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Care Home: The Laurels

  • 130/134 Church End Lane Runwell Wickford Essex SS11 7DP
  • Tel: 01268764105
  • Fax: 01268450909

Residents Needs:
Old age, not falling within any other category, Dementia

Latest Inspection

This is the latest available inspection report for this service, carried out on 15th January 2010. CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for The Laurels.

What the care home does well The Laurels provides people who live there with a pleasant and well maintained environment that meets their needs. A survey from a resident commented that "The Laurels is kept warm and clean" and from a relative "the home always has a fresh smell and the standard of hygiene is very high". Visitors told us that they felt welcome to visit at any time. People`s needs are assessed prior to admission so that they and the manager can be sure that The Laurels can meet their needs. People are welcome to visit the home at any time as part of the decision-making process about living or placing a relative there. Residents are also offered a choice of food and drinks at all meals. Information we received from people using the service, their relatives/visitors and health professionals tells us that people are satisfied with the standard of care they receive. Surveys received from residents said on what the home does well "24 hour care, looking after me, regular meals, medication monitored, well pleased". Relatives commented "the care and attention given to my (relative) is good and the home always has a fresh smell and the standard of hygiene is very high" and "very pleased (resident) is kept safe and well fed". Information that we received about the staff was positive. Comments included "I really admire and appreciate all that the staff do, I see care, patience and every effort to meet needs", "look after the people carefully, lovingly and kindly" and "the staff are so friendly and caring I can`t fault them in any way". A resident commented "the staff at The Laurels are kind and caring, they are very sensitive to personal care and also sensitive to likes and dislikes". What has improved since the last inspection? An experienced and qualified manager has been appointed who is providing clear leadership at The Laurels. Staff spoken with tell us that this has improved staff morale. The manager tells us that the registered provider is supportive and they have discussed and agreed clear roles and responsibilities to ensure effective management of the service, and an application is to be made for their registration. Improvements are noted to the way that medication storage is monitored to ensure it remains effective and a sample list of staff signatures is maintained to demonstrate the staff that the manager deemed as competent to administer medication. The complaints procedure has been developed to tell people timescales within which they can expect a response and also that they may take their complaints to social services. Other records implemented since the last inspection include nutrition records to demonstrate that residents are provided with appropriate nutritious diets and a clear system for maintaining and recording money held for residents. A system for formal staff supervision has been implemented and used effectively to support improved standards in care practice. The manager has issued notice to staff of planned changes to the rota that will ensure that it is arranged in the best interests of the service and the residents. The manager is able to demonstrate that a system is in place to induct staff to Common Induction Standards, ensuring they are aware of residents` needs and how to meet them. There was evidence that staff have attended training on safeguarding to help them promote resident best interests. The manager has undertaken a review of care planning and risk assessment in the home and while this is not fully implemented, interim plans are in place to support positive care outcomes. The manager is actively participating in the Essex Brokerage scheme to access a range of training for staff as well as sourcing additional training from outside trainers. Training and development of staff supports them in meeting the needs of residents more effectively. A survey received from a healthcare professional commented "since under new management, it has improved greatly regarding resident care and also communication with our service. A resident survey commented "hygiene has improved 100%. What the care home could do better: The plan for improving the quality of the care plans and risk assessments to be more reflective of peoples needs and safety requirements is an area of development that needs to be given priority. A healthcare professional survey commented on what the service can do better "improve communication skills amongst carers and remove deceased residents` names from the board in the entrance hall promptly". The programme of training for staff needs to be implemented and supported to enable them to best meet residents needs and promote their well-being. The management and staff should continue to develop the opportunities for social interaction and leisure activities for residents and ensure that these meet the individual person`s needs and abilities. In a survey, a relative commented "it would be good to see the clients were stimulated both activities within the home and also from people coming in". Key inspection report Care homes for older people Name: Address: The Laurels 130/134 Church End Lane Runwell Wickford Essex SS11 7DP     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: Bernadette Little     Date: 1 5 0 1 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 31 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Laurels 130/134 Church End Lane Runwell Wickford Essex SS11 7DP 01268764105 01268450909 enquiries@thelaurelsltd.