Care Home: The Laurels

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What the care home does well What has improved since the last inspection? The home has taken action to meet the requirements of the last report and have now provided all people living at the home, and/or their representative with the new statement of purpose and the new service user guide. Action has been taken to reduce any disruption caused by new admissions, by providing accommodation in the annex to the main home, thus enabling new people to settle at a pace relevant to their needs and wishes. CARE HOME ADULTS 18-65 The Laurels St Margaret`s Lane Titchfield Hampshire PO14 4BL Lead Inspector Mr Richard Slimm Unannounced Inspection 20th November 2007 11:00 The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 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 The Laurels DS0000028542.V349549.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 Adults 18-65. 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. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address St Margaret`s Lane Titchfield Hampshire PO14 4BL 01329 841919 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) Rivers Reach Care Limited ****Post Vacant**** Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd March 2007 Brief Description of the Service: The Laurels is a large family home on two floors, converted to meet the needs of the service user group. It is located in a quiet road, in a semi rural area several miles outside Titchfield Centre. Accommodation is provided in single bedrooms. There is a separate annex to the rear in order to enable new residents to settle and minimise disruption for existing residents. Communal space comprises two lounges, dining room and a large fitted kitchen. There is a small office on the upper floor. There is a large enclosed garden at the rear of the property. The Laurels is part of a Limited company, which runs care homes for people with learning difficulties across the South of England. The home is registered for service users with moderate to severe learning difficulties aged 18 to 65 years. The aims and objectives of the home are to enable and encourage the people living in the home to participate fully in daily living and meeting their own identified needs. People are encouraged to participate in the day to day running of the home and to access opportunities for education, employment and activities within the local community. The scale of charges relevant at the time of the inspection varied from £1321.20 to £2443.55. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and was carried out by Richard Slimm regulatory inspector. The information used to write this report was gained from the homes Annual Quality Assurance Assessment; a visit to the service and a review of comment cards received from stakeholders such as relatives, and health and social care professionals. Other information was gathered from the services history of events, previous inspection reports, direct conversations with staff, analysis of information supplied to and recorded by the link inspector. The findings of the inspection were discussed as they arose with the regional and acting home manager on duty at the end of the day. What the service does well: The regional manager, new acting home manager and staff team are committed to providing a good service for residents. Since the ownership of the home changed there have been a number of challenges. However, there was evidence to support the view that the service is improving and managers and most staff are looking forward to the opportunity to review and implement improvement plans for the future. The individual needs of residents are met and there are systems in place to encourage their independence. There is a range of activities available both inside and outside the home, which are suited to the needs and capabilities of residents. The healthcare and specialist needs of residents are identified and met through access to healthcare and specialist professional services. People are protected from harm or abuse through safe working practices and sound recruitment procedures. The home is generally run in the best interests of residents. Comments made to the us by stakeholders included – “It is immensely satisfying to know that my relative is here in such a caring, loving atmosphere.” “ I have complete confidence in the way my relative is cared for.” “My relative has settled in well the staff are helpful and he/she is quite happy.” “I am confident if anything serious occurs I would be informed immediately.” “ My relative is supported very well and I discuss any problems or worries I might have.” “The staff are kind and have helped my relative to have a more fulfilling life.” The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 6 “My concerns have been dealt with appropriately. My relative is supported well by staff at the Laurels and has extended her/his abilities. Staff members encourage my relative in many ways. The home is always clean and seems to have a cheerful feeling. “ Less positive comments included – “I am disappointed no staff have been sent for training on autism.” “Holidays are not organised well.” “There are often staff shortages, covered by agency staff.” 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. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. EVIDENCE: Three people were case tracked. There were up to date and full assessments of need, and assessments also took account of what people wanted. The home gives all people living at the home with a service user guide, provided in a format that can be easily understood or explained to people with learning difficulties. 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 9 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 the person and the care home that includes how much they will pay and what the home provides for the money. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 6, 7 and 9. Quality in this outcome area is good. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users could be further supported to take acceptable, identified risks as part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. The assessments identified above inform the plans of support and care, and were found to be person centred. People are encouraged and supported to make decisions about their life, including their finances, with support if they need it. This is because the staff members promote their rights and choices. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 11 Ensuring that staff members use risk assessments and a risk-taking framework to support people where appropriate to take risks to enable them to achieve greater independence could further enable people. While the staff members supporting people have appropriate information on which to base decisions in plans of support, risk assessments were found to be in need of review in order to make risk assessments relevant to the goals of service users. People are asked about, and are involved in most aspects of life in the home. Once more there is potential to extend this further. Both the acting manager and the area manager accepted this observation and had already identified areas where people could be provided with more opportunities for greater control over their daily lives. While the manager and staff offer people opportunities to participate in the day to day running of the home and enable them to influence a number of decisions, residents could be supported to engage more actively in improving and developing their independent living skills. This links closely with the comments made above in regard to risk assessments. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff members follow. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. This judgement has been made using available evidence including a visit to this service. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 13 EVIDENCE: 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 can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. Some people are supported to attend local colleges where they are learning skills in the area of daily living such as cooking. Residents could be more proactively supported to transfer these new skills to the home and their daily lives, by staff supporting and enabling each resident to prepare their own food more frequently at certain times as part of their individual support plan. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. While people are lead their chosen lifestyle, there were some areas where potentially residents could be provided with increased opportunities to make the most of their abilities, and practice new skills. People’s dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff members support their personal development. As identified above there are plans to extend this further with the people who live at the home. People choose and participate in suitable leisure activities. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 18, 19 and 20. Quality in this outcome area is good. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users could be further supported to achieve greater independence in respect of retaining, administering and controlling their own medication where appropriate. Current service users are protected by the home’s policies and procedures for dealing with medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People receive personal support from staff in the way they prefer and want. This is because there are comprehensive assessments of people’s needs, wishes and aspirations. Their physical and emotional health needs are met because these assessments inform person centred support plans and the home has procedures in place that staff members follow. Where specialist needs are identified the home accesses support for the resident concerned from the relevant external agency. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 15 Systems to store record and administer drugs and medications were found to be safe. However, the degree to which such a system could be developed to enable residents to take greater control of this aspect of daily living was unclear. The inspector was assured that if people are assessed as being able to take their own 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. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 22 and 23. Quality in this outcome area is good. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no formal complaints made about the home since the last inspection. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. Residents are all provided with a user-friendly complaints procedure in a format that can be easily understood or explained. Family members reported that there is listening culture at the home. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. Staff members are provided with training in adult safeguarding, and this as well as other training is periodically updated. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 24 and 30. Quality in this outcome area is good. Service users live in a homely, comfortable and safe environment. The home is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. Residents spoken to said they were very happy with their home. 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. People have enough privacy when using toilets and bathrooms. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 32, 34 and 35. Quality in this outcome area is good. Competent and qualified staff members support service users. Service users are supported and protected by the home’s recruitment policy and practices. Appropriately trained staff meet the individual and joint needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff members get the right training, supervision and support they need from their managers. The inspector was advised that specialist training in autism has been request and will be provided in due course. The acting manager has done an autism specific training course and will be cascading this to staff in the interim. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 19 An effective staff team who understand and do what is expected of them supports people. Staffing levels appeared to be good, and needed to be given the complex needs of some of the resident group. The home was providing 574 hours staffing for the week of the visit. There are occasions when permanent staff may need to be covered by agency staff. Managers were aware of the need to try and ensure use of agency staff is kept to a minimum and that agency staff do not work in isolation of regular staff. Staff interviewed said that they felt the needs of the people living at the home were well catered for. Some regular staff members are soon to leave the company, and there is currently a recruitment drive ongoing for the home. Ten of eleven permanent staff members have NVQ level 2 qualifications. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We reviewed standards 37, 39 and 42. Quality in this outcome area is good. Service users benefit from a well run home. Service users are confident their views underpin all self-monitoring, review and development by the home. The health, safety and welfare of service users are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s manager is currently in the process of making an application to apply to be registered with us. An acting manager due to maternity leave commitments is also covering the home’s manager. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 21 The organisation is notifying us of these arrangements formally. Another manager locally who is registered at another home run by the company is supporting the acting manager, and the area manager is also providing regular support and supervision. People have confidence in the care home because it is run and managed appropriately. The organisation is taking steps to register a manager as required. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The organisation has recently employed a quality assurance manager for all their services who has recently carried out an internal audit of the home. The environment is safe for people and staff because health and safety practices are carried out. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 23 CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X NO Are there any outstanding requirements from the last inspection? The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 24 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 YA9 Good Practice Recommendations Some risk assessments were found to be in need of review, and closer linkage to person centred plans and individual needs and aspirations. Staff members would benefit from input in how to best use risk assessments to further promote service users in achieving greater independence in their daily living. The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection 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 The Laurels DS0000028542.V349549.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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