Inspection on 21/04/05 for Laburnum House

This inspection was carried out on 21st April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Laburnum House 23/10/07

Laburnum House 03/08/06

Laburnum House 07/12/05

Laburnum House 14/09/04

Laburnum House 06/04/04

Laburnum House 28/10/03

Laburnum House 03/06/03

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

CARE HOME ADULTS 18-65 Laburnum House Second Drive Landscore Road Teignmouth TQ14 9JS Lead Inspector Sam Sly Announced 21 April 2005 st 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Laburnum House Address Second Drive, Landscore Road, Teignmouth, Devon, TQ14 9JS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01626 774662 Rotel Limited vacancy Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 14th September 2004 Brief Description of the Service: Laburnum House cares for up to 18 adults with learning disabilites under 65 years old. The Home is run by a company called Rotel that owns two other homes for adults with learningi disabilites in South Devon. The Home is in a residential area of Teignmouth within walking distance of the town centre, bus routes and the train station. There is level access into the front of the Home, but steps throughout the rest of building may present difficulties to someone with a mobility problem. All of the bedrooms are en-suite and single, with additional toilets, showers and a bathroom.Seventeen of the bedrooms are in the main building with a selfcontained flat in the grounds. There are a number of communal rooms throughout the Home. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Owners had been told that this Inspection was going to happen. It took place on a weekday in April. Over half of the time was spent in the office with the acting manager Iona Fusco, deputy manager Sara Watson and the representative for Rotel Alison Whitehead. This amount of time was spent looking at files, documents and care records, and talking to the management team because there had been shortfalls in the service identified at the last CSCI visit in September 2004, and there had been a lack of consistent management at Laburnum House for over a year. Time was also spent talking to, and observing, four residents and two staff members, and doing a tour of the whole building. No comment cards were received about the Home. An additional announced visit will take place in June 2005 to make sure requirements in this report have been acted on. What the service does well: What has improved since the last inspection? A programme of redecoration and refurbishment had improved the environment, which was looking clean, homely and comfortable. Iona and Sara had worked hard with Alison to make sure required records and paperwork was in place so that residents were safe and protected from harm, and staff could meet their care needs. There was now a stable management team, which meant residents and staff benefited from a clear sense of leadership. Iona, Sara and Alison had shown Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 6 commitment and dedication to improving the service for residents, by meeting many of the requirements of the previous Inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None were inspected. EVIDENCE: Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 Care plans reflected the assessed needs of residents, including risks, so residents and staff knew what care and support was required. Not every resident had personal goals identified, without goals residents will not grow in independence. EVIDENCE: Residents had a detailed care plan and risk assessment that he or she, or their relative had been involved with making. Plans reflected the needs of those residents spoken to, but not some of their personal goals. One resident wanted to gain confidence in using a plane to visit family abroad, and this was not recorded. However, by the end of the visit the Iona and Sara had spoken to the resident about this goal and started putting together a plan to achieve it. Some care plans examined did not have any personal goals recorded at all. Risk assessments helped, not hindered residents independence and reflected potential risks identified through talking to staff and residents. The plans had been regularly reviewed, and staff spoken to understood the needs of the residents. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 Most, but not all residents attended some leisure, work and educational activities. However, insufficient information was available for residents to make informed choices about activities and opportunities in the local community. EVIDENCE: Most residents attended day activities provided by Rotel called Focus 2000. This service included some leisure, work and educational activities. On the day of inspection, of the four residents spoken to, one had been to Focus 2000 and returned on the train as was usual, one had been out with staff in the local community shopping, one had attended a local church drop-in which he said he really enjoyed, and one was not doing much. Discussion with the Iona clarified that plans were being made to review the needs of this last resident. Those that needed it had extra staffing to help get the most out of activities. Resident’s daily records showed Focus 2000 offered lots of activities, but there was little evidence in the Home of information being given to residents about leisure, work and educational options so that informed choices were made and acted on. One resident said they would ‘like to go out more’. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 11 A requirement had been made at the last Inspection with regard to improving the educational, leisure and work opportunities for residents, there had been some definite progress, but still not full compliance. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19,20 On the whole, the physical, emotional and personal care requirements and preferences of residents were well documented, well understood and met by staff. This meant generally the residents remained fit and well. In theory residents could look after their own medicines and be more independent. In practice, at this time, none of them did. EVIDENCE: Rota’s showed that staff worked until 10pm, which meant residents could do more in the evenings. Residents spoken to confirmed their personal, physical and emotional care needs were met in the way they wanted, with professionals involved when necessary. This was recorded in care plans, and daily records. One resident with mobility problems liked having a bath but found it hard to get in and out independently, he also regularly used stairs that did not have a sturdy handrail. With his agreement Iona was told, and agreed to get an Occupational Therapist to review this resident’s mobility needs. In theory residents able to, could look after their own medication. In practice all residents had been assessed as not being able to, and had agreed to staff giving them their medication. Residents confirmed this. The written procedure for giving medication was followed by trained staff with accurate records kept. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 A lack of complaint investigation records meant the acting manager had little knowledge of whether complaints made had satisfactory outcomes. Arrangements for protecting residents were on the whole good, except for training staff on adult protection. This meant that residents could be at risk of harm or abuse. EVIDENCE: There was a complaints procedure that residents spoken to understood. A number of complaints had been made to CSCI concerning Laburnum House before the last visit. Some of the issues were reported at the last visit in September 2004 as still unresolved. Due to there being no record of these complaint investigations in the Home, Iona did not know all the outcomes. Iona had improved the practices regarding resident’s money, and staff received training on working with aggressive behaviour in positive ways. Few of the staff, including the Iona, Sara and staff left in charge of the Home, had received adult protection training, which left residents potentially vulnerable to abuse or harm. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 All the maintenance and redecoration issues in the Home had been identified and were being worked on. The Home presented as clean and hygienic, homely and comfortable. EVIDENCE: A thorough maintenance assessment had been carried out, and all the issues identified by the Inspector had already been recorded. Work was in progress on outstanding issues. Residents spoken to said they liked their bedrooms and the communal rooms. Iona had ideas for encouraging residents to make use of all the communal rooms dotted around the Home. Iona said the Environmental Health Department had visited the Home in November 2004, but did not have a copy of the report. She agreed to send a copy to CSCI. A new kitchen had been installed since the visit. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, 36 The procedures for recruiting staff were robust, and were on the whole being followed, however some missing information in staff files meant the recruitment process did not always protect residents. Lack of an overall training programme for staff, and training for supervisors, meant it could not be guaranteed that residents would benefit from appropriately trained and supported staff. EVIDENCE: Rotel had bought a training package for staff Induction and Foundation. It was found that some staff had not yet started this training. Staff files contained most, but not all, the required information for each staff member with regard to evidence of identity, competence and experience. It was clear that the Iona and Sara were in the process of up-dating all the staff files. All staff had received a range of training including specialist learning disabilities courses. However, a lack of detail about what staff had received and still needed meant Iona did not have an overview of staff training requirements. The cook did not have an up-to-date Food Hygiene Certificate, and was providing care and cleaning at times. Those senior staff supervising others had not received training, which meant residents might not benefit from well-supported staff. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 16 Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42 Laburnum House has been without a qualified, competent and experienced manager for over a year. This means residents and staff have not been benefiting from a well run home. Residents cannot be confident that their views underpin the quality monitoring, review and development of Laburnum House. The health, safety and welfare of residents are promoted and protected except with regard to the prevention of falls from windows. EVIDENCE: Iona and Sara have both only been in post for 8 weeks, and have achieved a huge amount in that time. Staff and residents spoken to, and staff meeting records showed, they have benefited from management stability. Laburnum House has been without a registered manager for over a year now, and this has contributed to many of the issues identified in previous CSCI reports. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 18 CSCI has not received a registration application from the current Iona Fusco yet. Rotel’s representative Alison Whitehead will be carrying out the quality assurance checks in the Home, but this process had not yet started. Although the Iona had a good idea of the shortfalls and strengths of the Home there was no written quality assurance system so that residents were involved in and benefited from continuously improving services. Training records showed the staff received a range of health and safety training. Fire records were kept appropriately and there were few accidents recorded. All the relevant electric, heating, boiler and Legionella checks had been carried out and any problems dealt with. An immediate requirement letter was left with Iona, as the lack of risk assessment or restrictors on first floor windows, could potentially lead to harm or injury to residents. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 24 25 26 Score 3 x x Version 1.20 Page 19 Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score 27 28 29 30 STAFFING x x x 3 Standard No 11 12 13 14 15 16 17 x 2 2 2 x x x Standard No 31 32 33 34 35 36 Score x x x 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 3 x Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 14, 13, 12 Regulation 16 Requirement Residents must be given a range of information about educational, lesiure and work opportunities so they can make informed choices about what to do. These choices must then be acted on by Rotel.(Timescale of 30/01/05 not met). All Staff must have adult protection training. Staff files must contain all the required information to prove identity, competence experience of staff. Evidence of training staff have received and still required must be kept. The cook must have an up-todate Food Hygiene Certificate, and any other training required for the role. The staff that supervise other staff must have training so they fully understand the process. There must be a manager appointed, and put forward to CSCI for registration. There must be a complete Quality Assurance system in place which captures the views of the residents and Timescale for action 14/06/05 2. 3. 23 34 13 (6) 17 (1) (a) Schedule 3 18 (1) (c) 18 (1) (c) 14/06/05 14/06/05 4. 5. 35 35 14/06/05 14/06/05 6. 7. 8. 36 37 39 18 8 24 14/06/05 14/06/05 27/09/05 Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 21 9. 10. 42 22 13 (4) 22 stakeholders. An annual report must be produced, with a copy available for CSCI and other interested people. First floor windows must have 21/04/05 restricted opening, if assessed as necessary, to prevent accidents. All information concerning 14/06/05 complaint investigations and outcomes must be kept in the Home. (Timescale of 14/09/04 not met). 11. 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. Refer to Standard 6 12, 13, 14 18 Good Practice Recommendations Long term goals should be agreed with each resident so that they gain independence and skills. Review with the placing authority the resident discussed. Make a referral to an Occupational Therapist for the issues discussed. Laburnum House D54-D07 S3733 Laburnum House V210853 210405 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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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