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Laurels Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Laurels is registered for the accommodation and care of twenty eight older people over the age of 65, who may have a range of care needs. One double room is provided and there are some en-suite facilities provided. The home provides a comfortable lounge area with a large adjoining conservatory. Further facilities include a dining/sitting room and a small television room that can also be used to provide a private area for service users and visitors. Bathrooms and toilet facilities are provided throughout the home in sufficient numbers. A passenger lift accesses the first floor. The home is furnished and decorated to a good standard. To the rear of the home there is a landscaped garden with a decked area. The home is located within a short distance of Wickford town centre on bus and train routes. There is off road parking facilities to the front of the home. The range of fees given at the time of the site visit was £580.00 to £625.00 per week. Any additional fees will need to be discussed Care Homes for Older People Page 4 of 31 Over 65 5 28 1 0 Brief description of the care home directly with the home before admission. The homes Statement of Purpose and Service Users Guide can be obtained from the home on request. Care Homes for Older People Page 5 of 31 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 last key inspection of this service was undertaken on 19th March 2009. This site visit was undertaken over an eight hour period on one day as part of a key inspection. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The registered provider submitted an Annual Quality Assurance Assessment (AQAA) as required by law prior to the site visit. This gives them opportunity to tell us their assessment of how well the service they provide meets the needs of the people using it, what has improved and what they plan to do better. The AQAA contained a limited level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, staff and health/social care professionals. Subsequent to the site visit, Care Homes for Older People Page 6 of 31 surveys were received from four residents and two health professionals. We took surveys to the service for relatives and 6 people completed them. No surveys were received from staff. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back and discussed with the manager and opportunity given for clarification were necessary. The assistance provided by all those involved in this inspection process is appreciated. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? An experienced and qualified manager has been appointed who is providing clear leadership at The Laurels. Staff spoken with tell us that this has improved staff morale. The manager tells us that the registered provider is supportive and they have discussed and agreed clear roles and responsibilities to ensure effective management of the service, and an application is to be made for their registration. Improvements are noted to the way that medication storage is monitored to ensure it remains effective and a sample list of staff signatures is maintained to demonstrate the staff that the manager deemed as competent to administer medication. The complaints procedure has been developed to tell people timescales within which they can expect a response and also that they may take their complaints to social services. Other records implemented since the last inspection include nutrition records to demonstrate that residents are provided with appropriate nutritious diets and a clear system for maintaining and recording money held for residents. A system for formal staff supervision has been implemented and used effectively to support improved standards in care practice. The manager has issued notice to staff of planned changes to the rota that will ensure that it is arranged in the best interests of the service and the residents. The manager is able to demonstrate that a system is in Care Homes for Older People Page 8 of 31 place to induct staff to Common Induction Standards, ensuring they are aware of residents needs and how to meet them. There was evidence that staff have attended training on safeguarding to help them promote resident best interests. The manager has undertaken a review of care planning and risk assessment in the home and while this is not fully implemented, interim plans are in place to support positive care outcomes. The manager is actively participating in the Essex Brokerage scheme to access a range of training for staff as well as sourcing additional training from outside trainers. Training and development of staff supports them in meeting the needs of residents more effectively. A survey received from a healthcare professional commented since under new management, it has improved greatly regarding resident care and also communication with our service. A resident survey commented hygiene has improved 100 . 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 9 of 31 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 10 of 31 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. Prospective residents will have their needs assessed and will have enough information about the home on which to base a decision to live there. Evidence: The Laurels provide people with a statement of purpose and service user guide. The manager is working on updating the statement of purpose. The service user guide has been updated to reflect the changes in the management of the home. The print in the document is larger in size making it easier for people to read. The service user guide tells people about the home and its facilities, how much it costs to live there, that they will have a preadmission assessment, are encouraged to visit and spend time in the home, will have a trial period there and will be issued with a copy of the contract of residency specifying the arrangements made. The service user guide explains that, prior to admission, prospective service users will be visited in their home/hospital and can visit The Laurels during which time a full Care Homes for Older People Page 11 of 31 Evidence: assessment of their needs will be carried out to establish if the home can meet their needs and is suitable for both parties. Assessment documentation was reviewed for two more recently admitted residents which confirmed that appropriate assessments had been undertaken prior to admission. Residents and relatives spoken with confirmed that the registered provider and a senior member of staff/key worker had undertaken an assessment of the residents needs prior to admission. People spoken with also told us that they were able to visit the home without appointment and on more than one occasion prior to admission to help them make a decision about whether it was the right place for them and/or their relative. The registered persons AQAA tells us that their plans for improvement in the next twelve months are to include the key worker in the preassessment visit to see the resident in their own surroundings and to be on duty at