Latest Inspection
This is the latest available inspection report for this service, carried out on 30th April 2008. CSCI found this care home to be providing an Good service.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
For extracts, read the latest CQC inspection for The Laurels.
What the care home does well The home provides a comfortable environment for people to live in; a visitor to the home said `It`s friendly, very nice for my relative`. Residents have care plans and reviews are carried out frequently. Staff members are well trained and feel supported by the registered manager. They have a sound knowledge of residents needs. The staff team work well together and have established a good working relationship with the community health care teams and local GPs. What has improved since the last inspection? Improvements have included new care plans that are tailored to meet individual needs. Environmental improvements have included a new `disabled` toilet, new roofing and new carpeting. What the care home could do better: There needs to be evidence to demonstrate that policies and procedures have been updated and are available to staff. Activities and events could be more widely advertised around the home so that both residents and their relatives knew when they were being held. There is currently no procedure for staff to manage documents in the owners` absence. CARE HOMES FOR OLDER PEOPLE
The Laurels 45 High Street Market Deeping Lincs PE6 8EB Lead Inspector
Julie Western Unannounced Inspection 30th April 2008 09:30 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 The Laurels DS0000002447.V364052.R03.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. The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Laurels Address 45 High Street Market Deeping Lincs PE6 8EB 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) 01778 344414 desmond_shiels@hotmail.com Mr Desmond Micheal Shiels Mrs Jacque Sonia Shiels Mr Desmond Micheal Shiels Mrs Jacque Sonia Shiels Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th April 2007 Brief Description of the Service: The Laurels is a Grade II listed building built in the early 1800’s. It is situated a quarter of a mile from the town centre of Market Deeping. The town has a range of facilities including shops, pubs, and banks. There are five single and two shared bedrooms on the ground floor and twelve single and one shared bedroom upstairs. There is a courtyard area with chairs and tables at the side of the home, and a garden with seating for residents to sit outside to the rear. The home is registered to provide accommodation for up to twenty-three older persons who need personal care. At the time of inspection, there were 21 residents. The Laurels is a family run business, the owners being joint managers and working in the home on a daily basis. The home confirmed that the weekly fees currently range from £394 - £431, depending on the assessed needs of the resident. Additional charges are made for services such as hairdressing. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report is available in the manager’s office. The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes.
This key inspection was carried out over three hours and took into account any previous information held by CSCI including the home’s previous inspection reports, its service history, any pre-inspection questionnaires completed by the Manager and any residents’ questionnaires sent to the home by the Commission prior to the inspection. An Annual Quality Assurance Assessment [AQAA] was completed by the manager and returned to us. Surveys were also sent to selected residents; at the time of the inspection none had been returned. The site inspection was unannounced and consisted of tracking a sample of residents’ care records and assessing the care given. Some policies and procedures were examined and some records concerning the safety of the home were also seen. Three residents, three care and ancillary staff and two visitors were spoken with. The owners were not present during the inspection but were both spoken with on the day of the inspection and were also spoken with by telephone the following day. What the service does well: What has improved since the last inspection?
Improvements have included new care plans that are tailored to meet individual needs. Environmental improvements have included a new ‘disabled’ toilet, new roofing and new carpeting.
The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 6 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 DS0000002447.V364052.R03.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): ha1,3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is not widely available to enable residents to make informed choices. An initial assessment ensures that the needs of residents can be met and prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis. EVIDENCE: The senior carer on duty confirmed that the manager or her husband always visited prospective residents at home or in a care setting such as a hospital to undertake a thorough assessment of all their care needs. Records confirmed this. Staff members did not have information they needed to give to prospective residents and their families; they said that any enquiries were managed by appointment with the owners. The statement of purpose and the service user
The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 9 guide were not available on the day of the inspection but were forwarded later. They contained information needed by residents to make an informed choice and were in clear print. All stays were initially on a trial basis. This gave new residents the chance to determine whether The Laurels was the right home for them and for staff members to carry out a thorough assessment based on a more detailed understanding of residents’ needs. A resident and her relative described how they had visited for the day before she was sure she wanted to move in permanently. The home does not provide intermediate care. The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are in sufficient detail to ensure that residents’ care needs can be met. EVIDENCE: The care plans looked at in depth, contained information about the residents’ health and personal care needs. They were reviewed regularly although they were not signed by the service user or relatives/advocates to show that they had taken part in them. They contained generalised risk assessments. There was a clear medication policy and the pharmacist visited regularly, the most recent visit being on 28/4/08, followed by training in drug administration. The senior carer on duty said that only seniors administered medication. Residents received regular visits from district nurses and other agencies involved with their care.
