CARE HOMES FOR OLDER PEOPLE
Laburnum Lodge 2a Victoria Street Littleport, Ely Cambridgeshire CB6 1LX Lead Inspector
Janie Buchanan Key Unannounced Inspection 10:00 3rd January 2007 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.V322360.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.V322360.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 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th May 2006 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 16 older people. The upper floor is accessed 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. The weekly charge is £340. A copy of the most recent inspection report is available in the entrance way to the home. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on the 03 January 2007 and was the home’s second key inspection for the year 2006/2007. It was unannounced. An additional inspection was undertaken on the 16 August 2006 and details of this can be obtained by contacting the CSCI’s eastern regional office. For this inspection three residents, two members of staff and the manager were interviewed. A tour of the home was undertaken, medicine administration was checked and a range of documents was viewed. What the service does well: What has improved since the last inspection? What they could do better:
This inspection has identified a number of serious hazards around the home that must be addressed to ensure residents’ safety. Please refer to standards 19-26 of this report. Although staffing levels were sufficient on the day of inspection they must be monitored closely, as staff reported there was not always enough of them on duty to fully meet all residents’ needs if one was very ill. The layout of the home also makes it difficult to supervise residents.
Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 6 The registered provider should make a specific budget available for activities so it is not reliant on staff raising money for them to be provided. Supervision for staff should take place more regularly so that their working practices can be assessed, and their training needs identified. Tighter auditing practices should be implemented to ensure that accurate records are kept of residents’ monies, and someone in addition the manager should check these records regularly. 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.V322360.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is good. Information is available about the home to help people decide if it is where they want to live. Residents’ needs are also assessed to ensure that they can be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose that gives good information about the home’s facilities and services. This document could be further improved if it was in a format suitable for its readers such as large print or audio. The manager visits all prospective residents to complete an assessment of their needs, and encourages them, where possible, to come and spend a day at the home to sample life there. The files for two recently admitted residents were viewed and each contained an assessment of their needs, and a contract stating the terms and conditions of their stay at the home. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Quality in this outcome area is good. Care plans ensure that staff offer support to residents in a consistent and comprehensive way. Residents health needs are monitored. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ care plans were checked. The information they contained was good, and residents’ needs in relation to their dressing, diet, continence, mobility and daily routines were clearly identified. Particular attention was paid to residents’ past social and life histories: this is to be commended. The inspector sat with two residents and went through their care plans with them. Both these residents agreed that the plan was an accurate reflection of their current needs. Residents’ health care needs were clearly recorded in their care plans, as was a monthly record of their weight (some of which showed that residents had been putting on a healthy amount of weight). All residents are registered with a local GP, a local optician provides optical health care and a chiropodist visits every two months. The manager reported that no resident had a pressure sore.
Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 10 Medication storage and administration records were checked and found to be satisfactory. However a number of medical creams and ointments were found in residents’ bedrooms and these should be kept in a locked facility in the bedrooms to ensure they are stored securely. Staff have undertaken training in medicines provided by the local pharmacy. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 11 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. Regular activities provide interest and stimulation for residents. Residents are offered a healthy diet and enjoy their meals and mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs specific staff to provide activities for residents for two hours each afternoon. These include bingo, dominos, skittles, quizzes, pamper sessions, and arts and crafts. There were a number of additional festivities over the Christmas period, with one resident volunteering to be Father Christmas. Every month there is ‘Sporting Chance’ where a sports therapist visits to facilitate a number of adapted sports for older people. There are regular visits from a variety of local clergy and the Sally Army, and staff accompany one resident to church. However, it was of concern to note that there is no specific budget for residents’ activities and staff have to raise money themselves in order to provide them. Friends are family are made to feel very welcome at the home, and residents spoken to reported that they see family members regularly. Residents also reported they spend their day how they wish. One commented ‘I like to go to my room at 7pm to watch my own TV and have a glass of Bailey’s’.
Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 12 Food at the home is good, with fresh produce being cooked. Bowls of fresh fruit were available in the lounge for residents to help themselves to. A number of staff have attended ‘nutrition and the elderly’ training. Lunch on the day of inspection was poached salmon with baked potato, broccoli and peas, followed by a dessert of chocolate sponge and custard. The food looked tasty and nutritious. A noisy Hoover in the background was the only thing that spoilt this otherwise relaxed and sociable mealtime. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 13 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 adequate. Residents have access to the home’s complaints procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has its own complaints procedure, details of which are in its Statement of Procedure and on display in the entrance hallway. Residents have a copy of the complaints procedure in their bedrooms and it was reported that their relatives are informed how to make a complaint. Those residents spoken to were not fully aware of the home’s complaints procedure but identified the manager as someone they could speak to if they were unhappy about any aspects of their care. Six staff have undergone training in protecting vulnerable adults, and the remaining staff will attend this training when places become available. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 14 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): 19,23,25,26 Quality in this outcome area is poor. Aspects of the home’s environment put residents at unnecessary risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were observed to be clean, bright and well maintained, with good quality furnishing and fittings in place. It felt homely and there was a cat, budgie and fish for residents to enjoy. New carpeting had been laid in the lounge and new armchairs for residents had recently been purchased. However the following issues need to be addressed, as some pose a serious health and safety hazard to residents. 1. Not all bedrooms contained bedside lighting as recommended by the standards. This is potentially hazardous for residents who need to get out of bed to switch the overhead light off, and then find their way back in the dark. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 15 2. A number of bedrooms had uncovered radiators in them. This is potentially hazardous to residents who could seriously burn themselves if they fell against them. 3. Overhead lighting in some bedrooms is very poor. Residents with visual impairments need good strong lightening to maximise their vision 4. Water from the hot taps in a number of toilets and bathrooms exceeds recommended temperatures and could potentially scold residents. 5. The carpet at the top of the main staircase is rucking up, thereby causing a potential trip hazard for residents and staff 6. There was a broken stained glass window upstairs. Not only is this dangerous, but it lets in very cold air. 7. One fire door on the upstairs landing was wedged open with a mattress, thereby preventing it from shutting properly in the event of a fire. 8. One double bedroom is used each week as a hairdressing salon. This is unacceptable as it prevents these two residents accessing their bedrooms during this time. It was not clear if these two residents actively consent each week to their bedroom being used in such a manner. 9. Some bedrooms do not contain a lockable space for residents to safely store medications, money or valuables 10. The manager’s office is very small and cramped and does not provide enough storage for all required paperwork, or for individual meetings with staff members. 11. There is no separate area for staff to have their breaks in, or for meetings to be held Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 16 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 adequate. Residents receive help from caring and competent staff, although staffing levels must be monitored to ensure residents’ needs are fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are two members of care staff on throughout the day to meet the needs of 16 residents. Cleaning and activities staff are also on duty during the day. The manager provides additional support during the week. At night there is one member of staff plus an ‘on call’ manager on duty. Scrutiny of the duty rota showed these staffing levels to be maintained, and agency staff are never used at the home. However staff reported that at times there was not enough of them available to meet residents’ needs, especially if a resident falls or becomes very ill. It was of concern to note that one resident is sometimes given a hand bell so that she can alert staff if a resident in the lounge requires assistance. This is unacceptable. The layout of the home also makes it difficult for just two staff to fully supervise all residents. Staff spoken to confirmed that they had received all mandatory training, and six of eleven staff hold an NVQ level 2 in care. However, training records viewed showed that the only training one member of night staff had received was in moving and handling seven years ago. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 17 The personnel files for two recently employed members of staff were viewed and each contained appropriate CRB and POVA checks, and satisfactory references. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 18 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): 31,32,35,36,38 Quality in this outcome area is adequate. Residents and staff benefit from the management approach of the home. However staff need to be supervised more frequently and better records need to be maintained of how residents’ monies are spent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager works hard to improve the standards of care in the home and is clearly committed to providing a good service for residents. Her management style creates an open, positive and inclusive atmosphere and staff report her to be caring about them and residents. Teamwork is reported to be good, and there are regular staff meetings. All staff attend in daily handovers at the home. However not all staff have received supervision as frequently as recommended by the standards. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 19 Appropriate records of financial transaction undertaken on behalf of residents are kept. However a few discrepancies were found between the records and the actual monies stored. A number of records in relation to health and safety (fire, portable appliance testing, fridge and freezer temperate recording and employer’s liability insurance) were found to be in good order. The kitchen was hygienic and all foodstuffs were stored correctly. However a number of serious health and safety issues have been identified under standards 19-26 of this report. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 20 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 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x 2 x 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x 2 2 x 2 Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? no 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. 2 3 Standard OP19 OP27 OP30 Regulation 13(2)(c) 18 (1)(a) 18 (1)(c) Requirement Item numbers 1-7 noted under standards 19-26 of this report must be addressed. Staffing levels must be reviewed to ensure that residents’ needs are fully met. All staff must receive training in moving and handling. Timescale for action 01/02/07 01/03/07 01/03/07 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 Refer to Standard OP12 OP35 OP36 Good Practice Recommendations A budget specifically for residents’ activities and entertainment should be made available. More robust auditing procedures should be implemented to check residents’ monies Staff should receive formal supervision at least six times a year. Laburnum Lodge DS0000015120.V322360.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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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