Inspection on 09/01/06 for Laburnum House

This inspection was carried out on 9th January 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Laburnum House 28/04/08

Laburnum House 19/06/07

Laburnum House 20/11/06

Laburnum House 06/01/05

Laburnum House 07/07/04

Laburnum House 19/02/04

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

CARE HOME ADULTS 18-65 Laburnum House 41 Grimston Avenue Folkestone Kent CT20 2QD Lead Inspector Julie Sumner Unannounced Inspection 9th January 2006 10:00 Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 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 DS0000023475.V280140.R01.S.doc Version 5.1 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 DS0000023475.V280140.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Laburnum House Address 41 Grimston Avenue Folkestone Kent CT20 2QD 01303 227192 01303 243416 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) Lothlorien Community Ltd Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Laburnum house provides support for six adults with learning disabilities and some challenging behaviour in the main part of the house. The top floor, called Tree Tops, has been made into a flat and has a separate entrance to the main home and is intended to provide support for four adults with learning disabilities in a more independent setting. At present there are four people living in the main home and three people living in the flat. The building is large with spacious and homely communal rooms and a wide staircase accessing all levels. Bedrooms are single, spacious and airy with good natural light. One bedroom is on the ground floor and one on the first floor is smaller than average. There is an extensive garden at the back and car parking in the front. The home is situated close to Folkestone town centre, the Lees and seaside. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during two separate days in January. The first day, 9th January, commencing at 10am and finishing at 4:45 pm and the second day, 19th January, commenced at 2pm and ended at 5:45pm and was arranged in order to talk to service users and to go around the flat, Tree Tops. When some service users were asked what they really like about living here they replied: “staff, nice bedroom, got new furniture”, “staff look after me, very nice”. The inspector spent time with service users who were less able to vocalise their views. The methods used to carry out this inspection were talking to service users in both the main home and Tree Tops, discussion with the staff also both in the main home and Tree Tops, discussion with the acting manager, touring the house and reading some of the home’s policies, service user plans, staff recruitment and training records and various home records. What the service does well: What has improved since the last inspection? The new patio at the back of the house has been laid with contrasting paving stones and looked smart and safe. Service users and staff were very pleased with it. There are two new vehicles for service users use. One is a minibus seating 9 and the other is a large car with 7 seats. Service users said they liked these very much and they are both comfortable. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 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 DS0000023475.V280140.R01.S.doc Version 5.1 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): 1, 2 The statement of purpose does not contain all required information. There are clearly written assessments for each individual living in Laburnum House and Tree Tops. EVIDENCE: The statement of purpose was amended. During the inspection when discussing the unoccupied room sizes it was discovered that there is no reference to the room sizes in the document. A requirement has been made to include this information as indicated in schedule 1 of the care homes regulations. A sample of service user plan folders were viewed containing an assessment of needs and interests. The service user plan was based on this. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 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 Service user plans have been well written taking individual preferences into account, looking at support from a person centred approach and promoting choice within a risk assessed framework. EVIDENCE: A sample of service user plans were viewed. They contain clear information about each person with guidelines for staff to support them. There were several examples of how individuals are supported in the way in which they have indicated that they prefer. Staff have got to know service users very well. There was evidence of respecting each person’s needs and interests and managing difficulties or behaviour in a way that is respectful and maintains individual dignity in a public setting. Risk assessments and plans for support with behaviour were viewed and when some behaviours were displayed staff were observed doing exactly what the written plan stated, which was commendable. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 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 the following standard(s): 12, 15, 16, 17 A good range of activities is provided based on individual interests and with consideration to development of social and occupational skills. Involvement with service users’ families is supported and encouraged. Routines in the home are flexible and freedom is promoted within risk assessed boundaries. A good range of food is provided taking into consideration individual health and medical conditions. EVIDENCE: Service users were in some of the time during the inspection and were participating in planned activities in and out of the home. There are a variety of activities offered depending on interests of individuals and some are designed around accommodating and diverting behaviour. The staff team are supported by the activity staff who were originally based at Woodend (the company activity unit that was recently closed). Activities