Inspection on 03/08/06 for Laburnum House

This inspection was carried out on 3rd August 2006.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Laburnum House 23/10/07

Laburnum House 07/12/05

Laburnum House 21/04/05

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 Devon TQ14 9JS Lead Inspector Sam Sly Unannounced Inspection 3rd August 2006 13:30 Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 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 DS0000003733.V289118.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 Adults 18-65. 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 DS0000003733.V289118.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laburnum House Address Second Drive Landscore Road Teignmouth Devon TQ14 9JS 01626 774662 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) Rotel Limited Mrs Iona Susan Campbell Fusco Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: Laburnum House cares for up to 18 adults with learning disabilities under 65 years old. A company called Rotel that owns two other homes for adults with learning disabilities in South Devon runs the Home. 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 the 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 DS0000003733.V289118.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was unannounced and took place during the afternoon and early evening of a weekday in August. The registered manager was not present. The visit included observation of the nine residents and their interaction with staff, discussion with five residents, all the staff members on duty and Sam Carus the deputy manager. Three resident’s care was partially case tracked. Care records and health and safety records were examined and a tour of the building, including almost all the bedrooms was made. The Inspection process also included a review of contact the Commission has had with Laburnum House over the past year and comment cards from seven residents, eight relatives/visitors, several staff and four professionals. The required pre-inspection information and data was also received from Iona Fusco by the Commission, as was an action plan for requirements made at the last Inspection. What the service does well: What has improved since the last inspection? What they could do better: Staff must make sure they record when medicine has been given to a resident so mistakes are not made. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 6 The Commission has made some recommendations to make Laburnum House even better for residents to live in. 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. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 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 the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs and aspirations are thoroughly assessed prior to admission. EVIDENCE: There have been no new residents at Laburnum House since the last Inspection. Three resident’s care planning files including their assessments were examined. Assessments were thorough, up to date and reflected the needs of residents as indicated in discussion with staff and residents. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 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 the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in decision-making about their lives and in developing their care plans. The care plans reflect the needs and goals of residents. EVIDENCE: Three residents care planning files were examined and were detailed and up to date. Residents had goals that staff helped them achieve. Residents were involved in compiling and updating plans and regular reviews were held with residents and other relevant people. Several resident’s files indicated they displayed challenging behaviour that involved the use of (PRN) medication. Although incidents were well documented, the use of medication did not form part of a written behavioural support plan for these residents. The behavioural policy for Laburnum House also required some review in light of this. Each resident had a suitable risk assessment that enabled residents to lead as independent a life as possible. There was evidence of key workers holding monthly meetings with individual residents to enable them to make decisions about their lives, as well as regular Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 10 resident group meetings where menus, activities and any other issues were discussed. Residents were supported by staff to look after their own finances and the registered manager kept sufficient, accurate records. Care plans recorded clearly for residents the benefits they were receiving. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy their meals and have varied and interesting leisure, educational and work activities. Resident’s relationships with family and friends are supported by staff. EVIDENCE: Most residents attend day activities during the week provided by Rotel called Focus 2000. This service includes some leisure, work and educational activities. Two residents receive 1:1 staffing (One at all times of the day, the other for several hours whilst at Focus 2000) to enable them participate in activities they choose. On the day of the site visit two residents were at home with two staff at 1.30pm, the others arrived later from Focus 2000 where they had been to the zoo for the day. Residents said they had enjoyed this trip. Discussion with residents found that they enjoyed going to their day service, or spending time at home doing household chores or making visits into the town. Some residents had links with a local Church. One resident said they liked Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 12 going to the pub too. Holidays were being planned for residents to places they had been involved in choosing. Residents were supported to keep in touch with family and friends, and all but one of the relatives that returned comment cards to the Commission said they were made welcome at Laburnum House. Half the relatives commenting said they were not kept informed of important matters, or involved in decisionmaking, however some of these relatives lived some distance from the Home. One of the relatives living a distance away from the Home said: ‘I keep in constant touch with [my relative] via their staff and their letters are always informative and the staff always keep me informed as to [my relatives] well being and activities’. Seven out of the eight relatives were unaware of the complaints procedure for Laburnum House and did not have access to the CSCI reports, so it was recommended that information was sent to relatives. One relative was not satisfied with the overall care provided for their resident, however examination of a recent review found that the issues involved had been fully discussed, with action agreed by the registered manager to improve the service. Staff on duty were observed to be respecting residents privacy and interacting with them at all times. Residents reported that food was good and they helped choose the menu. Residents are encouraged to join in preparing their food, however the deputy manager said some do not want to. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some of the medication practices at Laburnum House do not protect residents, however, resident’s personal care and healthcare needs are met by staff. EVIDENCE: Examination of medication records and observation of the procedures found that the receipt, recording, storage and disposal of medication are done in ways that protect residents and staff have received training. However, tippex was being used on the record sheets, and there were several gaps in the records of medication administered by staff. It was also found that medication given at lunchtime, whilst residents were at Focus 2000 was not being signed as given until they returned to Laburnum House several hours later. None of the resident’s self-administered medication, with this decision being made based on a risk assessment process. Residents confirmed that they had agreed that staff could administer their medication. One resident required insulin injections regularly and needles were disposed of appropriately. Three care plans were examined and showed in detail how residents preferred to have personal support provided by staff. There was a key worker system at Laburnum House, staff interviewed were clear about the purpose of this role Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 14 and residents could identify their key worker. The registered manager keeps clear records of medical checks and meetings, and healthcare was found to be taken very seriously. Comments from professionals received by the Commission were: ‘The staff have made a big impact on [my client] and her social interaction in the community and her peer group’. ‘Staff work extremely hard and followed guidelines and showed a very caring and responsible approach.’ One professional reported that the staff were poor in communicating with them, with contact being initiated by themselves or the resident’s family. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can feel assured that their concerns are listened to and acted on. Procedures at Laburnum House ensure that residents should be protected from abuse, however staff should be better aware of their roles and adult protection procedures. EVIDENCE: The Commission with regard to Laburnum House has received two complaints since the last Inspection. Both complaints were passed to the Responsible Individual Allison Whitehead for investigation, which was carried out swiftly and thoroughly. Residents are given 1:1 time with key workers and group meetings to discuss any issues, and questionnaires have recently been sent to residents too as part of the Quality Assurance system. The Responsible Individual also meets and talks to residents as part of her monthly visits. Seven out of the eight relatives who returned comment cards to the Commission said that they were unaware of Laburnum House’s complaints procedure. All residents that returned comment cards said they knew who to complain to. There was an appropriate Adult Protection policy and procedure for Laburnum House, and all but the newest staff had received Adult Protection training. The staff on duty during the site visit were asked several questions about their knowledge of the Adult Protection procedures and what constitutes abuse. One very new staff member did not know what constituted abuse, nor where the Adult Protection procedures were kept, another knew more about what constituted abuse but did not know where the procedure was kept. The deputy manager in charge at the time did not know what her role was, with both the Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 16 registered manager and Responsible Individual away, and did not have up to date contact numbers for an adult protection referral. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are suitably adapted, maintained, clean and furnished for its stated purpose, with a system in place to meet identified deficits. EVIDENCE: The site visit included a tour of the environment including some resident’s bedrooms, but not all. The environment was clean, well decorated and well furnished, with resident’s bedrooms reflecting their hobbies and interests. Each resident had their own single lockable bedroom with keys provided. Residents spoken with said they liked the house, and it was always clean. One resident had a self-contained flat, which again was furbished to reflect the personality of the resident. The fire panel box in the main hallway emits a continual buzzing noise. The deputy manager said that an engineer had been called but could not fix it, however the noise is unacceptable and it is recommended that another solution be found. Staff received training in health and safety areas including food hygiene, however several of the staff interviewed required refresher training. The laundry facilities were appropriate for the residents at Laburnum House. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well-supported, competent and qualified staff cared for residents. EVIDENCE: Three staff records were examined, and all the staff on duty were interviewed. Some staff comment cards were returned to the Commission as well. Staff records held appropriate fitness checks, application forms and evidence of an interview process. The interview record did not show that on two occasions’ issues that could potentially affect the employment of staff were discussed, with the registered manager’s decision-making recorded. Rotas showed that there were always two staff on duty, plus an additional staff member working in a 1:1 capacity with one resident. During the week the acting manager also works every morning. One relative who sent a comment card back expressed a view that not enough staff were on duty to take their resident out in the community. This issue had been raised at a recent review meeting also, and it was recorded that the registered manager was to take action to resolve the situation. Regular supervision was taking place and staff said they felt supported. Staff were doing NVQ training and a range of other training. With an overall training plan for the staff group. However, through discussion with staff it was found Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 19 that some training indicating that staff had completed certain training was inaccurate and in need of revision. It was unclear from the plan also, if training had been booked. Some staff had been employed for several months, and had not yet had some basic health and safety training. There was no equality and diversity policy in the home and staff had not attended any training. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a Home run by a competent manager, with the quality of the service being monitored and improved by the registered provider. EVIDENCE: The registered manager Iona Fusco was not present at the site visit, but contact with the Commission since the last key Inspection and the systems she has put in place to ensure the smooth running of the Home in her absence has proved that she is continuing to manage Laburnum House effectively. A Quality Assurance system that the Responsible Individual, Allison Whitehead, has put into place was examined. The system was very new, and only partly implemented, but would develop into an appropriate monitoring and development arrangement. A missing part to the system was an annual development plan. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 21 Health and safety training arranged for staff includes fire safety, safe handling of medication, first aide, food hygiene and infection control. The overall staff training plan did not make it clear which staff had completed all this required health and safety training, as it differed from the training needs identified by staff interviewed. The pre-inspection questionnaire received by the Commission form the registered manager stated that gas, heating and electrics are maintained regularly, water was monitored for Legionella and fire tests and checks are carried out appropriately. The fire records confirmed this. Window restrictors were observed on those windows seen during the site visit. Accidents were recorded appropriately. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 22 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. 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 23 No 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 YA20 Regulation 13(2) Requirement There must be no gaps in the records of medication administered by staff, and tippex must not be used. The administration of medication by staff must be recorded as soon as it is administered not several hours later. Timescale for action 07/09/06 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 YA6 Good Practice Recommendations Usage of PRN medication for behavioural issues should be part of a written behavioural plan. The registered manager should ensure that relatives and professionals are informed of events affecting residents. Staff should be aware of the equality and diversity barriers that residents face, and be actively findings ways through them. Laburnum House should have a policy on behaviour management and physical intervention. Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 24 2. YA7 3. 4. 5. 5. 6. YA22 YA23 YA24 YA34 YA35 YA42 The registered manager should ensure that relatives of residents are clear about the complaints procedure. Staff should all be clear about their role within the Adult Protection procedures, and know where the policy and procedures are kept and what they contain. The disturbing noise that is coming out of the Fire control box in the hallway should be stopped. The staff interview record should record decision-making about staff fitness issues that arise from references and Criminal Record Bureau checks. The staff training and development plan for Laburnum House should reflect what training staff have and have not done including health and safety training that requires updating Staff should be aware of the equality and diversity issues affecting residents, and be clearly breaking down barriers. The Quality Assurance system should result in an annual development plan and feedback to participants. 7. YA39 Laburnum House DS0000003733.V289118.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office 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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