Care Home: The Laurels

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What the care home does well Systems for managing medicines safely have improved so that if there are any concerns or anomalies they can be identified promptly and followed up. This shows there are systems in place to ensure medicines are managed safely. Staff now have better access to support, training and advice so that they can understand how to support people properly. They are more involved as `keyworkers` for small groups of people so they can ensure they develop an in depth knowledge of their needs and keepcare plans up to date so that colleagues will know how to meet those needs. The manager and deputy have worked hard to improve the way that people`s health care needs are followed up. Systems now ensure that any advice given by visiting health professionals is properly reported on to senior staff and acted upon. This shows that people`s health and welfare is promoted. We had positive comments from visitors to the home who value the input of the staff team. For example, relatives say things like, `The staff seem to treat the residents as their own family, nothing is too much trouble - a welcoming hand or words of comfort when needed.` `The staff are very kind.` `The home has a lovely caring staff of carers, cleaners and management.` Where there have been concerns about staff conduct, the manager has acted promptly to address them, and worked cooperatively with other professionals to promote people`s safety and wellbeing. What the care home could do better: There is one requirement from our last inspection. This is to do with ensuring people`s safety is promoted in an emergency and arose because staff were not able to tell us how many people were living at the home. This means that they, their colleagues, service users or fire officers could be placed at risk in the event of a fire. There are minor omissions in dating medicines supplied as creams, inhalers or drops, when they are opened. This means that people cannot always be sure whether these remain entirely safe and effective in use, or should be disposed of and replaced. There are some other things that the manager has in mind to improve things further and we have included these as recommendations for good practice. We would also welcome an improvement in the quality and robustness of visits made on behalf of the registered providers which could have been more in depth, particularly during the prolonged absence of a registered manager from this service during 2009. Random inspection report Care homes for older people Name: Address: The Laurels West Carr Road Attleborough Norfolk NR17 1AA one star adequate service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Judith Last Date: 2 9 0 6 2 0 1 0 Information about the care home Name of care home: Address: The Laurels West Carr Road Attleborough Norfolk NR17 1AA 01953455427 Telephone number: Fax number: Email address: Provider web address: Gooderham@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Claire Louise Durrant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Goodwood Care Homes Ltd care home 51 Number of places (if applicable): Under 65 Over 65 0 51 0 dementia old age, not falling within any other category physical disability Conditions of registration: 39 0 51 The maximum number of service users who can be accommodated is: 51 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (maximum number of places - 39) Old age, not falling within any other category Code OP Physical Disability - Code PD Date of last inspection Care Homes for Older People Page 2 of 10 Brief description of the care home The Laurels is a single storey building that is registered as a residential home. The registration has changed to include residents with dementia. The registration for older persons without dementia or for adults over 50 with physical disability is only for those residents who are already in the home. The long-term plan is that only service users suffering from dementia will be accommodated and so the home cannot now admit people who are not older people who also have dementia. The home provides 45 single bedrooms and 3 shared rooms. Twelve of the rooms have en-suite facilities. There are other toilets located throughout the building as well as bathrooms providing a range of different equipment to assist service users safely and in comfort. The shared rooms are only used to provide care to residents that chose to share together. The home does not provide nursing care but health care is by access to community resources. A chiropodist and dentist visit the home as required and a hairdresser visits weekly, for which additional charges may be made. Weekly charges are from £461 to £600 per week with the higher range predominantly applying to the en-suite rooms. Care Homes for Older People Page 3 of 10 What we found: Before we visited the home, we looked at all the information we had about it. This includes the history of the home, information the manager has sent to us since our last visit, and surveys we received from 15 people living in the home (some helped by relatives), and from 5 people visiting them. We also looked at things the manager has notified us about and that have happened in the home. We last visited the Laurels in July 2009. The last key inspection of the service was in December 2008. When we visit services, the main method of inspection we use is called case tracking. This means that we look at records and then try to find out from observation and discussion, how well peoples needs are being met and what outcomes there are for them in their daily lives. We looked at the way people are supported with their health and personal care, to make sure the requirements we made last time had been met. Care plans seen were up to date, clear about peoples needs, what staff should do to meet them, and reviewed regularly. There is an audit system in place to pick up if reviews have slipped. Since our last visit, people have had keyworkers allocated to them. This means that staff accept particular responsibility for supporting the person and for ensuring that their needs are assessed, planned for and reviewed. This represents a significant improvement since our last and previous visit. The manager and deputy know some further work is needed on care plans, for example to introduce assessments about peoples vulnerability to developing pressure sores so these can be linked to mobility, aids and preventative equipment and nutrition care plans. The management team also have plans to improve training for staff in continence management. Three relatives comments tell us that they find there is sometimes an odour associated with continence difficulties. However, the manager says there is a link staff member in place to work with the professional continence advisor and that the way people are referred for professional advice has improved. The management team says there has been an improvement in how peoples health needs are being met. They say that when the manager arrived in post in October, there were twenty five people needing regular input from district nursing staff. This is now down to five. A visiting health professional confirms that things are much better with carers now going round during visits and reporting back to the manager or deputy so that advice is acted upon. They attribute improvements to