the day of admission to greet them, and also to implement a welcome pack for each admission. The manager confirmed that intermediate care is not offered at The Laurels. Care Homes for Older People Page 12 of 31 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 living at The Laurels can expect their care and health needs to be met and their medication safely managed. Evidence: All residents and relatives spoken with confirmed they are satisfied with the level of care provided at The Laurels. This was also indicated in all the surveys received, where relatives confirmed that generally, the care service meets the needs of their relative and gives them the expected level of support. Comments included well pleased, overall we are very happy with the service offered to our relative, while the care and attention is as it is so far I am happy for (resident) to be here and the staff have attempted to make my relative comfortable though this is not always easy. A care planning system was in place to identify resident care needs and the support to be provided to them by staff to meet these. We reviewed two care plans with the manager. The care plan for a more recently admitted resident was noted positively to have clearer information, be based on the assessment, be signed by the resident and to have been written on the day of admission so that staff have information available Care Homes for Older People Page 13 of 31 Evidence: immediately to support the resident appropriately. A nutritional assessment contained a score but no indication of what that meant in terms of risk for or need of the person. The senior staff member who completed it advised they had never seen a scoring tool indicator and really were unsure as to the purpose of completing the assessment. The manager advised that since coming into post, she has identified that, while relevant information was available, it is difficult to access and follow the care plans and risk assessments. The manager stated that they will provide senior staff with training on care planning and risk assessing, and then review all of the care plans over a period of time, involving the residents and their relatives. In the interim, the manager has written an emergency care plan for each person based on information in their file, which provides basic information for staff to follow and also is available should, for example, the person need to be admitted to hospital. The requirements in relation to care planning and risk assessment will therefore not be repeated as there is a clear plan in place to address this and it will be reviewed at the next inspection. Records sampled showed that residents were supported to access relevant healthcare services to meet their healthcare needs. Surveys received from health professionals indicate a view that the service generally monitor, review and meet peoples health and social care needs, and seek advice and act on it to meet peoples health care needs and improve their well-being. The manager advised that they have recently affected a change in the supplying pharmacist as they were dissatisfied with the level of the service previously provided and of the outcome for residents. A monitored dosage system is in place. The Medication Administration Records (MAR) for two residents were reviewed. These were well organised, contained information on allergies and a photograph of the resident to support staff to ensure the medication was given to the resident for whom it was prescribed. It was recommended that code systems indicating refusals or as required medications be clarified and other reasons for some medication not being administered such as where a resident was now on antibiotics, should be recorded on the reverse of the MAR sheet and in their care plan. One resident manages some of their medication and a risk assessment was in place supporting this. The controlled drugs register was appropriately maintained and returned drugs signed for. The deputy manager advised that as required medications prescribed for pain relief are not supported by protocols currently as the residents they are prescribed for are able to state whether or not they require them. The deputy manager stated that if residents did not have this capacity, a protocol would be in place along with a plan of care and would indicate monitoring of issues such as abnormal behaviours or body Care Homes for Older People Page 14 of 31 Evidence: language that might indicate that the person was in pain. Medication was safely stored. Records of the room temperature were regularly recorded. Storage at appropriate temperature ensures the medication remains effective. An up to date list of sample signatures was available of staff that the manager had deemed competent to manage medication. It included more recently appointed staff, evidence of whose recent medication training was seen on their file. These are noted improvement from last inspection. An additional improvement noted was of competence assessment of staff in relation to medication, to ensure standards are maintained to promote satisfactory care outcomes for residents. Residents spoken with told us that staff do respect their privacy and dignity, for example by knocking on doors before entering rooms. Observation of staff practice during a site visit indicated that they speak and respond to people in a respectful way. This was confirmed by visitors spoken with. One survey from a health care professional told us that the care service usually respects peoples privacy and dignity and the other healthcare professional told us that this is always respected at The Laurels. Care Homes for Older People Page 15 of 31 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 living at The Laurels will be provided with a choice of nutritious meals, find their visitors welcomed and but may benefit from more opportunity for appropriate stimulation and social activity. Evidence: The manager advised that they have implemented requirements for care staff to engage with residents throughout the day, including in the evening. Times and place for activities were displayed on the noticeboard in the residents lounge, however this did not indicate what activities might be available. This information is contained in the activities programme displayed in the main foyer and includes allocated time for people who prefer to stay in their own bedrooms and for one to one sessions. A visitor spoken with said that staff do engage and play games with residents, even