Inspection on 10/10/08 for Laburnum Lodge

This inspection was carried out on 10th October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Laburnum Lodge 22/02/07

Laburnum Lodge 24/03/06

Laburnum Lodge 11/01/06

Laburnum Lodge 17/02/05

Laburnum Lodge 12/10/04

Laburnum Lodge 27/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Laburnum Lodge Breightmet Fold Lane Breightmet Bolton BL2 6PP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Tomlinson     Date: 1 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Laburnum Lodge Breightmet Fold Lane Breightmet Bolton BL2 6PP 01204337837 01204337838 pauline.crank@bolton.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Pauline Crank Type of registration: Number of places registered: Bolton Metropolitan Borough Council care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home Laburnum Lodge is owned by Bolton Council and is run by their Social Services Department. It is registered with us (the commission) to provide specialist care for up to 32 older people with confusion. Laburnum Lodge is a purpose built home, with 32 single bedrooms over two floors (with a passenger lift). The building is divided into four care units - Greengate and Bright Meadows on the ground floor, Bannister and Ashes Farm on the first floor. There is a lounge and an adjoining dining room on each unit, plus toilets and a bathroom. There are no en-suites, although all bedrooms have washing facilities. There is a central courtyard garden with a paved patio area. The home is near a main road in the residential area of Breightmet, approximately two Care Homes for Older People Page 4 of 34 32 Over 65 0 Brief description of the care home miles from Bolton town centre and is close to bus stops, pubs and local shops. There is some car parking to the front of the building. The current fees range from 102.90 pounds to 425.35 pounds (toiletries, hairdressing and dry cleaning are not included). Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Our visit, which the home was not told about beforehand, lasted 10 hours. We looked around the building and talked with a resident and with staff (including carers, domestics, catering staff and the manager). We spent time on the two units that were open, watching how staff cared for residents. We also looked at some paperwork. Before our inspection we had sent surveys to people who visit and work in the home. Five relatives and four staff returned them. Their views are included in this report. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year, telling us what they do well and what they would like to do better. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 34 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the homes specialist service and its fees was now clearer, helping a person decide if Laburnum Lodge was the right place for them. Providing this information in alternative formats and introducing ways to welcome and help a new person settle in would further strenghten the moving-in process. Evidence: We looked at the brochure (Service Users Guide) given to prospective residents and their families, telling them about Laburnum Lodge. Since our last inspection, this had been updated and amended. It now had the correct number of places available (32) and that only long term care was provided. Issue and review dates had been added (although the addition of page numbers would also be helpful to the reader). The minimum age range on admission had been lowered from 65 to 60. We advised this could, in exceptional circumstances, be lower (without needing to seek permission Care Homes for Older People Page 11 of 34 Evidence: from us), as long as the persons needs could be fully met. This was for the home to decide and explain in their brochure (and also in their Statement of Purpose). At our last inspection, we had advised about having the brochure in formats more suitable and meaningful to residents specialist needs. This was again suggested at this inspection. For example, in addition to giving the brochure, we advised a photograph album of the home (specific to each unit) could be shown. After the inspection, we provided information about how the brochure could be in a font size and layout that would better suit its target reader group of older people. We had previously advised that the brochure needed to have clearer information about the specialist service provided. There were now details about the specialist training undertaken by staff and a minor reference to the specialist building design. We advised a clear sentence telling people that Laburnum Lodge was a home for older with confusion would still be helpful. Also the term EMI was still used, which people may not understand. We discussed the admission criteria, as this was still a little unclear. Due to the extensive refurbishment work that had been taking place since the beginning of the year, the home had been running with very low occupancy levels. Only 15 residents were living in the home, when there could be 32. We were impressed Bolton Council had deliberately kept resident numbers as low as possible to ensure maximum staff support and minimum disruption. We looked at the records of two people who had recently moved in. Detailed assessments of their needs had been received from their social workers before admission. Good practice was noted, as the manager had also visited both residents prior to admission. A brief record of this was now being made. There were plans for care supervisors to carry out this pre-admission visit, with the personal care worker allocated to the new resident to also attend. As the admission process can be overwhelming, particularly for people suffering from confusion and short term memory loss, we commended the involvement of the personal worker at this early stage. We discussed how this could be developed to ensure the personal worker was also on duty when the new resident moved in, to welcome them and make them feel special. The manager confirmed they were already looking at ways of doing this. We discussed