Care Home: Laxfield House Residential And Nursing Home

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What the care home does well What has improved since the last inspection? Internal building work has now been completed, and enhances the residents living area. There is a dedicated member of staff, to organise and co-ordinate activities for residents, which are now more varied, and interesting, which has resulted in more residents taking part. They have started holding regular meetings, the frequency and content of which, is decided by the residents themselves. Although they have not jet started, the home has recruited another Cook, which will ensure a consistency in the quality of meals provided when the other catering staff are off. They have worked on improving the content of their care plans to `improve the overall quality of care received and also the quality of the life for the service user`. They have systems and checks in place; to ensure all medication received into the home is properly recorded. What the care home could do better: The home needs to continue developing their care plans, to ensure it gives a good balance of not only nursing and physical health, but support given to ensure their social and general well-being. This is important due to the range of different abilities within the home, from very independent to full nursing care. The home needs to continue to develop their range of activities. Where 6 of the residents are able to go out for walks independently around the local area, the home needs to continue looking at ways they can support 1 resident, who wishes to do this, taking into account their safety needs. CARE HOMES FOR OLDER PEOPLE Laxfield House Residential And Nursing Home Cundy`s Lane Brent Eleigh Sudbury Suffolk CO10 9PL Lead Inspector Jill Clarke Key Unannounced Inspection 12th October 2007 09:45 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 Laxfield House Residential And Nursing Home DS0000024431.V352906.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. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laxfield House Residential And Nursing Home Address Cundy`s Lane Brent Eleigh Sudbury Suffolk CO10 9PL 01787 247340 P/F 01787 247429 matron@laxfieldhouse.freeserve.co.uk 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) Mrs Elizabeth Priscilla Knight Mrs Elizabeth Mary Peters Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2006 Brief Description of the Service: Laxfield House is situated in the village of Brent Eleigh. First registered in 1990, the home provides care with nursing for up to 32 older people. The home is accessed via ‘Cundys Lane’, and there is ample car parking provided at the side of the home. Due to its rural location there is a limited bus service. The nearest shops and post office are located 2 miles away at Lavenham. Brent Eleigh has its own church and public house, which are located close to the home. There are 25 single, and 4-shared bedrooms, all with en-suite facilities, including a shower. In addition there are 2 communal bathrooms, for those residents who prefer, or need assisted bathing. Communal rooms include dining rooms, sitting rooms and a large conservatory providing wheelchair access to the garden. The large garden has a selection of small seating areas, a summerhouse and a patio/terrace. Charges for care (which includes personal laundry and colour television) are as follows: Residential Care Single room - £625 to £725 per week / Twin room - £400 to £550 per week Nursing care Single room - £650 to £850 per week / Twin room - £500 to £650 per week Short term respite care Residential care £625 per week / Nursing care £675 per week Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a unannounced key inspection, undertaken over 7 hours, which focused on the core standards relating to older people. We also assessed the key Lines of Regulatory Assessment (KLORA) outcomes for the people living at the home. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) surveys were sent to the home in September. This gave an opportunity for residents, relatives, visitors and staff, to give feedback on how they thought the service was run. At the time of writing the report 6 resident, 6 relative/visitor and 6 staff surveys had been returned. Comments from which have been included in this report. Prior to the inspection, the agency was asked to complete an Annual Quality Assurance Assessment (AQAA), to update the CSCI on work they are undertaking to meet/exceed the National Minimum Standards, and how they monitor their work. Comments from which have also been included in this report. The Registered Manager (Matron), was available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. A tour of the building took in all the communal rooms, kitchen, laundry and a sample of 2 bedrooms. Records viewed included, care plans, staff recruitment and training records, menus, staff rotas, Service Users Guide, pricing booklet and medication records. All the staff and residents met during the inspection were very helpful, welcoming, and supportive. Previous visits to the home identified that people living at Laxfield House, prefer to be known as residents, this report respects their wishes. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Internal building work has now been completed, and enhances the residents living area. There is a dedicated member of staff, to organise and co-ordinate activities for residents, which are now more varied, and interesting, which has resulted in more residents taking part. They have started holding regular meetings, the frequency and content of which, is decided by the residents themselves. Although they have not jet started, the home has recruited another Cook, which will ensure a consistency in the quality of meals provided when the other catering staff are off. They have worked on improving the content of their care plans to ‘improve the overall quality of care received and also the quality of the life for the service user’. They have systems and checks in place; to ensure all medication received into the home is properly recorded. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 7 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. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 8 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 Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 and 5. (the home does not offer intermediate care – therefore standard 6 was not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given information on the home, invited to look round and have their needs fully assessed. This supports people in identifying if the home can provide the level of care and environment they are looking for. EVIDENCE: Since the last inspection the home has developed their resident information booklet to be more informative of the service they provide. However, the manager sees this as a start, and will continue to develop the guide, using photography to give potential residents more detailed, personalised information. We felt this was a positive move forward, and will give people a greater insight of what it is like living at Laxfield House. All residents are given a contract setting out what they are paying for, and letter confirming the date they will be moving into the home. This reflected Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 10 information given in CSCI resident surveys, which confirmed that they had all received a contract. Copies of the ‘welcome’ letter and contracts signed by residents, (or if applicable their advocate), and the home, where held on file. Residents also confirmed that they had been given enough information about Laxfield House, before they moved in, which helped them decide if ‘it was the right place’ for them. Pre-assessments held on file confirmed that new resident’s care needs had been assessed prior to them moving in. In undertaking this, staff are able to answer any questions, and identify if they are able to give the level of support/nursing care required. Laxfield House Residential And Nursing Home DS0000024431.V352906.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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be treated with respect, involved in developing their care plans, and receive the required support with their physical and nursing care needs. EVIDENCE: Each resident has a care plan, which clearly sets out their nursing needs, to ensure that their physical health is monitored. This includes monitoring their skin, to prevent any pressure sores developing, nutrition, wound care if applicable (including action taken until it healed), and mobility needs. Records showed that where any changes occur, nursing staff update the care plan, and if required, liaise with other Health Professionals to ensure the best outcome for the resident. This includes the ‘Hospice at Home team’, to support residents with their end of life/palliative care. Records show that a ‘Chiropodist visits 6 weekly, the dentist can visit if requested, and an Optician provides an annual eye examination’ for those who wish to see them. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 12 A sample ‘cross-section’ of care plans (1 new resident, 1 resident with high care needs, 1 resident with low care needs) was looked at in more detail. Time was also spent talking/meeting the residents, and where able, listening to their views of the home. Information on all 3-care plans gave a good insight into the resident’s varying levels of support required. For 1 resident it included an ‘end of life care plan’ and included the ‘expressed’ wishes of the residents ‘in the event of their death’. Another included a ‘Living Will’ which had been reviewed, updated and signed by the resident. Residents surveyed, were asked if they felt they received the medical support they required, 5 replied ‘always’ and 1 ‘usually’. Comments included ‘I would class this as one of the major advantages of living here’, ‘GP calls once a month’ and ‘medical support and attention is forthcoming if, and when needed’. All the residents confirmed that staff listen and acted on what they said, with 1 resident commenting ‘yes – most of the time’. Relatives surveyed, also gave positive feedback saying that there was ‘no restrictions on visiting’ which supported them to keep in contact. They felt the staff ‘always’ delivered the level of support that they expected the residents to receive, and where kept up-to-date with any important issues affecting their next-of-kin. Comments included they provide ‘a person centred approach at a high level’. Relatives also felt that staff ‘always’ managed to meet the different cultural and diversity needs of the residents, with 1 relative commenting that this applied ‘to relatives’ but felt it was ‘not really applicable in the broader sense to this establishment’. Social interaction in the care plans, gave information on interests and how they would support the person to undertake them. However, this section could be written in greater detail, to included emotional needs. Where Nursing/physical care being undertaken is fully reflective in the daily report, the same level of ‘social’, content to monitor their ‘well-being’ is not always there. For example for a new resident, you would expect to see detailed observations/information on how they are settling in. For example their feelings about the move, any areas they may feel ‘restricted’, ‘de-valued’ and what action the home is undertaking to address this. Discussions with staff showed their commitment to continue to improve and develop this information in care plans, which was evidenced by some of the contents seen. For example 1 care plan held a good ‘excellent and moving’ life history, that the resident had written. This information helps staff know the person behind the illness/disability and supports them in working with the resident to produce a detailed ‘person centred’ care plan. Although staff are working to include this information, they are also aware of the resident’s rights, and are sensitive that people may not want to share their life history with staff. However, they will ensure that residents continue to be Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 13 fully consulted over the content of their care plans so it reflects their preferences and wishes. Information given in care plans, supported staff to maintain residents dignity and privacy whilst receiving personal care. As this was written around