Care Home: The Laurels

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What the care home does well The care home is very clean, well maintained, and has a welcoming, warm and homely atmosphere. Residents spoke positively of the home, and of being happy. They confirmed that staff were very caring and helpful. Comments included; `they are kind`, `I like the staff`, and `I am happy here`. A comment from a relative/visitors survey included the home is `always welcoming`. Care staff are experienced and are particularly understanding and sensitive in meeting the varied needs of people using the service. The home has close liaison with health professionals to ensure that residents have their healthcare needs met by the service. Care plans are updated in response to the changing needs of people using the service. The home and people using the service have close contact with the family members and friends of people using the service. A comment from a relative included `if there is ever a problem the home always gets in touch` and the home `always responds to queries about care quickly`. People using the service spoke highly of the meals provided. Comments from residents included, `the food is nice`, `I enjoy the meals`. Recorded feedback from relatives/friends included `I feel they really care for my (relative), she/he is always happy`, and the home is `always welcoming on arrival, and treats all residents with respect and care`. The registered manager/owner is experienced, and competent. She acknowledges the importance of providing a quality service to people living in the care home, and of continuing to put in place, systems and practice to improve and develop the service. What has improved since the last inspection? The requirements from the previous key inspection have been met, which indicates that the manager/owner has responded appropriately in meeting regulations, to ensure that a quality service is provided to people using the service. The home has a new carpet in the lounge/dining area, and other communal areas, which have improved the interior appearance of the home for people using the service and for others. Care plans and risk assessments have been improved and developed to ensure that it is evident that the care home understands and meets the needs (and changing needs) of people using the service. Record keeping has significantly improved, which ensures that resident`s rights and best interests are safeguarded. CARE HOMES FOR OLDER PEOPLE The Laurels 43 Salisbury Road Harrow Middlesex HA1 1NU Lead Inspector Judith Brindle Key Unannounced Inspection 09:05 17th and 18th June 2008 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 DS0000017546.V364430.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 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 DS0000017546.V364430.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address 43 Salisbury Road Harrow Middlesex HA1 1NU 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) 020 8861 4320 mariecatherine331@hotmail.com Mrs Bernadette Mitchell Mrs Bernadette Mitchell Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (6) of places The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 6 3rd July 2007 Date of last inspection Brief Description of the Service: The Laurels is a care home providing personal care, and accommodation for up to 6 older people. The care home is located in central Harrow, within a few minutes walk or drive from a variety of shops, banks, restaurants, a park, and other amenities including bus and train public transport facilities. Mrs B Mitchell owns the care home, and is also the registered manager. The home was first registered in 1993. The building is a semi-detached house located on a quiet residential road near the centre of Harrow. The home is in keeping with other houses within the area. The home has four single rooms, and one shared room. One of the single room has en-suite facilities. Three bedrooms are located on the first floor and two are situated on the ground floor. The home has an enclosed, accessible, and well-maintained garden. Information/documentation about the service and the range of fees (£470£550) is accessible from the care home to residents and others. Additional costs are recorded in resident’s statement of terms and conditions, and in the statement of purpose. The Laurels DS0000017546.V364430.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 unannounced key inspection took place during two days in June 2008. There were no vacancies at the time of the inspection. The inspector was pleased to meet, and spend a significant part of the inspection with the people living in the home. The registered manager/owner was present during part of the inspection. Prior to this unannounced key inspection the manager supplied the Commission for Social Care Inspection (CSCI) with a completed Annual Quality Assurance Assessment (AQAA) document. The AQAA is a self- assessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. Reference to some aspects of this AQAA record will be documented in this report. This document was completed fairly comprehensively. A number of feedback surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, relatives/significant others, health and social care professionals, and staff. At the time of writing this report, we had not received any completed surveys from people using the service, but had received 4 surveys from relatives/visitors, 3 surveys from a staff, and 1 from a health professional. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Also relevant information from other organisations, and from what other people might have told us about the service, was assessed. The inspector spoke with most of the people using the service, and with the staff on duty during the inspection. Documentation inspected included, all the care plans of people using the service, risk assessments, staff training, and staff personnel records, and some policies and procedures. The inspection included a tour of the premises. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 6 Assessment as to whether the requirements, and recommendations from the previous inspection had been met, also took place during this inspection. The previous inspection requirements were judged to have been met, and most of the recommendations were found to have been met. 26 National Minimum Standards for Older Persons, including Key Standards, were inspected during this inspection. The care home had displayed the preceding registration certificate at the time of inspection. Following the inspection the manager informed the Commission for Social Care Inspection that the new certificate of registration was now displayed in the home. The inspector thanks the people living in the care home, staff, the registered manager/owner, and all those who supplied us with completed feedback survey forms, for all their assistance in the inspection process. What the service does well: The care home is very clean, well maintained, and has a welcoming, warm and homely atmosphere. Residents spoke positively of the home, and of being happy. They confirmed that staff were very caring and helpful. Comments included; ‘they are kind’, ‘I like the staff’, and ‘I am happy here’. A comment from a relative/visitors survey included the home is ‘always welcoming’. Care staff are experienced and are particularly understanding and sensitive in meeting the varied needs of people using the service. The home has close liaison with health professionals to ensure that residents have their healthcare needs met by the service. Care plans are updated in response to the changing needs of people using the service. The home and people using the service have close contact with the family members and friends of people using the service. A comment from a relative included ‘if there is ever a problem the home always gets in touch’ and the home ‘always responds to queries about care quickly’. People using the service spoke highly of the meals provided. Comments from residents included, ‘the food is nice’, ‘I enjoy the meals’. Recorded feedback from relatives/friends included ‘I feel they really care for my (relative), she/he is always happy’, and the home is ‘always welcoming on arrival, and treats all residents with respect and care’. The registered manager/owner is experienced, and competent. She acknowledges the importance of providing a quality service to people living in the care home, and of continuing to put in place, systems and practice to improve and develop the service. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 7 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 DS0000017546.V364430.R01.S.doc Version 5.2 Page 8 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 DS0000017546.V364430.R01.S.doc Version 5.2 Page 9 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): Standards 1, 2, 3 and (6 is not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Some equality and diversity aspects of this assessment could be further developed. People using the service have a written contract, statement of terms and conditions with the home. EVIDENCE: The care home has accessible documentation, and information about the service provided by the care home. Both the service user guide, and the statement of purpose are in written format. There was a copy of each The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 10 document available in large print. These documents had been recently reviewed. The Annual Quality Assurance Assessment (AQAA) document informed us that each resident had been given a copy of the service user guide. The manager should look into producing the service user guide document in other formats (including pictorial and/or audio) to improve the accessibility of information to those who have difficulty in reading and/or sensory needs. The manager informed us that she had read a summary of the service user guide to a person using the service who has sensory needs, and who was unable to read Braille. The home has an admissions policy/procedure. The manager/owner spoke of having knowledge, and understanding of the importance of carrying out a comprehensive initial assessment of a prospective resident. She spoke of the process of assessment. This includes talking with the person who may use the service, and obtaining assessment information from hospital nursing staff, and/or relatives/significant others (when agreed by the person) when appropriate. She reported that there was ‘on-going’ assessment of the person’s needs, when they move into the home for their ‘settling in’ period, prior to permanently living in the care home. She gave examples of how the staff team, following the initial assessment, gained more knowledge and understanding of the needs and preferences of prospective residents. This included getting to know resident’s particular morning and night time routines, and their food preferences, by talking to the person and from observation. A resident spoke of having visited the care home ‘several times’ prior to moving in, and commented ‘I knew the home before moving in’. The care plans of the residents most recently admitted to the home confirmed that each had received an initial assessment. This assessment included assessment of personal care needs, mobility, religious/cultural needs, communication, medical, medication, mental health, food ,diet and weight needs. Further development of recorded assessment (documented in the person’s care plan) of other equality, and diversity needs could be more evident to ensure that the care home shows a comprehensive understanding, and respect for all aspects of diversity including gender, age, sexual orientation, race, and disability. Care plans inspected included copies of individual resident’s contract/statement of terms and conditions, which recorded the fees. A relative generally signed the contracts in the care plans inspected if the person using the service was unable to sign it. It should be recorded in the care plan the reasons for a resident not signing their contract with the care home. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 11 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): Standards 7,8,9, and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each person using the service has a plan of care, in which residents’ health, personal, and social needs are set out. People using the service are respected and their right to privacy upheld. People using the service are protected by the home’s policies and procedures for managing and administrating medication to people using the service. EVIDENCE: Each person using the service has a plan of care. All the care plans were inspected. It was evident that the care plans had undergone considerable review since the previous key inspection, and all are based upon the assessed needs of each individual person. The care plans included information about the life history of the person, medical needs, dietary needs and preferences, sight, hearing, communication, oral health, foot care, mobility, history of falls, continence, and personal safety. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 12 The care plans included recorded staff guidance for meeting each person’s assessed needs. It was evident that this guidance was reviewed in accordance to the changing needs of people using the service. The inspector spoke with the manager/owner with regard to developing more understanding of equality and diversity needs of people using the service. She spoke of her plans to provide more staff training in this area, and to further develop this in the care plans of people using the service. Care plans inspected informed us that care plans are reviewed on a monthly basis. It was not evident from speaking to residents and from records, as to how much involvement people using the service had in their review of their care plans. The resident did not generally sign these reviews. Annual Quality Assurance Assessment (AQAA) documentation told us that care staff were now more involved in the care plans and their review. This is positive. A staff survey recorded the comment ‘my manager always discusses and gives the information that I need about the residents’. Individual daily and night progress records are documented by staff. The home has a risk management policy/procedure. Care plans include risk assessments, such as risk of falls, use of the stairs, nutritional needs, road safety, pressure area care, moving and handling, and bathing. These recorded evidence of having been reviewed monthly, and of having been improved and developed since the previous inspection. Resident’s personal care needs, and preferences are recorded in the care plans. This record includes the level of assistance (with regard to resident’s personal care needs) needed to be given by care staff. Staff spoke of their role in supporting residents with their personal care. One resident who has recently become more frail, has had her care plan reviewed and updated to include changes in her personal care needs, and in the amount of support and assistance she receives from care staff. People using the service have access to care, and treatment from a variety of health professionals, and specialists, including GP, dentist, continence advisor, community nurse, and chiropody treatment and care. A resident told me that he/she had ‘seen the doctor’, and another said that she/he regularly attends a ‘clinic’ because of specific health needs. Another person confirmed that she/he regularly has her ‘toe nails cut’. Residents’ hospital appointments, and general health checks are recorded. A community nurse visited a resident during the inspection, and was positive about the close liaison that the home had with the healthcare community team. Comments from feedback surveys included the home ‘always responds to queries about care quickly’, and ‘any treatment needed i.e. visits to the doctor are always relayed to us’. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 13 A feedback survey from a health professional included the comment that the home provides an ‘extremely high standard of person centred care’, and confirmed that they thought that the care staff have the right skills and experience to support individual’s social and health care needs. Records and staff confirmed that each person using the service have their weight monitored closely. The manager spoke of a resident whose physical health had improved since moving into the home. This included some needed gain in weight. A visitor told me that he/she had known a seen a significant improvement with regard to the ‘well being’ of this resident since the person was admitted to the care home. Staff provided assistance and support to residents in a sensitive and respectful manner. It was evident from observation and from talking with staff that they have an understanding of the importance of upholding resident’s right to privacy. A feedback survey from a visitor included the comment ‘all care of my (relative) is done well and considerately’. Staff were observed to regularly ask some residents if they wanted to use bathroom/toilet facilities, and provided appropriate support and assistance as and when needed. A resident spoke of making choices, which included choosing her own clothes, and of the time she wished to go to bed, and get up in the morning. A person using the service spoke of being provided with a ‘nice cup of tea, when I wake up in the morning’. People were observed to be dressed appropriate to their culture and age. Residents (female) were wearing nail varnish. A person using the service told me that she had a manicure by a staff member every week. Another resident spoke of having her ‘hair done’ regularly. Care plans included evidence of people’s choice being acknowledged and staff guidance (to meet these needs) was incorporated into their plan of care. One resident enjoyed a glass of sherry in the evening prior to living in the home. Records confirmed that this had continued when she was admitted to the care home. This is positive. The home has a medication policy/procedure, which has been recently reviewed. Medication is stored securely. Records, and staff confirmed that they had received medication training. The manager spoke of the process/assessment carried out to ensure