how the home planned to increase its resident numbers now the refurbishment was near completion. The manager explained they were awaiting to recruit additonal staff and when these were in place, resident numbers would be increased slowly. The manager mentioned plans to move two new residents to an Care Homes for Older People Page 12 of 34 Evidence: empty unit (with an existing resident, whos family wished them to return to their original, pre-refurbishment room). The manager was aware of the need to discuss the purpose of this move and its advantages and disadvantages with the residents respective families and social workers before any decison was made. The manager confirmed prospective residents were welcome to visit to look around, although due to the confusion experienced by most, family members usually made trial visits. At the last inspection, we had asked the home to ensure residents and their families received clear information about the cost of living in the home - both initial general details and later, personalised information if they moved in. The current lowest and highest possible fees were now on display in the lobby. The home was also arranging for details of a new residents weekly fee to be brought to their initial review (held 6 weeks after moving in). Until this started, the manager had added residents individual fee details to their personal files. We advised the home still needed to confirm residents and or their families were receiving clear and helpful information. As whilst we had seen placement agreements on file, 3 surveys returned to us from relatives said they had not received (or did not remember receiving) a contract. The home could also consider giving details in the brochure of the standard, initial fee charged for a residents first 6 weeks. (Intermediate care is not provided by the home. Consequently standard 6 does not apply and was not assessed). Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents received good, personalised care from caring and skilled staff. Improvements in the monitoring of physical aggression and some medication records would further strengthen the quality of care practices. Evidence: Due to the confusion, memory loss and communication difficulties experienced, most residents were unable to tell us what it was like to live at Laburnum Lodge. Consequently, we spent time watching how staff spoke to and cared for residents. Staff were warm, considerate, patient and respectful (e.g. crouching down to make eye contact when talking with residents who were seated and being discreet when asking residents if they wanted to use the toilet). One resident spoke highly of the staff, saying you cannot knock them. Residents dignity and privacy was further promoted with an effective personal worker system. Carers had extra responsibilities for certain residents. This included helping them to bathe or shower, ensuring this intimate task was not shared across the staff Care Homes for Older People Page 14 of 34 Evidence: team. Positive feedback about the care were also in the surveys relatives returned to us. One person said they were happy with their aunties welfare. Relatives also felt staff listened to them and acted on what they said. The staff we spoke with had a very good understanding of the help and support residents needed and how they liked this to be given. Care records generally supported this. We looked at four residents files. All had detailed and personalised care plans and risk assessments (including ones for diet, moving and handling, and pressure area care). A separate monitoring sheet had been introduced to show these records were regularly reviewed. The home was planning to introduce a new care plan summary sheet as a quick reference guide. Good practice was seen for one resident who had just returned from hospital. They had a new detailed care plan and risk assessments, giving staff clear and helpful guidance about their new care needs. Each resident had a separate care plan about the help they needed at night time. Good practice was seen for one new resident, as theirs had clear, helpful information about personal preferences (e.g. they liked to watch television, have a glass of water by their bed and the light left on). Risk issues were generally being thought about and acted upon. However, we advised the recording of physical agression could be improved. Clearer descriptions of what actually happened before, during and after any incident (e.g. rather than just writing very violent) would better inform staff and also help identify any possible triggers. Accompanying care plans and risk assessments need to be clear, with specific, personalised guidance about how to reduce the risk of or any manage any further physical aggression. If staff need to restrain a resident (for their or others safety), as mentioned in one care file we looked at, full details of the incident need to be recorded. We should also be formally notified if restraint has been used. Separate knocks, falls and irregular happenings forms were used. The home needs to ensure any incidents of physical aggression recorded in these are fed back into and update relevant care plans and risk assessments. There were also gaps where accidents had not been recorded, although separate accident forms had been completed. Residents health was actively promoted and maintained. Records showed residents received regular check ups (e.g. optician, chiropody) and health care services were Care Homes for Older People Page 15 of 34 Evidence: promptly contacted with any concerns (e.g. GP, district nurse). At times we found these records difficult to follow. The form and how it is used would benefit from being reviewed to ensure it is a helpful stand alone document (without the need to cross reference through past daily records). The reason for a check up or visit, the outcome and any follow up action needed or taken need to be clearly shown. This would allow health issues to be easily tracked over time (ensuring an accurate health history and any follow up visits had