in the evenings, there has been dancing and staff do interact with residents, however this is some staff more than others. There was some information on peoples social, recreational and religious interests in their assessment and care plan but this did not indicate how they were to be met in everyday practice, particularly for those with cognitive impairment including in relation to dementia. It is recommended that this is addressed in the review of the care plans. Care Homes for Older People Page 16 of 31 Evidence: The registered providers AQAA recognises that they could do better by providing a rota of events that include pictures of activities to assist all residents to understand what is on offer. It is recommended that information about activities available should be provided to residents in a format that is suitable to their needs, such as pictorial or large print. In their AQAA, the registered provider advises that they have improved the staff hours solely allocated to activities each weekday. One of the activities coordinators is currently on extended leave and the other person has been providing some cover in a carer role on occasions to ensure that minimum staffing levels are met. Four of the relatives surveys received indicated that provision of appropriate stimulation for residents is an area that could be developed further. Comments included not a lot happens during the day, where as in other homes I understand they have a small timetable of activities, perhaps a bit more stimulation. One person suggested that some of the activities available, for example jigsaws are not really appropriate for people who have poor eyesight. Residents spoken with and able to express a view that they do have opportunity to make every day decisions such as a choice of food and drinks, what to wear, where to spend their time or whether to join in activities or have them in their own room. One resident survey commented The Laurels allow me to be myself and take appropriate control.... my family visit when they like and I get a lovely hot water bottle every night, my priest is welcomed to visit each week. A resident told us that they have their own key to their room and have their preference for coffee rather than tea met. One relative commented in a survey they would like the service to improve in ensuring that the right persons clothes are returned to their room. Discussions with residents and relatives indicated that visitors are welcomed at The Laurels and residents are encouraged to maintain contact with relatives and friends. In a survey, a relative stated they have managed to create a lovely homely atmosphere so it is a pleasure to visit. In a survey, a resident told us that what the service does well is regular meals and another person said the food is not as hot as I would like. Residents spoken with told us that there is a choice of meals and drinks and this was observed on the day of the site visit. Records sampled indicated that people had a choice at each meal including cooked items at breakfast and the introduction of nutrition records is a noted improvement from last inspection. The days lunch and tea menu were displayed on a whiteboard in the dining area. The manager stated that they plan to introduce menus for the tables in a format that is suitable for the people living at The Laurels. They also Care Homes for Older People Page 17 of 31 Evidence: advised that the registered provider ensures the residents are offered a glass of wine at weekends, sherry in the evening and at other residents have a glass of whiskey or a Guinness in line with their preferences. Ample food stocks were available and the cook was aware of individual residents specific dietary needs. Staff were observed to provide sensitive and patient support to residents who required this at lunchtime, sitting with them, giving eye contact, interacting with them and addressing them by name. It was observed that tablecloths remained on the table while residents ate, a noted improvement from the last inspection. Care Homes for Older People Page 18 of 31 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. People living at The Laurels can expect to be listened to and have their concerns acted upon and to be safeguarded by staff knowledge and supporting policies and procedures. Evidence: The current manager is planning to hold a monthly surgery and told us that they spend time each day walking round the home and talking with residents, relatives and staff so they are accessible, readily known to people and aware of what is happening. This was observed and confirmed by people spoken with during the site visit. A complaints procedure with up to date contact details was displayed in the hall and is contained in the service user guide. The manager maintains a record of all complaints received along with investigation details and actions taken since they came into post. Appropriate actions have been taken in response to the complaints received and, where they related to poor or inappropriate practice by staff, disciplinary procedures had been instigated and some staff dismissed. The manager stated that the culture within the home is changing and improving to ensure that residents always receive good quality care outcomes. Visitors and relatives spoken with who are able to express a view told us they would feel able to raise any concerns or complaints. All surveys received from residents, relatives and professionals confirmed that they would know how to make a complaint Care Homes for Older People Page 19 of 31 Evidence: at The Laurels. One survey commented manager is very responsive to issues I have raised. Compliments were noted, including on the newly introduced Penny for Your Thoughts cards available by the visitors signing in book. These included comments such as I have seen some very good changes since Christine took over as manager, she has bought a much more caring attitude amongst residents. There have been more activities. I find Christine very approachable and (relative) appears more settled... its such peace of mind knowing she is in good hands, well done to you all at The Laurels and found the home lovely, no smells and staff very helpful. Policies and procedures on safeguarding vulnerable people and whistleblowing were readily available. The manager also had available the local multidisciplinary guidance and protocols. The registered persons AQAA tells us that there have been no safeguarding referrals or investigation since the last