded to. There are resident relative meetings and staff meetings which are minuted and form Care Homes for Older People Page 21 of 25 Evidence: part of the quality assurance system. The complaints received are also audited and responded to. The home manage the personal monies for a number of their residents. Monies are held in a separate interest bearing account as per the Southern Cross Organisation policies and procedures. It was confirmed that the system used provides an audit trail of how transactions are managed on behalf of residents. Thus safeguarding residents financial interests. Evidence was seen of regular supervision sessions and all staff spoken with confirmed that they are now receiving regular supervision. Mrs Yurteri confirmed and the staff training records show that all staff are kept updated on the Health and Safety policies. The manual is available to all and clearly defined with regularly updated policies and procedures and best practice guidelines. This ensures that the health safety and welfare of the people using the service are both protected and promoted. The accident book was completed in full and the organisation conduct an audit monthly and strategies are put in to place for prevention of a recurrence. First aid boxes are located in the home and easily assessable when required. Care Homes for Older People Page 22 of 25 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 23 of 25 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 24 of 25 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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