that staff are competent to administer medication to people using the service. Since the previous inspection she has developed a checklist/medication assessment that staff need to achieve prior to them administering medication to people using the service. The manager/owner confirmed that this ensures that staff have an understanding of the principles behind all aspects of the home’s policy on medicines handling and records. The manager spoke of residents having their medication regularly reviewed by the GP. She gave an example of a resident having been admitted to the home with prescribed medication at night that had a sedative effect. Following a few weeks assessment of this person, the manager asked the GP to review this The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 14 particular medication, and it now no longer needs to be prescribed. This is positive. Two residents, who kindly spoke with me, were knowledgeable of the medication that they were prescribed. Medication administration record sheets inspected, confirmed that there were no gaps in recording. The registered manager confirmed that she had obtained an up to date British National Formulary (BNF) from a pharmacist. This details medicines prescribed in the UK, with special reference to their uses, cautions, contra-indications, side effects, and dosage, which is useful to staff working in the care home. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 15 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): Standard 12,13 14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have the opportunity to take part in activities, but there could be further development in the provision of daytime activities, including community based leisure pursuits. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Meals provided are varied, and wholesome. The menu could be more accessible to people using the service. EVIDENCE: It was evident from talking with residents, and from records that the manager/owner, and the staff team have continued to develop and improve the variety, and number of activities for residents. Records informed us that people using the service participate in leisure pursuits. Activities included bingo sessions, exercise sessions, and music sessions, walks in the local park, gardening, making cards, knitting and The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 16 cooking. A person using the service spoke of enjoying arts and crafts sessions, and of going to clubs several times a week where she/he meets friends. She/he spoke of looking forward to a holiday in 2008 that she/he planned to take with friends from a club that she attends. Comments from residents included ‘ we make things, I have made cards’, ‘we play bingo sometimes’. A resident spoke of enjoying going out in the garden during fine weather. Other people spoke of going out with family members. A resident, staff, and records confirmed that resident’s birthdays are celebrated in the care home. Other activities that took place during the inspection were watching television, reading newspapers, and reading books, and a resident went for a walk in the local park. Records, staff and a resident confirmed that religious/spiritual needs of people using the service are identified, and met. Representatives of a particular church regularly visit the home. The manager told me that recently several residents participated in and enjoyed a religious service held in the home. The provision and development of activities has been discussed with the manager during the previous inspection. It was evident that the home has worked hard to improve the choice of leisure pursuits for people using the service, but there are some areas where there could be further improvement. Comments received from people completing feedback forms in response to the question ‘what the service could do better’ included, ‘take service users for shopping and restaurants’, and’ having more activities for residents, they seem to sit around an awful lot’, and ‘more activities for the elderly needed’. There could be further improvement with regard to planned ‘community based’ activities for those residents who enjoy going ‘out and about’. This was discussed with the manager who spoke of her plans to continue to develop the number and variety of activities (including community based activities) for people living in the care home. The home could seek advice from organisations that might provide advice on providing activities for older people with varied needs to ensure that people using the service lead a stimulating and active life. This could include developing activities for those with particular care needs, including those with communication needs, and include understanding and incorporating the role of sensory stimuli (colour, smell, touch and sound) in helping to improve communication with them. This could mean for example having available soft cuddly toys, and a scented garden. The visitor’s record book indicated that people regularly visited the home. Residents spoke of visitors that they had had. Comments included ‘I get visitors, my (relatives) and friends visit me’. A resident spoke of her family member visiting her regularly. Another told us that that she her relative frequently visits and sometimes takes her/him out. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 17 A person spoke of receiving regular telephone calls from family members, and of having a telephone in her/his bedroom. Care plans indicated that the home has significant contact with relatives and friends of resident. Comments from feedback surveys included ‘I really feel that they care for my (relative), she is always happy, which as a (relative) is important to me’, and the home ‘is always welcoming’, staff ‘treat residents with respect’ and a great deal of love goes into the care provided’, and ‘if there is ever a problem the home always gets in touch’. The home has a menu. Annual Quality Assurance Assessment (AQAA) document informed us that residents are participate in the formulation of the menu, and that following feedback from residents, the menu, was recently reviewed and changed to incorporate more of the resident’s preferences. The menu is in written format and located in the kitchen. The accessibility of the menu to people using the service could be improved, for example it could be better displayed and include photographs of meals, and/or other pictorial format. This could help in informing and reminding people using the service of the choice of meals planned to be served to them that day. Staff confirmed that residents had a choice of meals, and spoke of the particular food preferences and dietary needs of several people using the service, and of how these are met by the home. Food ‘likes’ and ‘dislikes’ were recorded in care plans inspected. Residents spoke of enjoying the meals. Comments from people using the service included “ I like the meals”, I like the food’. Residents told us that they enjoyed the lunches that were provided during the inspection. These meals were judged to be wholesome and nutritious, and included fresh produce. A person using the service had knowledge and understanding of eating healthily; she/he spoke of the staff supporting her to lose some weight. Several residents sat at the dining room table for their lunch. The table was attractively laid. Other people using the service were assisted with their meal by staff. Staff, who supported residents with their meal, spoke to them, informing them of what the meal consisted of (one person had sensory needs), and interacted with them in a sensitive manner during their lunch. A variety of food items were stored. These included fresh, frozen, dried and tinned foods. Fresh fruit was available. Hot and cold drinks were regularly provided to residents during their meals and throughout the inspection. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service and others are confident that their complaints will be listened to, looked into and action taken to put things right, but there could be development in the recording of “comments/concerns”. Residents are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints procedure, a summary of which is recorded in the service user guide. The complaints procedure includes timescales with regard to responding to a complaint. The registered person/manager should examine ways (with people using the service) to improve the accessibility of the complaints procedure for those who have difficulty reading, (and for those possible future residents for whom English might not be their first language). This could help people living in the care home to complain or communicate a concern. The manager/owner told us that she had verbally informed a resident (who has sensory needs who was unable to read or use Braille) of the complaints procedure. There was one complaint recorded in the ‘complaints book’. This had been responded to appropriately. The manager/owner spoke of the ways that she and the staff team respond to ‘concerns’/complaints from people using the service, and others. She confirmed that she was continuing to improve the systems and practices of recording any ‘concerns’. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 19 Two staff who spoke with the inspector had an awareness and understanding of the reporting and recording procedures with regard to responding to ‘concerns’/complaints. Feedback from residents/visitors surveys confirmed that they knew of the complaints procedure. Feedback from residents during the inspection told us that they would speak to the manager, care staff, or family members if they had a concern. The home has a protection of vulnerable adults policy. The manager has a local authority safeguarding procedure, but should up date this with the most recent policy. Staff who spoke to me were knowledgeable of the reporting and recording procedures with regard to an allegation or suspicion of abuse, and confirmed that they had received training in abuse awareness. A staff member spoke positively and of the knowledge that she had gained from the safeguarding adult’s training that she had recently received. The manager confirmed that ‘abuse awareness’ is included in the induction programme, and in the National Vocational Qualification (NVQ) care training undertaken by staff. She reported that she had plans to ensure that more staff undertake ‘refresher’ training in safeguarding adults. The care home has a anti harassment policy, physical intervention policy and whistle blowing policy. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 20 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): Standard 19, 23, and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose. Resident’s bedrooms, are individually personalised and meet their individual needs. EVIDENCE: The care home is located within a few minutes walk from the local shops and bus and train public transport facilities of Harrow. There is parking for two cars on the forecourt of the care home. The inspection included a tour of the premises. The front of the property is tidy and attractive looking with a number of potted flowers located near the entrance. The care home is well maintained, homely, clean and airy. The living environment is appropriate for the particular lifestyle, and needs of The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 21 people living in the home. Houseplants, ornaments, photographs and pictures, and books are located in the communal sitting/dining room of the home. The garden area is enclosed and well kept. It contains a variety of flowers and other plants and shrubs. Seating is accessible to people. Residents told us that they enjoy the garden facility and access it frequently during nice weather. Comments included ‘ I sit in the garden sometimes’. Residents spoke of their involvement in the garden. I was shown a small area of the garden containing a variety of flowers and other plants, which a resident with staff had tended. Since the previous key inspection the home has had a new carpet put down in the sitting room and the other communal areas including the stairs. A resident said that she liked the carpet and she told me about the day when