Care Home: The Laurels, Huntley

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What the care home does well A feature of this service is the homely, comfortable and relaxed atmosphere. There is a clear admission procedure that ensures peoples` needs, will be met within the home. People are clear about whom to speak to if they are unhappy. The manager and staff promote people`s independence, by enabling them to carry out tasks themselves with staff support, if required.People living at the home are provided with fresh, home cooked meals, which they spoke positively about. What has improved since the last inspection? Two requirements were set at the last inspection. Both have now been met. One related to recruitment, and the other to staff training. The home now employs a part time member of staff, who carries out manicures, hairdressing, quizzes and will sit and have a chat with people if they wish. The home have recently had a new kitchen installed. What the care home could do better: When a potential risk such as falling is identified, strategies to minimise the risk must be addressed within the care plan. Some information needs greater clarity and subjective terminology such as `requires assistance` should be avoided. Medication received from the pharmacist, should stipulate if it is `as required` (PRN) medication or medication, which is taken regularly. Any unexplained gaps in staff employment history, should be explored and recorded. CARE HOMES FOR OLDER PEOPLE The Laurels Main Road Huntley Glos GL19 3EA Lead Inspector Pauline Lintern Unannounced Inspection 9:30 29th July 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 DS0000016615.V360651.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 DS0000016615.V360651.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address Main Road Huntley Glos GL19 3EA 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) 01452 831484 01452 830604 Mrs Patricia Alice McCreery Mrs Patricia Alice McCreery Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th May 2007 Brief Description of the Service: The Laurels is a comfortable well-maintained care home providing personal care for eight people who are aged 65 years and over. The house is situated on the A40 in the village of Huntley, approximately 6 miles from the city of Gloucester. The eight single bedrooms, five with en suite facilities, are located on the ground floor, with toilets, a shower and assisted bathing facilities within easy access. A lounge and dining room are provided for the use of people living at the home. All rooms are equipped with emergency call bell facilities. They also have the benefit of a small private garden at the rear of the house. Mrs McCreery is the registered provider and also the registered manager. Mrs McCreery lives with her family in the property and provides overnight cover for the home. The fees range from £400 to £425 a week. Extras to this include hairdressing and chiropody. The home displays copies of their Statement of Purpose and Service Users’ Guide in the hallway. The Laurels DS0000016615.V360651.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. This key inspection took place between the hours of 9.30am and 2.30pm on 29th July 2008. Mrs McCreery was available throughout the inspection. Feedback was given to Mrs McCreery at the end of the visit. Time was spent with people in the privacy of their rooms and in communal areas. Discussions were held with two staff members. Care planning information, daily records and assessments were viewed. The medication systems were examined and a tour of the accommodation was made. Staff recruitment and training records were sampled. Systems for health and safety and quality assurance were also examined. As part of the inspection process, surveys were sent to the care home for the people living there to complete if they wanted to. Two people responded to our questionnaires. We also sent surveys to relatives and we received three responses. Specific comments are included in the main text of this report. Prior to our visit to the service, we asked for an Annual Quality Assurance Assessment (AQAA) to be completed. The AQAA provided us with the information we required. All key standards were assessed on this inspection and observations, discussion and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: A feature of this service is the homely, comfortable and relaxed atmosphere. There is a clear admission procedure that ensures peoples’ needs, will be met within the home. People are clear about whom to speak to if they are unhappy. The manager and staff promote people’s independence, by enabling them to carry out tasks themselves with staff support, if required. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 6 People living at the home are provided with fresh, home cooked meals, which they spoke positively about. 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 DS0000016615.V360651.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a Statement of Purpose and Service Users Guide, which provide clear information about the service offered. New people to the service are assured that their needs will be met through a thorough assessment process. EVIDENCE: Within the AQAA, it states that the manager has updated the Service Users Guide and Statement of Purpose, by adding further information about night cover and visiting times. These documents are now kept on display by the front door. Mrs McCreery reported that there has only been one new admission to the service, since the last inspection. She added that she had written to the person confirming that the home could meet their current needs. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 9 Each person living at the home has a written contract and statement of terms and conditions. They have a letter to say they have been offered a placement at the home. One month’s trial is offered. Within our surveys, people confirmed that they received enough information about the home, before they decided if it was the right place for them. People we met with spoke highly of the service. Comments included: “I like it here very much, they are all very good” and “I’m very happy here, they treat me very well”. The assessment documentation of three people was viewed. The information gathered included information relating to health, mobility, physical and emotional needs, medication, religion, social needs and likes and dislikes. Details of next of kin and family links were also included in the pen profile. Assessments are dated when they are completed, and reviewed monthly. Intermediate care is not offered at this home. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans have been further developed, to be more informative. However, when a potential risk such as falling is identified, strategies to minimise the risk must be addressed within the care plan. Generally the management of medication is good. People using the service told us that they are always treated respectfully and their privacy is maintained. EVIDENCE: Mrs McCreery stated in the AQAA, that she ‘has reassessed Care Plans and redesigned them to contain more detailed information of individual problems and how the Care Plan can meet their needs. We also now involve residents/relatives in this. We have devised a special procedure form for ‘dealing with wasp/bee stings’ and are monitoring all new service users to ensure we have relevant protocols for any future individual cases’. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 11 As part of the inspection process, three care plans were examined. They showed that the person using the service had signed to say that they agreed to their plan. Care plans are reviewed monthly. Files sampled showed that during their initial assessment, two people had no history of falls. Both had a falls risk assessment completed during their initial assessment. These had been reviewed monthly. However, records showed that both people had fallen recently. This was not fully reflected in their care plans. Discussion with the manager took place with regard to the ‘risk assessment tool’ currently being used by the home. It was agreed that Mrs McCreery would contact the falls clinic to access a more robust assessment form. Following the inspection the manager confirmed that she had addressed this and would no longer be using the old type of assessment form. One care plan recorded that, ‘X is independent when using the toilet.’ It then added ‘X requires assistance.’ It was not clear, as to how this support was to be given. Mrs McCreery was advised to ensure recording is specific, so that staff have a clear understanding of what support is required. Overall care plans provided the reader with clear guidelines on how personal care should be delivered. Plans talked about empowering people to remain as independent as possible. There were suggestions made on how this could be achieved. For example, one person told us “I am fairly independent and can dress myself and get myself to bed, but I need a little support when I bath.” One care plan informs the reader, ‘encourage X to dry themselves, but staff are to remain with them’. Mrs McCreery told us that one person would like to be responsible for their medication. However, following a risk assessment, it was deemed that the potential risk was too high. Staff ensure that the person is able to selfadminister their topical creams themselves, with staff monitoring. Mrs McCreery added that this maintains the person’s independence. When asked in our survey: what do you feel the home does well? One relative commented, “They encourage mum to be as independent as possible, they look after her well and tend to all her needs.” Other comments to the question were, “They give good advice when needed, “general care is good” and “the care staff are very caring and nothing is too much trouble.” People who met with us confirmed that if there is a need for a doctor to be called, this is done straight away. Entries in the daily notes indicate that health appointments are attended, such as chiropodists, dentists and opticians. On the day of our visit, one person told us that they were waiting for ‘dial a ride’ to arrive to take them to the doctors. Mrs McCreery explained that the staff will book the ‘dial a ride’ service for them, and then the person is able to attend their appointments independently. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 12 Records show that people are weighed monthly. Mrs McCreery reported that one person’s needs had recently changed significantly. She added that the home was continuing to meet those needs. Evidence showed that guidance had been sought from the relevant professionals. They were visiting the person regularly to monitor any changes and to offer support. Records showed that some staff had received specific training to provide them with sound underpinning knowledge of palliative care. The home has a medication policy and all staff receives training before they can administer medication. Medication is stored appropriately and medication records were satisfactorily properly. We saw that the medication administration record currently being used does not provide space to record why ‘as required’ (PRN) medication, may be have been refused. The manager reported that she would look at alternative options for recording. It was noted that some PRN medication did not clearly state on the box, that it was prescribed ‘when required’ and not for regular use. The manager confirmed that she would discuss this with the pharmacist. At the time of the inspection the home did not have any one who selfadministered their medication. There were no controlled drugs. The manager explained that she had a locked box, which was locked inside the medication cupboard to use for controlled medication. We discussed the recent legislation regarding the storage of controlled medication. It was recommended that consideration be given to purchasing a new cupboard, which meets the legislation, in case it is needed in the future. Mrs McCreery reported that she might discuss this further with the pharmacy inspector, as lack of free wall space may make this difficult. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 13 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): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the opportunities to participate in activities and social events if they choose to do so. People told us that links with families and friends are encouraged. People have the opportunity to make choices in their daily lives. People told us that they enjoy the food provided. EVIDENCE: People told us that they have the opportunity to attend activities, if they wish to do so. Mrs McCreery reported that she now employs a staff member who works three days a week. Their remit is to carry out manicures, quizzes, oneone chats and hairdressing. The manager added that she has a blackboard, which she uses to display the activities taking place that week. Mrs McCreery reported that many people using the service are reluctant to go on day trips or participate in certain activities, although they are encouraged by the staff team. Mrs McCreery added, “it is people’s choice whether they participate or not, we would not force anyone to attend if they didn’t wish to.” The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 14 One person told us “ I used to do some knitting, but I am not bothered about going out”. Records demonstrate that on occasions when trips have been arranged, only one person has shown any interest in attending. However, records and daily notes indicate that music and movement is very popular with most of the people living at the home. Each care plan has a record of activities that have been attended by the person using the service. One person’s daily notes recorded trips to a ‘lunch club’, shopping and lunch out with friends. One person told us that they enjoy knitting and colouring books. Another person said that they enjoy socialising with others at mealtimes. People have the opportunity to attend religious services if they wish. The manager reported that currently, only one person attends church regularly. The Statement of Purpose states that visitors are welcome at the home at all times, with the person’s permission. Daily diaries record that friends and relatives regularly visit the home. The manager reported in the AQAA that she is planning “to involve the relatives/friends of service users, we are introducing a system of getting relatives/friends to read and review Care Plans and then sign them and make comments.” Within the relatives’ surveys, we asked if they felt the care home meets the needs of their relative or friend. One person said ‘always’, and two people said “usually”. As mentioned earlier in this report, a feature of this home is that people are encouraged to remain as independent as possible, and make decisions regarding the way they choose to live their life. People are able to bring personal possessions and furniture into the home, to ensure that they feel comfortable in their surroundings. People told us that they decide when they want to go to bed and when they get up in the morning. Some people choose to take a rest in their bedrooms in the afternoon or relax in the chairs in the lounge. People spoke very highly of the meals provided by the home. Comments included: “the food is lovely and there is plenty of it” and “it’s good food here.” One relative told us in their survey, “mum looks forward to her meals at all times, which she didn’t before when she was at home, the food s excellent”. The cook told us that the lunch menu is completed for three weeks, and then it changes. The cook explained that having worked at the Laurels for twelve years, she has a good knowledge of people’s likes and dislikes. She told us The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 15 that all of the food served is homemade. During the morning of our visit the cook was observed preparing fresh produce and baking. The cook confirmed that she has attended basic food hygiene training. Minutes from ‘residents meetings’ show that people using the service have the opportunity to discuss meals and suggest any changes they may wish for. One person told us that before they go to bed they are offered a hot drink of their choice. Another person reported that they have their breakfast in their bedroom, so that they can watch the early morning television. The manager explained that she arranges for canned food to be delivered to the home. She said she would buy all fresh produce herself, as it is required. It was noted that a bowl of fruit was available for people to help themselves to if they wished. The fridge was well stocked at the time of our visit. Mealtimes are evenly spread out throughout the day. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 16 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): NMS 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place. People feel that their concerns will be listened to and acted upon. Arrangements are in place, for protecting people from possible risk of harm. EVIDENCE: The home has a complaints policy and procedure in place. This is on display to visitors. The policy states that any complaints will be responded to within 28 days. The manager reported that to date, she has not received any complaints. The manager was asked to ensure any complaints or concerns raised in the future, be fully recorded. This should include any actions taken and the outcome of the investigation. Within our surveys, we asked if people knew who to speak to if they were unhappy. Two people confirmed that they knew who to speak to and one person did not answer the question. We also asked relatives, in the surveys, if they knew how to make a complaint. Two people said ‘yes.’ One person said ‘I can’t remember’. One person commented “I don’t think I have ever been told how this works.” This was discussed with the manager during feedback. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 17 People we spoke to said that they would raise any concerns with Mrs McCreery, if they needed to. One person told us “It is really lovely living here, I have no complaints at all.” Mrs McCreery reports in the AQAA, that they safeguard people using the service by ‘having clear policies on safeguarding service users and acting on suspicion of abuse. Our staff must familiarise themselves with these policies. All staff are CRB checked before they are able to work with the service users.’ Evidence demonstrates that staff members have attended the ‘Alerters Guide’ training. Staff members told us, that they know the local procedures for safeguarding people. They were able to explain the ‘whistle blowing’ policy. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 18 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): NMS 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with a comfortable, well maintained environment, which is clean and hygienic. EVIDENCE: Within the AQAA it states ‘the home is subject to monthly checks and regular maintenance to keep the high standards of things such as grounds, decoration, furniture, fabrics, layout of accessibility. Records of these checks are kept in the Diary. Carpets are regularly cleaned by industrial cleaners. Policies on laundering/washing, infection control, hand washing facilities and protective clothing are adhered to.’ The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 19 As part of the inspection process we toured the premises. We met with some people in their bedrooms and in communal areas. All parts of the home were found to be clean and tidy. The communal areas are appropriate to suit the needs of the people living there, with comfortable chairs and settees and a large television in the lounge. There is a pleasant outside seating area for people to sit in when the weather is warm. One person told us ‘ I don’t sit outside but I do enjoy looking at the flowers out there’. Bedrooms viewed contained individual’s personal belongings such as pictures, photographs and ornaments. The manager explained that some people like to keep their own room tidy, whereas others like the staff to do this for them. There were no unpleasant odours throughout the home. All bathrooms and toilets were found to be clean and hygienic. Anti bacterial hand wash was available at hand washing facilities. Staff members are provided with disposable aprons and gloves. The manager confirmed that the staff always uses protective clothing. Staff members report that the laundry facilities are satisfactory for the needs of the people living at the home. A new kitchen has recently been fitted. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 20 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): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are competent and qualified to carry out their duties. Training opportunities have improved for staff members. The home’s recruitment policy and procedures are generally robust yet exploring gaps in employment history would further ensure people’s protection. EVIDENCE: People told us that they felt there is sufficient staff on duty to meet their current needs. One staff member said that more staff would not be needed at this present time. The manager explained that she is usually on duty with one other member of staff. Mrs McCreery confirmed that she is currently recruiting for one part time staff member and for another member of staff to work two extra days during busier periods. The home currently employs six members of staff. Within surveys, one relative commented “sometimes I feel there is not enough staff on duty” We asked people using the service, if staff were available when needed. Two people replied “always.” . Mrs McCreery has attended a training programme for recruitment and The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 21 selection to improve her recruitment procedures. Staff members told us that they were recruited, inducted and trained properly. We examined three staff recruitment files, including those of the most recently recruited member of staff. Records demonstrated that the required checks had been made with the Criminal Records Bureau (CRB) and the POVA list. This ensured that the prospective staff were suitable to work with vulnerable people. Two references were requested prior to commencing employment. It was noted that there was a gap in one staff members’ employment history. This was discussed with the manager, who said that this would have been when the staff member was bringing up her family. She said she would explore this further. Care needs to be taken to ensure that any gaps in employment history are explored and recorded to safeguard the people living at the home. Two staff members have a National Vocational Qualification (NVQ) in Health and Social Care level 2 or above. Training records show that staff receive mandatory training in manual handling, basic first aid, medication, fire awareness, basic food hygiene, health and safety and safeguarding adults. Some of the staff team have attended training in Dementia and the Mental Capacity Act. The manager reported that she aims to send all staff on this training. We discussed the need for infection control training. Mrs McCreery confirmed that she was trying to locate a training course on this subject. People we met with told us that the staff treats them well. One person commented: “Staff are very nice and respectful, they will sit and chat when they do my feet.” Another person commented: “ I have a laugh and a joke with the staff.” The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 22 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): NMS 31, 33, 35 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A competent and qualified manager runs the home, in the best interests of people. The health and safety of people using the service and staff members is promoted. EVIDENCE: Mrs McCreery was a registered nurse although she said her ‘PIN’ number has lapsed. She has successfully achieved her Registered Managers Award (RMA). Mrs McCreery lives on the premises, and is therefore available to the people living at the home, at all times. The ethos of the home is to provide a homely, family environment. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 23 Mechanisms are in place for monitoring Quality Assurance. The manager arranges ‘residents and relatives’ meetings twice a year, where any issues or ideas can be exchanged. Questionnaires are also sent out to residents annually. The manager explained how she had managed one response from a relative. Minutes from the last ‘residents and relatives’ meeting on 30/6/08 were sampled. Seven people using the service had attended although no relatives had attended. Topics discussed included: running of the home, times of getting up and meals. People were asked if they had any concerns or complaints. None were raised. People said that they were happy with the care and felt their needs were being met. One relative commented in their survey: “Sometimes I leave a message to say not to give mum lunch as we are taking her out and we turn up and she has eaten.” Another relative commented, “Personally I don’t think the home could improve as far as I am concerned.” Within the AQAA, the manager states: ‘I aim to improve communication between all channels in the home to include service users, relatives/friends, staff and management. I will introduce a notice board and relatives’ surveys and a comments box in the home. Also I will continue to encourage an open flow of communication amongst everyone’. As part of the inspection process we examined various health and safety documents. The manager reported that they had a visit from a fire officer to carry out a check of fire safety in the home. A fire risk assessment is now in place dated August 2007. This assessment needs to be regularly reviewed. Evidence shows that the home has recently received a visit from the Environmental Health Officer, which resulted in the home being awarded 4 stars. An environmental risk assessment was completed in June 2007 yet it was not signed. It is also now due to be reviewed. A date has been arranged for a Portable Appliance Test (PAT) to be completed on 8/8/08. Radiators are guarded and thermostatically controlled to safeguard people. The manager confirmed that she carries out regular health and safety audits and records her findings in the diary. Entries were sampled and demonstrate that any health and safety issues are identified and measures put in place to rectify them. The home does not manage any monies for people living at the home. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 25 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. 1. 2. Standard OP29 OP7 Regulation 19 13 (4) b c Requirement Any gaps in employment history must be explored and recorded. Measures must be identified to reduce potential risks. Timescale for action 29/07/08 29/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 4. 5. 6. Refer to Standard OP7 OP9 OP9 OP16 OP38 Good Practice Recommendations Care plans should contain sufficient detail and avoid terms such as ‘needs assistance’. Medication received by the home from the pharmacy should clearly state if it is for PRN use. Consideration should be given to purchasing a medicine cupboard for controlled medication, which complies with the Misuse of drugs (Safe Custody) Regulations. There should be a system in place for recording any complaints or concerns raised, with timescales and outcomes identified. Fire and environmental risk assessments should be kept under review. The Laurels DS0000016615.V360651.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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