Care Home: The Laurels

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What the care home does well Provides a good standard of care for service users. Provides a safe and homely environment for service users. Supports and encourages service users to lead an independent life according to their needs and strengths. Service users benefit from a core of well established staff who know their needs well. Service users are supported to consult with health care professionals when they need to and without undue delay. What has improved since the last inspection? The appointment of a permanent manager has improved staff morale and benefited service users by providing a more cohesive team. Communication between staff has improved which has further enhanced care for service users. What the care home could do better: Appoint permanent staff to the service including two senior support workers to provide more consistent care for service users. Ensure every shift includes the availability of a driver to enable service users to participate in more outside activities. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Laurels 3 Nine Mile Ride Finchampstead Berkshire RG40 4QA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Newman     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Laurels 3 Nine Mile Ride Finchampstead Berkshire RG40 4QA 01189737110 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dimension (NSO) Ltd The registered provider is responsible for running the service care home 6 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be acommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The Laurels is a small residential home that is part of Dimension (NSO) Ltd, a large provider group, and is registered for 6 people who have learning disabilities and some physical disabilities. The care needs of this group are complex. The home is a large converted bungalow, including two self-contained flats with facilities within. The house is situated in a rural area at one end of a busy road. There is a large well-maintained garden with a patio area and lawn. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home The charges for this service are from £1165 to £1222 per week Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an inspection conducted over the course of 3 1/2 hours duration. Time was spent in discussion with the three members of staff on duty and telephone discussions were held with the manager and the area manager. A visiting relative was spoken to in private. Observations of activities within the home were conducted and all service users were spoken to. A tour of the communal areas was undertaken, and a range of documentation was seen. Four bedrooms were seen. Information provided by the service prior to the visit has been used in the evaluation of outcomes for service users. All outcome areas were judged as good. No recommendations or requirements have been made as a result of this inspection. Care Homes for Adults (18-65 years) Page 6 of 27 The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, cultural, and racial needs. No complaints have been received by the Commission about this service since the last inspection. The home has until March 2009 had an unsettled period of temporary management. This has resulted in outcomes for service users being sustained but not developed to any substantial degree. There has also been a shortage of permanent staff and the home has relied on regular agency support. There was evidence that the appointment of a permanent manager had already provided positive benefits for both service users and staff. She is supportive of staff and service user focussed. The new manager is competent and experienced and whilst acknowledging the challenging tasks ahead was confident that improvements could be made in all areas. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, 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 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident that their needs would be fully assessed prior to admission to ensure that the home was able to effectively meet their needs. Evidence: Although there have been no new admissions to the home for a number of years it was evident from discussion with the manager and staff that prospective service users would be fully assessed prior to being offered a place. There are comprehensive admissions policies and procedures in place that detail the assessment that would take place taking account of the persons views and those of relatives, advocates and professionals involved. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s 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. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual service users are fully involved in decisions about their lives, and play an active role in the care and support they receive. Evidence: Information was obtained from examination of care plans and associated documentation, from information provided by the service prior to the visit, from discussion with staff and from talking to and observing service users. Care plans are in the process of being fully updated and are being organised into a consistent format that is service user centred and enables important information to be easily accessed. 3 plans of care were seen in detail. In the updated format there was evidence of clear goal planning involving the individual in their wishes and aspirations. Support needs were very detailed and provided clear guidance for staff. All service users have a nominated key worker who takes responsibility for ensuring Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: that their needs are met and that appointments and commitments are adhered to. From discussion with staff and the manager there was a clear commitment to involve service users as much as possible in decisions about their lives. More regular service user meetings are planned where individuals are encouraged and supported to share their views about the running of the home. The inspector witnessed a service user choosing a particular staff member to assist him getting ready to attend a bowling session. Risk assessments were seen within care plans and provided clear and useful direction for staff in relation to risks associated with individual service users. These were regularly reviewed with the involvement and participation of service users. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They 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. 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. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their 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 support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who use the service are supported to make choices about their lifestyle and are encouraged to develop their life skills. Social, educational, cultural and recreational activities are provided and offer individual choice and meet aspirations and expectations to a good standard. Evidence: A range of evidence was provided by the service to demonstrate that positive outcomes for individual service users is aspired to by the manager and staff in respect of their lifestyle. This evidence included information provided prior to the visit, a range of documentation maintained within the home together wih discussions with the staff and service users and a brief discussion with the manager. All service users have an individual timetable of activities that is reviewed together Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: with the service user on a regular basis. There are plans in place to widen the scope of opportunities for individuals with more outings tailored to individual preferences. The current range of activities is wide and includes paid work, a college course, day centre attendance, social and leisure pursuits. Since the appointment of the current manager one service user who has refused to leave the home for in excess of 2 years, has enjoyed 3 recently arranged outings. This demonstrates clear goals, confidence and positive management of the staff team. Service users are supported to maintain family links and evidence of contact details and family information was clearly recorded within those care plans seen. The service does have access to its own vehicle and there are a reasonable number of authorised drivers on the staff team. The inspector spoke with the mother of a service user, in private, who had returned from her regular weekend stay. The relative felt that the home provided a good standard of care where the individual needs of service users was well understood. She felt that there had been a difficult period where the temporary management arrangements for the home had challenged the staff team. However, she was very reassured at the appointment of a permanent manager who she believed to be competent and strong. Another service user was looking forward to a birthday outing the following day with his parents. It was clear from observations and from discussion with staff and service users that the routines in the home are flexible and meet with individual preferences. There are no hard rules about bedtimes or meal times and service users are able to decide for themselves whether to engage in activities or not. The kitchen facilities were seen and were found to be clean and tidy. Menus are planned on a weekly basis taking account of service users needs and preferences. Shopping is regularly ordered on line with periodic trips in between. Staff advised that service users do occasionally accompany staff on these trips. There is an emphasis on promoting healthy eating and portion control is adhered to. The last food safety inspection was undertaken on 28.04.09 and 4 recommendations were made. Further documentation confirmed that regular checks are undertaken on food temperatures and fridge and freezer temperatures. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of service uses are met. The arrangements for medication are robust and protect service users. Evidence: The health and personal care needs of service users are clearly documented in their care plans. It was noted that the new format supported easier access to up to date information. The range of health care porfessionals called upon to assist with meeting individual health care needs was provided within information made available by the service prior to the visit and included a wide range of health care porfessionals. This information was in evidence within health action plans and care plans. This documenation included specific plans in relation to individual needs such as epilepsy. From these plans guidelines were in evidence to support staff in meeting these specific health care needs. It was clear from discussion with staff that the personal and health care needs of individual service users is well understood. The medication storage facilities were seen within the staff office. Prior to the appointment of the current manager two medication errors had occured within the Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: home. These incidents had been fully investigated by the provider organisation and further training and revised procedures had been put into place. The lunchtime adminstration of medication for one individual was observed by the inspector whilst staff provided information about the process and their responsibilities. Those care plans seen contained clear support guidelines for individuals in respect of their medication. An audit of the medication arrangements had been undertaken by the Primary Care Trust in Febuary 2009 but no report could be located at the time of the visit. The manager later confirmed that the report had concluded that the standard relating to medication had been met. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that their views and concerns will be listened to and acted upon and that they are protected from abuse and neglect. Evidence: Information provided by the service prior to the visit confirmed that no complaints had been made about the service since the last inspection. The Commission has received no complaints or concerns about the service. The relative spoken to stated that she had always felt able to raise any concerns that she might have about the care of her daughter and these had always been responded to appropriately and without delay. There is a robust complaints procedure that is made known to the representatives of service users and is available to service users in a range of formats to meet their particular communication needs. Prior to the appointment of the current manager a safeguarding referral was made to the local Social Services Department. This involved some unexplained bruising on a service user but staff and the acting management failed to respond under the safeguarding procedures. A thorough investigation by the provider organisation resulted in further staff training and a tightening of procedures. Those staff spoken to demonstrated a clear understanding of the action that should be taken when an allegation or suspicion of abuse comes to their attention. All staff have received training in the protection of vulnerable adults however, an audit of staff training Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: records was not undertaken to determine how up to date individual staff training was. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well maintained and comfortable environment that is safe, clean and hygienic. Evidence: A tour of the communal areas was undertaken. All areas seen were tidy and clean. Information provided by the service prior to the visit confirmed that a rolling programme of refurbishment is in place and that new carpets and a replacement sofa are planned. A range of equipment is available to assist service users in moving around the home. Two door ways have been widened to enable easier passage through the home for the wheelchair users. One service user showed the inspector his bedroom. It was comfortable and well equipped and clearly reflected his interests and hobbies. There is a comprehensive cleaning schedule in place that ensures that the home remains clean and hygienic. A maintenance record is maintained to chart the progress of repair requests. Laundry facilities were seen and were considered to be adequate to meet the needs of the current service users. At the time of the inspection the washing machine had broken down and staff had taken appropriate steps to call an engineer without delay. A record for Control of Substances Hazardous to Health was in evidence Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: and staff spoken to confirmed that they received appropriate training. Information provided by the service prior to the visit confirmed that comprehensive polices and procedures were in place regarding the control of infection and related health and safety matters. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, 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 get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the support of well trained and competent staff and are protected by the organisations policies on recruitment. Evidence: Information provided by the service indicated that all staff are subject to an extensive recruitment programme that complies with the regulations. Staff spoken to confirmed that they had completed an application form and had supplied references. Service users are supported to be involved with the recruitment of staff to the home. The manager confirmed that the home had been short of permanent staff for the last year but that these shortfalls are covered by the use of regular bank and agency staff. The inspector was informed that a recent organisational recruitment drive had been successful and it was hoped that permanent senior staff for the home would be secured. Staff spoken to were clear about their roles and observation throughout the course of the inspection confirmed that staff were competent, calm and went about their daily tasks with the minimum of fuss. Interactions between staff and service users were observed to be positive, warm and friendly. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Information provided confirmed that all new staff are subject to comprehensive induction training and receive protection of vulnerable adults training within six months. There is a rolling programme of staff training and an expectation that all staff attend for regular updates in areas such as food hygiene, fire safety, moving and handling and health and safety. Additional specialist training is provided in accordance with service users needs. The manager confirmed that the service is working towards achieving 50 of the staff group to be qualified in National Vocational Qualifications. Staff spoken to confirmed that under the clear direction of the new manager the team is now working well together and staff morale has improved significantly. All staff are supervised by the manager and they feel well supported by her. Staff meetings are held but the latest written minutes could not be located. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. 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 environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service uses benefit from a well run home where their views are taken into account with regard to the development of the service. Service users are protected by the homes policies and procedures for health and safety. Evidence: The manager has been in post since March 2009 and is about to submit her application for registration. She has 9 years experience of management within a care home including the last 2 years as a registered manager. She is currently working towards NVQ 4 and the Registered Managers Award. She also attends a Development Management Course with the provider organisation. It was clear from discussion with staff, a relative and the area manager that the manager had already make a significant and positive impact on the running of the home. She was highly regarded and was described as strong, approachable and fair. In discussion with the manager she reported that she felt well supported by the organisation and was provided with sufficient resources to run the service and to ensure that service users needs were met. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: In information provided prior to the visit it was reported that the service had received positive feedback from families and the people supported. The manager intends to collate this information and incorporate it into an annual development plan for the home. A nominated individual from the organisation attends the home on a monthly basis in order to ascertain that it is running according to regulations and organisational obligations. Recent reports were not available and the manager will obtain copies to be kept in the home. The review process provides a forum for feedback about the home by all parties involved in individual service users care and the relative spoken to confirmed that she had recently attended a review for her daughter. There are robust health and safety practises within the home that are underpinned by comprehensive policies and procedures. A range of checks are undertaken, and a senior member of staff on duty confirmed that she takes lead responsibility to ensure that all health and safety matters are kept up to date. Documentation seen provided evidence that fire safety, hot water outlets, portable appliance checks are undertaken regularly and equipment used within the home is serviced according to manufacturers instructions. Although there is a facility for staff to sign all documents as read and understood this is currently inconsistently applied. The manager was aware that a fire drill is now overdue. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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