are mostly based in the local community using the public facilities. There is also some attendance at the local KCC day opportunities centre. Calmer activities like walking in the Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 11 local area, including parks and seafront, are also included in the activity plan to promote a healthy lifestyle and to give service users the opportunity to do something with less pressure on their behaviour. Service users spoke about their families and there were photos around the home and in their bedrooms. Some service users go home at times and visits are encouraged and supported. Family albums are kept and some are used as a communication aid. Service users spoke about how they spend their days, going to bed, getting up and mealtimes. They said they were happy with their lifestyle. Their bedrooms are treated as private and they can lock their doors if they want to. There is a menu and a record of meals provided. This also includes guidelines on special diets provided to maintain individual health with particular reference to medical conditions. The inspector had lunch with service users, in the main home, which was served nicely and the meal time was calm and pleasant. Service users in the flat sit round the table and plan the menu and there is some participation in the cooking. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 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 the following standard(s): 18, 19, 20 Service users’ preferences in how they are supported are taken into account. Service users are supported well with maintaining their health and managing individual health conditions. There is an adequate medication and administration system in place making sure that all service users receive the correct medication at the right times. EVIDENCE: In observation and directions in the service user plans it was evident that service users have choices in how they are supported. There are likes and dislikes lists, written answers to questions that have been asked around what each individual likes to do and what is important to them. Service users spoke positively about their lifestyle. Staff know service users very well and have demonstrated competence in recognising symptoms that indicated a very serious health condition. One service user has recently been in hospital having had surgery. Medication was discussed and a sample of records were viewed. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 13 Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 14 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 The company has an effective complaints procedure. There are effective procedures in place to protect service users from risk of abuse. EVIDENCE: There is a complaints process and procedure. And one with adapted guidelines for what to do if a service user wishes to complain. There is a notice for visitors of how to complain. Service users said that they like to talk to the staff and manager and if they are concerned about anything that is how they resolve it. Staff have attended adult protection training recently to up date and confirm knowledge and information received previously. Financial records were viewed. Service users are supported with their money. Receipts are kept and two signatures are required for all transactions that are assisted. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 15 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 Improvements to the environment will enhance the service users’ quality of life. The home is clean. EVIDENCE: The new patio has been laid at the back of the home in front of the garden and looks attractive and safe. A tour of home was carried out with a member of staff. The home was clean and bedrooms were personalised. There are some areas in need repair and redecoration. The bathrooms are in a poor state of repair with damage caused by damp and general wear and tear. The windows need attention and the acting manager said that they were waiting for the windows to be repaired/replaced before the refurbishment could commence. Priority needs to be given to this. A requirement has been made to refurbish and redecorate the bathrooms. There was some discussion about room sizes of the two vacant bedrooms as they will not meet the standard without compensatory space allocated. The sizes of these bedrooms need to be stated clearly in the statement of purpose. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 16 The sleep-in room is a room that you get to by going through the laundry room and various measures have been put into place to make sure that staff are safe and are able to hear service users if they are in need. Now that there are some vacancies in the home consideration needs to made to review the site of the sleep-in room as it is not in a very good position. There have been discussions with the previous manager about changing the room but none of the ideas have been approved. A recommendation has been made for this. The laundry room was viewed. It is spacious with a hand washbasin and surfaces for easy organisation and has appropriate appliances. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 17 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, 34, 35 NVQ training is ongoing and the staff team are working towards achieving the target of 50 of the workforce achieving NVQ 2 or above. A robust recruitment process is carried out to protect service users. Staff have a good range of skills to support service users. Designing a training plan around assessed needs of service users will enhance staff skills and knowledge and support development of the support and care provided. EVIDENCE: Three support staff have just completed NVQ 3. The deputy manager (currently acting manager) has almost finished NVQ 3. Three support staff are currently studying NVQ 3 and 2 support staff have just started to study NVQ 3. One staff has just completed NVQ 2 and one is working towards NVQ 2. There has been little change with the staff team having been stable for a few years. A sample of staff files was viewed. All appropriate checks are carried out as part of the recruitment process. CRB and POVA checks and references are requested. There is a training plan and the manager enters any completed training for each person into the home’s statistics spreadsheet, which was viewed. Training courses included on the statistic sheet are based around statutory Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 18 courses and health and safety for service users and staff. The majority of staff have attended all training planned. Any gaps have been through sickness, holiday etc and alternative courses have been planned. Staff have attended training on other areas of care but these are not included on a training plan. It is recommended that a training plan be designed around individually assessed needs of service users living in Laburnum and Tree Tops, to include specific health conditions, support with mental health, communication, consideration for different activities to develop independence and social skills and occupation/sheltered employment opportunities. The training plan can also include support and advice given by community specialists and attendance at seminars and to include what is studied in the NVQ. The staff team use some diversion techniques and some planned responses to manage and minimise behaviour that is not sociable or potentially aggressive. Blocking techniques are used in the event of aggressive behaviour towards staff or other service users and most times this does not involve physical touch. Staff have received CPI training, the content of which was discussed in light of the home not routinely needing to use any restraint techniques. The acting manager explained that the training included diversion, talking in response to challenge, blocking techniques and some restraint but there was less emphasis on this. All support staff had attended the training. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 19 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, 38, 39, 42 The home is well organised. The current temporary arrangement is effective but only for the short-term. Need a registered manager. The quality assurance process needs to be strengthened to include views of service users and other significant people involved in their care. The home is maintained safely. EVIDENCE: The home has been without a registered manager for several months. The company are recruiting a manager and the deputy manager (acting manager whilst the company is recruiting) said that there had been some progress. As stated in the previous report: The deputy manager has worked in the home for several years and also has over three years experience as the previous manager of the home. The acting manager is very competent but does not wish to be registered manager again. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 20 The home’s quality assurance system was discussed. Regulation 26 visits are conducted monthly, usually by the area manager and sometimes by other home managers. The company uses a home audit questionnaire that is completed annually by the manager to measure the quality of the service. This covers the care, support, staff training and skills, range of activities, the standard of décor and building maintenance and facilities etc. Service users should be given the opportunity to give their views and these should be taken into account. The home’s development plan needs to reflect the feedback received so that the service offered is what the service users want and also addresses the areas that need improvement so that it continues to develop. A requirement has been made to strengthen the quality assurance process. Staff have attended statutory training and nearly all staff are up to date in all courses. There is a maintenance log for both the main home and Tree Tops. Copies of servicing certificates are kept. The maintenance log for Tree Tops was discussed and covers all areas of safety: door security, fire equipment, window restrictors and plug sockets amongst others. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 21 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 2 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 3 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 1 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 3 2 x x 3 x Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 22 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 YA1 Regulation Schedule 1 23 (2) (d) Requirement Include the bedroom and communal room sizes and features in the statement of purpose. The bathrooms need refurbishment including repair/replacement of windows. Maintenance plan with estimated dates for works by timescale. Need to ensure that a manager is employed as swiftly as possible and that there are no unnecessary delays in applying for registration. Develop the quality assurance system to include views and action plan from service users in the home. Timescale for action 28/02/06 2. YA24YA27 28/02/06 3. YA37 10 (1-3) 30/03/06 4. YA39 24 (1) (a, b) (3) 30/03/06 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 YA24 Good Practice Recommendations A maintenance plan needs to be written for the overall DS0000023475.V280140.R01.S.doc Version 5.1 Page 23 Laburnum House 2. 3. 4. YA24 YA32 YA35 refurbishment and redecoration of the home, with particular reference to areas of damage and worn flooring. Consideration needs to made to review the site of the sleep-in room. To continue providing NVQ training and working towards achieving 50 of team holding NVQ 2 or above. Staff training plan to be designed around individually assessed needs of service users. Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. Extracts may not be used or reproduced without the express permission of CSCI Laburnum House DS0000023475.V280140.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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