Inspection on 30/05/06 for Laburnum Lodge

This inspection was carried out on 30th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Laburnum Lodge 18/01/10

Laburnum Lodge 28/10/09

Laburnum Lodge 16/06/09

Laburnum Lodge 13/01/09

Laburnum Lodge 26/06/08

Laburnum Lodge 03/07/07

Laburnum Lodge 03/01/07

Laburnum Lodge 20/12/05

Laburnum Lodge 22/06/05

Laburnum Lodge 16/11/04

Laburnum Lodge 12/07/04

Laburnum Lodge 28/04/04

Laburnum Lodge 21/01/04

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Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Laburnum Lodge 2a Victoria Street Littleport, Ely Cambridgeshire CB6 1LX Lead Inspector Janie Buchanan Key Unannounced Inspection 30th May 2006 11:00 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.V291836.R01.S.doc Version 5.1 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.V291836.R01.S.doc Version 5.1 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 Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2005 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 DS0000015120.V291836.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 30th May and was unannounced. The inspectors spoke with three residents, two relatives and a visiting NVQ assessor. They also interviewed the manager and two members of staff. A tour of the home was undertaken, medicine administration was checked and a range of documents was viewed. Ten requirements and one recommendation have been made as a result of this inspection. Three requirements remain outstanding from the previous inspection and failure to comply with the regulations may result in CSCI taking legal action against the registered person. What the service does well: What has improved since the last inspection? What they could do better: Assessment and care planning must improve to ensure that staff know what to do for each resident. Residents must also be involved in drawing up and reviewing their care plans. There are no risk assessments in place for residents for such things as moving and handling, falls or mental health. This puts residents, and staff, potentially at risk. The procedures for recording and storing medication are poor. Staff do not receive formal feedback about their working practices. A serious concern is that staff are being employed without proper checks to ensure that they are suitable to work with residents, leaving them potentially at risk. The home is without a registered manager. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 6 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 DS0000015120.V291836.R01.S.doc Version 5.1 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.V291836.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3 Outcomes in this group of standards are poor. Information is available about the home to help people decide if it is where they want to live. However, information about prospective residents is not detailed enough to ensure their needs can be fully met at the home, and some residents do not have details of the terms and conditions of their stay at the home. 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. This practice is to be commended. However, it was of concern to note that no assessment could be found for one recently admitted resident, and other assessments that had been completed were basic in detail and did not give adequate information to ensure the home could meet the person’s needs. There was also no contract available for one resident. A requirement has been made about this. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 9 Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7,8,9,10 Outcomes in this group of standards are poor. Information in care plans is not detailed enough for staff to know exactly what care each resident needs. Potential hazards to residents are not identified and assessed. However, Residents’ health needs are monitored at the home and there is access to health care services to meet their needs. EVIDENCE: Three residents’ care plans were checked. The information they contained was very basic and did not provide enough information for staff to know exactly what care was required. For example, all that was written on one plan under ‘dressing’ was ‘needs quite a lot of assistance’. The sort of assistance actually required was not detailed. There was no evidence that residents had been consulted about their care, and little evidence that the plans had been reviewed monthly as required by the standards. None of the plans contained any risk assessments for residents. A requirement has been made about this. Residents spoken to on the day of inspection were not aware that such plans existed and reported that they had never seen them. Requirements have been made in relations to this. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 11 All residents are registered with a local GP, a local optician provides optical health care and a chiropodist visits every two months. One resident visits a local dentist and another resident is currently seeing the district nurse after falling in the home. The manager reports that no resident has a pressure sore. Residents are weighed monthly. One resident told the inspector that her eyes were tested six weeks ago and that she sees the chiropodist regularly. A number of problems were identified in the receipt, recording, storage and stock control residents’ medications that were discussed at length with the manager. Staff do not receive accredited training in administering medication, and no formal practical assessment of their competence is completed or documented. A Requirement has been made in relation to this. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12,13,14,15 Outcomes in this group of standards are good. Regular activities provide interest and stimulation for residents. Residents are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: The home employs two specific staff who provide activities for residents for two hours each afternoon. These activities include bingo, dominos, skittles, quizzes and arts and crafts. At a recent Bank Holiday the home hosted a ‘Land Army’ celebration where staff dressed up as land girls, and food and music of that era was provided for residents. A garden fete is planned for July and there are regular visits from local clergy and the Sally Army. Staff are available to take residents out and one resident regularly visits the local betting shop. Friends are family are made to feel very welcome at the home, and the inspector talked to one person who continues to visit residents even though her aunt died at the home two years ago. Daily routines at the home are flexible and residents can choose how to spend their day. One resident told the inspector she likes to lie in till 9 or 10 am of a morning, another that he gets up at 7.30am each day. One resident commented: ‘you can do what you like we’re not pushed around like sheep’. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 13 On the day of inspection residents were enjoying a lunch of sausage or scampi and chips, followed by a dessert of strawberry flan. Lunchtime was sociable and unhurried, and residents were given plenty time to eat. A brief tour of the kitchen was undertaken: food was dated and stored correctly in fridges and a detailed record of what is cooked each day is kept. The cook has recently undertaken a nutrition course. There were bowls of fresh fruit around the home for residents to help themselves to. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16, 18 Outcomes in this group of standards are poor. Residents do not how, and to whom to complain. EVIDENCE: The home has its own complaints procedure, details of which are in its Statement of Procedure. However, the procedure is too basic and does not give the stages and timescales for the process. The manager herself was unaware of the details of the complaints procedure, as were residents and visiting relatives. Ways of making the complaints procedure more accessible to residents (such as making it the topic of a residents’ meeting, displaying it widely around the home, giving residents copies of it in large print, explaining it individually to residents) were discussed with the manager. No staff have yet had training in protecting vulnerable adults (POVA), although some is planned in the coming month. One member of staff was subject to a recent POVA investigation. The manager acted appropriately by immediately suspending this staff member and subsequently referred her to be included on the POVA list. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19, 20, 22,23,24,25,26 Outcomes in this set of standards are good. Residents live in a homely and comfortable environment and have access to a range of communal spaces. However, there are no separate areas for staff. 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. Residents’ bedrooms were comfortable and personalised and four have ensuite facilities. However, 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. The home has a range of aids and equipment such as grab rails, hoists, bath chairs and raised toilet seats available that promote residents’ safety and mobility. Residents have access to two large lounges and a dining room area. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 16 However there is no separate area for staff to have their breaks, or meetings to be held. The inspector had to use a residents’ bedroom in order to interview staff, and an NVQ assessor, visiting the home on the day of inspection, had to use another residents’ bedroom for her work. Due to this lack of space staff meetings are held in the residents’ lounge. This not only compromises residents’ living space but could also breach their confidentiality, as they are often the subject of the meetings. For example, at the staff meeting held on 24 May residents’ health and continence needs were discussed by staff. The manager should consider holding staff meetings out of earshot of residents. 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. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Outcomes in this set of standards are adequate. Staffing levels are sufficient and residents receive help from caring and competent staff. However, the home’s recruitment procedures need to be more rigorous to fully protect residents EVIDENCE: There is a minimum of two staff on throughout the day to meet the needs of 16 residents. Cleaning and activities staff are also on duty during the day. At night there is one member of staff plus an ‘on call’ manager on duty. The manager provides additional support during the week. Staff reported that these staffing levels were adequate for them to do their job, although reported that the mornings were often very busy and sometimes felt rushed. Residents told the inspector that they never waited too long for help, and that staff were always nearby for help. The inspector received many positive comments about the quality of staff both from residents and their visitors. Two staff have completed their NVQ level 2 and a further 6 are currently undertaking it. The NVQ assessor was at the home during the inspection and was confident that the staff currently undertaking the NVQ would achieve the award. The personnel files for two recently employed members of staff were checked. It was of concern to note that there was no evidence that one member of staff had had a CRB check and there was only one reference available. Another Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 18 member of staff had commenced employment prior to her POVA first check being completed. This means residents are receiving help form staff who have not been properly vetted. A requirement has been made about this. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38 The outcomes in this group of standards are poor. The home continues to operate without a registered manager and staff to do not receive formal supervision of their working practices. EVIDENCE: The home is still without a registered manager. This has been a requirement outstanding from the previous two inspections and one that the registered provider continues to ignore. Operating a care home without a registered manager is an offence. The acting manager works hard to maintain 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 in the home. However, she lacks sufficient knowledge about the legal requirements and national minimum standards relating to the running of a care home. She states that she does not feel well supported in her Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 20 job, and there is no deputy manager in place to help her. Staff echoed this concern. The manager states that she is ‘on call’ every night of the week. This is excessive, and does give the manager adequate time off. Night cover should be shared by a number of staff on a rota basis. The manager has signed an employment contract, but this contract does not actually state the number of hours to be worked each week, or the number of weeks annual leave she is entitled to. It also does not state the terms and conditions for covering night duty. Formal supervision for staff is poor. Records checked by the inspector showed that one member of staff had only received one supervision since November another member of staff had received none. The importance of individual supervision with staff (that covers aspects of their working practices, career development needs, philosophy and policies of the home) was discussed with the manager. A requirement has been made about this. The manager has recently sent out a number of ‘visitor’s questionnaires’ to actively get feedback about the quality of the service provided at the home. The questionnaire asks for comments about the quality of the environment of the home, the staff attitude and food. The inspector viewed 6 completed questionnaires all of which rated the home as ‘excellent’ or ‘good’. The inspector suggested that this survey also be extended to seek the views of the varying health care professionals who regularly visit the home. A number of records in relation to health and safety (fire, portable appliance testing, emergency lighting and call bell servicing) were viewed by the inspector and found to be in good order. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 21 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 1 8 3 9 2 10 3 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 2 17 x 18 2 3 2 x 3 3 3 3 3 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 2 3 2 x x 1 x 2 Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 22 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 OP2 Regulation 5 (b) Requirement All residents must receive terms and conditions in respect of accommodation to be provided, including the amount and method and payment of fees. Care plans must be written in consultation with the resident and/or their representative and must be signed wherever possible, or a reason recorded as to why this has not been possible. Care plans must be reviewed monthly. Residents must, wherever possible, be consulted about the review of their care plan. Records of the prescribing, administration and disposal of medicines must be maintained correctly and consistently. Appropriate checks must be undertaken for all prospective staff before the commence employment at the home. The registered person must ensure that all staff have an employment contract and job description(s) appropriate to the DS0000015120.V291836.R01.S.doc Timescale for action 01/08/06 2 OP7 15 01/08/06 4 OP7 15 01/08/06 5 OP9 13(2) 17(1)(a) Sch 3(3) 01/07/06 6 OP29 7,9,19 30/05/06 7 OP29 17(2) 01/07/06 Laburnum Lodge Version 5.1 Page 23 role(s) they carry out as required by schedule 4 (6(e(ii)))of the Care Homes Regulations. Timescale of 30/01/06 not met. 8 OP31 8 The registered person must appoint an appropriate manager and complete an application for their registration with the CSCI. It should be noted that this requirement is outstanding from the last inspection and failure to meet this requirement will result in prosecution. Timescale of 30/01/06 not met. 01/07/06 9 OP36 18(2) The registered person in the 01/08/06 absence of a registered manager must ensure that appropriate supervision of all grades of staff is carried out at least 6 times per year and formal records kept. Timescale of 30/01/06 not met. Risk assessment must be completed for residents in relation to their moving and handling, falls and any other identified activities that could cause harm. 01/08/06 10 OP38 13 (4) 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 OP16 Good Practice Recommendations Staff should explain the complaints procedure to residents. Laburnum Lodge DS0000015120.V291836.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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