Inspection on 25/04/05 for Laburnums

This inspection was carried out on 25th April 2005.

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

Laburnums 29/06/07

Laburnums 06/06/06

Laburnums 14/11/05

Laburnums 13/12/04

Laburnums 27/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Laburnums 20 Chalkwell Avenue Westcliff on Sea Essex SS0 8NA Lead Inspector Trevor Davey Unannounced 25 April 2005 9:00 th 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 and Care Homes for Adults 18 – 65*. 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. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Laburnums Address 20 Chalkwell Avenue, Westcliff on Sea, Essex, SS0 8NA 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) 01702 477898 01702 480678 East Thames Manager post vacant Care Home 9 Category(ies) of LD Learning Disability (9) registration, with number of places Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Care and accommodation to be provided to persons between the age 18 and 65 with a learning disability. Date of last inspection 13th December 2004 Brief Description of the Service: Laburnums is registered to provide personal care and accommodation to nine residents whose primary need of care is learning disability. Residents living at Laburnums are over 65 years of age. Accommodation is provided in a larger style three-storey house in a residential area. The type and style of property provides plenty of space for service users and has a large garden area. It is close to local shops and main bus routes the home provides individual and personalised care of for service users. A large range of social recreation activities/events are facilitated. All service users have their own bedrooms which are decorated and personalised to individual preference and choice. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of 5.5 hours. The inspection focused mainly on the progress the home had made since the last inspection although a number of other standards of care were also considered. A partial tour of the premises took place and the relief manager assisted the inspector during the day. Conversations also took place with some of the members of staff and residents. A notice was displayed in the main entrance area throughout the day advising all visitors to the home that an inspection was taking place with an open invitation to speak with the inspector. The inspector gave a full and detailed feedback to the relief manager at the end of the visit with opportunity for questions and any clarification which may be needed. Assurances were given that shortfalls identified would be taken up with the Service Manager. What the service does well: The relief manager and existing staff team were observed to be interacting well with the residents and residents spoken to were positive in the way key members of staff supported them in the home and also in local community activities. Resident’s bedrooms, lounges and dining areas are good and the property is ideally located within an area where residents are able to go shopping and attend various day-care facilities. The gardens are well maintained. Other facilities are also available in the grounds where residents take part in handicraft and occupational therapy activities. From conversations with staff, they felt supported by the relief manager who was always willing to discuss issues and resolve any problems quickly. From discussion with residents, observation and a sample of the records examined, the home was able to demonstrate its aim of developing a person centred approach recognising the rights of residents together with their ability to choose, enjoy privacy and independence so far as it was possible, as well as a fulfilling lifestyle. Overall, there was a good atmosphere in the home and positive comments were made by residents of the support received by the staff team. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home could improve the time it takes to meet Regulations and National Minimum Standards to improve practice. Some recruitment records were not available on file including application forms and references to ensure resident safety. Whilst it is acknowledged that considerable improvement has begun to take place in reviewing the format and updating of personal-care records and risk assessments, some information was still not available. Assessments are needed to ensure that proper agreed procedures are in place for the safety of residents and to minimise injury in moving and handling procedures. It was noted that considerable time was having to be spent by the relief manager and staff to identify and collate essential information which needs to be included in the personal records of residents. The policy on prevention of abuse and the whistle blowing procedure did not include the essential steps to follow and agencies to contact when abuse is identified or suspected. This could mean that staff may not take the action needed to safeguard residents. Maintenance systems and upkeep of the building needs improvement. This included the safety hazard at the foot of the external fire escape where a paved area is uneven. Please contact the provider for advice of actions taken in response to this Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 There is no consistent system in place to undertake pre-admission assessments to ensure care needs can be met. EVIDENCE: From the sample checks made, some information was available showing reviews which had taken place as well as other healthcare professionals who had been involved. However, there was not always pre-admission assessment information and staff were unable to produce this to show they have knowledge of residents’ needs. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 The home access local doctors and other healthcare professionals as needed. Personal life plans and risk assessments need to be updated for all residents to reflect needs and safety requirements. Medication procedures need to be clear. EVIDENCE: Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 11 Evidence was available to show that residents had access to doctors and other healthcare professionals when required. Records also included resident’s wishes following death and comments received from residents showed that they were treated with respect with their right to privacy being upheld. The homes personal life plans and other resident’s records were not all up-to-date and did not always include essential information. Personal life plans were in the process of being modified and updated at it was noted that risk assessments were not always complete or available. This can lead to misunderstanding and inconsistency in the way care and support is delivered. Resident’s safety could also be at risk. Although the medication procedures were not inspected on this occasion, there was some ambiguity in the wording of the form which had been signed in respect of medication. Personal care records must clearly reflect residents needs and take account of changes which must be regularly reviewed and documented. Where some of the personal life plans had been reviewed, these had not always been dated or signed for. There was no provision for residents to sign indicating their involvement and agreement to the provision of care and support to be provided. Although one of the service users had bed rails, there was no evidence of a risk assessment on file to show they are needed and safe for residents’ use. The home must also be able to demonstrate that the use of bed rails does not inappropriately restrict the movement of residents. This was also highlighted as a requirement at the last inspection. Residents were positive in their comments regarding the care and support given by staff and in helping them to make decisions on plans for their future. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14and15 Handicraft and occupational activity is provided on the premises on a regular basis. The home is ideally placed in enabling residents to easily be involved in the local community. Residents are consulted and enabled to develop skills. EVIDENCE: Staff spoken to confirmed that they were involved with residents in supporting them in their daily activities both in the home and in the local community. Another resident mentioned some of the items which had been purchased at the local shops. A record was also available showing weekly activities which had been attended by residents. Minutes were also available of residents meetings which take place and discussion is also included on a one-two-one basis and in small groups between residents and staff. Residents are also encouraged to select their meals and they visit shops with their key worker to buy food which they also help to prepare in the home. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,and18 Residents are made aware of the complaints procedure. The home’s protection of vulnerable adults and whistleblowing procedure must be updated. EVIDENCE: Residents spoken to confirmed that any issues or complaints were dealt with by the staff team . Residents also commented that they felt safe in the home. However, the homes policy on abuse and the whistleblowing procedure is a very lengthy document and does not clearly stated the responsibility of the manager and Registered Provider to contact essential agencies in all cases where abuse is witnessed or suspected. There was no clear instruction indicating that the police must always be contacted at (where criminal activity is suspected) all that the CSCI must be contacted under Regulation 37 of the Care Homes Regulations. Neither was there any clear instruction that the local Social Services Department must also be notified under their alert system to ensure that a POVA strategy group meeting takes place. Clarity about the suspension of staff implicated pending the outcome of any inquiry, was not evident in the whistleblowing procedure. The POVA guidance must be updated to ensure residents are protected and staff take appropriate action when required. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,25,and26 Overall, the decoration, cleanliness and hygiene standards in the home are good. The systems for undertaking maintenance needs to be improved. EVIDENCE: Items of maintenance and upkeep of the home although reported to East Living for attention, are not dealt with promptly and some items are still outstanding which affects the well-being and safety of residents. Reference was made in the previous inspection report of uneven paving at the bottom of the external fire escape as this presented a potential trip hazard. This has still not been attended to. There is also dampness in areas of the conservatory which remains outstanding. Since the last inspection, two new water tanks had been installed in the loft and records are now being maintained of hot water temperatures. However, the record of water temperature in bedrooms Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 15 five and six were shown in the homes as running cold. Staff need to take action to ensure water temperatures are safe for residents’ use. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27and29 Staffing levels in the home meet the needs of residents. Not all staff recruitment records were complete which could jeopardise the safety of residents. EVIDENCE: The staff team who were present during the day of the inspection, were positive in their comments and showed a commitment and satisfaction in the roles they were fulfilling in the home. The use of agency staff has been reduced considerably and the staff rota showed that adequate cover was being provided throughout a 24 hour period. Staff confirmed that they were now receiving one-to-one supervision and documentation was available. Some of the recruitment records did not have available application forms or two references for staff working in the home. Staff were positive in the support provided by the relief manager. However, being without a permanent registered manager for eight months, has led to inconsistency in the daily running of the home for residents and the delivery of care which has not always followed correct procedures. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,and38 There were shortfalls in the areas of the management and administration of the home in ensuring that policies, procedures, risk assessments and the safe upkeep of the building has not always been monitored. The suspension of a member of staff had not been notified to the CSCI. EVIDENCE: Risk assessments for residents and also for a safe working environment were not always in place and items which require maintenance such as the regular safe delivery of hot water for residents had still not been rectified. Although reported, the paving at the foot of the external fire escape had still not been made safe and the dampness in the conservatory still exists posing potential risk to residents and staff. Workplace assessments for a safe working Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 18 environment were not in place. Staff spoken to confirmed they were receiving staff supervision and records were available. The Inspector was advised whilst carrying out the inspection, that a member of staff had been suspended from duty but no notification under Reg. 37 had been received by the CSCI. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 19 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 x 2 x 3 x 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 x x x x x 2 3 Score Standard No 7 8 9 10 11 Score 2 3 x 3 3 Standard No 27 28 29 30 3 x 2 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 3 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 3 34 x 35 x 36 3 37 2 38 2 Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 20 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 31 Regulation 8 Requirement The Registered Person must appoint a manager and inform the Commission of Social Care Inspection of their detail with a supporting application to enable registration to be considered (previous timescale of 7/2/05 not met). The Registered Person must ensure that all recruitment checks have been completed and documents are available for inspection in the home including references and application forms (previous timescale of 7/2/05 not met). The Register Person must ensure that all parts of the home to which service users have access are so far as reasonably practical free from hazards to their safety and that the supply of hot water is regularised to ensure this is safe to prevent risks from Legionella and from risks of scalding (previous timescale of 7/2/05 not met). The Registered Person shall not provide accommodation to a service user unless a preadmission assessment has been Timescale for action 31st July 2005 2. 29 19 (2) 30th July 2005 3. 25 13 30th July 2005 4. 3 14 30th. June 2005 Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 21 5. 7 & 37 15 6. 7 13 7. 19 & 38 13 &23 8. 29 37 9. 18 12 &13 received and is collated as part of the personal-care records and needs identified can be met (previous timescale of 7/2/05 not met). The Registered Person must continue to update service uses care plans which must be kept under review on a monthly basis to reflect changing needs and current objectives (previous timescale of 7/2/05 not met). The Registered Person must make suitable arrangements to provide a safe system for moving and handling service users and ensure that risk assessments are updated to take account of any hazards to their safety. Risk assessments for bed rails must be properly documented and reviewed monthly. The Registered Person must ensure that any unnecessary risks to health or safety of service users are identified and so far as possible eliminated and that the premises are of sound construction and kept in a good state of repair externally and internally. This relates specifically to the uneven paving at the bottom of the external fire escape and the damp areas in the conservatory. (Previous timescale of 7/2/05 not met) The Registered Person must give notice to the Commission without delay of the occurrence of any allegation of mis-conduct by the Registered Person or any staff that works at the care home. The Registered Person shall ensure that the care home is conducted so as to make proper provision for the care, health and 30th July 2005 30th June 2005 30th July 2005 15th June 2005 15th July 2005 Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 22 welfare of service users by training staff to prevent service users from being harmed or suffering abuse or being placed at risk from harm or abuse. The homes of abuse and whistleblowing policy must be updated to include the essential agencies to be contacted when reporting such incidents. This includes the police, the local Social Services Department regardingP.O.V.A. alert requirements and the local Commission for Social Care Inspection office. 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 9 Good Practice Recommendations The Register Person should ensure that any documentation regarding the responsibility for whom should be administering medication is clear and unambiguous.. Laburnums I56 S15444 Laburnums V225456 250405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Kingswood House Baxter Avenue Southend-on-Sea Essex, SS2 6BG 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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