Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Laburnum Lodge 2a Victoria Street Littleport, Ely Cambridgeshire CB6 1LX The quality rating for this care home is:
one star adequate 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: Janie Buchanan
Date: 1 3 0 1 2 0 0 9 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 26 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 26 Information about the care home
Name of care home: Address: Laburnum Lodge 2a Victoria Street Littleport, Ely Cambridgeshire CB6 1LX 01353860490 01353860845 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Dr A Hassaan,Mrs S Hassaan Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Laburnum Lodge is a two-storey house, that includes a single storey extension, to provide accommodation, personal care and support to 22 older people. The upper floor is accessed via stairs or a stair lift. A garden is available to the rear of the building. The home is situated in the centre of the village of Littleport and is close to shops, cafes, pubs and local amenities. A copy of the most recent inspection report is available in the entrance way to the home. The weekly charge is #340. 0 Over 65 22 Care Homes for Older People Page 4 of 26 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: one star adequate 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: For this inspection we (the Commission for Social Care Inspection) visited the home and talked with 3 residents, two members of staff, the owner and a regular visitor to the home. We undertook a tour of the building, checked medication recording and storage, and viewed a range of documents. We also received 23 completed surveys from residents, their families and staff working at the home. We undertook an additional inspection on 2 September 2008 to check on compliance with the requirements we made at our last key inspection in 26 June 2008. Information from that inspection is also included in this report. Care Homes for Older People Page 5 of 26 Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Although there have been considerable improvements since this homes last inspection, there is still much to do: Information about the home, including the statement of purpose and service user guide `should be given to people before they move in, so they have a chance to read about what the home is like and whether or not they would like to live there. Risk assessments need to be much more detailed to ensure the safety and well being of residents. The recording of variable dose medication such as paracetamol must improve so there is a clear record of how much medication residents have received. Care Homes for Older People Page 7 of 26 Residents need to be given opportunities to discuss their preferences about end of life issues and to record these to ensure their wishes are respected. Both staff and relatives felt strongly that more money should be spent on improving the internal and external environment. The garden area to the rear of the home could be made much more accessible and interesting for residents so that they have easy access to sunlight, fresh air and sensory stimulation. Recruitment of prospective staff still needs to be more robust to ensure that only the right people are employed to look after vulnerable adults. In particular appropriate references must obtained, especially if someone had worked in a care setting previously. Dangerous cleaning products need to be stored securely and safely away from residents. The home needs to develop good quality assurance and monitoring systems. In particular it must get feedback from its residents, their families, and other regular visitors to the home to how it is performing and to identify areas for improvement The home must not retain any money for residents who have moved to another home or died. The manager has now been in post for about 9 months and must apply to register with us as soon as possible so we can assess her suitability, skills and experience to run a home for older people. 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 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 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 9 of 26 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. The homes admission procedures are good ensuring that peoples needs can be met there. Evidence: We checked the file of the most recently admitted resident. It contained a preadmission assessment completed by the manager and her deputy who had both visited her in her own home to check her needs could be met at Laburnum Lodge. Prospective residents are encouraged to visit and one who completed our survey told us: I visited the home prior to moving in, spent the day there and stayed for dinner. This is good practice and ensures that people get a chance to test drive the home and assess its facilities. However one resident we talked to told us she did not receive any written information about the home before she moved in, and would have liked this to know what to expect. Care Homes for Older People Page 10 of 26 Evidence: Each resident is also issued with a basic contract describing the terms and conditions of their stay at the home and we saw these on the files we checked. Care Homes for Older People Page 11 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are met at the home. Evidence: We checked the care plans for three residents living at the home. The information they contained was good, with residents needs in relation to their health, communication, eating and drinking, personal hygiene and mobility clearly recorded. The plans showed that residents needs had been reviewed meaningfully every month so that any changes to their health and well being could be picked up quickly. However, two of the residents we spoke to told us they had never seen their care plans, despite both being very able to read and understand their plans. There was no evidence that these residents had been actively involved in drawing up and reviewing their plans and one residents daughter told us she had never seen her mothers care, despite being very involved in her care. There was also little evidence in the plans that we checked that residents were given the chance to talk about and record their end of life preferences to ensure that these are carried out. We checked the risk assessment for one resident who had a history of dehydration. The information in this assessment was very poor
