CARE HOMES FOR OLDER PEOPLE
Laburnum Lodge 2a Victoria Street Littleport, Ely Cambridgeshire CB6 1LX Lead Inspector
Jenny Cangy Unannounced 22 June 2005 @ 11:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Laburnum Lodge Address Victoria Street Littleport Ely Cambs CB6 1LX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01353 860490 Mr A Hassaan FRCS none Care Home 16 Category(ies) of Older people (OP) 16 registration, with number of places Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 16/11/04 Brief Description of the Service: Laburnum Lodge is a two-storey house, that includes a single storey extension, to provide accommodation, personal care and support for a maximum number of 16 places for individuals over 65 years of age. The upper floor is access via stairs or a stair lift. The home is situated in the centre of the village of Littleport and is close to shops, cafes, pubs and local amenities. A garden is available to the rear of the building. Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and commenced at 11am. Notices were put up to tell service users and visitors that an unannounced inspection was in progress. When the inspector arrived Mrs Cousins the acting manager was checking service users money records so the Inspector undertook a tour of the home. Service users, staff and visitors were spoken to. All areas of the home were found to be clean and fresh and staff were observed appropriately interacting with service users. An engineer was present in the home fitting a new mechanism to the stair lift. A review of the requirements from the last inspection report was conducted with the acting manager. The inspection process was explained and the revised report format was shown to the Acting manager. Lunch was observed and was noted to be well presented. Service users spoke highly of the quality of the food. The atmosphere in the home was informal and friendly. What the service does well: What has improved since the last inspection?
The information in care plans has improved. No service users outside of the registration category are accepted. The acting manager has maintained a good service. Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 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 Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5 The information to enable service users to make an informed choice is not up to date and has not been used since the Registered manager left. However the acting manager has assured that prospective service users know the service being offered. EVIDENCE: The statement of purpose and service user guide is out of date and has not been used since the registered manager left. This was discussed with the acting manager who stated she would take appropriate action. The acting manager assesses all prospective service users prior to accepting them. They are encouraged to visit the home prior to moving in, as are their representatives. The home only accepts service users within the registration category and those whose care need can be met. Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,11 Staff have comprehensive care plans to refer to ensuring all the service users needs are met. Not all service users wishes with regard to illness dying and death are known thus denying their wishes being met. EVIDENCE: On the whole care plans are informative and contain sufficient information for staff to meet the needs of those in their care. Outside professional help is sought where appropriate and all service users are registered with the local GP practice. The information to ensure service users wishes for their final illness and after death is not complete in some care plans. This was discussed with the Acting Manager who agreed to take appropriate action Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Service users enjoy a lifestyle of their choice that includes activities within and outside the home. EVIDENCE: Service users have activities provided both within and outside of the home. These include entertainers, bingo, arts and crafts, attending the local over 60,s clubs and church. Religious services of all denominations are organised within the home as appropriate. Staff have training in nutrition and the community dietician visits. There is a rotating menu and a choice at all meals. Meals are treated as a social occasion. Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17,18 Service users have their legal and civil rights upheld and are protected from abuse, thus ensuring they enjoy a safe secure life. EVIDENCE: Service users are on the electoral roll and are enabled to exercise their right to vote. They have access to legal representation as required and independent advocacy is sought if needed. Staff have training in Protection of Vulnerable Adults (POVA)and recognising abuse. The acting manager is familiar with POVA procedures. The home has a whistle blowing policy. Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,23,24,26 On the whole the service users have a safe comfortable, clean, well maintained environment. However service users have been put at risk due to equipment being used that is unsafe. EVIDENCE: The home is well maintained and clean. There were no unpleasant odours and bedrooms are welcoming and personalised. There is a separate area for service users that smoke. All three shared bedrooms have screens to ensure privacy. It was noted that a toilet seat was missing from the first floor toilet. An immediate requirement notice was left to prevent the use of the ground floor bathroom until the bath hoist is replaced. This has been declared unsafe by an occupational therapist due to the lack of a locking mechanism to prevent it swinging around full circle. This has been outstanding for more than 6 months and any further delay will result in legal action being taken Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 There are insufficient staff in the evenings to adequately meet the needs of the service users. Staff have training to ensure they are able to meet the need of the service users. EVIDENCE: Some of the service users currently living in the home wish to stay up until late evening. When they are ready for bed only one staff member is on duty. Although some service users are able to go to bed independently others need assistance. This causes concern to the acting manager and the night staff as they are unable to cope with the work-load without leaving service users unattended. This is unacceptable. Staff training is available to ensure staff are competent to meet the needs of the service users. Four staff have almost completed NVQ level 2 in care. Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37,38 Although the acting manager is able to maintain a good quality of care within the home there is little evidence of leadership and support from the proprietor while she gains the confidence, knowledge and skills to enable her to take the home forward. Thus the home is failing to ensure service user benefit from the ethos, leadership and management of the home. EVIDENCE: The registered manager left the home without giving notice several months ago. Since then the home has been run on a day to day basis by the acting manager. She has maintained a good quality of care within the home but demonstrated no knowledge of the National Minimum Standards and had no access to these. She was advised by the inspector on how to obtain them. She has had no advice from the proprietor about the NMS, Regulations or the Care Standards Act 2000. She has had no formal supervision from her employer. She is to be congratulated on her efforts to maintain a high standard of care with little support or guidance.
Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 15 Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 2 1 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 2 1 2 x x x 3 2 Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 17 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 6 Timescale for action The registered person must By 30th review and update the statement August of purpose and service user 2005 guide and ensure all service users have access to them. The registered person must With ensure the ground floor immediate bathroom is not used for service effect from users until the bath hoist is the date of modified or replaced. inspection The registered person must By 30th arrange for the bath hoist in the July 2005 ground floor bathroom to be modified of replaced. The registered person must With ensure there are sufficient immediate numbers of competent staff on effect from duty at all times to meet the reciept of needs of the service users. this report. The registered person must Appropriat recruit and appoint a manager e action to and ensure the person appointed recruit a is fit to be registered with the manager CSCI. must be taken by 30th August 2005 The registered person in the With absence of a registered manager immediate must provide sufficient guidance, effect from support and supervision to the receipt of
Version 1.30 Page 18 Requirement 2. 19 23(2c) 3. 22(4) 23(c) 4. 27 18(1a) 5. 31 8 6. 32 10 Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc 7. 33 24 acting manager until such a time as a manager is registered with the CSCI. In the absence or unavailability of the provider the acting manager must have a contact name and number to consult at all times. The registered person must ensure a method of quality assurance monitoring is in place at least annually this report 8. 31.8 10(1) The registered person must notify the CSCI in writing of the plan of action to meet the above requirements. (It should be noted that in the absence of a registered manager the registered person is the provider(proprietor)) A quality review must be planned for by 30th August 2005 by the 10th August 2005 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 38.6 Good Practice Recommendations The registered person should carry out a risk assessment regarding the method by which staff members handle the payroll. Steps to ensure the staff members safety by putting into place a policy and procedure to ensure no member of staff takes on this duty unsupported by a second person. They should also ensure that the homes insurance covers this practice and would compensate the members of staff if they were injured whislt dealing with the payroll. Laburnum Lodge I53 I03 15120 LABURNUM V234856 220605 STAGE 0.doc Version 1.30 Page 19 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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