Care Home: The Laurels - Winsford

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What the care home does well People`s needs are assessed before they go to live at The Laurels to make sure that it is the right home for them. Residents have choices in how and where they spend their time and a good range of social activities is provided for those people who like to take part, so they can stay active and busy. There are very attractive gardens that are accessible for residents so they can sit out on warm days. Most of the care staff have an NVQ in care and others are working towards a qualification so they can provide better quality care for the people who live in the home. Good recruitment procedures are followed to ensure that new staff are suitable to work with vulnerable older people, and new staff complete a thorough programme of induction to make sure they know how they should provide care for the people who live at the home. What has improved since the last inspection? Since our last big inspection, a system of staff appraisal and regular supervision has been established to make sure that staff receive the support they need to enable them to provide good quality care for the people who live in the home. Since the inspection carried out by a CSCI pharmacist inspector on 30 May 2008, all senior staff have had a competence assessment on their ability to manage medicines safely and there have been improvements in this area. What the care home could do better: More work needs to be done to make sure that records of medicines in the home are kept accurately to ensure that all medicines are accounted for and to show that the people who live in the home have received their medicines as prescribed. When medicines are prescribed to be given `as required`, there should be written guidance for staff to tell them in what circumstances the drug should be given. CARE HOMES FOR OLDER PEOPLE The Laurels - Winsford Walnut Drive Winsford Cheshire CW7 3HH Lead Inspector Wendy Smith Unannounced Inspection 14 and 18 August 2008 10 am 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 - Winsford DS0000006519.V369940.R02.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 - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels - Winsford Address Walnut Drive Winsford Cheshire CW7 3HH 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) 01606 593048 01606 863401 www.clsgroup.org.uk CLS Care Services Limited Philip Caine Care Home 41 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (10), Old age, not falling within any other of places category (31) The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum number of 41 service users to include: * * * Up to 31 service users in the category of OP (older people not falling within any other category) Up to 10 service users in the category of DE(E) (Dementia over the age of 65) Up to 5 service users in the category of DE (Dementia under 65 years of age) 24 August 2006 Date of last inspection Brief Description of the Service: The Laurels provides personal care for up to 41 older people and people with dementia. The home is managed by CLS Care Services, a not for profit organisation which manages a number of homes in the north west of England. The Laurels is in the Wharton district of Winsford, Cheshire, approximately one mile from the town centre, within walking distance of a number of community facilities. It was purpose built in the 1960s and provides single bedroom accommodation on the ground and first floors. One part of the home (Willow) has been converted to provide specialist self-contained accommodation for ten older people with dementia. A separate staff team cares for the residents in this unit. There are several comfortable lounges of different sizes, providing a good choice of communal areas around the home. The home has large enclosed and secure grounds with seating areas and walkways. The Laurels - Winsford DS0000006519.V369940.R02.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 stars. This means the people who use this service experience good quality outcomes. Two inspectors made an unannounced visit to The Laurels on 14 August 2008, with a further visit on 18 August to meet the manager. At the time of our visit there were 35 people living at the home; three other people who live at the home had been admitted to hospital and one was on holiday. During the visit we spoke with residents and staff. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent talking with the home manager. We also looked at any information that we had received about The Laurels since our last big inspection on 24 August 2006. A CSCI pharmacist inspection has visited the home to carry out a short inspection and found there were problems with the way people’s medicines were being managed at the home. What the service does well: People’s needs are assessed before they go to live at The Laurels to make sure that it is the right home for them. Residents have choices in how and where they spend their time and a good range of social activities is provided for those people who like to take part, so they can stay active and busy. There are very attractive gardens that are accessible for residents so they can sit out on warm days. Most of the care staff have an NVQ in care and others are working towards a qualification so they can provide better quality care for the people who live in the home. Good recruitment procedures are followed to ensure that new staff are suitable to work with vulnerable older people, and new staff complete a thorough programme of induction to make sure they know how they should provide care for the people who live at the home. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 6 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 - Winsford DS0000006519.V369940.R02.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 - Winsford DS0000006519.V369940.R02.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): 1 and 3 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who are interested in going to live at The Laurels are given information about the home to help them make a decision. The home manager had done a full assessment of their needs before they moved in to make sure that these could be met at the home. EVIDENCE: There is a service users’ guide for the home that contains information about the home and is produced in clear English in large print. It also contains details of how to make a complaint or raise a concern about the home. The home has a total of 40 places and 35 people were living there when we did the inspection. Three people were in hospital and the manager said that two of these people may need nursing care in the future; if this was confirmed they would not be able to return to The Laurels, as it does not provide nursing care. One person had gone on holiday and there was one vacancy. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 9 Ten people were living in the Willow household which provides specialist care for people with dementia. The manager told us that the needs of these people are kept under review. If their needs change, a re-assessment is requested to decide whether they require nursing care. The care plans we looked at showed that the manager had done an assessment of each person’s needs before they moved into the home. A copy of the assessment done by the person’s social worker had also been received. The Laurels does not provide intermediate care so Standard 6 does not apply. The Laurels - Winsford DS0000006519.V369940.R02.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): 7, 8, 9 and 11 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live at the Laurels receive good standard care to make sure their needs are met in the way they prefer. The recording of medicines needs to continue to improve to show that people have received their medicines as prescribed. EVIDENCE: Each person who lives at the home has a care plan that contains details of their needs and guidance for staff about how these needs should be met. The care plans that we looked at had been completed to a satisfactory standard but were rather long because of the format being used. They are written in the first person; this makes them more personal to the individual. Good daily records are kept and they have meaningful comments about how the person has been that day. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 11 Care plans are reviewed monthly. The manager told us that care plans for people living in the dementia care unit are going to be changed to a more person-centred format in the near future. The care plans recorded visits from health care professionals including speech therapist, district nurse and GP. Accident records are put onto a database and where a need is identified a plan for falls prevention is produced and put into the care plan. Examples of these were seen for two people and measures such as hip protectors were being used. The home does not have good facilities for the storage of medicines. Medicines for people living in Willow household are kept in the small office in the unit, and medicines for the main part of the home are kept in a very small storeroom. A fridge in Willow Unit is used for any medicines that need to be stored at low temperature. In general the records showed that people get their medicines as prescribed by their doctor. The monthly repeat medicines are checked in on medication administration record (MAR) sheets, but where additional items had been received during the month, the handwritten entries were not always signed and dated, and the quantity received was not recorded. Medicines on Willows unit that had been prescribed to be given ‘as required’ were not all recorded on the MAR sheets. There were no records to show that these medicines were in the home, and some of these items dated back to February 2008. The care plans did not provide any guidance for staff about when these medicines should be given. There must be a stock balance kept of these drugs as they are being kept in the home. There were no stock balances for pain relief medication that had been carried over from one month to the next. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 12 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): 12, 13, 14 and 15 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live in the home are able to exercise choice about their daily lives and there are regular social activities for those who wish to take part so they can keep active and stimulated. EVIDENCE: Two part time activities organisers are employed at the home and they provide a variety of social opportunities for residents including at the weekends. We spoke with several people who were joining in a quiz in the activities room and they were enjoying taking part. There is plenty of equipment for them to use, including a computer with large keys, and one person told us she gets e-mails from her family. Other people living in the home are going to be offered the opportunity to learn to use the computer and there is a web cam that they can use for communicating with family and friends. During our visit, some residents were enjoying being outside in the garden. There is also a bowling green that they can use. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 13 During the afternoon of our visit there was a communion service in one of the lounges. This was advertised around the home and was well attended. One person was using the lift to go up to the first floor for the service and she was able to do so without assistance from staff. We saw plenty of evidence of that people are encouraged to maintain their independence. There are a number of small lounges, which gives people a choice of where they would like to sit and who to sit with. There is a lounge that can be used by residents who smoke. Staff must ensure that the door of this lounge is kept shut. There is a pet cat living in the home. In Willow household there are memory boards outside the bedrooms, with pictures and items that are familiar to the resident. Bedrooms are well personalised with belongings that people have brought from their home. The staff of this unit do not wear uniforms and this gives a more friendly and informal ambience. There are touch boards in the main corridor, but we thought that there could be more stimulation for people in the lounge. Residents told us that they very much enjoy the meals provided. There is always a choice and this is written on a menu board. The dining room is pleasant and spacious and lunch was a lively social occasion. People living in Willow household are able to have their meals at a time that suits them. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 14 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): 16 and 18 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live at the home are protected by robust procedures for addressing complaints and safeguarding so that people can be confident that any concerns will be addressed. EVIDENCE: Policies and procedures for dealing with complaints are clearly defined and there is information in the service user’s guide about how to make a complaint. The complaints file recorded one complaint, and this was received in November 2007. There was evidence of an investigation and communication with the person making the complaint. Action has been taken to address the issues identified. CLS provides policies and procedures to guide staff about safeguarding residents from abuse. Training records showed that staff have received training about the protection of vulnerable people from abuse and that this training is regularly updated. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 15 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): 19 and 26 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The Laurels is well maintained both inside and out so it provides a comfortable, clean and safe environment for people to live in. EVIDENCE: The home is surrounded by well-kept gardens with flowers and pleasant sitting areas. Vegetables are grown in a greenhouse and residents are able help with tending the plants. Contractors cut the grass and the home’s staff look after the flowers and produce. All parts of the home were seen to be in a good state of repair. A new bath has been installed on the ground floor. There are several small kitchen areas around the building where drinks can be made. Bedroom doors have knockers and there are names on the bedroom doors. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 16 All areas looked clean but there were some odours in parts of the building. We were told that this is due to some people having continence problems, but if continence is properly managed odours should be preventable in most cases. Most people use commodes during the night as they do not all have a toilet close to their bedroom. Daily cleaning schedules are kept. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 17 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): 27, 28, 29 and 30 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Robust recruitment procedures are followed to make sure that new staff are safe and suitable to work with vulnerable older people. Training is provided to ensure that staff know how to work to a good standard. EVIDENCE: In the main part of the home there is a care team leader and two care staff on duty during the day and two staff at night. For Willow household there is a care team leader and a carer during the day and one member of staff at night. Although some staff told us in surveys they returned to us that they felt there should be more staff at times, the current numbers are adequate provided that the dependency of residents remains low. However, numbers may need to increase if there are more residents who need a lot of assistance. In addition, there are two members of staff working in the kitchen each day, two cleaners and a laundry assistant. The home employs 31 care staff and 24 of these have an NVQ level 2 or 3 in care. Others are working towards level 2 and 3. There are four NVQ assessors in the home. This is a very good achievement. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 18 Personnel records were looked at for the two most recently recruited staff. These showed that all of the required safety checks were carried out before they started working at the home. Interview records were kept and records of a thorough induction process. There is a development plan for each member of staff and a good system of regular staff supervision. The home has training facilities on the second floor. A training schedule for the year is on the notice-board in the manager’s office. Training records showed that staff are kept up to date with mandatory training that ensures they know how to work safely. CLS provides a five day training course about the care of people with dementia and the manager told us that this is an excellent course; however some staff working in Willow household have not received any training about dementia for a few years and may benefit from an update. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 19 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): 31, 33, 35 and 38 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well managed by a competent person to ensure that the best interests of residents are always the priority. EVIDENCE: A new manager for the home has recently been registered with CSCI. He has considerable previous experience of managing care homes and has worked for CLS for several years. The manager showed a good awareness of the importance of the rights and dignity of residents. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 20 The manager holds staff meetings whenever he thinks helpful. There were a series of team meetings earlier in the year to discuss changes needed on Willow household and to monitor progress. A recent staff meeting was held to tell staff about changes to CLS. Relatives meetings are not well attended but a recent satisfaction survey has had a good response. The manager has been collating responses and making a report. Many positive comments have been received, for example ‘the food is always first class’. All of the relatives either agreed or strongly agreed that they are consulted. Responses received from four health/social care professionals gave very positive feedback. An auditing system is in place and this includes looking at a number of care plans each month. An action plan detailing any areas for improvement is given to the responsible care team leader. Medication administration records are audited at the end of each month and the care team leader informed of any problems. The medicines audit in July 2008 identified that stock checks were not recorded. Records showed that action was being taken following the pharmacist’s inspection. A fridge that was not working properly was condemned and thrown out. All of the staff who administer medicines have been completing competence assessments with the manager. Staff complete an accident form whenever an accident occurs and the details are put onto a database. When a problem with a resident falling is identified they are referred to the falls prevention team and a plan for falls prevention is produced and put into the care plan. Examples of these were seen for two people and measures such as hip protectors were being used. The home does not manage the financial affairs of any residents but there is a system in place for people to keep small amounts of personal spending money securely in the home. Detailed individual records are maintained. A part time maintenance person is employed at the home and he carries out and records weekly checks of fire equipment, emergency lighting and water temperatures. A service folder gave details of when all plant and equipment had been checked and serviced and these were all up to date. Training records showed that staff are kept up to date with mandatory training to protect the health and safety of everyone in the home. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 21 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 3 9 2 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 4 29 3 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 - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Timescale for action A record of all medicines that are 30/09/08 currently kept at the home, including a stock balance of all drugs that are carried over from one month to the next, must be kept. This is to make sure that there is no misuse of drugs. All hand-written entries on 28/08/08 medicine administration records must be signed and dated by the member of staff who writes the entry and the quantity of medicines received should be recorded. This should also be counter-signed by a second person to confirm accuracy. This is to ensure that staff have accurate information about how the medicine should be given and that there is accountability. Requirement 2 OP9 13(2) The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations When medicines are prescribed to be given ‘as required’, there should be written guidance for staff about the circumstances when the drug should be given. The Laurels - Winsford DS0000006519.V369940.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North West Region Unit 1, Level 3 Tustin Court Port Way Preston PR2 2YQ 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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