resident’s individual needs, to include any examples may lead to people being identified. Staff throughout the day were seen to be respectful and polite to residents, addressing residents by their preferred name, and always knocking before entering residents bedroom. The home has systems in place for the safe storage, recording, dispensing and disposal of medication held in the home on behalf of residents. Medication Administrations Records seen were generally completed to a good standard, with each resident’s medication listed, on their individual MAR chart. However, 1 resident’s MAR showed that 2 signatures were missing to confirm that medication had been given. However, a check of the actual amount of tablets held, against the home’s record identified that the resident had been given their medication, but staff had forgotten to sign. The Manager confirmed they would address the situation by reminding staff to complete the MAR chart, at the time of giving out the medication. There was no shortfall identified in the 2 other residents’ medication that was checked, or procedures in place for the safe handling of night sedation and controlled drugs. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. You can expect to be offered a range of activities, which you can choose to join in with, and offered nutritious home cooked meals, which are well presented. EVIDENCE: Since the last inspection, a ‘dedicated activities coordinator’ had been assigned to address recommendations made following the last key inspection. Time spent with the member of staff showed their enthusiasm and commitment to ensuring residents are able to keep stimulated, and take interest in what is happening at the home. This has been undertaken by increasing the range of activities for residents to access. The home are aware that the residents range of abilities and interests vary, from those very able residents who are ‘not concerned about filling in time’, to those requiring a high level of support and on bed rest. Residents surveyed felt there was ‘always’ or ‘usually’ activities that they could take part in, and 1 resident commented that ‘the home has instigated periodic conferences where clients are encouraged to make suggestions which are followed up’. These meetings are also used to ask residents what activities they would like to see arranged. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 15 Information in 1 resident’s care plan, showed that further work needed to be done to support their wish to be more independent, and be able to go for a walk on their own. The situation was fully discussed with the manager, including approaching the situation differently, which they will look into. Another resident kindly went through each of the activities on the ‘October’ list, which they said they received each month. They felt it catered for everyone, and it had encouraged them to take up knitting again, which they “hadn’t done for years”. They felt the “Movement and Music with a Gin and Tonic” was “very popular”. Even though they felt they received enough exercise without attending, careful timing on their part enabled them to join the group just before the end “in time for a Gin and Tonic”. The manager said residents had come up with the idea of a drink at the end of the session. Other popular activities were “floral bingo – if you win you get a floral arrangement”, “card making” where “staff help – but you are doing it” which they felt was very good for people “who have had a stroke and have limited ability”. They also enjoyed “making bread rolls” and “decorating their individual Christmas cakes” last year. Residents are also offered ‘Pre Lunch drinks and Canapés’ every other Sunday, which are “very good”. Also once a year, residents and their guests are invited to a ‘garden luncheon party’, which this year achieved a ‘new record’ with 94 people attending. The AQAA noted that staff had ‘notably observed some residents who were negative to partake in the first instance – have now become regular attendees’. They had also noticed how the craft sessions had benefited a resident with sensory loss, who enjoyed the ‘opportunity to demonstrate’ their ‘artistic flair with clay to much success, and enjoyment’. The home has been left a large donation to “develop the activities for the long term enjoyment” of the residents. The home also have themed meals for October which included ‘Trafalgar day” and ‘Halloween’ lunches. Last year the residents said the tables looked lovely “with little pumpkins that lit up”. Residents views on the catering was generally very good, although 2 noted that the standard could ‘vary’ especially ‘lunch’, depending who was covering for the Chef in their absence. The manager confirmed the situation had now been rectified, as a previous member of their catering staff was returning, whose cooking abilities are well known to them, and should ensure the normal high standard is always maintained. Residents are given daily menus to complete, which covers breakfast, lunch and high tea. The menu sheet, which offers 2 main choices for lunch and high tea, also enables residents to note any preferences, or make special requests. Menus seen gave a good range of choices, for example for breakfast (16th October) Orange, Grapefruit, Prunes, Cereal, porridge, Eggs, Bacon, Sausage, Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 16 Tomato, Toast, Bread & Butter, Preserves, Tea or Coffee. A resident commented that they were more worried about “putting on weight”. The manager meets regularly with catering staff to discuss menus and individual residents nutritional needs, linked with any identified weight loss/gains, which may be of concern. Time spent with catering staff, showed the good practices instigated to monitor residents who require extra calories and encouragement to maintain a healthy weight. For example giving food supplements, making pureed foods to “look and taste nice”, and offering extra “high calorie cakes” during the day. Staff also feedback information on residents likes and dislikes, especially when trying new recipes, to ensure their individual preferences list is kept updated. During the visits to the kitchen, staff were taking residents their mid-afternoon ‘tea trays’. Plates were set out for residents who had requested sandwiches for high tea, with their preferred filling, and white or wholemeal bread. Presentation of meals made food look appetising, and tasty. Laxfield House Residential And Nursing Home DS0000024431.V352906.