Care Home: The Laurels

What the care home does well People who live at the home are able to make their own choices and decisions about things like how they spend their time, what they want to eat and how they want their care to be given. People are treated with dignity and respect, and one person told us that the care is `excellent`. There are enough staff on duty to make sure that people`s needs are met, and people told us that staff are always available when they are needed. There are lots of activities for people to join in with if they choose to, and people are supported to maintain as much independence as they can. The staff are well trained, and the care plans help them to make sure that people get the right support and care. What has improved since the last inspection? This is the first inspection of the home since it was registered with a new owner. We know that since the new owner has taken over they have done things like painting people`s bedroom doors in the colours that they want, and put new fencing around the gardens so that people can use the gardens safely. What the care home could do better: We have not said that the home must do anything at this time. However the manager has told us that she will look at how they can provide more outings for those people who want them. She has also told us that she will update our contact details in their complaints policy. Key inspection report Care homes for older people Name: Address: The Laurels Lincoln Road Holton-Cum-Beckering Market Rasen Lincs LN8 5NG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Wendy Taylor     Date: 2 4 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Laurels Lincoln Road Holton-Cum-Beckering Market Rasen Lincs LN8 5NG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Grace Bryce Type of registration: Number of places registered: care home 22 Vaghjiani Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 22 The registered person may provide the following category of service only Care home with nursing Code N To service users of the following gender, Either Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category, Code OP Dementia, over 65 years of age Code DE (E), maximum number of places 1 Date of last inspection Brief description of the care home The Laurels can provide accommodation for up to twenty two people who have personal care and nursing needs. It is located in a rural setting in the village of Holton cum Beckering, Lincolnshire. There are no local services in the village, but there is a bus link to surrounding villages. The village of Wragby is approximately two and a half Care Homes for Older People Page 4 of 25 Over 65 22 0 Brief description of the care home miles away, and the town of Market Rasen is six miles away. It is a detached property, with landscaped gardens, a patio and greenhouses. There is a car parking area to the front of the home. There are three lounges and a large conservatory for people to use, and the bedrooms are located on both the ground and first floors. There is a passenger lift to the first floor. The home is owned by Mr Kanji Vaghjiani, and the registered manager is Mrs Susan Bryce. The manager has told us that the current fees for living at the home range between £416.00 and £603.60 per week. Information about these fees and the day to day management of the home can be obtained from the main office within the home. Care Homes for Older People Page 5 of 25 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is 2 stars, which means that the people who live there receive good quality outcomes. This inspection was the first one since the home was registered with a new owner in August 2009. In the report the terms we and us refer to the Care Quality Commission (CQC). The report takes into account any information that we knew about before we visited, such as the providers self assessment, which shows us how well the home thinks it is meeting standards, and how they plan to improve the service over the next year. We also received surveys from people who live at the home, staff members, and other professionals who work with the home. During the visit we spent time watching how staff did their job, and we spoke to them, Care Homes for Older People Page 6 of 25 the manager, and people who live there. We followed the care that three people receive in detail, and this is called case tracking. We looked at a range of records that the home keeps, such as care plans, staff files, daily notes, and health and safety records. Care Homes for Older People Page 7 of 25 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 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 Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Assessments assure people that the home can meet their needs and wishes. Evidence: People who live at the home told us that before they moved into the home the manager had carried out an assessment with them to find out what care and support they needed and wanted. Other people told us that the assessment arrangements helped to make sure that the right service is planned for people. We saw that peoples files contained clear information about things like their likes and dislikes, who their GP is, and details about their family. The assessments we saw covered needs such as personal care, diet, mobility, social needs, and sleep patterns. The home does not provide intermediate care at this time. Care Homes for Older People Page 10 of 25 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People are treated with respect and their needs are met by way of clear care planning, and a knowledgeable staff team. Evidence: People told us that they get all of the care and support that they need at the home. They said that staff are always available when they are needed, and they know how to care for peoples needs. They also said that staff will make sure they see a doctor when they need to. Other people told us that peoples personal and healthcare needs are always met, monitored and reviewed in a professional way, and staff have an in-depth knowledge of peoples needs. They also told us that people are