Care Home: Lauriston House Nursing Home

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What the care home does well The service is well managed by an experienced individual and support is provided through Southern Cross senior management . Care plan documentation and risk assessments reflect the needs of resident and these are kept under review. Staff are subject to induction procedures and thereafter kept updated in the mandatory training topics Equipment is provided which enables staff to undertake the work safely. The home is well maintained and the lower ground floor particularly pleasant. What has improved since the last inspection? Since the last inspection the home has appointed a permanent Manager who is applying to become the registered Manager. The registration process for the Dementia unit has been completed and this unit is now fully operational. What the care home could do better: The home needs to ensure that staff are provided with sufficient and specific training to undertake the work, this includes training on subjects such as learning disability and Dementia. The Company should consider renewing the laundry equipment as it is now ten years old and breakdowns are evident, this impacts negatively on resident`s daily lives. The paving to the front of the building needs to be made good ensuring that it is safe to walk on. The policy on Crushing / Disguising medications needs to be amended to appropriately reflect covert administration procedures. The hot water boiler needs to be made safe . CARE HOMES FOR OLDER PEOPLE Lauriston House Nursing Home Bickley Park Road Bickley Kent BR1 2AZ Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 09:30 26 October and 2 November 2007 th nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lauriston House Nursing Home Address Bickley Park Road Bickley Kent BR1 2AZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8295 3000 020 8295 3674 lauriston.house@ashbourne.co.uk Ashbourne Life Ltd vacant post Care Home 100 Category(ies) of Old age, not falling within any other category registration, with number (90), Physical disability (10) of places Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. As agreed on 10th November 2006 10 places to be registered for PD (Physical Disability) for the age range 40 to 65 years. One (1) place for a service user under the age of 65, requiring general nursing care, can be accommodated 6th September 2006 Date of last inspection Brief Description of the Service: Lauriston House is a purpose-built care home for the nursing care of older people. Ninety-eight beds are currently being used. At the time of the inspection the home had eighty-two residents on site. The accommodation for residents is on three floors, all accessed by two passenger lifts. There is a large garden at the back of the home and parking at the front. The home is two miles from Bromley town centre and within walking distance of Bickley rail station for those with full mobility. The home is on a bus route. The home has been taken over by Southern Cross. The registration categories in the home have changed and the lower ground floor is now for Dementia. The Manager is in the process of becoming the Registered Manager under CSCI procedures. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a one and a half day period by two inspectors. The two site visits were unannounced. The inspectors spent time on different floors, the lead inspector on the newly developed Dementia floor and the second inspector on the ground floor. During the second site visit both inspectors spent time on the first floor. During the site visits the inspectors met with staff and residents as well as any visitors who were in the home. Prior to the site visit the AQAA had been completed and fifteen residents and relatives questionnaires returned. Three staff surveys were also received prior to the second site visit. The inspector also had feedback from a placement officer who stated that good standards were maintained in the home and that it was the first place that she would consider to place terminal and heavily dependent residents. Other feedback received was generally positive with the exception of staff comments, which are related under the section headed staffing. During the site visits the inspectors met with the visiting GP who again provided positive feedback about the service. On the evidence obtained it was established that the home provides a good service, which in such a large facility is a difficult task. What the service does well: The service is well managed by an experienced individual and support is provided through Southern Cross senior management . Care plan documentation and risk assessments reflect the needs of resident and these are kept under review. Staff are subject to induction procedures and thereafter kept updated in the mandatory training topics Equipment is provided which enables staff to undertake the work safely. The home is well maintained and the lower ground floor particularly pleasant. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are conducted prior to admission into the home. Prospective resident are offered opportunities to sample the service prior to any decision being made. Information is provided detailing the level of service offered. EVIDENCE: At the time of the inspection there were 70 residents on site. The home is now registered for 92, which includes 19 beds for Dementia care on the lower ground floor. This unit had opened approximately eight weeks ago. At the time of the inspection the Dementia unit had three vacancies. The home is also registered for 10 young physically disabled between the ages of 40 and 65. There are 63 beds for frail elderly residents. The changes to the registration are reflected in the certificate. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 9 The inspectors selected residents to case track on the two floors where they spent the majority of their time. On the lower ground floor the assessment information for two residents was inspected. The Deputy Home Manager had completed a pre admission assessment. This is recorded on a standard form. This information included personal and contact details for the residents. Information on the resident’s medical diagnosis and medication were recorded. Physical and social issues were outlined . A property inventory was completed with staff and residents signature in place. Prior to admission a GP registration form was completed to ensure that the residents have a GP immediately on admission. In addition a draft care plan is developed using the information available. In the second care plan the items as detailed above were in place and this file also contained a discharge letter from the hospital. Both of these residents were privately funded hence there was no Social Services assessments. One resident with whom the inspector met explained that she had spent several periods in the home prior to her admission, this had included lunchtime and a full day. Once the assessments have been completed a confirmation letter is sent, and once admitted residents are issued with contracts. It was noticeable on the Dementia unit that the level of dependency was less that that normally found in Dementia nursing homes. The Manager explained that she had refused many residents due to the fact this was a new direction for the home and more training needed to be provided to the current staff group. The following information relates to the information obtained from the ground floor. The three files viewed showed there to be an assessment undertaken by the home prior to the residents’ admission. The Manager provides written confirmation of the home’s ability to meet the individual’s needs. One relative spoken to stated that they had received a contract. One file viewed showed there to be information on the fee charged although from this document, it was not clear who pays what and whether anyone else was involved in contributing to the fees. In another file there was information regarding funding by the PCT. The Manager is reminded of the need to ensure all residents have copies of their terms and conditions even when funded by the PCT or Local Authority. There is Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 10 also a need to ensure there is clarity about fees, to ensure it specifies who is responsible for contributing towards or payment of fees. The Manager must familiarise themselves with Regulation 5 of the Care Homes Regulations 2001 (amended). There is a Statement of Purpose and a Service Users Guide produced which is made available to all residents. Please see requirement 1. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care are well provided for in this home both by staff on site and the multi disciplinary team input. Care plans are reflective of need and provide staff with a good framework form which to provide care. Medications are well managed. EVIDENCE: The case notes of the two residents selected for case tracking were inspected and both met with the inspector. Information received from the two resident was limited due to communication difficulties. The care plans of the residents were recorded on standard Southern Cross forms. The first care plan was that of a resident admitted 19/10/07. A photograph was on file. The care plan identified issues with personal hygiene communication eating and drinking and sleeping. One problem headed impaired memory had an aim of “ reducing levels of confusion”. This could have been more specific both in terms of the problem and the objective. The Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 12 interventions section headed “planned care “ was reasonably well completed. The care plans referenced the supporting risk assessments .The staff signature was in place. A body map indicating any area of bruising or skin breaks was within the file. The waterlow score was 21, which indicates very high risk, the nutrition assessment also was in the very high-risk category. The dependency assessment tool was partly completed and dependency was indicated as medium. The resident’s weight was recorded .The daily progress sheets mainly referenced the physical care provided .It is important with Dementia resident’s psychological care is included. There are other specific forms that can be used for issues such as wound care, close observation etc. In the care plan on the health professionals visiting sheet, there was one entry that of a GP visit. In the GP visiting book there was more information relating to the visit including the presenting problem and the prescribed treatment. In the second care plan there were a number of issues identified covering physical health problems and they contained good interventions from which staff could address the care. Evaluations provided good information. This resident had a Dementia care plan in place. This could have included more basic information such as reality orientation, explanation of procedures etc. Assessments covered a number of potential risk areas. The daily events again were physically based and limited on other aspects of care. The end of life care plan, which is built around the Gold Standards Framework, was to a good standard. Within some files there is still a mix of Ashbourne and Southern Cross paperwork, which can be confusing. Staff commented upon the burden of paperwork and this detracting from hands on care. One response in a comment card related to the issue of trimming the paper work as it was onerous. The care plan format is a comprehensive tool from which staff can address the care although it is cumbersome and would be very time consuming to complete. The home is supplied with the equipment that they need and had recently purchased new handling slings. Two new hoists were due to be ordered ,and 34 profiling beds had been purchased. Three bathrooms are due to be converted to showers. The home’s GP was in visiting and provided information to the inspectors. He was confident about the home’s ability to care for the residents in it. He stated, “I like coming here “and felt he was well received by professional staff. He felt instructions were carried out and information referred on appropriately. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 13 The inspector obtained the following information during the site visit to the first floor. Three residents’ files were viewed in depth. The care plans, supporting assessment and risk assessment documentation provided a good deal of information on the needs of the residents and risks to their health and well being. In some areas there was some conflicting information that was not up to date and gaps noted. For example one resident had MRSA and Clostridium Difficile the information was not current in respect of personal hygiene and information on the pain relief required as part of their healthcare. The plans would also benefit from detailing where night staff are responsible for the personal care needs of the individual. Risk assessments were in place for falls, moving and handling; nutrition and pressure care and in most cases where risks had been identified a care plan had been developed detailing the action taken to minimise the risks. In the case of one person the pressure care plan required more information on the equipment used and it was unclear as to whether one of the wounds was still current. Risk assessments and/or care plans must also be developed with regards to smoking and particularly, as was the case, that of a resident on oxygen who smokes. The Manager demonstrated a positive attitude to the inspection process and improving the quality of care by implementing and amending those care plans identified by the second day of the inspection. It is also positive that the Gold Standards framework is being implemented for those residents requiring palliative care or for those whose care needs would benefit from inclusion. Health and daily records showed the care and treatment being received and the role of other professionals involved in the care of the individual e.g. St Christopher’s’ Hospice. Feedback about the good standard of care was received from four visitors including three relatives with specific comments on the caring staff and their treatment of their relatives. One relative told the inspector of staff providing personal care in private and that they spoke to their relative throughout despite them not being able to respond. They also felt staff were well aware of their needs. One resident spoken to also confirmed that they were happy here and staff were friendly. Residents generally looked well cared for, well presented and groomed. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 14 Medications. The administration of the morning medications were observed on the Dementia Unit. The procedures undertaken were safe and correct. There were reference books available including a BNF for 2007. Within the medication file there was a signatures list of all those staff who undertake medication procedures. On the individual medication chart there was a record of the known allergies and a photograph of the resident. The administration records were completed without gaps. Those medications received into the home were checked and signed in. Medication records of those returned to pharmacy were completed. Medications prescribed, “ as required “ had the maximum dose documented. The fridge temperatures were recorded. The medication policy had information on homely remedies . Within the medication procedures there was information headed “crushing/disguising “ medications. In the event that this practice is used then a covert administration policy should be drawn up. This must clearly identify the medication, the form by which it is to be administered and kept under close review. This decision should be made by the multidisciplinary team. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with choices in their day and routines are made as flexible as possible to meet these. Visiting is open and encouraged. The food provided offers a balanced diet although more residents input into menu planning should be considered. Alternative arrangements for mealtimes should be investigated to maximise staff resources during these times. EVIDENCE: On display there was a poster advertising a Halloween event and the home was decorated to reflect this. In the lounge areas, the home had purchased a large plasma screen TV that was clear to see even from a distance. This had been purchased out of funds raised through events organised in the home. There was evidence of a selection of daily newspapers on all of the floors. Many resident had their own TV’s and radios which they used whilst in their bedrooms. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 16 Residents were seen to spend their time whether in their bedrooms or the communal areas On the Dementia Unit three ladies were very content sitting in the corridor watching the comings and goings. The inspector spent time on the Dementia Unit with three residents. They all were well presented and demonstrate good signs of well being .One was knitting, another was reading the newspaper and another resident was engaging with the two, with whom she was sat. They provided good comments regarding their stay in the home, the food provided and staff. One comment regarding the food was that more home cooking would be appreciated. One resident stated that she attends activities “ upstairs “ and enjoys these. Activities are arranged by the activities coordinator, these include regular sessions as well as outside entertainers. A bingo session is arranged weekly which residents enjoy. The