taken place). We advised where a resident is at risk of developing or has developed a pressure sore (and the district nurse is involved), a care plan for the homes staff needs to be in place (e.g. with guidance about bathing, pain relief, frequency of position change, dressing). We looked at a sample of medication records and medicines. Medicines were stored safely, with a secure, wall mounted cupboard installed since our last inspection (with separate storage for controlled drugs). Records were generally in good order, showing medicines entering the home, being administered to residents and any unused medicines returned to the pharmacist. Most medication administration records (MARs) were pre-printed by the pharmacy. Some handwritten records were used. We saw two that had not been signed or countersigned. We advised this was necessary to reduce the risk of error. We also saw one MARs where lots of changes had been made. This had resulted in a record that was confusing and difficult to use. We advised this was rewritten to reduce the risk of mistakes. To aid identification, photographs of residents were in place. Further good practice was noted, as the home was about to introduce a list of initials and signatures of staff authorised to administer medicines. We discussed the practice of hiding or disguising medication in food or drink. Staff were aware this should be an exceptional occurrence. Such practice currently concerned only one resident. There were letters on file from both their GP and their consultant agreeing to this action, plus a brief reference in their general risk assessment. We advised a specific document would be more helpful. This would better meet the requirements of the Mental Capacity Act 2005, showing how and why the decision was reached, that any family and the pharmacist have also been consulted and that the decision was being kept under regular review. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and catering staff were motivated and enthusiastic, with residents enjoying good food and a mix of social activities. Plans to further improve these areas will help meet residents specialised needs, ensure greater enjoyment and satisfaction. Evidence: The home did not employ an activities co-ordinator, rather care staff organised and carried out a range of social activities as part of their general duties. We watched activities taking place on both the units that were open. The recording of residents participation was very brief, with individual tick charts completed. These did not provide any additional information, e.g. to help (subsequent) staff regarding what part, if anything, of the activity had been enjoyed. There was also no timetable or information to guide staff or inform residents and relatives what activities were being planned or provided. Surveys returned to us identified some relatives were unsure what activites were provided. As the refurbishment was nearing completion, the manager said activity boards were going to be introduced. Other good practice had started, calenders with local photographs of Bolton had been Care Homes for Older People Page 17 of 34 Evidence: bought for each residents bedroom. Relatives were being asked, with the support of personal workers, to add birthdays and anniversaries to these, so staff can help residents make and or send cards. This project was starting with Christmas cards. Memory boxes were also being made, with practical aids (i.e. photographs and favourite pictures) inside to prompt one to one reminiscence work. This was supported by detailed personal life histories kept in care files. These provided staff with personal information about residents lives, including family members, jobs and hobbies. As resident numbers increase, the information from these life histories and memory boxes should be used to shape one to one and group activities. At our last inspection, some staff had attended a dementia activities course, which they had found very useful. This training was helping them meet the specialised needs of the residents. The manager confirmed remaining staff were being put forward for this training. The home was aware of the therapeutic benefits of encouraging residents to do ordinary, everyday activities - two residents helped set and clear tables at mealtimes and other residents were supported to have handbags and newspapers. We advised as the refurbishment was near completion, these informal activities could now be expanded. For example, ornaments and dusters could be provided. Residents, where able and willing, could help make their own beds. Linen, stockings, socks etc. could be folded each day with residents in the lounges, rather than being done by staff in the laundry. In the spring time, the washing line could be put back in the courtyard garden but at a lower height so residents can hang out washing. In addition to the existing bird and squirrel feeders, raised tubs or planters could also be provided so residents can garden. As the refurbishment was just finishing, pictures and other homely touches were still being completed. Continuing the theme of everyday stimulation and encouraging residents to remain active, we advised reminiscene memorabilia, photographs and particularly objects could be placed in displays around the home for residents to look at and touch (rather than being kept in the activity room or just brought out for formal reminiscence sessions). New, large, wall mounted televisions had been provided in each lounge. These reduced the risk of a resident pulling a television over and also enabled all residents to see them. Good practice was noted, as televisions were often turned off, with music being played or activities carried out instead. Visitors felt they were made welcome and as the refurbishment was near completion, bedrooms were being re-personalised (all bedrooms had been redecorated). Care Homes for Older People Page 18 of 34 Evidence: We discussed our recent report called See me, not just the dementia, regarding understanding peoples experiences of living in a care