Care Homes for Older People Page 12 of 26 Evidence: and did not detail how much fluid this person was to have daily, how it was to be given to her and how her intake was to be monitored. In another plan we checked, there was a risk assessments for someone to go shopping which was very out of date and no longer relevant. Residents health care needs are met at the home: they are weighed regularly to monitor their health, their nutritional needs are assessed monthly, a chiropodist visits every 6 weeks and a GP visits every Wednesday. All residents are registered with a local dentist and optician and staff support residents to attend appointments there. One resident told us that staff had been quick to spot that she had very dry eyes and had got the GP in immediately to sort them. She has now been prescribed eye drops that have greatly improved her sight and comfort. Another resident told us she had been to the dentist two weeks ago and was very pleased with her new crown that had been fitted. We checked medication storage and recording systems. There have been considerable improvements in this area however we noted that on some occasions the amount of variable dose medication had not been recorded, so it was impossible to tell how many tablets residents had received. Care Homes for Older People Page 13 of 26 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. The home provides activities to keep residents stimulated and entertained Evidence: There has been much activity and entertainment for residents over the Christmas period. In the month of December alone there have been visits from an Elvis impersonator, a Salvation Army carol service, and the Tickle Pink and the Wizard of Oz theatre companies. Staff take two residents out every Thursday evening to bingo at a local club and there are regular exercise and music sessions for residents to participate in. The home has a volunteer who has been visiting for many years to talk to residents. Despite this however, one relative told us; there is meant to be a daily activity between 2 and 4pm but there never is. Residents also confirmed this and one reported that she greatly missed the drawing and painting sessions that used to occur frequently. Relatives told us that staff at the home are good at letting us know what is going and at keeping them up to date with important issues affecting their friend/relative Daily routines at the home are flexible and residents we spoke to told us that they get
Care Homes for Older People Page 14 of 26 Evidence: up and go to bed when they want, and can choose how to spend their day. One reported its easy to live here. Residents told us they always get a choice of what to eat and the cook asks them each day what they want. Lunch when we visited consisted of turkey drumsticks or corn beef hash with potatoes, parsnips, broccoli and cauliflower, followed by mince pie or fruit salad. One resident told us: we always get what we ordered, its cooked well. We saw bowls of fresh fruit around the home for residents to help themselves to, however we found some rather old looking and out of date carrots and leeks in the kitchen which we instructed the cook to throw out immediately. Care Homes for Older People Page 15 of 26 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. Residents are produced by the homes improved reporting systems. Evidence: The complaints procedure is displayed around the home and information about how to complain is include in the statement of purpose and service user guide. Most relatives and residents who completed our survey told us that the home usually responds appropriately when they raise concerns about their care. We have received one complaint about the home since the last inspection concerning residents continence pads not being changed frequently and a fire door being propped open, thereby preventing it closing in the event of a fire. We passed this complaint to the manager who investigated it properly using the homes procedure. There have been two POVA (protecting of vulnerable adults) incidents since the last inspection. One concerning an incident of aggression between two residents and the other concerning the maltreatment of one resident by a member of staff. In both cases the manager responded quickly, informing the local adult protection social worker, and making appropriate referrals to the POVA list for the member of staff concerned. Staff we spoke to confirmed that had received training in protecting vulnerable adults and one even knew the name of the local adult protection social worker. Care Homes for Older People Page 16 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely environment. Evidence: There have been some improvements in the environment of the home since the last inspection. Rotting windows and facia boards have finally been replaced, rotting shelving in the laundry room has been repaired, en suite facilities have been added to a number of bedrooms, a double room has now been made single and areas of the home have been redecorated. The owner told us that he also planned to install a basin in an upstairs toilet so that residents and staff can wash their hands. Despite these improvements however, a number of staff and relatives felt that much more needed to be done to make the home more pleasant to live in. Comments included: more money is needed for improvements in and outside the home another commented: surrounding area and gardens could be better, access for wheelchairs is cramped and the view from my window is rather depressing. One visitor to the home told us everything seems to be done on the cheap and a residents told us that the lock on her bedroom door had broken so that she could no longer lock it. The managers office is very small, cramped and not really fit for purpose and confidential conversations about residents personal health needs can be easily overhead from outside it.
Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 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 receive their care from trained and competent staff Evidence: There are two members of staff on throughout the day and night to meet the needs of 11 residents currently. The manager is also on duty during the day. Residents told us there were staff available when they needed them and they only occasionally waited a long time for help. We received positive comments about the staff including; the friendliness of the majority of staff is appreciated and I do not think there is one member of staff that does not give 100 . Staff told us they had received training relevant to their role and that kept them up to date with new ways of working. Staff training records that we checked also confirmed this. We checked the personnel files for two recently recruited members of staff. They showed that appropriate CRB (criminal records bureau) and POVA checks had been completed before the person started working at the home. We also looked at interview notes for these candidates which showed that only appropriate and suitable questions, in line with equal opportunities legislation, had been asked. However, the references for one of these staff were unsuitable as, despite having worked in two care homes previously, she had given a neighbour and a friend as her referees. No effort had been made to contact the
Care Homes for Older People Page 19 of 26 Evidence: managers of the care homes where she had worked to get feedback about her working practices. Care Homes for Older People Page 20 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is managed adequately. Evidence: A new manager has been appointed to the home since the last inspection: she is a trained nurse and has previous experience of managing a residential care home. She has introduced many positive changes in how the home is run and has a better understanding of the national minimum standards and legal requirements than the previous manager. However, she is still to undertake her registered managers award and also to register with us so we can assess her suitability to run a care service. Concerns were raised to us by both staff and some residents that the manager is rarely around, (although she has had time off to recover from an operation) and some staff felt the owner did not show enough appreciation for the work they do. However, one relative described the deputy manager as very helpful. Staff told us that they did have supervision meetings with their line manager, but one
Care Homes for Older People Page 21 of 26 Evidence: reported that she didnt find it particularly useful and rarely got feedback about her everyday working practices such as how she completes care plans etc. She told us she would value this greatly. The home holds money for some residents. We checked a sample of cash sheets and these were satisfactory, with amounts recorded accurately and appropriate receipts kept. Hoverer, we found bags of money for about 4 residents who no longer lived at the home, either because they had moved somewhere else or had died. The home had failed to forward these monies on to the residents themselves or their families. The chiropodist who visits the home does not issue receipts to residents so there is no way of checking or proving that this is what they have spent their money on. We checked the homes fire log which showed that all members of the night staff had now received training in fire drills. We saw no major health and safety hazards on the day we visited, apart from some dangerous cleaning products were kept, unlocked and easily accessible, in the laundry. Care Homes for Older People Page 22 of 26 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 23 of 26 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 7 13 Residents risk assessments 02/03/2009 must be much more detailed to ensure that their well being and safety is maintained. 2 9 17 The amount of variable dose 02/03/2009 medication must be recorded to ensure there is a clear record of how much medication someone has received. 3 29 19 Suitable references must be sought for prospective workers at the homes. to ensure that only the right people are employed to look after residents. 02/03/2009 4 31 8 An application to register a manager of the home must be made 01/06/2009 Care Homes for Older People Page 24 of 26 so we can assess that they have right skills and experience to run a residential care home. 5 38 13 All dangerous chemicals must be locked away securely so they are kept safe from residents. 31/01/2009 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 1 Prospective residents should be given the homes statement of purpose and service user guide before they move in, to ensure they have good information about where they might live. Residents should be actively involved in drawing up and reviewing their care plans so they have a say in how they are to be supported. Residents should be given opportunities to discuss their preferences about end of life issues and to record these to ensure their wishes are respected. 2 7 3 11 Care Homes for Older People Page 25 of 26 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. Copyright © (2009) 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. Care Homes for Older People Page 26 of 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
