Care Home: The Laurels Nursing Home

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What the care home does well Staff spoken with indicated that morale in the home was good. The atmosphere in the home was cheerful and calm. Staff were noted interacting with residents in a respectful and friendly manner. Residents were relaxed and looked well cared for. All the relatives and residents spoken with were pleased with the care offered in the home and the quality of the staff. The home was found to be clean, warm and free from unpleasant odour.The Laurels Nursing HomeDS0000049317.V377781.R01.S.docVersion 5.2Some positive comments received from residents included: " They look after everyone well” and “I am very happy” and “ the food and activities are good”. What has improved since the last inspection? The requirements made at the last inspection have been met. That 50% of care staff have achieved NVQ level 2 or 3. There was evidence that care plans are being written in a more person centred way and in consultation with the resident themselves or their representative and that reviews had been completed appropriately. The registered provider have developed a holistic/person centred dependency tool that links to staffing numbers and skill mix to resident numbers and needs. Hot water temperatures are controlled and monitored to reduce the risk of scalding to residents. The supervision process has commenced. What the care home could do better: The registered provider should ensure that end of life planning and personcenteredness is further developed. The registered provider should ensure that registered nurses learning needs are fully recorded and assessed at appraisal and access training for related to the Mental Capacity Act and other identified clinical areas.The Laurels Nursing HomeDS0000049317.V377781.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE The Laurels Nursing Home South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER Lead Inspector Andrew Pollard Key Unannounced Inspection 15th October 2009 09:00 DS0000049317.V377781.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.2 Page 2 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 The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Nursing Home Address South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER 01761 470631 01761 471351 Lreuropeancare@aol.com www.europeancare.co.uk European Care (SW) Ltd 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) Ms C Watkins Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 36. 14th October 2008 Date of last inspection Brief Description of the Service: The Laurels is a care home operated by European Care as from May 2003. The company operates numerous other care homes registered with the Care Quality Commission. The company has one other registered care home within Bath and North East Somerset. The home is an older detached property, which has been considerably extended and adapted. It is situated in the village of Timsbury, which is approximately 9 miles from the city of Bath. Accommodation is offered on two floors and there is a passenger lift between floors. There are a total of twenty-eight single bedrooms and five shared rooms. Only one of the single bedrooms offers en-suite facilities. There is extensive parking available to the side of the property. The Laurels Nursing Home DS0000049317.V377781.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 two stars. This means that the people who use the service experience good quality outcomes. Part of this visit was to concentrate on checking whether the home had met the requirements of the last report. Seven resident surveys were available prior to this site visit and one staff survey. A number resident, relatives, staff and the manager were consulted during the visit. The home had submitted an Annual Quality Assurance Assessment prior to the visit, which was well completed and gave useful information. There have been a number of improvements in quality of care in the home for residents since the last inspection. These are described in the sections below. This visit took one day to complete. Information has also been gathered from the Annual Quality Assessment Audit, the last report and notifications sent from the home to the Commission. Discussions were held with resident’s relatives and staff about their opinions of the care and service provided. The home is being managed by Ms Watkins who has been in post since August 09 but has yet to submit an application for registration to the Commission. The key findings of this visit were given to the manager during the visit. What the service does well: Staff spoken with indicated that morale in the home was good. The atmosphere in the home was cheerful and calm. Staff were noted interacting with residents in a respectful and friendly manner. Residents were relaxed and looked well cared for. All the relatives and residents spoken with were pleased with the care offered in the home and the quality of the staff. The home was found to be clean, warm and free from unpleasant odour. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.2 Page 6 Some positive comments received from residents included: They look after everyone well” and “I am very happy” and “ the food and activities are good”. What has improved since the last inspection? What they could do better: The registered provider should ensure that end of life planning and personcenteredness is further developed. The registered provider should ensure that registered nurses learning needs are fully recorded and assessed at appraisal and access training for related to the Mental Capacity Act and other identified clinical areas. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.2 Page 7 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. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 People using the 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 clients and their families are given relevant information and terms and conditions in written or verbal form about the home to assist them in deciding if the home is suitable for their purpose. As a result of effective assessment of needs prospective residents can be confident that needs will be met in a manner to suit the individual. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 10 EVIDENCE: A statement of purpose and service user guide is made available at the initial stage of enquiry to prospective residents/families. This provides useful information about the services available and includes the terms and conditions. There is a document giving additional information to prospective residents about how the company/home operates. The Statement of Purpose will need to be amended to show the change of manager, CQC contact details and the admission criteria. Visits by prospective residents to the home are encouraged either for the day or perhaps for lunch dependent on their wishes. The home has an improved person centred admission procedure and preadmission assessments based on the activities of daily living. Post admission a more detailed assessment is carried out which along with the Social Services care plan (where appropriate) informs the care plan. All residents have Waterlow, handling, nutritional, falls and continence risk assessments. The assessments were fully completed and gave useful information to staff. The manager is committed to the full implementation of person centred planning to enhance resident’s quality of life. A dependency assessment is also made which is regularly repeated and a more specific version to link staff skill mix and numbers in high dependency cases. All bar one of the residents are older people and of white UK ethnic origin. The AQAA does not indicate any residents with particular needs related to culture religion or sexuality. Individual assessments ensure that any specific needs i.e. spiritual/cultural if identified are included in the care support plans. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans detail residents care needs they are clearly written and have a person-centeredness approach. End of life planning and needs further development. Appropriate personal and nursing care is offered to residents to maintain residents’ health, well being and dignity and residents are treated with respect and given choice in how needs are met. Proper arrangements are in place for residents to access healthcare services and for the administration of their medication to maintain or improve their quality of life. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 12 EVIDENCE: Several individuals care records were reviewed at this inspection and it was found that the plans in place had been generated from a care management assessment. Information contained within care records included: an individual’s profile containing information about the reason for admission, health care support services involved, next of kin, family contact details and medical history. Risk assessments were in place with detailed information to ensure safe procedures for example, manual handling, the correct use of bed rails and how to reduce the risk of falls. Each resident also had records of health professionals visiting, daily records of individuals routines and a care plan. A more person centred/holistic approach is evident in the management of care and documentation, which the manager will further develop. It is intended that each resident has a brief biography written and a person centred assessments where their wishes, likes and dislikes are put at the centre of the care provided. It is intended that people’s health and social needs including, psychological, emotional, and cultural needs be addressed to demonstrate that the home takes a holistic approach to the provision of care. The manager is considering creating care summaries to be kept in residents rooms for use by care staff. Wound care plans were present and were accompanied by wound assessment forms, which allow an assessment of the size and condition of the wound. These gave sufficient information to gauge any improvement or deterioration in the wound. End of life Care Plans are becoming established and will be enhanced whereby residents are encouraged to think ahead about the care they would like to receive if their health deteriorates. A nurse has delegated responsibility for developing this aspect of care and documentation and has received appropriate training for this purpose. Regular evaluation of resident’s care plans was taking place, where possible with the involvement of the resident, family members and key worker. The reviews allow opportunity to discuss and evaluate residents’ care plans and any issues or concerns they may have. We discussed the value of an annual reassessment and care plan re-write (where indicated), which could be linked to Social services, review and involve residents or advocates. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 13 Each resident was referred to a GP on admission to the home and an initial first visit was then set up. The GP’s conduct weekly visits or on request and good working relationships are in place. General Practitioner (GP) and Para-medical visits and their outcomes were well documented. Returned resident surveys indicated their satisfaction with comments such as, ”The staff have always looked after me well” and “I think this is a good home where the residents are well cared for”. Policies and procedures for receiving, storing, administering and disposing of medications are in place and meet with current legislation. The receipt, administration, disposal and controlled drug records were up to date and in order. The pharmacist who supplies the medication also receives unwanted medication for disposal. None of the current residents is able to self medicate at present but appropriate policies and risk assessments are in place if the need arises. There was appropriate storage and recording for controlled medications. The home has a pharmaceutical storage fridge the temperature of this is checked daily. Throughout the inspection all of the staff on duty were observed helping residents with their needs in a polite way. Staff knocked on resident’s bedroom doors and spoke to residents respectfully. Comments from residents were very complimentary of the staff and the care they provided. All the residents spoken with said, they were satisfied with the overall level of care being provided. They spoke highly of the staff saying they were, “Friendly and caring”. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social and recreational activities is arranged that seek to enhance the quality of life for the residents. Resident’s families are involved and informed of issues related to their relatives and are able to maintain close contact with families and friends. The food is of a good standard and provides a balanced diet for residents. EVIDENCE: It has been possible to recruit an activity organiser who is working full time in the home and has enhanced the quality of social and recreational activities taking place. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 15 We discussed the value of individuals being assessed basis on admission and thereafter to enable the staff to plan suitable activities relevant to their cognitive function and preferences. A programme of events is written and on display. There is a record of activities that residents have participated in are recorded. Special events including: harvest, fetes and Halloween take place. Various entertainers visit the home. Various outing have taken place for which residents have free use of a community mini bus. Photographic displays recording these events were seen. Individuals have records of their social and activity choices and record of participation in their files. A relative and resident forum is in place and is chaired by the activity organiser. Resident’s benefit from services run by the local churches including weekly hymn singing and Holy Communion each month. A resident spoken with enjoys the service. At present there are no residents with specific cultural or religious needs other than those of a Christian background. The menus are provided are four week rotational with seasonal variation. The menus are in part based on the outcome of a survey of resident’s preferences. However the manager has obtained some very helpful guidelines from The Food Standards Agency, which will be used to revise menus in the near future. Staff were seen to be assisting some residents to eat on a one to one basis in a dignified manner. Residents spoken with said they enjoyed their meals and said the portions were good, although a small number of people in surveys said that they only some times liked the food. Surveys indicated the majority of respondents felt there were always activities that they could take part in. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies in place to protect residents, investigate complaints or manage allegations of abuse. Arrangements are in place for staff training in these matters so residents can feel safe and have their concerns dealt with. EVIDENCE: A copy of the complaints procedure is on display in the main foyer and is included in the Service User Guide provided to people on admission. The complaints policy and procedure is clear and contains most of the required information but reference should be made to the funding authorities that have the power to investigate should the internal process not resolve matters. One formal complaint has been received by the home since the last inspection, which has been well managed by the manager and to the satisfaction of the complainant. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 17 Several thank you/complimentary letters were seen from relatives on the notice board. The home has written procedures related to adult protection and whistle blowing. The Local Authority ‘No Secrets’ document was available. Abuse and adult protection training is included in the induction workbook for all staff. Local Authority (LA) alerter training is regularly arranged for all home staff in adult protection procedures. It was suggested that the manager undertakes higher level investigators training in adult protection run by BANES. All resident surveys indicated that they knew how to raise a complaint or concern if need be. Staff spoken with were aware of the basic procedures and none had seen any thing that gave them cause for concern. There have been no allegations of abuse. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26, People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a safe and well maintained clean environment with good furnishing their needs are met by having bedrooms and communal rooms and facilities, which are suitable for their purpose and meet the resident’s needs. The general décor requires upgrading in a number of areas. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 19 EVIDENCE: The home was found clean, warm, well lit and free from unpleasant odours. Resident’s rooms were well furnished and had been personalised. Surveys and comments indicated that the home was kept fresh and clean. The general level of décor is adequate but a rolling programme of upgrades and redecoration is needs to prevent the standards becoming poor A number of bedrooms need painting and replacement carpets and corridors are beginning to look tatty in places. The residents sitting in the communal areas appeared relaxed in their environment. Suitable dining room seating and table facilities are provided so that residents can enjoy their meal times comfortably and in a congenial setting. However the manager has plans to reconfigure the communal areas to make better use of the space. One room has an en-suite bathroom. There is a shower and parker bath in the home to offer more flexibility to residents. Resident areas are fitted with appropriate aids such as grab rails, suitably equipped bathrooms and there are fixed and mobile hoists and stand aids. All rooms have a nurse call system with audible alarm facility. A range of pressure relieving equipment is in use and kept in stock. A passenger lift ensures level access throughout the home. The maintenance man regularly tests and records hot water outlet temperatures, however these are often well below 43 degrees and we discussed the need to raise water temperatures for hot water. Safety valves have been put in place to all hot water taps in the communal baths, showers throughout the home Sluice areas included a washer disinfector. The laundry has sufficient washing machines and tumble dryers. There are infection control, policies and procedures in place. Alcohol hand wash is available at the front door for all visitors to clean their hands. The clinical waste is correctly disposed of to prevent the spread of infections. The most recent Environmental Health report detailed a list of minor contravention, which have all now been resolved. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 People using the 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 recruitment procedures and records are in good order. There are sufficient numbers of staff to meet resident’s needs. Progress is being made training care staff but Registered Nurse training needs more fully need to be addressed for the benefit of residents. EVIDENCE: At the time of the visit there were 26 people living in the home. In the morning 6 care staff and 1 Registered Nurse (RN) are on duty. In the afternoons there are 5 care staff and 1 RN. At night there is 2 carers and 1 RN, all are waking. The manager role is supernumerary Monday to Friday. The manager stated that the dependency levels are reviewed to ensure appropriate skill mix and staff numbers. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 21 There has been minimal use of agency staff and where possible continuity of supply is maintained. A holistic/person centred dependency tool is available to ensure high dependency levels are properly resourced. All residents have a key worker and named nurse to support them with the manager being involved with the overall monitoring of individual care. It was clear from surveys and discussions that staff have good relationships with individuals and support people appropriately. There are satisfactory staffing arrangements for housekeeping, laundry, catering and maintenance. Residents’ surveys agreed that staff were available when they needed them and always listened and acted upon what the residents had to say. Staff that were observed to be supporting and caring for the residents, they were patient and encouraged residents to make choices. The organisation has an equal opportunities policy and conducts diversity monitoring of staff. The recruitment records seen were in good order and met the requirements of the Regulations. Completed application forms, two written references, a statement of health and fitness to work, proof of identity, interview notes and the persons qualifications are on file. There was evidence that the home seeks confirmation from the CRB of the persons suitability to work with vulnerable people. The original disclosure form was kept until signed off during the inspection by a Commission inspector. A formal log has been created which records all the relevant details. The company policy is to renew the disclosures triennially. Some disclosures contained information and there is a procedure for carrying out risk assessments where disclosures revealed convictions. The risk assessments had been completed by the previous manager and lacked sufficient detail and need a record of the interviews and confirmation from HR that appointment is appropriate. The home uses a comprehensive induction booklet, which is given to new staff to work through when they start. The book contains sections on principles of care, safeguarding adults, person centred care and safe systems of working among others. 