Inspection on 14/05/07 for Laburnum House

This inspection was carried out on 14th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Laburnum House 28/02/06

Laburnum House 08/09/05

Laburnum House 15/03/05

Laburnum House 16/08/04

Laburnum House 10/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Laburnum House Laburnum Avenue Shaw Oldham OL2 8RS Lead Inspector Jenny Andrew Unannounced Inspection 14 May 2007 08:45a 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 Laburnum House DS0000005510.V333075.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. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laburnum House Address Laburnum Avenue Shaw Oldham OL2 8RS 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) 01706847846 01706881624 Laburnum House Shaw Limited Mr David Ferguson Care Home 34 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (2) Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 34 service users to include: *up to 7 service users in the category of DE(E) (Dementia over 65 years of age); *up to 25 service users in the category of OP (Old age not falling within any other category); *up to 2 service users in the category of PD(E) (Physical disability over 65 years of age). A Manager, working a minimum of 30 hours each week, must be in place at all times who has the qualifications, skills and experience necessary for managing the home and who is registered, or has an application for registration pending, with the Commission for Social Care Inspection. 28th February 2006 2. Date of last inspection Brief Description of the Service: Laburnum House is a purpose built care home, which is owned by Laburnum House (Shaw) Ltd. It is registered to provide care for older people and has seven places for people who have dementia. One of the owners is also the registered manager. The home is situated close to bus routes and local amenities in the centre of Shaw, Oldham. Accommodation for service users is provided on the ground and first floors of the building. A passenger lift has been installed between these two floors. There are 34 single bedrooms, and en-suite facilities are provided in eight of the rooms. Three lounge areas are provided where residents may also eat. The home is well maintained, both internally and externally. The gardens are attractively laid out and accessible to service users. Private car parking is available, as well as on street parking. At the time of this inspection, the weekly fees ranged from £330.00 to £343.00, the higher rate being for an en-suite bedroom. The home does not charge privately funded residents any more than those funded by the Local Authority. Additional charges are made for private chiropody, hairdressing, newspapers and magazines. Upon admission new residents are invited to join the social amenity fund, which costs £1.00 per week. This is not, however, compulsory. The providers make information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the most recent Commission for Social Care (CSCI) inspection report is kept in the office and a notice to this effect is displayed on the home’s notice board. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection, which included a visit to the home, took place unannounced. This meant the manager was not informed we were coming. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly (care plans) and other records the home needed to keep to make sure the home was safe for those living there. In order to obtain as much information as possible about how well the home looked after the residents, the joint owner, two care assistants, the chef, domestic, three relatives and the visiting district nurse were spoken with. In addition, three residents were spoken to individually and informal discussions took place with groups of residents in each of the three lounges. Comment cards were sent out before the inspection to relatives and residents and of these, four resident and six relative/visitor questionnaires were returned. Their comments, together with information that had been received about the service over the last few months, has also been used as evidence in the report. What the service does well: The joint owners provided good support to the staff as well as spending time with the residents. The residents spoken to felt they were well cared for and that one of the owners was always there to speak to if they had any problems. They also felt the staff were respectful and kind. Comments made included, “the staff are really good”, “if anything’s wrong they listen to you and put things right”, “there’s never a raised word”, “the staff couldn’t be better”, “it’s home from home” and, “the staff are excellent”. Relatives/visitors’ feedback about the staff was also good, with comments being made such as “the staff are always pleasant, cheerful and caring”, “staff are helpful, polite and friendly”, “the staff are dedicated to their jobs and care to the residents is outstanding” and “the staff appear caring and committed to their job”. The home was good at making sure residents’ health was well taken care of by sending for district nurses and other health care workers whenever they felt they were needed. Residents said they felt safe and well cared for. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 6 The residents spoken to were all pleased with the meals they received with choices being offered at each mealtime. They commented; “you always get a choice”, “the food is really good”, “excellent”, “its lovely food”, “they watch what you eat to make sure its healthy because we’ve won an award for that”, “you can have anything you want for breakfast” and “we have good cooks here”. Those people who needed special diets were well catered for. The home was really well decorated and furnished. There were no unpleasant smells anywhere in the building and it was spotlessly clean. Residents and relatives spoken to all commented upon how clean the home was kept. The joint owners were careful about whom they offered a job to and made sure they checked people out before they started work at the home. The owners were good at checking out the quality of care given. To do this, they asked residents, relatives and other visitors to the home about their opinions and took steps to put what they said into practice. What has improved since the last inspection? What they could do better: The home looked after people who had some confusion (dementia) but the staff had not had any specific dementia care training. This training would help them to better understand the residents’ behaviour and the problems they experience. From talking to the owner and staff it was clear that people who lived in the home were supported to live safely. However, the records kept about risk areas did not always show this and where residents could be at risk, because of problems to do with skin conditions, falls or challenging behaviour, risk assessments needed to be written together with what action was to be taken to reduce the risk for the resident. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 7 Although staff did training when they first started work, the training programme needed to be changed so that it covered all the things the new national induction training programme says it should (“Skills for Care”). This would then make sure that all the training, such as food hygiene, moving/ handling, infection control, first aid and fire, was done within the first three months of working at the home. 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. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Standard 6 was not assessed, as the home does not provide intermediate care. The admission process was thorough with relevant information being given to residents before they moved in and an assessment taking place to ensure the home could meet their identified needs. EVIDENCE: Three files were checked, two for people who had very recently moved into the home. Each contained an assessment that had been completed before the resident moved into the home. The owner said she or the manager would visit potential residents wherever they were living at the time so they could make sure they would be able to meet their needs at the home. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 10 When residents were assisted with their funding by the Social Services Department, a care manager assessment was also received. The owner said, in some instances, even when a resident was privately funded, they sometimes received a care management assessment and such documents were in two of the files seen. Prospective residents were invited to visit the home before they made a decision as to whether they wanted to come and live there. A resident and his relative were spoken to during the visit. Both confirmed they had visited the home to look around and meet the staff and other people who lived there. The relative said one of the reasons for choosing the home was that it was clean, well decorated and did not have any unpleasant smells around the building. She also liked the different lounge areas so that people could choose where to spend their time. She said an assessment had been done and they had been given a copy of the service user guide. The home was registered to provide care for up to seven people with dementia. From speaking to staff and checking staff training files, it was identified that the staff had not received any dementia care training. This was discussed with the owner who said she had experienced difficulties in sourcing this training. In order to ensure the needs of people with dementia are fully met, staff must receive appropriate training. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were being well met by staff who respected their privacy and dignity. EVIDENCE: Three care plans were checked for people with varying needs. These included the needs of people during the day and at night. Residents and/or relatives had been included in this process with the care plans being signed. They were reviewed on a monthly basis. The plans contained relevant information about each person but could be further improved by including more information from the care management assessment documents. One person had mental health needs and this was not detailed on the care plan. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 12 Whilst the good practice of documenting the importance of maintaining peoples’ privacy and dignity during assistance with personal care tasks, the plans did not record what assistance each person needed help with and what they could do for themselves. There was nothing documented about bathing, although the residents spoken with all said they had a weekly bath. Two files did not contain a social history, although one plan did record the person did not wish to discuss this. Risk assessments for moving/handling were in each of the care plan files. However, where other risk areas had been identified, such as people exhibiting challenging behaviour, there was no risk assessment in place, with only very brief mention of “maintaining calm” in their care plan. Other risk assessments were absent, such as, where pressure mats were used to alert residents’ movements, skin care (Waterlows) and falls. However, it was apparent from speaking to the owner and care assistants that they were familiar with how to care for and support each person. The residents all felt they were well cared for, that their needs were being met, their preferred daily routines respected and that staff treated them with respect and dignity. A key worker system was in place and several of the residents spoken to knew whom their worker was. Some with short-term memory loss were not able to name their worker but spoke positively about the staff team overall. Key workers were responsible for keeping wardrobes/drawers tidy, purchasing toiletries and consulting relatives, should this be needed. Feedback from relative questionnaires indicated they felt they were kept informed of important matters affecting their relatives/friends. During the visit, a key worker came into the home, in her own time, to accompany one of her residents on a hospital visit. She felt she needed to be there to give the person reassurance and support, which showed real commitment to her job. Whilst there was no nutritional assessment in place, when residents first came into the home, they were weighed and a diet plan was formulated. This could be in respect of under/over-weight or for special dietary needs. Residents’ weight was being regularly checked and a height measure was also in place so that more exact calculations could be made. The senior care assistant had very recently attended a training course in the use of the new Malnutrition Universal Screening Tool (MUST) which is a way of assessing whether people are at risk in respect of being under or over weight. The home had not yet implemented this tool. The owner said she would ensure this was done. This assessment tool should now be used for all newly admitted people and for those residents already in the home where there is concern in respect of weight loss or over-weight. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 13 The visiting district nurse was spoken to during the visit. She was extremely pleased with the way the residents were cared for at Laburnum House. She said the home was always clean and odourless, that staff followed her instructions and there was always one of the owners or a senior to speak to. She also said that when prescriptions were needed, they were obtained without delay. She felt the staff were “extremely caring”, “friendly” and “had a brilliant attitude with the residents”. She said she had recently been visiting on a daily basis to provide nursing care to a resident who had recently passed away. Her comment about the care afforded this person was, “they couldn’t have got better care anywhere”. The turning, fluid and dietary charts were seen which showed the resident had been cared for in line with the District Nurse’s recommendations. All health care professionals’ visits to the home were recorded on each resident’s file and care plans were reviewed to include specific instructions. The residents said if they felt ill, staff would send for their GP without delay. One relative said, “if mum has any medical concerns, the staff always take appropriate action and send for the GP, get her prescriptions, etc. A medication policy/procedure was in place but it did not include reference to controlled drugs or the use of homely remedies. The owner said there had been no-one on any controlled drugs that she was aware of and that they did not use any homely remedies. Given that a resident may be prescribed controlled drugs, this must be addressed within the policy. The morning medication round, done by the senior care assistant, was observed during the visit. The good practice of a second care assistant to assist with the round was noted. The medication was being given out efficiently and in line with the home’s policy. A monitored dosage system was in place with the suppliers being a local pharmacy. The arrangements in place in respect of receipt, recording, storage, handling and administration of medication were satisfactory. As part of the admission process, residents were asked about holding their own medication. If they wanted to do so, a risk assessment was done identifying any risk areas and the action which would be taken to address the risk. One resident only was holding her own medication and a risk assessment was in place. All the staff responsible for giving out medication had received appropriate training. Two seniors had also done an advanced medication training course. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity were respected at all times. This was also observed during the inspection. Residents were taken to the toilet without having to wait, toilet doors were closed and staff knocked on bedroom doors before entering. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 14 Relatives confirmed they were satisfied with the staff’s manner and attitude towards the people they visited. One relative commented “staff attitude to residents in excellent with dignity preserved at all times”. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. These included closing toilet doors, waiting for residents outside the toilet or bathroom if the person wished them to do so, knocking on doors before entering, talking people through how they were going to assist them and keeping the person covered up as much as possible when assisting them to get dressed. Evidence of this was seen at the time of inspection when a district nurse visited and the person was seen in the treatment room. Sixty percent of the staff had done NVQ level 2 or above training which included how to treat residents with respect and dignity. Residents were also encouraged to remain as independent as possible and this was observed during the inspection. Residents who were becoming less mobile were being encouraged to continue to walk, with the aid of their zimmer frames or walking sticks. The home was adequately equipped with necessary aids and adaptations, which promoted people’s independence. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents were able to follow their chosen lifestyles, both in and outside of the home and varied and nutritious meals were provided for them. EVIDENCE: Residents were able to make choices in many areas of their daily routines but this did depend on their mental frailty. Residents spoken to gave examples of choices they regularly made: where to sit or eat (there being three lounge/ diners), what to wear, whether to join in with activities or not, when to get up and go to bed, what to eat and where to see their visitors. When residents first came into the home, a brief social history was recorded, involving the resident and/or their relative so that the home would have some information about what kind of things the person had previously enjoyed taking part in and what sort of routine they preferred. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 16 The majority of the residents who were able to express their views said they were satisfied with the social activities that were arranged in house which they said took place regularly twice a week, when the owner’s wife came in specially to arrange things. One of the newer residents said he would like to be kept more occupied and play dominoes or other games more frequently and go out for a walk to the local shops. During the visit one of the carers accompanied him for a walk to the shops. Some relative feedback, from returned questionnaires and from those spoken to during the inspection, also indicated they felt that more daily stimulation could be offered to the residents. Comments made included, “the service could be improved with more daily activities being offered” and “my relative likes to keep occupied and there’s not enough for them to do”. The staff said they tried to get all their jobs completed during the morning so they would have time to spend with the residents in the quieter period in an afternoon. During the visit, staff did spend time on a one to one basis, chatting with people and one carer was manicuring the nails of a resident who said she loved having her nails done. There was, however, no evidence recorded of what activities were taking place on a weekly basis, as there was no activity programme or individual social activity sheet on the individual residents’ care plans. The manager said she would address this shortfall. In-house entertainment, special celebratory days and trips out were however arranged on a regular basis. Upon admission, residents were asked if they would like to join the social fund, which cost £1.00 per week and included all external activities. Those declining to join were charged for any outings they took part in. Residents were included in the planning of what events they wanted to take part in or to be arranged for them within the home. These were usually done at resident meetings that took place every three months. The minutes of the meetings were seen. Those for the most recently held meeting, that had taken place on 2 April 2007, identified various functions had taken place. These included an Easter buffet and birthday party, a potato pie supper, “chippy” supper and celebrations with entertainment for St George’s day. Future planned events included an entertainer on 20 May 2007, resident birthday parties and a summer fair on 2 June. Residents had also requested a repeat visit to Southport Flower Show, a trip to Hollingworth Lake and a garden party in the summer. The manager may wish to put up posters advertising forthcoming events so that both residents and visitors to the home will be reminded of what is to take place. One relative commented, “special dates, such as Christmas and birthdays, etc., are always celebrated in great style”. Those residents not wishing to join in with the entertainment were not put under pressure to do so. One relative comment card said, “my aunt does not like a lot of fuss or noise. When the home has events for the residents, they always take her to a quiet room so she does not get agitated or upset”. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 17 Feedback from relative/visitors’ returned comment cards identified they were made very welcome when they visited. Comments made were, “family and friends are always made welcome and can visit at any time”, “the atmosphere within the home is really one of visiting my mother’s home, not a care home”, “whenever you visit there is laughter, music, friendly staff and a general relaxed feeling” and “the staff are friendly to relatives/people who visit the home - there are no restrictions on visiting”. Whilst residents were encouraged to manage their own financial affairs, as far as they were able, it was generally their relatives who assisted with this. The home was however, aware of advocacy services should a resident need some impartial advice and support. Good provision was made for residents to continue to follow their chosen religions, with regular attendance at the home by representatives from Church of England, Roman Catholic and Methodist faiths. The Salvation Army also visited to see one of the residents. Feedback from residents about the food was excellent in respect of choices, amount and quality. The Chef had been awarded several awards in respect of food and hygiene, including the “Heartbeat Award” by Oldham Council’s Environmental Health Department. This was in respect of adhering to healthy eating standards, such as low use of salt in cooking, utilising fresh products, etc.. The standard of cleanliness and organisation of the kitchen and storage facilities was of an extremely high standard. Resident meetings, which were held quarterly, were used to discuss changes in the menu and this had happened very recently. From checking the fourweekly menus, it was identified that meals were balanced and nutritional with a good assortment of meats, fish, vegetables and fruit being offered. Fresh fruit and salads were available daily. Breakfast was observed during the visit and residents could have more or less anything they liked. Grapefruit, bananas and prunes were offered, together with cereals or porridge. This was followed by something cooked, which on the day of the visit was bacon. Two hot choices together with a salad were offered at lunchtime. At teatime, a hot meal/snack as well as sandwiches was offered. Desserts were served at lunchtime and home baked products served with tea. Fresh fruit was available at any meal. In addition, residents enjoyed suppers and said they could have cakes, biscuits, sandwiches or toast. Milky drinks were also offered. Residents also said if they didn’t like what was on the menu, they would be offered something else. The individual dietary needs of residents were being well met and dietary and fluid charts were completed as and when needed. The chef held copies of the special diets for individual residents. His way of cooking enabled anyone with diabetes to enjoy many of the same foods as the other residents. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 18 There was one main dining room and two smaller ones, as each of the lounges had dining facilities. The rooms were bright and well decorated and attention was paid to how the tables were set. Teapots and jugs of juice were put on the tables so that residents could help themselves and remain as independent as possible. Assistance was given to the more dependent people. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which residents were familiar with and the majority of the staff had received adult protection training so they were clear about what action to take if they felt a resident was being abused. EVIDENCE: A complaints procedure was in place which was included in the service user guide and statement of purpose. It was also displayed within the home. A complaints log book was in place but there had been no entries made. From speaking to staff and residents, it was clear that minor grievances had been made in respect of loss of clothing but these had not been logged as a complaint, as immediate action had been taken to address the problem. Discussion with the owner took place about the good practice of recording all concerns, together with action taken to address them, as part of their quality assurance process. Residents spoken with knew who to speak to if they had any problems and said they would be listened to and things would be put right. The Commission for Social Care Inspection had not had cause to investigate any complaints about the home since the last inspection. The residents spoken with all felt they could speak to the owners or any of the staff about problems and that they would be listened to. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 20 A procedure for responding to allegations of abuse was available as was the Oldham Inter-Agency Protection of Vulnerable Adults (POVA) procedure. No protection investigations had taken place over the last year. At the inspection which took place in February 2005, all the staff had completed protection training. With the exception of NVQ training which some staff had completed, no further training for new staff had been arranged. The owner said she was finding it difficult to find the training for a small number of people. She was aware that protection training should be updated on a two yearly basis. Staff files showed that Criminal Record Bureau checks had been done before new staff started working at the home so as to ensure that the staff were suitable to work with vulnerable people. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home was clean, safe and extremely well maintained providing a comfortable and homely environment for the residents who lived there. EVIDENCE: The home owners had a maintenance programme in place, ensuring that the home was well maintained, as had been the case at previous inspections. They were committed to providing a safe, attractive environment for the residents and ensured bedrooms were re-decorated and carpeted as needed. All the residents spoken to were really pleased with their bedrooms and those seen had been personalised with small ornaments and photographs. They were decorated and furnished to a good standard. One relative commented, “the home is like a five star hotel”. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 22 In one of the lounge areas, there were facilities for the residents or visitors to the home to use to make drinks. One of the visitors spoken to said she really appreciated this. The maintenance plan for 2007/8 showed the owners were considering providing a walk-in shower but this had not yet been finally agreed. This provision would enable residents with a physical disability to have more choice in bathing/showering. The toilets and bathrooms were spacious and well equipped with aids and adaptations, which assisted residents in remaining as independent as possible. The en-suite toilets were also well equipped. The corridors were of a good width and fitted with handrails so that residents could easily get around the building. One resident, who was reliant upon a wheelchair for moving around, was seen to propel himself independently, using the handrails as necessary. There were safe contained gardens and level access provided for those people who were unsteady on their feet. As a result of the new no-smoking rules coming into force from 1 July 2007, the owners had made a decision to make the home non-smoking. None of the present residents smoked and so the owner said they would be changing the Statement of Purpose and Service User Guide to reflect the change. The no smoking rule would apply to residents, staff and visitors to the home. Since the last inspection, both fire and environmental health visits had taken place. Any requirements made in the reports had been met. Relatives and residents were very complimentary about the cleanliness within the home and said that the home never had any malodours. A walk around the building supported this view and the home was spotlessly clean throughout. Residents and relatives particularly commented upon how clean the home was kept. One visitor said the clean well-kept building had influenced her choice when looking around the home initially. Everyone thought the home was a safe place to live and work in. Infection control policies/procedures were in place. At lunch time, staff were seen to change into blue protective aprons for serving food. High standards of hygiene were being maintained in the kitchen. Whilst liquid soap was provided in all the toilets, bathrooms and staff toilet, paper towels were not. In order to try and prevent the spreading of infection, paper towels should be provided in all areas. This should include the bedrooms where residents require staff assistance with their personal care needs. There was a plentiful supply of disposable gloves and aprons available for the staff to use. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 23 The laundry was sited away from the food preparation area and was clean, well decorated and orderly. Sufficient and suitable equipment was provided and sluicing facilities supplied on each floor of the home. One resident had a laundry basket in her room, as her relative preferred to do all the washing herself. Her wishes were being respected. Feedback from one or two residents indicated that missing clothing was not a big problem but some items did occasionally go missing. The care staff were responsible for the laundry, with one person being designated to oversee laundry when coming on duty. The staffing section below comments further on the absence of a laundry assistant. An infection control policy was in place and several of the staff had undertaken relevant training. However, from checking staff training files, it was apparent that several staff had not yet done this training and the manager should ensure this is followed up. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Sufficient numbers of staff, with an appropriate skill mix were provided who did not start work until all references and checks had been undertaken, ensuring they were suitable to work with the residents. EVIDENCE: Inspection of rotas showed that staffing levels, as previously set, were adequate to meet the needs of the current resident group. In order to check out this comment, residents and staff were asked about staffing levels. Residents said the staff were attentive and spent time with them, when they were not looking after other residents or doing other things. All were satisfied with the care they were receiving. Staff felt they were able to do their jobs adequately with present staffing levels. When asked about other duties they had to undertake, they said they did the laundry but the time spent doing this varied from day to day. In order that care staff are able to spend more one to one time with the residents and organise more in-house activities, it is recommended that the owners recruit someone to work part-time in the laundry. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 25 The home had no vacancies, although the owner said she was considering employing a further care assistant. When staff were absent due to holidays or sickness, the part-time staff picked up additional hours or bank staff were used. Although there had been some changes in the staff team since the last inspection, these were not excessive and some of the staff had worked in the home for several years. The staff team make-up reflected the culture of the people using the service. Feedback from the residents was very positive about the staff team and the owners. From observations made during the report, it was evident that good relationships had been made between staff and residents and staff were polite and respectful towards them. Staff feedback indicated staff morale was high, resulting in good teamwork by an enthusiastic workforce who worked positively with residents to improve their quality of life. The manager made sure that staff had the necessary information to undertake their roles efficiently and effectively. Good communication systems were in place, e.g., staff handovers, communication book, work rotas and diaries. Staff meetings were held approximately every two months and staff said they were able to contribute to the agendas. Minutes of the meetings were seen. The owners were committed to offering NVQ training opportunities to the staff. Of the 25 care staff currently employed (which included four bank staff), 15 had successfully completed NVQ level 2 training or above which meant the home had 60 trained staff. In addition, two carers were currently doing NVQ level 3 training and one staff was due to complete her level 2 training at the end of the week. One of the senior staff interviewed said she had recently started on the Registered Manager’s Award and was really enjoying it. Inspection of records showed that safe recruitment and selection practices were followed in line with the home’s procedure. These included receipt of two satisfactory references, Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) checks. Staff were also given copies of the General Social Care Council’s “Codes of Practice” upon appointment. The owner said they never started new staff until they had received a satisfactory Criminal Record Bureau check so they could be sure the people were suitable to work with vulnerable residents. One of the care assistants who had started working at the home within the last 12 months confirmed this good practice, stating she had waited five weeks to start work. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 26 When new staff started work, they did in-house induction training in order to learn how to do their jobs safely. Whilst the areas covered were thorough, they did not meet the Skills for Care common induction standards. Of the three files checked, only one contained a completed record of induction. The other two were incomplete, although they were signed off at the end as the person having completed the training. Evidence to show how the various areas had been assessed was not recorded. Discussion took place with the owner about new staff completing the Skills for Care induction training within the first three months of employment. It was also pointed out that new workers who have already completed accredited externally assessed training will only need to complete the sections which particularly relate to the home, such as policies/procedures, aims/objections and care practices. In order to ensure that all Skills for Care training units were adequately addressed, it is recommended that their format be used. When using this format, where staff have successfully completed NVQ level 2 training, it should be cross-referenced within the induction training records. Staff training files showed that mandatory training had not been undertaken by some of the newer staff. Again, when new staff start work, all mandatory training should be arranged within the first three months of their employment, so as to ensure the safety of themselves and the people for whom they care. The owner had recently booked some staff on moving/handling, food hygiene and fire training but not infection control. In order to monitor training needs, the manager should formulate individual staff training profiles, listing all the training undertaken and identifying when the training is due to be renewed. One training shortfall was identified with regard to equality and diversity and the manager should make this a training priority. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 27 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, 36 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The home was well run by the joint owners, resulting in a high standard of care being given to the residents living there. EVIDENCE: The home was jointly owned with one of the owners also being the registered manager. There was always one of them present over a seven day period, with the manager working three or four days per week and the other owner working the other days. Both were very much involved in the day to day running of the business, and worked alongside staff as well as doing the management tasks. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 28 Residents and relatives liked the fact one of the owners was always around, as this gave them confidence that things would be well run and any problems be immediately addressed. The manager had been running the home since they purchased it in 1999 and was a qualified Registered Mental Nurse (RMN) and General nurse (RGN), as well as holding a Certificate in Management Studies. He was therefore knowledgeable about the conditions and diseases associated with older age. It was, however, identified that this year, he had let his nursing qualifications lapse and was not renewing his PIN number to remain a registered nurse. Mr Ferguson, the manager, was not on duty on the day of the inspection and Mrs Bardsley, the other owner, was in charge of the home. She had a Higher National Certificate in Managing Care, a City & Guilds Teacher Training Certificate, was a qualified NVQ Assessor and had been part of an NVQ level 5 pilot scheme several years ago. Whilst the owner said she and the manager kept their mandatory training updated, they had not attended any recent courses in relation to management of the home. Given the changes in legislation which have taken place over the past 12 to 18 months, it is recommended they attend courses in respect of equality and diversity, risk assessment and The Mental Capacity Act. Feedback from the staff about the manager and owner was positive with comments made such as “fair”, “approachable”, “has given me really good training opportunities”, and “offers support when needed”. The staff interviewed said that whilst informal support and supervision were always available, they did not receive regular one to one sessions and there were no supervision records in the staff files inspected. They did, however, feel that either one of the owners was always there if they wanted to discuss anything with them. They had regular team meetings and annual appraisals were undertaken. One of the senior care assistants said she had just started to do appraisals, with the first one being done the week before the inspection. As well as achieving The Investors In People Award, which had been renewed in October 2006, the systems for resident consultation in this home were good with a variety of evidence seen. This indicated that residents’ views were both sought and acted upon. The owners worked alongside staff on a daily basis and could monitor care practices. Resident meetings were held where people could air their views and opinions and make suggestions about future trips out and entertainment. Staff team meetings were held, with one being arranged for the week of the inspection. In addition, an annual quality audit was undertaken whereby questionnaires were sent out to residents, visitors/ relatives and other stakeholders and an analysis of the survey was produced to show the outcomes. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 29 The majority of the residents living at the home, relied upon their relatives to handle their financial affairs. Some relatives left money at the home for staff to give to individual residents as they needed it and receipts were in place where staff had purchased items on their behalf. Personal monies for three residents were checked and found to be in order. All accounts, including the residents’ social activity fund, were externally audited on an annual basis. The pre-inspection questionnaire recorded that all required health and safety policies and procedures were in place and that all maintenance checks were up to date. Random record sampling was undertaken of the public liability certificate, servicing of lifts/hoists and fire equipment. As previously identified above, not all staff had completed all the required mandatory training. The owner was aware of the shortfalls and was in the process of accessing the training needed. Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 30 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 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 31 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 OP3 Regulation 18(1)(c) (i) Requirement As the home is registered to care for people with dementia, the staff must receive training so they will better understand the needs of the people they care for. Risk assessments must be in place in respect of skin and, where applicable, challenging behaviour, falls and pressure mats in order that staff know what action to take to lessen the identified risk area. Timescale for action 31/10/07 2 OP8 13(4)(c) 29/06/07 Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 32 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 3 4 5 Refer to Standard OP7 Good Practice Recommendations Information from the care management assessment should be included in the care plan so that it is more detailed. The medication policy should include the procedure for controlled drugs and homely remedies so these medications will be given out safely. The manager should consider recording individual activities enjoyed by residents on their care plan file. Paper towels should be available in toilets and bathrooms and staff should receive infection control training . A part-time laundry assistant should be recruited so that the care assistants will have more time to spend with residents on a one to one basis and to organise more activities. The induction training programme for new staff should meet the Skills for Care induction standards and all new staff should complete this. The owners should keep up to date with new legislation and undertake training in respect of equality and diversity, risk assessment and the Mental Capacity Act. All staff should receive regular one to one supervision. OP9 OP12 OP26 OP27 6 7 8 OP30 OP31 OP36 Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Greater Manchester Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laburnum House DS0000005510.V333075.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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