The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 11 The staff team were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are regular and are tailored to suit individual residents’ needs. Residents have a choice of meals from a balanced and varied menu. EVIDENCE: Care plans seen included residents’ likes and dislikes. There is a programme of regular activities, including entertainers, armchair exercises, church services and various board and card games. Following the inspection it was suggested that a calendar of activities was displayed in the entrance area to inform residents and their relatives of forthcoming activities in good time. The senior carer said that residents were accompanied on trips to the local shops and cafes and residents and their relatives confirmed this. Residents spoken with all said they had a choice of whether or not to take part in activities. One resident spoken with said she preferred to watch television in the small lounge.
The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 13 All residents said they enjoyed the meals served; one said ‘It’s good oldfashioned home cooking’. The menu was programmed over a four-week period and offered a balanced diet. Staff members said there was a use of fresh, locally –sourced vegetables and meat. The cook said that if residents didn’t like any of the choices for the main meal, she would make them an alternative within reason. The cook was knowledgeable about the nutritional needs of service users and described cooking for diabetics. The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s procedures for addressing complaints and for protection from abuse are clear. Residents and their families are confident that their comments and concerns will be listened to. EVIDENCE: Residents spoken with said they did not wish to complain but knew how to make a complaint. The home had a copy of the Local Authority adult protection procedures. The manager said that residents and their families were regularly asked for their views regarding the running of the home. Since the last inspection there had been no complaints. The Environmental Health Officer had visited on 26/9/07 and awarded 4 stars for hygiene in the local food hygiene award scheme. Staff spoken with confirmed that they had received training in safeguarding adults. The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a safe, comfortable and pleasant environment that is suitable for their needs EVIDENCE: Overall, the standard of decoration internally was good and afforded residents a comfortable place to live. The gardens were well maintained and offered pleasant places for residents to sit out in good weather. Staff members described how any repairs needing attention were carried out by the owner himself, or by contractors. They confirmed that repairs and refurbishment were quickly addressed.
The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 16 A resident said ‘It’s not like home, but it’s very comfortable’. A relative said that the home was situated near to the town centre for residents to be taken shopping easily. Recent improvements included a new ‘disabled’ toilet, new roofing, new carpeting and the ongoing refurbishment of rooms upon vacation. There were safety notices around the building to prevent the spread of infection and COSHH regulations were observed throughout. The owner said that a risk assessment of the building was regularly carried out. The building was clean throughout The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 17 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent. EVIDENCE: The daily staff rota showed that there were 3 staff for 21 residents and in addition the owners were usually present. The home also employed a cook and domestic staff. The most recently appointed staff member described how she had an interview, gave references and underwent an induction and CRB/POVA checks. The manager said that three staff members were working towards achieving the National Vocational Qualification [a nationally recognised qualification] at Level 2 and a further two staff members were working towards Level 3. Staff members said that they had received recent training in dementia, first aid, fire procedures, health and safety, medication administration and moving and handling. The manager said that staff members received regular supervision and staff members spoken with confirmed this. Residents spoken with all praised the staff; one said ‘They’re so kind, they’ll do anything for you’ and another said ‘they always have time for us’.
The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 18 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): 31,33,37 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of the residents are listened to and they are involved in decisions affecting them. The home’s records are not updated and are unavailable to staff in the absence of the owners. EVIDENCE: The manager has owned the home together with her husband for 20 years. She is a registered nurse and has specialised in orthopaedics in a teaching capacity. Staff members spoken with said the owners were very approachable and accessible; one staff member said ‘I’ve been a carer for 17 years and this is the best place I’ve worked – you feel really supported here’.
The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 19 The owners were not able to be present during the inspection but were spoken with briefly. There is currently no procedure for staff to manage documents in the owners’ absence. Several documents could not be located; these included the statement of purpose and service user guide. Two folders were located in the kitchen, where some of the records are kept; the documents in them were out of date. In discussions later, the manager agreed to take these folders away as they were obsolete. The owner subsequently mentioned that there was a large policies and procedures manual in the building but staff members spoken with during the inspection were not sure of its whereabouts. No survey forms sent to selected residents were returned in time, but there is a quality assurance system in place; this consists of sending questionnaires to residents and their families/advocates. On return, these are discussed with the manager and owners and any issues from the returned forms are addressed. The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 20 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 2 X 3 X X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X 2 X The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 22 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP37 Regulation 17 (1)(a) Requirement The registered providers must maintain records so that policies and procedures can be easily found. [Some progress has been made but further work is still needed.] Timescale for action 29/08/08 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 OP1 Good Practice Recommendations The information setting out what facilities the service provides needs to be more freely available for prospective residents and their families visiting in the owners’ absence. Care plans and reviews should show that residents have been involved in the process. A calendar of activities should be on display to inform residents and their relatives of forthcoming activities in good time. 2 3 OP7 OP12 The Laurels DS0000002447.V364052.R03.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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
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