home. The manager confirmed she had a copy and was in process of working through it with the staff team. We also discussed funding for end of life care. The manager was aware of recent national guidance and how this could support a resident to remain at Laburnum Lodge. With regard to residents being helped to make choices, night staff told us they were under no pressure to get people up, with residents able to wake naturally (no residents were up when we arrived at 6.45am). Regarding food choices, whilst likes and dislikes were known by care and catering staff, residents were also asked what they would like to eat. Good practice was noted, as hot choices were available for breakfast, lunch and tea. Further good practice was noted, as kitchen staff were producing new photo menus to help residents choose what they would like. These menus would then be displayed again at meal times, as a prompt for what was to be served. We observed lunch being eaten on both units. Tables looked pleasant with tablecloths, cups, saucers and napkins. Chairs had armrests, although not all had glide rails. There was a calm and relaxed atmosphere, with residents given plenty of time to enjoy their food. One resident said food was very good. Staff provided assistance discreetly, individually and patiently. Staff said at times not enough chairs were available for them to use, resulting in them having to stand over residents. We advised some small stools were provided to avoid this. We also discussed staff sitting and eating with residents (as part of their work), helping promote meals as a social and homely event. Good practice was noted, as a special effort had been made in the past to enable residents husbands, wives or partners to join them for a personal, 1 to 1 Christmas meal (with tables set out in the activity room). We discussed developing this, so such meals also took place on other special occasions (i.e. anniversaries, Valentines day). We advised cake making that used to take place in the activity room (with support from the kitchen), could also be re-started. This could be developed to include regular food based activities on the units (e.g. sandwich making or other light meals that could be made in a microwave). Special dietary needs were catered for, with low sugar, soft and pureed meals provided. Good practice was noted, as pureed foods were served separately, maintaining taste, texture and appearance. Catering staff had a good awareness of how to provide finger foods and fortified diets, and full fat milk was used as standard. Fresh, soft cut fruit was now being served daily. This was clearly enjoyed by residents, several of whom asked for second helpings. Further good practice was noted, as catering staff were developing themed meals (e.g. Italian etc). We advised these could be supported by care staff to become a social activity. Care Homes for Older People Page 19 of 34 Evidence: To further support the above good practices, we showed a copy of Water for Healthy Ageing, a best practice toolkit for care homes to avoid dehydration. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for protecting residents from abuse or harm and for taking concerns seriously were in place. Evidence: Information about how to make a complaint was given in the homes brochure. A notice was also displayed in the entrance. This was accompanied by a new compliments and comments book. Re-wording the notice to show how the home welcomes suggestions as well as complaints, and having it displayed on each unit, may encourage people to use this new book. Surveys from relatives confirmed they generally knew how to complain. Those from staff confirmed they knew what to do if they had any concerns about residents safety or felt they were at risk of abuse. No complaints had been received by the home and none had been received by us. Formal complaints could be made to the home or to the councils complaints department. The manager was aware of the need to keep a full record in the home detailing all complaints made. The benefits of also recording more informal issues, showing how all concerns were taken seriously and acted on, had been discussed at our last inspection. Care Homes for Older People Page 21 of 34 Evidence: With regard to advocacy, the manager was aware how local services could be contacted if needed. We advised this information could be put out on display. The management team had recently completed training about the Mental Capacity Act 2005, including the help available to people who are unable to make important decisions for themselves (e.g. an Independent Mental Capacity Advocate (IMCA)). The manager discussed a recent situation where an IMCA had been involved with a resident. We discussed the general issue of capacity and how care staff can record the different ways they facilitate everyday decision making for all residents. No safeguarding alerts had been made concerning the home. At the last inspection, we had advised domestic staff (as well as care staff), received training about abuse awareness. Good practice was noted, as this had been acted upon, with domestic staff now due to complete this training. Care staff also received training about dealing with verbal and physical aggression. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recent, extensive refurbishment had greatly improved the home, with residents benefiting from better facilities, decor and specialist equipment. Evidence: Laburnum Lodge was just coming to the end of a complete refurbishment. This had begun in January 2008, resulting in extensive external and internal work. This included a new roof, new electrical systems, a new heating system and new kitchen equipment (including a new oven and a complete overhaul of the venting system). The work had been carried out in two phases, with residents living in one half of the building, whilst work went on in the other half. During the first phase, the kitchen and laundry were unavailable. The activity room had been converted into a small kitchen for light meals, with the main meal coming from the councils community kitchen. Laundry had been washed at another home. As already noted, the refurbishment work was achieved with the least disruption to residents by having low occupancy and very good staffing levels. The manager and staff did a great deal of preparatory work with relatives before the refurbishment started, explaining the process and encouraging questions. We received a letter from one relative, praising the amount of time and effort staff, in particular the manager, had taken in liaising with families. As residents had been moved to new bedrooms to Care Homes for Older People Page 23 of 34 Evidence: accommodate the work, some families had asked for them to remain in these, rather than returning to their original room. These requests have been met. The work has included a complete overhaul of the bathrooms and toilets, with new tiles and new, up to date, specialist equipment including a rise and fall bath, a walk in level access wet room with shower, a swivel chair bath, the refurbishment of an existing wet room and new toilets with lowered sinks. Hand rails remained on both sides of corridors and grab rails in toilets. To maximise accessibility, the existing lowered light switches and raised sockets were also kept. Digital, electrical seated weighing scales were available. The home had retained its design of small group living - divided into four small units, Greengate and Bright Meadows on the ground floor and Ashes Farm and Bannister on the first floor. This created a more homely, less institutional environment, which was helped further by the continued use of wallpaper. Designated storage space had been created for mobile hoists (keeping communal areas free). All areas have been redecorated, with new flooring and new curtains and blinds. Fixtures and fittings were of high quality, including new lounge chairs, sideboards and standard lamps. With regard to meeting residents specialist orientation needs, signs had been put on lounge doors. Toilet doors had been painted red and both bathroom and toilet doors had words and picture signs. Bedroom doors were numbered and displayed residents names. Each unit also had its own colour theme (in communal areas). The home retained a smoking room, a hairdressing salon, an activity room and a training or conference room. The lift had been serviced but would benefit from internal decoration as it was not now to the same high standard as the rest of the home. We advised bedroom doors were again personalised, e.g. photographs of family members or favourite pets. This would be helpful for those residents who could no longer read (A4 size covered notice boards could hold this information in place). Some final work was due to be completed as part of the refurbishment - painting of external windows, replacement of the large reception windows and external handrail, new external signage and replacement of recently vandalised windows on the currently empty Greengate unit. We noted the exit door on Bright Meadows was banging shut very loudly, which would disturb residents in adjacent bedrooms. The manager organised for this to be mended as soon as possible. Care Homes for Older People Page 24 of 34 Evidence: The home was clean and tidy and generally smelt fresh. Surveys from relatives confirmed this was usual. We did find a strong malodour in the lounge on Bright Meadows. A thorough clean was carried out during the inspection to address this problem. Good practice was noted, as the home was introducing a colour code system for staff to improve infection control practices. Santisizer hand foam dispensers were also being fitted around the building. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were protected by generally very good recruitment practices and benefited from very good staffing levels, provided by an experienced and stable team. Gaps in training put this at risk. Evidence: Due to the refurbishment and the accompanying low occupancy levels, residents had benefited from very good staffing levels (usually three and often four care staff, plus a care supervisor during the day and two staff at night). The manager explained these levels will be maintained as resident numbers increase. Five part-time care vacancies were currently being recruited to (which included an additional 37 hours more than pre-furbishment staffing levels). The home wants to operate with a minimum of six care staff during the day and three at night. The rota continued to support staff communciation, with senior care staff having a paid handover. Residents continued to benefit from a stable, consistent and experienced staff team. Prior to the current recruitment, no new care staff had started since our last inspection. Sickness levels were low, with the sickness in the management team we had found at our last inspection generally resolved. With regard to NVQ training, we were impressed 24 out of the 25 care staff had Care Homes for Older People Page 26 of 34 Evidence: attained an NVQ level 2 care award (three staff also had the level 3 award and one the level 4). Bolton council recognised the benefits of a skilled and trained workforce, with nine staff now going on to do the level 3 care award. Other staff were being supported to undertake external qualifications, with a kitchen assistant and two domestics to also do an NVQ award. Staff recruitment records were held centrally at the councils head office. A sample of these was looked at during a visit by two of our inspectors in August 2008. Records were in good order, with application forms, full employment histories and appropriate criminal record checks in place. Proper references had been taken up for most staff. However, one person had been employed without a reference from their current and previous care employers. Proof of identity was now being kept, although copies of relevant care qualifications (e.g. NVQ 2 award certificates) were not. These qualifcations were not necessary for most of the council care posts, unless there were a large number of applicants. We advised copies should