treated with respect and their privacy and dignity is maintained by the staff. A relative described the care and respect given to people as excellent. We saw that staff spoke to people using their preferred names, knocked on their doors before entering, and carried out personal care in private. We also saw that staff used things like hoists and wheelchairs in the right way for people. Care Homes for Older People Page 11 of 25 Evidence: The care plans we looked at showed us that staff had used the admission assessments to develop the plans, and they contained information about maintaining peoples dignity, and how they make choices. The plans cover needs such as hygiene and dressing, mobility, moving and handling, pain control, medication, and diabetes. Records show that they are reviewed every month, and changes are made where necessary. People have signed their care plans where they are able to. There are risk assessments in peoples files for things like pressure area care, using bed rails, diet, falls, and moving and handling. Staff also record when they have checked peoples blood pressure or pulse, and when they have seen a healthcare professional such as the chiropodist or GP. There are clear policies in place about how to manage peoples medication. We watched how people get their medication, and saw that staff followed all of the policies and guidance in the right way. The medication records were completed in full, and there were special instructions about how to give people medicines that they only need to take occasionally. Care Homes for Older People Page 12 of 25 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People benefit from a range of activities and a wholesome diet, and an atmosphere in which they can make their own choices and decisions. Evidence: People told us that they have plenty of activities arranged and they can choose whether they want to join in or not. Some people said they like to spend time in their rooms with their own things around them, others said they enjoy sessions when they talk about the old days, and one person said they enjoy outings but would like more of them. We spoke to the manager about this and she said that she will look into the issue. Records show that activities such as show bingo, musical exercise, baking, flower arranging, games, and religious services are offered to people. There is also a member of staff who is responsible for planning the activities. We saw that daily newspapers and magazines are made available for people, and personal photos and ornaments are arranged around lounges where people want them. People have also have their bedroom doors painted in a colour of their choice so that they can recognise them more easily, and one person told us that they chose the Care Homes for Older People Page 13 of 25 Evidence: colour of the front door they had in their own home. Other rooms in the home, such as bathrooms and toilets, have pictures with words on the door so that people can see what the room is for. People said that staff make their visitors very welcome and offer them drinks when they come. They told us that they choose what they want to do with their time, and they can choose to do things such as vote in local or general elections. Other people also said that the home supports people to live their chosen lifestyles, and maintain as much independence as they can. We saw that staff have started to help people to complete life plans which contain information about their chosen lifestyles, special memories, and personal social history. Care plans also contain information about how to support people with their social activities and any cultural and religious needs. Peoples daily records show what they have eaten so that staff can make sure they are having a balanced diet. We saw daily menus placed around lounges and on dinning tables. People told us that they enjoyed the foods that were served, and they could choose alternatives to the menu if they wished. We saw people doing this and their choices were cooked with no problems. There was a wide range of foods available in the kitchen and the chef and care staff showed us that they have a very good knowledge of what people do and dont like to eat and drink. The chef told us about using local suppliers for meat and vegetables, and we saw that there was a range of home baking choices for people to eat. People had individual support to eat their meals, and we saw that they could choose where they wanted to eat, for example in their own rooms or the lounges. Care Homes for Older People Page 14 of 25 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Robust systems protect people from the risk of abuse, and people are assured that their concerns will be listened to and dealt with. Evidence: Records show that no complaints have been made about the service provided at the home since they registered with us in August 2009. The records also show that there have been no referrals to the Local Authority Safeguarding Adults Team about people being at risk of harm. We saw that the home has a policy about how to keep people safe, and they also have a copy of the Local Authority guidance on how to do this. Records show that staff receive regular training on this subject, and they were able to describe how they would deal with situations where they thought people were at risk of being harmed. We also saw that the home has a complaints policy, and this was displayed at the entrance to the home, so that everyone could see what they need to do. The manager said that she would update our contact details in the complaints policy. People told us that they feel safe living at the home, and that staff make sure that they are looked after properly. They told us that they know how to make a complaint if they need to, and that they can talk to the manager and staff about any problems they have. They said staff always listen to them and act on what they say. Other people told us that the home always responds in the right way if they raise any Care Homes for Older People Page 15 of 25 Evidence: concerns. Care Homes for Older People Page 16 of 25 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, 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. 