it was laid. The carpet improves the look of the home, and it was evident that it was appreciated by the people using the service. A new boiler has also been installed. The manager/owner spoke of her plans this year to develop the layout of the upstairs bathroom to improve the bathing and a shower facilities. A resident kindly showed me her bedroom. This was individually personalised., with lots of photographs, and ornaments. She has her own telephone and television. She spoke of being happy with her room. Comments included ‘I like my room’, and ‘I come and spend time in my room when I want to during the day’. The home has an infection control policy/procedure. Laundry facilities are located away from food storage, and food preparation areas. The home has an infection control policy/procedure. Hand washing facilities are located throughout the home. There are accessible paper hand towels and soap in bathrooms inspected. Staff were observed to wear protective clothing including disposable gloves, as and when needed. Records confirmed that a staff member had received infection control training. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 22 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): Standard 27,28 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff training could be further developed and improved to ensure that it is evident that all staff have the skills and knowledge to carry out their roles and responsibilities in meeting the varied care and support needs of people using the service. Sufficient numbers and skill mix of staff are employed to ensure that there are enough competent staff on duty at all times to meet the needs and changing needs of people using the service. People using the service are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: The staff rota was available for inspection. There are generally 2 to 3 staff including the manager on duty in the home during the day and at night there is a ‘wake’ night staff member on duty. A comment from a relative/visitor feedback survey was ‘there is a good staff/resident ratio, and the staff are concerned and helpful in looking after the needs of the people staying there’. Staff were observed to be very approachable and interacted with residents in a particularly sensitive manner during the inspection. They spent a lot of time The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 23 talking with people using the service, sitting with them and assisting them promptly with their personal care needs. Comments from staff feedback surveys included, ‘Communication between residents and staff is always good’, ‘when problems arise in the home they are always dealt with immediately’. Comments about the staff from people using the service included ‘I like the staff’, and they ‘are kind’. The home has a staff induction policy/procedure. Two completed staff induction record books were available for inspection. Staff, and records and a staff survey form confirmed that new staff receive an induction programme when they commence employment, which ensures that they have a good understanding of their role and of the systems in place for providing a quality service to residents. A comment from a staff survey with regard to induction included ‘my manager showed me the things that I needed to know’. AQAA information recorded that 50 of home staff have achieved an NVQ (National Vocational Qualification) level 2 care qualification. Staff training included, medication training, fire awareness, First aid, manual handling, health and safety, food and hygiene training, dementia care and ‘managing challenging behaviour’ training. Certificates of staff training were accessible in the staff personnel files. Staff training was discussed with the manager. Staff spoke of having received appropriate staff training with regard to their role and responsibilities. The manager spoke of her plans to make it a priority in 2008 to improve and develop training for care staff, and to update training records, and to put into place individual staff training plans and records. The manager confirmed that there was training for staff planned. This action should take place, to ensure that it is evident that all staff receive appropriate and required training to carryout their duties in supporting and caring for people using the service. The care home has a recruitment and selection procedure. Three staff personnel files were inspected. These were not in good order and should be reviewed and be in separate individual files with regard to data protection/confidentiality. These contained confirmation that staff have received an enhanced Criminal Record Bureau check to gain information as to whether potential staff have a criminal record. One staff file only included evidence of one satisfactory reference, and did not include a completed application form. Following the inspection the manager/owner supplied documented evidence that these checks had been carried out. The home has a recorded staff code of conduct, and equal opportunity policy/procedure. Staff job descriptions were available for inspection. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 24 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): Standard 31,33,35, 36, and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager/owner is qualified, competent and experienced to run the care home appropriately. Effective quality assurance, and quality-monitoring systems are in place to monitor, develop and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected, and their financial interests are safeguarded. EVIDENCE: The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 25 The registered manager is also the owner of the care home. She has managed the home since 1993. She has achieved a NVQ level 4 Registered Manager’s Award qualification. She reported that she was planning to commence an NVQ level 4 course in care in September 2008. The registered manager reported that she undertakes periodic training to update her skills and knowledge. The manager works in the care home most days, and told us that she was easily accessible