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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect any concerns to be listened too, and acted on appropriately, by trained staff, committed to safeguarding the interests of people they care for. EVIDENCE: Records seen (AQAA, Complaints Log) showed there have been no complaints made direct to the home, or the Commission during the last 12 months. The complaints policy giving required timescales for investigating complaints is displayed in the home, and a summary contained in the Statement of Purpose. It was positive to see that the home had updated their complaints procedure to reflect the new address and contact number of the CSCI local office. Information supplied in residents surveys, showed that residents knew who to speak to if they were unhappy ‘can talk to all grades of staff’. All but 1 (who said they ‘don’t know’) of the residents surveyed also knew how to make a compliant, ‘this can be done verbally or in writing’. Residents spoken with during the inspection confirmed that they were happy to raise any concerns direct with staff, they said they had “no cause” to make any formal complaints. This reflected information given on the relatives’ surveys whose comments included ‘never had any need to complain’, and ‘not applicable’. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 18 Staff were aware of their responsibilities, and action they should take if a resident or their advocate raised any concerns about the home saying they would pass on the concerns ‘verbally to a senior member of staff’, or ‘write it in the communication book’. Information given in the AQAA, and training records seen, showed that staff had received adult protection training, undertaken by an external trainer in September 2007. The training content gives staff a greater awareness of the different types of abuse that can occur, especially within a care setting, and action to be taken if the situation ever occurred. The AQAA confirmed that the staff would receive on-going refresher training in ‘Adult Abuse’ to ‘remind staff of the importance and need for duty of care, all due diligence and respect at all times’, to ensure ‘high standards’ of care are maintained. Recruitment records showed no staff has started work at the home until a Prevention of Vulnerable Adults (POVA) clearance has been received, and that they were ‘under full supervision at all times until full (Criminal Bureau Records) disclosure has been received’. Laxfield House Residential And Nursing Home DS0000024431.V352906.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): 19, 20, 23, 24, 25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. You can expect a well maintained, clean, and homely environment to live in. EVIDENCE: Spending the day at the home enabled many areas of the environment to be seen. This included a resident’s bedroom, 2 lounges, laundry, garden and kitchen. All areas visited were found to be clean and fresh, which reflected comments made in the residents surveys, saying that the ‘cleaning staff are meticulous’. The AQAA informs us that through their ‘small building programme, the layout of the home has improved’. Since the last inspection ‘A large entrance hall has been developed’, and the manager now has their own office, therefore able to conduct meetings in private. There is a new separate ‘treatment room’, ‘which gives staff the opportunity to perform dressings and treatments away from Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 20 residents’ bedrooms. Other ways the owners have improved the layout of the home, to benefit the residents, is by the original kitchen being ‘relocated to another wing giving rise to creation of a large sitting room and dining area’. Also a ‘new service hallway has removed all public thoroughfare from previous function rooms’. Whilst at the home, builders were laying down a new pathway around the garden, which give easier access to people using mobility aids and wheelchairs. A small group of residents were sitting in the conservatory which looks out over the “lovely and green” gardens. Another resident was walking with a carer, enjoying the fresh air. A high standard of decoration is maintained through their on-going redecoration programme. Laxfield House Residential And Nursing Home DS0000024431.V352906.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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. You can expect to be looked after by trained staff in sufficient numbers, who are committed to providing you with a high standard of care. EVIDENCE: Residents asked (CSCI surveys) if staff were available when they needed them, replied ‘always’, or ‘usually’, with 1 resident acknowledging that on ‘occasions when several people call for assistance at the same time’ that ‘some delay is bound to happen, but otherwise the response is speedy’. This reflected another resident’s comments who said that staff are ‘normally very prompt to respond’. Staff themselves felt they ‘usually’ had enough staff on duty ‘to meet the individual needs of all the people who use the service’. They felt any variation was caused through ‘last minute sickness’ and not being able to find ‘appropriate cover’. Previous inspections confirmed that the Manager is also available to help out in emergencies. The AQAA gave staffing levels as ‘6 carers on an early shift, 4 on a late shift, and 3 on night duty’. In addition to the carers there is ‘always 1 RGN on duty’. They also confirmed that ‘if there is unexpected absence or sickness’ these shifts were covered by agency staff to ensure staffing levels are ‘maintained’. No concerns were raised by residents spoken with during the inspection over staffing levels, or any delays to staff responding to call bells. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 22 Relatives/visitors surveyed were asked if they felt ‘the care staff have the right skills and experience to look after people properly’, 4 replied ‘always’ and 2 ‘usually’. A relative commented that they ‘were completely satisfied with the level of competence and care shown by the nursing and care staff’. Information given on the AQAA confirmed that ‘all Common Induction Standards are met within 6 weeks’ of a new carer starting work at the home. Staff surveyed felt their ‘induction’ covered what they needed to know when they started, with 1 carer commenting that although they were already an experience carer, they felt the induction period was useful ‘to learn new routines’. Information supplied by the home showed that out of 28 staff, 8 had obtained their National Vocational Qualification (NVQ) level 2 or above, with a further 6 currently undertaking the training course. 1 member of staff spoke of the support given by the home to ‘obtain their NVQ 3 in care’. Staff have individual training files, which gives information on training undertaken. Staff surveyed felt that the training they received was ‘relevant’ to their role, and helped them understand and meet the individual needs of the service users’. Since the last inspection a new ‘Sister’ has been appointed who is responsible for co-ordinating the training for staff, to ensure it is kept up-todate. Discussions with the manager confirmed that Nurses were keeping up their Nursing knowledge and skills through training days, and distant learning courses. This included palliative care, manual handling and 1 member of staff had applied for a wound care course. All new staff are sent a letter to make them aware that their employment is subject to ‘receipt of satisfactory references, an initial 3 month trial period, a POVA first check, and satisfactory enhanced CRB check’. The recruitment records of 2 new members of staff showed that they had been undertaking this. There was also paperwork to validate the person’s identity and current address. The completed application forms identified gaps in the applicants employment history, which once brought to the attention of staff, confirmed that they would take action (which they started to do during the inspection) to obtain the missing information. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. You can expect a well managed home, based on openness and respect, working in the best interests of the people living at Laxfield House. EVIDENCE: The home is managed by Elizabeth Peters, better known to residents as ‘Matron’. An experienced Registered General Nurse (level 1), Mrs Peters is currently undertaking the ‘Registered Managers Award’. Throughout the inspection Mrs Peters demonstrated her commitment to providing a quality, and individualised service for the people living at Laxfield House. She spoke highly of the staff, which works well as a team. The manager undertakes supervision for the Nursing staff, who in turn, meet regularly with their Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 24 ‘allocated’ members of staff every 6-8 weeks, to undertake their 1 to 1 supervisions. Time spent with the Manager and senior staff showed their commitment to running the home in the best interests of the residents. To enable them to do this they recognised the importance of getting residents to have a greater say in how they want the home run. To support them in undertaking this, they arranged their first residents meeting in November last year. During the meeting residents were asked how often they would like to meet, and it was agreed ‘3 meetings a year would be adequate’. The Manager said the meetings gave residents a “voice” and a chance to raise any issues and make changes. Minutes from meetings held in November and April (the minutes for the meeting just held on the 7th October, was waiting to be typed up) showed issues raised by the residents. They also gave information on the response given by the owner, as to what action they will/had taken to address them. For example where residents had said they were “fed up with large sausages” that had “tough skins”, the owner had written ’we have gone back to the good quality skinless sausages, that we had before’. Residents are also able to feedback their views on the service provided through the home’s annual quality assurance surveys, which has recently been completed. Once the results have been analysed they will be made available for people to read, as well as sending a copy to the CSCI. As stated in the last report ‘the home does not offer safekeeping facilities to look after resident’s monies, instead all residents are provided with either a lockable safe or drawer in their bedroom’, which they are encouraged to use. If a resident does not wish to pay directly for services such as chiropody, hairdressing and newspapers, the home will pay, and invoice the resident direct. The system for undertaking this was looked at during the last inspection, and showed that they were following safe accounting practice. Records seen throughout the inspection were generally maintained to a good standard, with 2 minor shortfalls identified in the completed of 1 MAR chart, and employee’s employment history (see sections Staffing and Health and Personal care of this report). Information supplied in the AQAA, CSCI surveys, observation of practice, discussions with residents and staff, showed that the home has policies and procedures in place to ensure the safety of people and working at the home. These polices were being reviewed yearly, and where required updated. Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 3 N/A 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 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 2 3 Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP29 Good Practice Recommendations The home should have systems in place to check application forms at the time of the applicant’s interview, so any gaps in employment can be identified, and action taken to ensure the home has a full employment history. MAR charts should be completed at the time of dispensing medication, to ensure that staff do not forget. 2. OP37 Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Laxfield House Residential And Nursing Home DS0000024431.V352906.R01.S.doc Version 5.2 Page 28 - 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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