Care Home: The Laurels

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What the care home does well The three people who live at the home live as part of the family. They see themselves very much as part of the family and refer to themselves as guests. They have lived at the home for between 14 and 19 years.Care and support is provided in a `common sense`, discrete and relaxed manner. People are encouraged to participate in routine homely tasks such as making drinks, snacks, feeding the animals and occasionally washing the dishes. There is a focus on positive risk taking and encouraging people to be as independent as possible whilst bearing in mind their abilities. The family are managing to maintain the balance of being a family home whilst understanding the need for some records and assessment of risks for people. What has improved since the last inspection? All the people living at the home have a copy of their contract and social services contracts and care plans are in place. Medication risk assessments have been reviewed. Records of people`s financial transactions are now kept in their diaries. The bath on the second floor has been replaced. Records are kept of any training or professional updates that the family receive. There are records of ongoing maintenance checks. What the care home could do better: The family need to make sure that they sign the medication administration record when they have administered any medication. This is to make sure that people receive their medication as prescribed and accurate records are kept. CARE HOME ADULTS 18-65 The Laurels The Green Wilmcote Stratford On Avon Warwickshire CV37 9UU Lead Inspector Jo Johnson Key Unannounced Inspection 30th April 2008 09:00 The Laurels DS0000004358.V363750.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 DS0000004358.V363750.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 DS0000004358.V363750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address The Green Wilmcote Stratford On Avon Warwickshire CV37 9UU 01789 262547 F/P 01789 262547 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jillian Amy Desperles Mrs Jillian Amy Desperles Care Home 3 Category(ies) of Learning disability (2), Mental disorder, registration, with number excluding learning disability or dementia (1) of places The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Accommodation When the existing service user no longer occupies the top floor attic bedroom this room must not be used for any other service user. Use of Rooms The registered person must seek agreement from the Commission for Social Care Inspection, in advance, to the use of any other room to be used as a bedroom by service users. 14th April 2006 Date of last inspection Brief Description of the Service: The Laurels is located in the village of Wilmcote, which is approximately two miles outside of Stratford upon Avon. The village, including parts of the Home, has a number of links with Shakespeare, which date back to Shakespearean times, the Home was known as a public house at that time. The Home provides accommodation and support to three people. It is privately owned and managed by the proprietor, opening in the early 1990’s. There is a shop and public house in the village and tourist attractions. The Home is domestic in nature and is a detached property on the village green. There is a garden to the front of the property, which is easily accessible to the residents. The accommodation in the home is over three floors, and accessed by two staircases. Each person has their own bedroom. One bedroom is on the second floor of the property, the person has the sole use of a bathroom on the same floor. The second bedroom is on the first floor of the property with the third bedroom being on the ground floor. Two residents share a shower facility that is on the first floor of the property. Shared indoor space in the home consists of a large family kitchen cum dining room, laundry area, downstairs toilet and residents have their own separate sitting room. The Laurels is also home to a number of family pets. The Laurels DS0000004358.V363750.R01.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 star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live at the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The manager/owner supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgements about the service, and have been included in this report. Surveys were sent to the people living at the home in January 2008 for the Annual Service Review. All of the surveys were positive and show that people are very satisfied at the home. The findings of the surveys are reflected throughout the report. This was the home’s first key inspection of 2008/2009. The inspection visit was unannounced (we did not let the home know that we were coming) and took place on 30th April between 9am and 1pm. The inspection involved; • • Observations of and talking with the people who live at the home and the manager/owner and daughter in law. All of the people were identified for close examination by reading their, care plan, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including training and maintenance records. • The inspector would like to thank the people who live at the home, the manager/owner and family for their hospitality and cooperation during the inspection visit. What the service does well: The three people who live at the home live as part of the family. They see themselves very much as part of the family and refer to themselves as guests. They have lived at the home for between 14 and 19 years. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 6 Care and support is provided in a ‘common sense’, discrete and relaxed manner. People are encouraged to participate in routine homely tasks such as making drinks, snacks, feeding the animals and occasionally washing the dishes. There is a focus on positive risk taking and encouraging people to be as independent as possible whilst bearing in mind their abilities. The family are managing to maintain the balance of being a family home whilst understanding the need for some records and assessment of risks for people. 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 DS0000004358.V363750.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 DS0000004358.V363750.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): Quality in this outcome area is good People’s needs are assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three people who live at the home have lived there for between 14 and 19 years. There are personal profiles in place in the individual’s care records. All of the people were admitted into the family home before the service needed to be registered and there was not any formal assessment process. The manager/owner is aware of the assessment process if any new people were to be admitted into the home. Two of the people have had recent reviews by social workers and adult care and health assessments are in place. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 9 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): 6, 7, 9 Quality in this outcome area is good The people living in this home are involved in decisions about their lives and the support they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three people’s care records were looked at. There are care plans in place for all the people who live at the home. These are based on social work reviews and the needs and wishes of the individuals. The care plans are in sufficient detail so that the family members can safely support and meet the people’s needs. One person said, “xxx (Social Worker) came and took me out, she’s sorting out what I do in the day, I’m going to visit xxx (day service)”. Another person said, “ I have reviews with Dr XXX”. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 10 People living at the home do not need any hands on support with personal care. Diaries are kept that include details of how people have spent their time and any significant events. These reflect that people are living their lives as detailed in their care plans. Risk assessments are in place for most aspects of daily living. One person had risk assessments in place for their vulnerability in the community. Other risk assessments were in place for self-administration of medication people spoken with confirmed that they managed all aspects of their own medication. Risk assessments were also in place for any behaviour that may place the individuals or others at risk of harm. Following discussion with the manager/owner and another family member, these are kept under review. They said they would be amended if individuals’ developed any consistent patterns or behaviours that may place them at risk of harm. The approach to risk management makes sure that there is a balance between enabling the individuals to retain their levels of independence within a safe framework. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16, 17 Quality in this outcome area is good The people living in this home are supported to make choices about their lifestyle and to develop life skills and participate in their local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at the home, all three people were in. Two of them went out later, one to their day service and another to see their friend. One person has a voluntary job and visits a friend and family during the week. They stay over night with their parent once a week. Another person attends a local mental health day service now that they have retired from their job. One person is not receipt of a day service now and spends time both in the home The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 12 and the community with family members. This person needs more support and prompting than the other two people. This person particularly enjoys shopping with the family. They said, “I want to go shopping with XXX (family member), we go to Tescos to get the food”. Two of the people can independently travel and make use of the local bus and train network. From discussion with people and information on the AQAA, they get on well with people who live the village. One person said “I don’t know everyone but I know a lot of people by their first names…I go to the post office to fetch the papers every morning and my money”. Peoples’ surveys show that they can choose how to spend their time during the week, that they make decisions about what they do each day and that can do what they want at the weekend. Two of the people who live in the home told us that they are responsible for cleaning their rooms and their laundry. All of the people help with some bits of food preparation but mainly family members cook the main meals. One person said, “ I can’t even boil an egg and I’m quite happy not knowing”. People living at the home told us that they have areas of special responsibility. For example, one person is responsible for feeding the animals. They said that it was their decision to undertake the tasks for which the manager/owner pays them. Details of any extra monies that people earn are now recorded in their diaries. People do not enter each other’s bedrooms or those of the family. They have their own lounge and share the kitchen cum dining area. People also spend time in the family lounge with the agreement of the family members. This was observed to be a regular occurrence throughout the inspection. The home encourages people to maintain contact with friends and relatives. One person visits their friend and parent at their home and another meets with ex work mates in the town. People told us that they all eat together as a family in the kitchen. They told us that the extended family comes for dinner on a Sunday and they all really enjoy having everyone around. One person said, “They treat us as one family…I feel like I am part of the family”. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 13 There is a sample menu in place but in reality, as most families’ do, they all decide on the day what they would like to eat. They are trying to promote health eating with one person in particular. They have been referred to a dietician on a number of occasions but have chosen not to take their advice. The Laurels DS0000004358.V363750.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): 18, 19, 20 Quality in this outcome area is good The health and personal care that people in this home receive is based on their individual needs. Family respect the people and promote their dignity and privacy. Medication systems in place are largely safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were positive relationships and interactions observed between the family and the people who live at the home. They all commented that they get on well and other family members and they treat them well. People do not usually need any support with personal care. In the main, support is provided by close monitoring and prompting. Discussions with people, family members and entries in individual health records show that people access appropriate healthcare support where required. Peoples’ records show that they have been supported to access an The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 15 extensive range of consultants and health professionals. One person said “I’m going to see Dr xxx tomorrow, he’s a nice man I like him”. From discussion with the manager/owner and a family member, multidisciplinary meetings are arranged if and when people’s behaviours or mental health fluctuates. One person said, “xxx (manager/owner) gives me boundaries, this helps me manage things”. Two people manager their medication and arrange their own general doctor appointments. They said they have an agreement with the manager/owner that they let them know if they have been to the doctors. There were medication risk assessments in place for these two people. They were knowledgeable about their medication and when they should take them and when their injections were due to the doctors. The one person who the family administers medication to told us that they “have a tablet every morning and night and an injection with the doctor”. Medication is stored appropriately and records of administration are in the main completed. Medication should be signed for so that an accurate record of what has been administered and to ensure that people receive their medication as prescribed. The Laurels DS0000004358.V363750.