the new manager and the systems she has now put in place. Ten out of thirteen people who wrote to us say the home always makes sure they get the medical care they need and three say this is usually the case. This supports that staff make efforts to refer people for advice or treatment when it is needed. Medication systems were checked, with records of administration being completed for Care Homes for Older People Page 4 of 10 most of the four weeks up to our visit. These showed significant improvements in the way medication is recorded by staff, with audit processes that are more robust in picking up and tracing any errors promptly. Reports of monitoring visits on behalf of the provider confirm that the process is more robust and staff are administering and recording medicines more safely and accurately. We found two packs of medicines (one of drops and one inhaler), that need to be discarded within a specified period from the date they were opened, and were undated. This means that, were they to be persistently refused and not given, staff would be unclear whether they remain safe and effective in use. However, we saw that two packs of medicine for administration into peoples eyes, had been dated to make sure they remained safe for use. One person is prescribed one monitored release capsule a day and where this was not given on two occasions, the record chart showed it appropriately and recorded why. Two capsules remained in the pack supporting the accuracy of the record. However, the reason the medicine had not been given was because the person was sleeping. There was no evidence that advice had been sought from the G.P. as to whether this could be offered at a later point when the person woke up, (or of staff offering it outside of the specified medicine round time,) to make sure they gave every opportunity to the person to have the medicine. There are regular visits made by the service provider to check on the quality of the service. During the absence of a registered manager last year, the robustness of these did not identify problems in standards of care and staff conduct. The reports do not show clearly how many people (staff and service users) have been spoken to and that the visits gave opportunities for people to raise any concerns they may have at different times of day. However, the manager has checked upon the quality of the service over the 24 hour day. Records, discussion and notifications made to us show that she has taken action promptly where peoples welfare has been affected, and she has been supported by the service providers in this. She has cooperated fully with other professionals involved to achieve improvements in the way people living at the home are protected. We asked two staff members how many service users there were living at the home on the day we visited. One person was unable to tell us exactly how many people resided at the home, and another took some time to work out where the vacancies were. This indicates that, as at our last inspection, people are not entirely safe in the case of an emergency should a fire break out. We discussed with a manager how she might ensure this is addressed during the handover period. What the care home does well: Systems for managing medicines safely have improved so that if there are any concerns or anomalies they can be identified promptly and followed up. This shows there are systems in place to ensure medicines are managed safely. Staff now have better access to support, training and advice so that they can understand how to support people properly. They are more involved as keyworkers for small groups of people so they can ensure they develop an in depth knowledge of their needs and keep Care Homes for Older People Page 5 of 10 care plans up to date so that colleagues will know how to meet those needs. The manager and deputy have worked hard to improve the way that peoples health care needs are followed up. Systems now ensure that any advice given by visiting health professionals is properly reported on to senior staff and acted upon. This shows that peoples health and welfare is promoted. We had positive comments from visitors to the home who value the input of the staff team. For example, relatives say things like, The staff seem to treat the residents as their own family, nothing is too much trouble - a welcoming hand or words of comfort when needed. The staff are very kind. The home has a lovely caring staff of carers, cleaners and management. Where there have been concerns about staff conduct, the manager has acted promptly to address them, and worked cooperatively with other professionals to promote peoples safety and wellbeing. 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 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 38 13(4) The management team must 11/09/2009 take steps to ensure staff on duty always know how many people there are living in the home. This is so they can respond promptly to unexplained absences and are aware of how many people need to be evacuated if there fire brigade ever needs to know Care Homes for Older People Page 7 of 10 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, 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 1 9 13 All medicines that have a 16/07/2010 limited shelf life, such as creams, eye preparations and inhalers, must be dated on opening so staff know when they are to be disposed of. This is to ensure that medicines remain active, safe and suitable for administration as prescribed. Regulation 13(2) of the Care Homes Regulations sets out that there must be arrangements for the safekeeping and safe administration of medicines. 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 1 8 The further work proposed to care plans should take into account peoples vulnerability to pressure sores, where their mobility or nutrition is compromised. This is so it can Page 8 of 10 Care Homes for Older People 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 be assessed, advice taken and care or equipment put into place to promote skin integrity. 2 8 The further work proposed to care plans should improve evidence peoples mental capacity is taken into account in developing them, and the way staff have gone about ensuring decisions are always taken properly and in peoples best interests. Where difficulties with continence management give rise to associated odours, this should be discussed with professional cleaning companies to explore what cleaning regimes or products will help address the problem. Training should be provided to all staff about the management of continence and how they can contribute to promoting it. This is to maintain and improve the dignity and welfare of service users as far as possible. The quality monitoring visits made on behalf of the registered provider should record the timing of visits and show that these are varied throughout the working day. They should show clearly numbers and roles of people spoken to and that there is a robust approach to monitoring the quality of the service, giving opportunities for complaints to be raised and for staff to discuss issues about performance or practice. This is particularly important if there is no registered manager in post, or if the person is away from a prolonged period. 3 8 4 8 5 18 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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