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. People benefit from living in a comfortable and well maintained environment. Evidence: During our visit we looked around the home. We saw that it was very clean and tidy everywhere, and all of the decoration, and furniture was in good order. Peoples bedrooms were personalised to they way they want them with photos, ornaments and furniture. The home employs a handyman to carry out work, and records show that all of the maintenance was up to date. A new fence has been put up around the rear garden so that people can use it safely. We saw staff washing their hands in the right way, and they used aprons and gloves whenever they needed to. We also saw that the home has a policy about reducing the risk of infections. We know that in January 2010 the home was awarded a 5 star certificate for their food hygiene arrangements, which means that they do things very well. People told us that the home is always clean and smells nice, and they can spend their time where ever they choose to. Care Homes for Older People Page 17 of 25 Evidence: There is lots of space around the home for people to use, such as three lounge areas and a large conservatory. Things like wheelchairs and walking frames were stored so that they do not cause obstructions for people. Care Homes for Older People Page 18 of 25 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. People are protected by having sufficient staffing levels, and a well trained staff team. Evidence: On the day of the visit the manager, a qualified nurse, and four care staff were on duty. As well as care staff, there was a cleaner, a chef, and a handyman working in the home. People said that there are always enough staff around to help them. They made comments such as they always come when you call them, and nothing is too much trouble for them. Staff also told us that there are enough of them on duty to the jobs they need to do. Other people told us that staff are always helpful, obliging, and welcoming. Staff files contain things like criminal record bureau checks, application forms, at least two written references, and identification with a photograph of the person. Staff told us about how they were recruited and confirmed that they had all of the checks that their files contained. They told us that they were given a good introduction to the home and how to do the job when they started work. They also said that they worked with a more experienced member of staff until they felt confident to work on their own. Their files contain a record of the inductions they are given. Care Homes for Older People Page 19 of 25 Evidence: Staff also told us that they have really good training. They said the training keeps them up to date, and they can ask for training in any subject that they feel they need to do their job better. Records show that they receive regular training for things like fire safety, first aid, infection control, moving and handling, and dementia. They also show that training is provided for subjects like new laws about people making their own decisions, diabetes, and looking after catheters. On the day of the visit staff were receiving training about Parkinsons Disease. Care Homes for Older People Page 20 of 25 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 home is well managed in the best interests of the people who live there. Evidence: The home was registered with a new owner in August 2009. The registered manager has run the home under previous owners since 2004. We know that she continues to update her knowledge by attending training course with staff, and attending regular meetings with other professionals for things like infection control. People who live at the home said things like the manager is always around to help us, she listens to what I have to say. A relative said that the manager and staff are approachable. Staff said that they can talk to the manager if they have any problems and she always tries to help out. One person said she rolls her sleeves up and helps us. Other professionals told us that the manager and staff have the right skills and experience to look after the people who live at the home. Records show that staff receive regular supervision sessions, and staff confirmed this Care Homes for Older People Page 21 of 25 Evidence: when we spoke to them. We know that the owner of the home visits regularly, and we saw reports of the visits that he makes. The reports highlight any issues that are found and says what actions are needed to put things right. Records show that the manager regularly looks at things like care plans, medication arrangements, peoples bedrooms, and the kitchen environment to make sure that everything is being done in the right way, and that things are of a good standard. She writes a report of the things she finds, and these reports show what actions are needed to improve any issues she highlights. The manager also told us that surveys for people who live in the home, relatives, and other professionals are due to be sent out, so that they can say what they think of the service. We saw the forms that are going to be used. Policies are in place for things like health and safety, and there is information about how to safely use substances that may cause harm to people. We saw that these substances are stored safely, and we saw staff using moving and handling equipment in the right way. Records show that maintenance tasks are completed in a timely way, and fire safety equipment and fire alarms are tested regularly. Fire evacuation drills are also carried out regularly. The manager told us that they do not look after personal money for anyone who lives in the home. Care Homes for Older People Page 22 of 25 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 Older People Page 23 of 25 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 Older People Page 24 of 25 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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