still be kept, to inform both the assessment of a new starter training needs and their manager about how many of their staff had an NVQ award. We advised procedures were also reviewed regarding existing employees (i.e. domestic staff) who also did casual care work. Whilst new application forms were in place for those who applied for permanent care work, they were missing for those who did casual care work. A range of good practice was noted. This included a formal shortlisting process, an interview panel of at least two staff, standardised interview questions with responses recorded and scored, detailed health questionnaires reviewed by the council occupational health department and a comprehensive 7 day induction for care staff that exceeds Skills for Care requirements. We looked at training completed by existing care staff. The manager confirmed all 25 had completed an introduction to dementia course and ten had gone on to do advanced dementia awareness training. However, actual training records were unclear and the manager had to supply further information to us after the inspection. This showed two of the four staff we looked at had not received annual refresher training in moving and handling and one had not received annual fire safety refresher training. (Moving and handling training was due to take place in November 2008). In addition to formal courses organised by the council training department, we advised staff meetings could also regularly be used to deliver informal training (as a quick and local response to new residents needs, e.g. Parkinsons, diabetes and pressure area care). Staff were not wearing name badges. As a memory and orientation prompt for Care Homes for Older People Page 27 of 34 Evidence: residents, care and domestic staff uniforms were going to display their first name in large, clear letters. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff benefited from a well managed home. Evidence: The Registered Manager of the home, Mrs Pauline Crank, had been in post for 8 years. She had obtained the Registered Manager Award and an NVQ level 4 award in care. Mrs Crank was due to retire in December 2008. Mrs Crank was supported by three care supervisors and two acting care supervisors. Surveys returned by staff confirmed they felt supported by the management team, who also kept them well informed about any changes. All staff we spoke with said they received regular, formal supervision. One person said they felt listened to by the manager and that Laburnum Lodge was a good place to work. The manager explained formal team meetings had not been held regularly during the refurbishment, although they were now due to re start. Care Homes for Older People Page 29 of 34 Evidence: With regard to how the home monitored the quality of its service, no formal surveys had been sent out since our last inspection. However, as noted, relatives had appreciated and felt well informed by the meetings held to explain the refurbishment process. Requests for feedback from professionals involved with the home (e.g. district nurses, community psychiatric nurses, social workers) was still due to be implemented. Small amounts of money and occasionally valuables were held on behalf of some residents. These were stored safely. We checked four cash balances. These were correct, with appropriate transaction records. We advised a carbonated receipt book was used for recording the receipt of any vaulables (showing when an item was handed in and when returned). With regard to safe working practices, we received formal confirmation in the AQAA that all safety and maintenance checks were up to date. The fire alarm system had been effected on a daily basis during the refurbishment, with daily and weekly checks not possible. The manager was aware these needed to now re start. To encourage familiarity and confidence, we advised as many staff were involved with these routine checks as possible (e.g. a different staff member asked to assist each week, with their name recorded in the fire safety log). Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Two satisfactory written 30/01/2009 references must be obtained for all staff. To ensure residents safety. 2 30 13 All care staff must receive annual moving and handling refresher training. To ensure residents and staff safety. 30/01/2009 3 30 23 All care staff must receive annual fire safety refresher training. To ensure residents and staff safety. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Clearer and more comprehensive recording of any physical aggression would ensure any incidents were fully reviewed, safeguarding residents and staff. To ensure accurate medication records and reduce the risk of error, all handwritten entries on medication Page 32 of 34 2 9 Care Homes for Older People administration records should be signed, checked and countersigned. To safeguard residents and guide staff, the decision to covertly administer any medicines should be more clearly documented and regularly reviewed. 3 12 Clearer information about social activities available would better guide staff and help residents and relatives understand what social activities are available. Copies of relevant qualifications and training should be kept. This information will inform a new starter training needs assessment and the homes overall performance regarding its NVQ training target. To enable effective monitoring, staff training records should be easily understood by any senior staff member, showing what training each staff member has completed and when. It would also be helpful if these records identified the courses considered mandatory by the council, with their expected frequency (e.g. moving and handling, fire safety, food hygiene, health and safety), those considered mandatory by the home due to the specialist service provided (e.g. dementia awareness, challenging behaviour, dementia care activities), plus any additional, local training. 4 29 5 30 Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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