by care staff for advice. Staff confirmed that the manager was approachable and easily contactable. The manager/owner is aware that there are improvements to the service that could be made, such as improving the number and varieties of particularly community based activities, improving the format of some documentation, and to focus on developing the staff training and supervision provided to staff. Records and the registered manager informed us that the care home monitors the quality of its service provided to residents. The AQAA confirmed that required, appropriate and reviewed policies and procedures were in place to ensure that the residents are provided with a safe, quality service. Staff sign when they have read policies/procedures. Care plans and other records were up to date. Two recently completed satisfaction questionnaires from people using the service and some from their relatives/friends were available for inspection. The manager spoke of her plans to use the Annual Quality Assurance Assessment (AQAA) document as a tool as a ‘working document’ to ensure that she monitors the quality of the service as required. Records confirmed that a resident meeting had taken place in the home. People using the service should have the opportunity to participate in regular resident meetings. Records of staff meetings were supplied to the Commission following the inspection. We were told that relatives, or the local authority manages resident’s finances. The manager said that invoices of purchases for residents are sent to the appropriate person managing the resident’s finances. Records of expenditure were available for inspection. The home has a staff supervision policy. Staff confirmed that they receive regular staff one to one staff supervision, which ensures that they are supported in carrying out their role and responsibilities for meeting the care and support needs of people using the service. The manager spoke of carrying out ‘ongoing’ staff supervision. A record of recent staff supervision was seen. The frequency of some recorded staff 1-1 supervisions should be reviewed by the manager to ensure that this always meets the National Minimum Standard of care staff receiving formal supervision at least six ties a year. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 26 The home has health and safety policies and procedures, and risk assessments (including kitchen safety, and use of household products) to ensure staff and residents are protected and safe. Fire safety guidance is displayed in the home. Required fire safety checks and fire drills are carried out, and there is a fire risk assessment. Documentation told us that the equipment (including the bath hoist) located in the home has been serviced or tested as recommended by the manufacturer or other regulatory body. Certificates of up to date required gas and electrical system service checks were available for inspection. The home lets us know about things that have happened; they have shown us that they have managed issues appropriately. The home has an accident policy/procedure. Incidents and accidents are recorded as required. The registered person should ensure that she meets the recommendations from the Environmental Health Inspection, with regard to completing the ‘food safety monitoring manual’. The home has an up to date displayed employer’s liability insurance certificate displayed in the care home. The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 27 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 3 3 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 3 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 3 X 3 3 X 3 The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP1 Good Practice Recommendations The manager should look in to producing the service user guide document in other formats (including possibly pictorial and/or audio) to improve its accessibility to those who have difficulty in reading and/or sensory needs. It should be recorded in the care plan the reasons for a resident not signing their contract/terms and conditions with the care home. Further development of recorded assessment of some equality, and diversity needs could be more evident. To ensure that the care home shows a comprehensive understanding, and respect for all aspects of diversity including gender, age, sexual orientation, race, and disability. The manager/owner should support and encourage people using the service to be more involved in their plan of care. The manager/owner should seek ways to improve the accessibility of the menu to people using the service. DS0000017546.V364430.R01.S.doc Version 5.2 Page 29 2 3 OP2 OP3 4 5 OP7 OP15 The Laurels 6 7 8 OP18 OP29 OP30 The manager/owner should obtain a copy of the up to date lead Local Authority Safeguarding Adults guidance. Previous recommendation Staff personnel files should be reviewed and documentation be in separate individual files with regard to data protection/confidentiality. A review of staff training should take place, to ensure that it is evident that all staff receive appropriate and required training to carryout their duties in supporting and caring for people using the service. Staff training records could be improved. The registered manager should complete an NVQ level 4 course in care to ensure that she up dates her skills with regard to meeting the care needs of people using the service. Previous recommendation. The frequency of some recorded staff 1-1 supervisions should be reviewed by the manager to ensure that this always meets the National Minimum Standard of care staff receiving formal supervision at least six ties a year. The registered person should ensure that she meets the recommendations from the Environmental Health Inspection, with regard to completing the ‘food safety monitoring manual’. Previous recommendation. 9 OP31 10 OP36 11 OP38 The Laurels DS0000017546.V364430.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 DS0000017546.V364430.R01.S.doc Version 5.2 Page 31 - 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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