inspection. The manager subsequently notified the Commission as required of a recent event where a resident left the premises and where procedures had failed to ensure that staff were aware of this and supporting them. The manager demonstrated, through staff meetings and supervision records, that appropriate actions had been taken to address this with the senior staff, clarifying their responsibilities and safe procedures and identifying the expected levels of practice. A current risk assessment and care plan were in place relating to this. Staff spoken with were aware of these, of what constitutes abuse and of appropriate reporting requirements. Records sampled confirmed that staff had been provided with training on safeguarding vulnerable people. Care Homes for Older People Page 20 of 31 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. The Laurels provides residents with a pleasant and well maintained environment that meets their needs. Evidence: The registered providers AQAA tells us they provide a clean, spacious and well maintained environment for resident enjoyment and practical needs. The Laurels is well maintained, decorated and is furnished to a high standard. There is an ongoing programme of refurbishment. Residents spoken with said they were satisfied with their own rooms and the communal areas available. They told us they found them comfortable and they had been able to bring personal items with them to make the place feel more homely. A resident commented in a survey they encourage me to have my personal belongings in my room. Some residents prefer to spend time in their room and told us this choice was respected. Other residents sit in the lounge or the conservatory overlooking the garden. The AQAA tells us that the gardens are user-friendly and well-stocked and residents spent time there in the summer months. Bathrooms and toilets viewed were clean and provided appropriate facilities. The broken lock on the toilet door identified at the last inspection was working and so supporting peoples privacy and dignity. Care Homes for Older People Page 21 of 31 Evidence: No health and safety concerns were observed. The kitchen and laundry were clean and well organised and staff were seen to wear appropriate protective clothing to promote effective management of the risk of cross infection. The registered persons AQAA tells us that 13 of the staff have received training in prevention and control of infection. Upstairs window sampled were safely restricted and hot water temperatures sampled were satisfactory. Survey received told us The Laurels is always kept warm, clean and safety is assured and the home always looks clean and tidy. Care Homes for Older People Page 22 of 31 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 living at The Laurels can expect to be supported by adequate numbers of increasingly competent staff who are recruited in a way that safeguards people. Evidence: A relative survey commented my impression is that The Laurels would benefit from having more staff for example to enable quicker response to buzzer and medication. The manager stated that the current staffing levels of one senior carer and four care staff during the day and one senior carer and two care staff at night is appropriate to meet the needs of the current service users. The manager told us that they also occasionally work as part of the care staffing levels to provide necessary cover to ensure staffing levels are met and have also undertaken spot checks at night. They advised that as some staff have left under disciplinary procedures and some have chosen to leave since they came into post, some shifts are currently supported by agency staff, although there is ongoing recruitment for permanent posts to improve continuity of care for residents. The manager confirmed that they will notify the Commission as required should staffing levels not to be met on any occasion. Minutes of a staff meeting and information from the manager demonstrate that staff have been informed and given notice of planned changes to the way the staffing rota is organised. This is to ensure that the staff rota is arranged to meet the needs of the service and the residents. Care Homes for Older People Page 23 of 31 Evidence: Records provided by the manager indicate that three of the current care staff have completed training to NVQ level II, one has achieved NVQ level III and one NVQ level IV. The manager advised that places have been booked for eight staff to commence NVQ training in February 2010. Files were reviewed of two more recently recruited staff. This was to assess if appropriate references and checks had been undertaken to ensure that prospective staff are suitable people to care for residents of The Laurels. Both files contained evidence of required information and checks obtained prior to employment commencing to evidence robust recruitment procedures to safeguard residents. Where an initial POVAFirst check was in place, the manager had also undertaken a risk assessment requiring the member of staff to work with a second member of staff until such time as their criminal records bureau check was in place. All permanent staff undergo a twelve week probationary period. Profiles were available in relation to the safe recruitment and training of agency staff. Both staff whose files were sampled had previous relevant experience and qualification. A record of initial first day induction to The Laurels was available on the file, as was a completed record of induction to Common Induction Standards. The latter had been completed on one day. The manager explained that this would be provided to all new staff at an appropriate pace over several weeks, but in the case of the staff who were so Experienced, they had gone through the standards with them to ensure they were clear on what was expected. Induction training ensures that staff are aware of the needs of the residents they are to care for and how to meet these. The manager demonstrated that plans are in place to provide staff with training appropriate to their role and to meet the requirement from the last inspection. Evidence was available to demonstrate that the manager is actively involved in arranging training as part of a consortium of care homes with the support of Essex Brokerage services to improve quality outcomes service users. Courses applied for include person centred care, nutrition, continence management, deprivation of liberty safeguards, care planning, risk assessment