50 of care staff have achieved level 2 or 3 National Vocational Qualification (NVQ). The home is working towards improving the percentage of staff that have an NVQ level 2 in care. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 22 A training matrix has been developed to show that all mandatory training including fire safety, food hygiene, first aid, load handling, medication and adult protection were undertaken and course dates that have been organised for staff. NMC qualification confirmations are checked for all RN’s annually. We discussed the need to enhance the clinical updating for RN’s at a professional level in areas relevant to caring for older people. It was recommended that RN learning needs be fully assessed at appraisal and supervision and individual nurses equipped to have some expertise in various areas of clinical practise. Individual training records for RN will be updated to evidence they are meeting minimum registration standards for clinical updating. This was raised with the previous manager but not completed before she left. Ms Watkins is now dealing with the issue. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run takes into account the views and wishes of the relatives and residents and as they are able. There are good arrangements in place to maintain and service the equipment and facilities in the home. The Home protects the health and safety of residents and staff. The staff supervision and appraisal arrangements are in place. EVIDENCE: The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 24 There has been a high turnover in registered managers. Ms Watkins has been in post since August but has yet to submit an application to the Commission. An application is expected to be submitted in the coming week. In the past this continuing difficulty has inhibited progress in uplifting and maintaining quality in all aspects of the service and it’s rating, however there is a notable improvement in the management which is to the benefit of the residents. Ms Watkins is a registered nurse who was able to demonstrate an understanding of the needs of the individuals living in the home and considers she has a good team who are working to raise standards of care and quality of life for the residents. A deputy manager is in post to support Ms Watkins. There are weekly team manager meetings and monthly staff meetings. The programme manager has been visiting the home regularly and is responsible for monitoring the home and carrying out monthly Regulation 26 visits and writing a report, however a number of reports were not available on file and it is unclear if they had taken place. The manager feels well supported Most staff had received supervision on a one to one basis, which has been delegated to RN team leaders and is now properly established. A Process is in place to conduct annual appraisals for all staff. The procedure for safekeeping of resident’s money was examined at the last inspection and the report stated: Each person has a ledger sheet, which accounts for all transactions and receipts for purchases are kept. The records were clear in good order and up to date. Valuables taken into safekeeping are to be returned to relatives if the resident does not wish to or is unable to keep it himself or herself. The fire alarm system is checked weekly and the maintenance checks of the fire fighting equipment and alarms are done regularly and relevant invoices seen. Staff are updated with fire safety training, the night staff having three monthly and the day staff six monthly updates. The home has appropriate moving and handling and pressure relieving equipment and that staff have attended updates on safe handling of residents and further training is planned The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 25 The home employs a maintenance man who works full time; he completes weekly and monthly maintenance checklists. Records showed that relevant inspections and maintenance has been carried out at the required intervals for the fire alarms and equipment, electrical services, water, wheelchairs, hoists and lifts. The gas safety certificate was not available but the manager stated the inspection had taken place and will forward a copy of the certificate. The home has a Health and Safety policy and audits and relevant training takes place. Generic and individual risk assessments are in place and kept under review. Manual handling risk assessments are completed for all residents; a review of these documents at the home found that these had been fully completed and identified areas of potential risk and how individuals would be supported in line with their assessed needs. There is a process for accidents recording and those forms seen were properly completed and followed up. All residents have risk assessments including tools for assessing and reducing the risk of falls. Weekly meetings are held between the manager and heads of departments and weekly trained staff meetings take place. There is a monthly SW manager group meeting with the programme managers. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 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 2 3 3 3 X 3 x 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 27 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. Standard OP19 Regulation 23(2)(d) Requirement Ensure that all bedrooms communal areas and corridors are decorated and carpeted to are reasonable standard. Timescale for action 21/01/10 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. Refer to Standard OP7 OP30 Good Practice Recommendations The registered provider should ensure that end of life planning and person-centeredness is further developed. The registered provider should ensure that registered nurses learning needs are fully recorded and assessed at appraisal and access training for related to the Mental Capacity Act and other identified clinical areas. The registered person shall ensure that hot water temperatures are controlled and monitored to reduce the risk of scalding to residents but hot enough to meet their DS0000049317.V377781.R01.S.doc Version 5.3 Page 28 3. OP38 The Laurels Nursing Home needs for a hot bath. The Laurels Nursing Home DS0000049317.V377781.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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