CARE HOMES FOR OLDER PEOPLE
Laburnum Lodge 2a Victoria Street Littleport, Ely Cambridgeshire CB6 1LX Lead Inspector
Janie Buchanan Unannounced Inspection 26th June 2008 08.30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000015120.V367079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Laburnum Lodge Address 2a Victoria Street Littleport, Ely Cambridgeshire CB6 1LX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01353 860490 01353 860845 Dr A Hassaan Mrs S Hassaan Mrs Julie Dawn Cousins Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th March 2008 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 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. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes.
For this inspection we (the CSCI) visited the home and talked with three residents, two members of staff and the manager. We undertook a tour of the building, checked medication storage and recording, and viewed a range of documents. We also received information from the home’s annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We received 12 completed surveys prior to our inspection from residents, their families and staff. The home has been subject to additional inspections due to concerns about the quality of care provided and information from these inspections has been included in this report, as has information received by us from the local social services team. Social services have currently suspended placing people at the home because of these concerns. What the service does well: What has improved since the last inspection? What they could do better: Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 6 There is much this home needs to do to improve its service: Risk assessments, with particular attention to the risk of falls, should be completed for all residents so they are better protected. The recording and storage of residents’ medication must improve so that residents receive their medicines safely. The home must also purchase an appropriate facility to accommodate controlled drugs so that they can be stored safely. Complaints about the service must be dealt with more professionally and in a timely manner, so that residents and their relatives can be assured that their concerns are taken seriously and acted upon. All serious issues affecting the wellbeing of residents must be reported to the appropriate authorities so they can be monitored and dealt with according to local guidelines. The home’s adult protection procedures and key contact names and numbers should be made available to residents and their relatives so they know who to contact to report any concerns they may have. The home’s external environment continues to be poorly maintained and gives a shabby and neglected appearance. This was raised at the last inspection but the proprietor has done nothing to improve it, and has failed to meet the timescale given. Staff must receive all mandatory training so they have the skills and knowledge to properly support residents. The home’s recruitment procedures are very poor, and put residents at serious unnecessary risk. These must improve so that only the right people are employed to look after vulnerable adults. Supervision for staff is also poor and they should receive it more regularly so their working practices can be assessed and their training needs identified. All night staff should receive fire drill training so they know what to do in the event of a faire. They must also receive training in first aid so they can respond correctly in the event of an emergency. Many of the issues listed above have been raised at previous inspections (the shabby external environment, poor medication recording, poor staff training, inadequate recruitment practices) but little has improved. This shows a poor regard for the regulations and national minimum standards by the proprietor, and a lack of commitment to providing a well-maintained and safe environment for residents living there. If further timescales are not complied with we will consider taking legal action. We acknowledge that the new manager is working hard to improve standards, with some success, however there is still much to do to raise the quality of this home. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is adequate. Information is available about the home so that residents can decide if it is where they want to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents told us that they did receive enough information about the home before they moved so they could decide if it was the right place for them. One resident who visited first commented ‘I was greeted by the manager and was impressed by what she said and what I saw’. No new residents have been admitted to the home since our last inspection where the previous manager had carried out inadequate pre-admission assessments. However, the new manager showed us a more comprehensive pre-admission form to assess residents’ needs that will be being used for future admissions. We saw basic contracts describing the terms and conditions of people’s stay at the home on the files we checked. The home has been admitting residents with considerable mental health needs, despite not being registered for this category of residents. This is
Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 10 unacceptable, as staff do not have the training, knowledge and skills to meet the needs of these residents. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Residents’ health needs have not always been met fully met and the home’s medication procedures do not fully protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We checked the care plans of three residents living at the home. The information they contained was satisfactory with residents’ needs in relation to their personal care, eating and drinking, communication, mobility and continence recorded. They also contained good information about each resident’s social history and past life. However, one resident had experienced a number of falls recently, and although these falls had been recorded, no falls risk assessment had been completed or falls care plan implemented by the home to reduce this happening again. We issued a requirement at the last key inspection that all the plans had to be more detailed, despite this, only 3 of 14 of these had been fully updated. Residents are weighed regularly to monitor their health, a chiropodist visits monthly and a GP visits every Wednesday to attend to residents. We
Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 12 interviewed a GP who was visiting a resident during our inspection. He told us that his practice did receive appropriate referrals from the home and he felt the care provided by staff was adequate. However, during the last year we have received information from the local social services team that the home had been failing to refer residents to appropriate health care professionals such as the OT and continence nurse, thereby denying them vital health care intervention. We checked medication storage and recording systems; the following shortfalls were noted: • Hand written additions to the printed medication administration sheets had not been signed or dated • The amount of variable dose medication had not been recorded, so it was not possible to tell how many tablets someone had received • We found two unopened bottles of liquid medication that were very out of date • The medication trolleys were cluttered and dirty and some bottles were very sticky to the touch • The home does not have facilities to store controlled drugs safely Resident we talked to told us that staff treated them well, and we observed positive, encouraging and enabling interactions between them and staff during our visit. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. The home provides activities to keep residents stimulated and entertained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are activities for residents everyday between 2 and 4pm, and these are advertised on a board in the residents’ lounge. The day we visited all but a few residents had attended a Strawberry Tea in a local hall. There are music sessions for residents on a Thursday, and a monthly exercise class. Despite this, one relative told us she would like to see more exercise for residents and ‘that it would be nice for them to have more outings’. Residents are able to choose how the spend their day and one told us he enjoys going to Ely every Thursday by bus for the market. Residents told us they enjoyed their meals at the home and one relative commented the ‘’the food is very good and they encourage my mother to eat’. Lunch consisted of gammon, baked beans waffles and scrambled eggs followed by a dessert of fruit flan, fresh fruit or ice cream. We noted that most residents had large cups of juice by their side throughout the day to help maintain their fluid intake and hydration.
Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 14 Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. Complaints are handled poorly by the home and serious concerns are not reported to the relevant agencies, thereby failing to protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the responses to a number of recent complaints and incidents the home had received in the last year concerning, amongst other things, a cold bathroom; poor quality dining room chairs; aggressive incidents between residents and a resident being left for an unacceptably long time, having been assured by staff they would return. Not all the complaints were responded to within a reasonable timescale and the quality of the responses varied enormously: in one instance the response was unprofessional. Whilst looking through the record of complaints we came across an incident concerning the possible financial mismanagement/abuse of one resident’s money. There was no evidence that this incident had been reported to the local adult protection team, and no record of any follow up action or outcome for this resident. We followed this up and local adult protection team told us that the incident had only come to light following a conversation overheard between staff by a relative in the home. The home had not recorded, or informed the local adult protection at the time, and had only recorded it after told to do so by them. However, another allegation of theft has recently been raised by a resident and the manager responded quickly, informing all the appropriated authorities.
Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 16 We looked at the home’s adult protection policy that is currently being updated. It does yet not include details about the role other organisations such as the local authority and police and does not give information about the local point of contact for referral. It is also not in line with local guidance and reporting procedures. Information about whistle blowing and where to report concerns to is not available around the home for residents, their visitors or staff to view easily. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 Quality in this outcome area is adequate. Residents live in a homely environment, although their external environment is poorly maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises are homely, made more so by the presence of a cat, a budgie and a large fish tank for residents to enjoy. One relative told us that her mother’s room ‘ is always warm and clean’. However we noted the following shortfalls: • • • • the paintwork on the external windows and doorframes is peeling and one window is actually coming loose from its frame. The ramp leading to the entrance does not have railings to protect wheelchair users whilst using it, and a chair blocks the way. The exterior of the premises looks shabby and neglected, giving a poor first impression of the home. The laundry room is cluttered and dark. The sink is badly stained and dirty and wooden shelving is rotten and broken. One relative told us:
DS0000015120.V367079.R01.S.doc Version 5.2 Page 18 Laburnum Lodge • • ‘we think the laundry room could be improved to make it better for the care workers’. We found the door of the laundry unlocked, despite a large notice stating that the ‘door to be shut and locked’. The home has no separate sluicing facility to clean residents’ commodes properly and reduce infection control There is an upstairs toilet with no sink in it so that residents and staff can wash their hands. There has been one out break of diarrhoea and vomiting since the last inspection. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 19 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. The home’s recruitment procedures are poor and put residents at unnecessary risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently two members of care staff on duty through out the day and night to meet the needs of 14 residents. The manager is also on duty during the day. Residents told us that there were staff available when they needed and staff reported that they do get time to spend with residents. We checked the training records for a number of staff. One member of night staff had not received training in first aid and another member of staff, despite working at the since January 2008, had only received training in moving and handling. Moving and handling training was out of date for other staff. We viewed the personnel file for the most recently employed member of staff. The references for this person were inadequate: neither had been obtained from her previous employers, instead one was from someone who described herself as the person’s friend. Despite these poor references the home employed her before they received her CRB. This CRB listed serious concerns about the parson’s suitability to work in a caring role. Nothing was done about this, and the employee continues to work at the home. The home’s recruitment procedures continue fail to meet equal opportunities and employment legislation. The home’s staff application form contains questions about the number and age of children a prospective employee has
Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 20 and what regular exercise they take. One question asked at interview concerns how the person would travel to work. These questions are irrelevant to someone’s ability to be a carer. This was raised at a previous inspection but little has changed. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 21 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,34,36,38 Quality in this outcome area is adequate. Previous management of the home has been poor, but a new manager is introducing changes to improve the service for both residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager has recently been appointed to run the home. She is a registered nurse and has previous experience of running a residential care home. Many of the continual shortfalls highlighted in this report have been primarily as a result of the previous management arrangements, and not her direct responsibility. Staff are positive about the changes the new manager has introduced, and morale is reported to be better. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 22 Supervision of staff at the home continues to be poor, one member of staff has only received 2 supervisions in the last year, and a new member has only received one supervision since she started working at the home 6 months ago. The home holds money for some residents. We checked a sample of cash sheets and these were satisfactory, although some receipts were not dated making it very difficult to audit residents’ accounts. The provider visits the home regularly and completes regulation 26 reports. These are poor quality and do not provide enough information to assess the standard of care provided by the home. They do not provide evidence that he has talked with residents or their representatives, that he has inspected the premises or he has checked the home’s record of events and complaints. The home’s policies are very basic, and are not reviewed regularly enough to reflect changes in practice and legislation. The new manager is, however, working hard to update them, and has so far managed to update about 16 policies. We could not find any evidence that all night staff had completed fire drills to ensure that they know what to do in the event of a fire, or evidence that a gas safety check had been undertaken in the last year. We also found some undated items of food (piece of meat and quiche) in the fridge so it was not possible to tell whether or not they were fresh. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 2 x 2 x x x x 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x 3 x 1 x 2 Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 14(1) Requirement All residents must be fully assessed before being admitted to the home so they can be assured that their needs will be met. It was not possible to assess this requirement on this occasion. Extended timescale has been given. 2. OP7 15(2)(b) Information care plans must be much more detailed so that it accurately reflects residents’ their needs. This requirement has only been partially met. New timescale given. 3 OP9 13 (2) & 17 (1) (a) The administration and recording 26/06/08 of medication must be reviewed and improved, in order to protect residents. Previous extended timescale of 01/06/08 not met. CSCI may consider taking further legal action.
Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 25 Timescale for action 01/10/08 01/09/08 4 OP16 22 (3) & (4) All complaints must be recorded and investigated so that residents know their concerns are taken seriously. Previous timescale not met. New timescale given 01/09/08 5 OP18 13(6) All issues concerning the welfare 01/09/08 and safety of residents must be reported to the local adult protection team so that residents can be protected from abuse. This requirement has been partially met within the timescale. New timescale given The home must be kept in a good state of repair externally so that residents live in a wellmaintained and safe environment. Previous timescale not met. New timescale given. 6 OP19 23 (2)(b) 01/09/08 7 OP29 7,9,19 8 OP30 18(1)(c)(i ) Proper checks must be undertaken before someone starts working at the home so that residents are protected and only suitable people are employed to work at the home. All staff must receive up to date training in moving and handling so that residents are moved safely and without the risk of injury. Previous timescale not met. New timescale given 01/08/09 01/09/08 9 OP38 23 (4)(d) All staff must participate in regular fire drills so they know what to do in the event of a fire. 01/09/08 Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 26 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 2. 3 4 Refer to Standard OP7 OP29 OP18 OP36 Good Practice Recommendations Falls risk assessments should be completed for residents so that the risk of them falling is reduced. The home should operate through a recruitment procedure based on equal opportunities and non-discriminatory practices. Information about protecting vulnerable adults should be made available to residents and their relatives so they know who to report concerns to. Staff should receive supervision more frequently so they have the opportunity to discuss their working practices and training needs. Laburnum Lodge DS0000015120.V367079.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 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
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