hairdresser comes in twice a week and was on site during the inspection. The ladies appeared to enjoy this. Within the comment cards one resident remarked that she would like to make a friend in the home and be assisted to do so, she also would like to spend more time in the garden, this should be facilitated in the warmer weather. Visitors were seen to come and go throughout the two site visits. Those who met with the inspector said that they were well received and that they felt that the care was good. The lunch was nicely presented with salt, pepper and sauces appropriate to the meal. Serviettes plate guards and juice were all available. The lunch was unhurried although staff were busy and more staff are needed during this period. There where 13 residents who needed supervision or assistance with the meal and only two staff were present. One resident was wandering and one staff was required to assist a resident in her bedroom. The qualified staff was doing the medication and the phone was ringing. The organisation of mealtimes needs to be reviewed to ensure maximum numbers of staff are available to assist residents to eat and drink whilst supervising the others. Food and drink are essential to the well being of residents and mealtimes must take a priority. Visiting is open and relatives were seen to come and go throughout the two site visits. It was evident that some routines do prevail throughout the home although choice is facilitated as far as possible. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information how to m raise a concerns or complaint are made available. Concerns and complaints are taken seriously and action taken when necessary. Staff are trained in adult protection and had a working knowledge of the action to take. This provides residents with the knowledge that they are safe to raise concerns and are protected from abuse. EVIDENCE: The complaints procedure was on display in the main reception area. The procedure includes information on recording, investigating and responding to complaints. A copy is also included in the information issued to residents including the Service Users Guide and Statement of Purpose. The complaints file was inspected. The last complaint investigated by the home was well documented with statements retained. It is recommended that a matrix outlining complaints received is retained in this file. One complaint had been referred through adult protection procedures .The home had investigated it, and as a result disciplinary action was taken. The Manager displays an open approach when dealing with concerns and complaints and has always kept the appropriate bodies informed of developments. The Manager is usually able to deal with issues as they arise without people needing to go down the official complaints route. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 18 There are regular relatives meetings that also provide a forum for raising and responding to concerns. Adult protection and Whistle-blowing procedures have also been produced and staff receive guidance in how they can identify and respond to any incidents. Those staff who were interviewed as part of the inspection site visits, were asked about adult protection procedures and whistle blowing . They all confirmed that training was provided on these topics as part of regular updates on statutory training. They demonstrated a working knowledge on the topic of abuse and more importantly reporting of such. The staff demonstrated a basic understanding of what may constitute abuse and were clear that they would refer any issues to the Manager or someone else in the organisation. The term “whistle blowing” seemed to pose some difficulties although once this was explained staff did understand the concept. There is a need to re-iterate, during training, the role of other agencies, for staff to have an understanding of what “whistle-blowing” means and the security it provides them. Please see recommendation 1. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is maintained in a domestic fashion wher the separate floors all have individual sitting and dining areas. Ares inspected were clean and odour free . EVIDENCE: The inspector was impressed by the refurbishment of the lower ground floor. All areas were nicely presented and old musical hall pictures in the corridors gave a reminiscence theme. The inspector arrived as breakfast was underway and the dining areas were nicely presented. Quiet music was playing in the communal areas. Bedrooms were personalised clean and tidy. All areas were clean tidy and odour free, there was a reality orientation board which was correct. Clocks and Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 20 calendars were evident. Colour coordinated doors assist residents to identify areas such as toilets and bathrooms. During the site visits the inspector observed that the hot water dispenser in the dining room was accessible, this needs to be made secure. This is particularly important with residents who wander and have little or no concept of danger. On the 8 November the inspector received information from the Manager that the hot water boiler had been made safe on the Dementia Unit, and the other floors were to have the same safety devices fitted. Within the comment cards received there were negative comments regarding the laundry with items said to be lost or frequently mislaid. In the laundry one washing machine was out of order. There had been a second one out of order for the week previous although this had now been repaired and was in working order. In such a large home, it is important to maintain all equipment in working order, this needs to be addressed. A reduction in laundry staff hours has also meant increased pressure on the laundry The front of the building had been improved by plants and large pots adding colour to the stairs up to the front of the building. The rear garden had also benefited from some planting and maintenance. The area to the front of the building is uneven underfoot. This could pose a potential hazard to anyone walking on it and this will be more dangerous once the wet and frosty weather takes hold. This is particularly concerning as elderly people visit the home and their mobility can be impaired without this further hazard. Please see requirement 2. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to address the work although at peak times some deficits in care were observed. Mandatory training is well provided for although specific training on the conditions presented by residents in the home must be addressed. EVIDENCE: On the lower ground floor there was one qualified and two care staff. This is the same for the afternoon period, with one qualified and one care staff on night duty. The Deputy Manager was in charge of this floor. She is a general nurse and stated that the only tuition on Dementia which she had received was in her RGN training, several years previously. This needs to be addressed. The staff in the unit seemed busy and this was particularly evident over the lunchtime period. The shortages of staff and the level of work were commented upon in several of the comment cards received by the inspector from residents, relatives and staff. All of the staff comment cards referred to the need for more staff and that the home should work to the maximum staffing levels not the minimum. Once this unit is full and with more dependent residents, staffing levels will need to be reviewed to ensure that all care can be addressed. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 22 The Deputy Manger is also a trainer for manual handling and a number of the statutory training topics, including adult protection and whistle blowing. She confirmed regular updates on these topics. She has completed the RMA qualification and was awaiting her results. The Dementia Unit has one RMN amongst the staff team, which had been discussed at the point of registration. The Manager advised the inspectors that all staff will be provided with training on Dementia and associated topics, this must be addressed as soon as possible to ensure staff have sufficient skills to care for residents. Those staff working on the Dementia unit met with the inspector. Training in Dementia has so far been limited , however staff did in their answers, provide information on the basic principals of care for Dementia suffers, dealing with the right approach, explanation and spending time with residents. Staff clearly indicated that training was provided although on specific topics such as clostridium dificile they had a limited knowledge. Those staff who are newly appointed are brought to the home for two days induction prior to commencement of work. Thereafter they have two twelve hour shifts where they are wholly supernumerary. One recently recruited care assistant required two weeks induction to introduce her to the work. This is good practice and should be commended. On the first floor the qualified member of staff met with the inspector. She demonstrated a good knowledge of topics with the exception of whistle blowing which needed some explanation before the information could be extracted . She confirmed regular supervision, which she felt was provided in a supportive manner. She had received regular updates in mandatory training and abuse. She was working in the Young Physically Disabled Unit although had no previous experience or qualification in this area. On this unit there is also a resident with learning disability, again this was a field where she had little experience or training .This needs to be addressed. A member of the care staff met with the inspector. She had been previously working in the Ukraine. She confirmed training but again information on whistle blowing was difficult to extract. The ground floor unit was staffed by three trained nurses and four care staff. The floor is separated into three units with a trained nurse in charge of each one. Discussions with relatives showed there to be adequate numbers of staff to care and support residents. However, the inspector observed the lunchtime meal and it is apparent that the staffing levels either need to be increased or the mealtime practices reviewed to ensure people receive the support they Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 23 require. Please note the comments previously made in the section” Daily lives and social activities”. Staff were observed throughout the day with two individuals spoken to in more depth. Overall the quality of care was observed to be good, although the quality of some staff interactions could be improved. This was referred to the Manager for action. Staff spoken to had a sound knowledge of accident procedures, including what they would do if they observed anything untoward and a basic understanding of infection control. There is a need to ensure staff are provided with clear understanding and guidance on Clostridium Difficile and good practice in managing the infection. Training records were viewed and found to cover core training, including first aid; moving and handling and adult protection. Nursing staff also receive updates in nursing practices through Southern Cross and the PCT. A sample of staff personnel files were viewed for two staff recruited since the last inspection. These were found to contain adequate checks on the applicant and records of application and interview procedures. Whilst the required checks had been completed and copies of certificates in place the Manager must ensure that references are legitimised through official stamps or attached compliment slips etc. The reasons for leaving previous employment in care must be explored and verified with records kept on file. Files also showed evidence of the staff handbook being provided and induction taking place. One staff member spoken to told the inspector that they had received a week long induction where they were provided with information on the home, emergency procedures, training in moving and handling and other areas and observation of practice. They also were required to complete the induction workbook. Please see requirement 3.Please see recommendation 2. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed by an experienced competent nurse. Systems are in place to incorporate the views of residents, staff and relatives in the service provision provided in the home. Heath and safety aspects are well addressed supported by regular servicing of equipment, training for staff and policies and procedures. EVIDENCE: The Acting Manager has been in this home for some time as the Deputy Manager. She has just applied to become the Registered Manager after having acted up for four months. The home has had some management difficulties since the long standing Manager left October last year. Verbal feedback from Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 25 staff and relatives showed the Manager to be approachable and open to discussions on how care could be improved. The inspector had received information regarding the lack of pagers in the home. This is a system whereby call bells activate a staff member’s pager for response. The Manager agreed this had been an issue and had only recently been resolved and more had been ordered. A sample of service contracts were viewed including gas, portable appliance testing; the fire system and equipment, fixed wiring and legionellas check. These were found to be satisfactory. There is evidence of staff receiving fire instruction from a member of staff who has been trained in a number of areas of health and safety. The fire alarm system is checked from different points each week to ensure it is working. The home is in the process of fitting fire door guards to every bedroom door at a rate of two a week. Fire drills were recorded and noted to take place regularly for day and night staff. The Manager and one of the RGNs is responsible for providing training in core areas and has undertaken training to ensure she is competent to do so. This includes moving and handling; health and safety; fire training and adult protection. The home has also achieved the clean food award to 2008. Southern Cross have a comprehensive system for monitoring and auditing of these systems and practices. These are undertaken at Home Manager and Senior Management level. These audits focus on core areas such as medication, care planning, personnel, domestic services and health and safety. Provider visits take place regularly although the current format does not allow for providing much information. (See recommendation-review of format) Part of the monitoring and improving the quality of care also includes surveys undertaken by the Provider. The last survey took place in August 06. However, the response was not collated nor any report produced. The Providers are reminded of the need to undertake a review of the service that includes consultation with residents and other stakeholders and supplying the Commission with the report on the findings. Relatives, heads of department and staff meetings take place regularly. Confirmed by staff and recent minutes viewed. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 26 A sample of individual residents monies were audited and found to be well recorded with receipts for expenditure as well as receipt. We discussed the way in which monies were held and were informed that these are pooled together in the organisation’s bank account. This is an interest receiving account but there is no evidence of where the interest is going. Such an account does not take into consideration amounts held by each individual and how much interest they should be receiving. The Manager did explain that there are changes due to this policy in the New Year. The changes should mean individual accounts with interest paid. Until this time residents and relatives should be made aware through the Service Users’ Guide how the current system works. On the Dementia unit there are five residents who have their finances over seen by a solicitor. The Employer’s Liability Insurance that is in date and to adequate amounts of cover is also on display. Please see requirement 4. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X x X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 OP3 2 OP19 23 Standard Regulation 5 Requirement Timescale for action 31/12/07 3 OP30 4 OP33 18 24 The Manager must ensure that all residents are issued with terms and conditions that clearly indicate financial implications. The Registered Provider must 30/11/07 ensure that all areas in the home, both internally and externally are safe for residents, relatives or any person visiting the home. All equipment must be maintained in good working order. The Manager must ensure that 31/12/07 all staff are trained to deal with resident’s conditions and that specific training is provided. The Registered Provider must 30/03/08 undertake a review of the service that includes consultation with residents and other stakeholders and supplying the Commission with the report on the findings Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. OP18 2 OP27 Refer to Standard Good Practice Recommendations The Registered Manager should ensure that staff are fully conversant with the term whistle blowing and in relation to reporting abuse the external bodies for this. The Manager must ensure that there are sufficient staff hours to address all residents needs this includes ancillary staff. Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lauriston House Nursing Home DS0000010139.V336308.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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