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): 22, 23 Quality in this outcome area is good Complaints procedures make sure that peoples and representatives concerns and complaints are listened to and acted upon. A family who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place with details of how to contact the commission. People regularly have the opportunity to meet and talk with people and professionals outside the family. When asked about whom they could talk to if they were unhappy, all of the people said “xxx manager/owner”. People’s surveys also show that they know who to speak to if they are unhappy and know how to make a complaint. There have been no complaints or allegations of abuse received by the home or commission since the last inspection. An adult protection procedure is in place at the home, so that all the family know how and to whom they can report any suspicions of abuse. The manager/owner and family member spoken with were confident of how to use The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 17 these procedures. The family member spoken with had attended adult protection training. They knew under what constituted abuse, the circumstances to report any allegations and to whom they could report it. People spoken with said they felt safe living at the home. One person said, “of course I feel safe, I’m part of the family, I’ve watched the children and grandchildren grow up”. Since the last inspection, the family have been recording in people’s diaries the details of their benefits and any financial transactions. This includes recording when people have been paid for undertaking household tasks on a voluntary basis. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 18 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): 24, 30 Quality in this outcome area is good People live in a homely, clean, comfortable shared family environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Laurels is a homely and comfortable family environment, which meets the needs of the people living there. One of the people gave us a guided tour of the home and their bedroom. They other people gave permission for us to look at their bedrooms. People’s bedrooms were personalised and reflected their personalities and their interests. The home was tidy and free from unpleasant odours. Surveys from people show that the home is fresh and clean. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 19 During the inspection, the lounge that is shared by the three people was being decorated. There is an ongoing programme of redecoration throughout the home. Since the last inspection, a hot tub has been installed in the garden. One person said “like going in it when it’s nice”. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 20 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): 32, 34, 35 Quality in this outcome area is good The family living and working at the home are skilled to support the current people who live there, and to support the smooth running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The family team consists of the manager/owner, her daughter, daughter-in law and granddaughter. The manager/owner’s daughter-in-law works in the home every weekday with other family members working as required. All of the family members who live or work in the home have had a CRB (Criminal Records Bureau) check. Discussions with the manager/owner’s daughter in law combined with records seen demonstrated that she has attended staff training through the Warwickshire Quality Partnership. From discussion with the manager/owner and family member, they keep updated on current practices via the internet. The manager/owner’s granddaughter is a psychologist, her daughter is a nurse The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 21 manager at a hospital and her husband is a deputy manager of a nursing home. They advise each other of professional updates. Records of these are now kept. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 22 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): 37, 39, 42 Quality in this outcome area is good People benefit from living in a well maintained and managed home as part of the family household. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager/owner is a retired nurse who opened the home for three people in conjunction with the local mental health team before it needed to be registered by the local authority and commission. This home has always been part of the family home. A positive relationship was observed between the people living in the home and the manager/owner and family member present on the day of the inspection. People live as part of The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 23 the family group and are routinely involved in the day to day running and decision making in the home. For example, people said that they are involved in decisions such as the decorating of their communal and individual rooms, menus and day trips. Information provided before the inspection, by the manager/owner in the AQAA (Annual Quality Assurance Assessment) indicates that relevant Health and Safety checks and maintenance are being carried out at the home. There is not any need for a formal quality assurance system at the home. One person said, “XXX (manager/owner) talk to me whether I’m happy”. All people have annual or six monthly reviews by health and social care professionals. The most recent review for one person in April 2008 shows that the social worker is satisfied with the service and that the home is able to safely maintain this person and their needs. The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 24 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 CHOICE OF HOME Standard No Score 1 x 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 The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 YA20 Good Practice Recommendations The Laurels DS0000004358.V363750.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000004358.V363750.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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