and safeguarding. The manager will provide training to staff on dementia and challenging behaviour. Training for staff in moving and handling, including use of the hoist, had not recently taken place as planned due to adverse weather conditions but was rebooked later in the month. This will be reviewed at the next inspection. Recent training has been undertaken in first aid, nutrition and medication. Overall, surveys received from relatives and health professional indicate that the care Care Homes for Older People Page 24 of 31 Evidence: workers usually have the right skills and experience to look after people properly. One person felt that communication skills amongst carers could improve and others suggested that staff could have greater knowledge of conditions that affect older people such arthritis, catheter care and diabetes. Comments from resident and relatives at the site visit included the girls are lovely and some staff are so sensitive and caring. Comments from relatives surveys included they all work extremely hard and are always polite and have a smile to offer. Staff spoken with indicated that morale has improved within the staff team since the new manager came into post. Care Homes for Older People Page 25 of 31 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. People living at The Laurels can expect a well managed service that is run in their best interests. Evidence: A qualified and experienced manager has recently been appointed and improvements to the service are already noted. The manager confirmed that the registered provider is in the process of making an application for their registration. Apart from the Registered Managers Award, the manager is a trainer for the Alzheimers Society, an NVQ assessor and has maintained other training such as in relation to safeguarding vulnerable adults, dementia care, basic food hygiene, nutrition and risk assessment to ensure their knowledge and practice remains current. A number of relatives and some residents spoken with at the site visit advised of positive changes and improvements to the service since the new manager came in to post. One person said I just wanted to say there have been great improvements since (manager) came. A health professional survey commented the new manager is Care Homes for Older People Page 26 of 31 Evidence: very helpful and communicative and general morale in the home seems to have improved and a relatives survey included the comment the manager makes herself available for contact even though she is extremely busy and is always ready and open to comments. She works very hard. The registered persons AQAA tells us that they distribute quality assurance questionnaires and hold service users meetings as ways of gathering the views of people who use the service. A copy of the previous years findings from the questionnaires was available and demonstrated that it included residents, relatives and staff and actions taken in response to any suggestions raised. The manager holds monies on behalf of residents and since the last inspection, has implemented a system for that maintains and records each persons money separately. This is a noted improvement. Inspection of a random sample of individual resident monies showed that they were in good order, with clear records maintained, two signatures used to record transactions and receipts available. Files sampled indicate that the manager has undertaken formal supervision with staff and, while the manager advises that supervision will normally be undertaken on a bimonthly basis for all staff, there was also evidence of more frequent supervision to address and follow issues identified where appropriate. The manager was recommended to consider using a supervision agreement and also a formal agenda to include items such as training and development and follow-up from the previous session. There was evidence that the manager has held meetings with both day and night staff since coming into post, to offer them support, clarify their expectations and inform them clearly of new systems being implemented to support more effective recordings, staff availability and ultimately care outcomes for people using the service. Aspects of health and safety management were reviewed to assess the systems in place to safeguard residents and staff. Current safety inspection certificates were available relating to the fire alarm, emergency lighting, fire equipment, water system, gas, portable appliances, platform lift and hoists. The training matrix recorded regular fire drills and staff attending and this was confirmed in staff training record sampled. The manager was recommended to implement and record regular checks of the water temperatures, fire alarm system and equipment as part of quality monitoring and to promote health and safety in the home. A letter was available from Essex Fire and Rescue Service confirming a satisfactory standard of fire safety in the home in July 2009. A current certificate of employers liability insurance was available. Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 7 The programme of reviewing and improving care planning and risk assessment should be implemented as a priority to ensure that residents safety and well-being is promoted. Code systems used on medication administration records should be clarified so that all staff are using the same code for the same reason and the information where appropriate is included in the persons care plan. Provide residents with information on the social activities available in a format that is suitable to their needs and accessible. Review the current programme to ensure that all residents are provided with with suitable stimulation and leisure activities that meets their individual need. Provide residents with information on the menu available in a format that is suitable to their needs and accessible. At least 50 of care staff should achieve relevant NVQ Level 2 training. The training and development progamme for all staff to continue to be implemented and achieved. Page 29 of 31 2 9 3 12 4 12 5 6 7 15 28 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 38 Implement and record regular checks of the water temperatures, fire alarm system and equipment as part of quality monitoring and to promote health and safety in the home. Care Homes for Older People Page 30 of 31 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 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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