Inspection on 29/06/07 for Laburnums

This inspection was carried out on 29th June 2007.

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 06/06/06

Laburnums 14/11/05

Laburnums 25/04/05

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 Carolyn Delaney Unannounced Inspection 15:00p 29 June & 5th July 2007 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 Laburnums DS0000015444.V339801.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 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 DS0000015444.V339801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laburnums Address 20 Chalkwell Avenue Westcliff On Sea Essex SS0 8NA 01702 477898 01702 480679 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) East Homes Limited Manager post vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care and accommodation to be provided to persons between the age of 18 and 65 with a learning disability. 6th June 2006 Date of last inspection 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 Currently living at Laburnums are in the older age range, with the majority being over 65 years of age. It has been considered appropriate, therefore, to focus the inspection on the Older People’s Standards. Accommodation is provided in a larger style three-storey house in a residential area. A shaft lift has been provided. 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. A variety of social recreational activities/events are available. All service users have their own bedrooms, which are decorated and personalised to individual preference and choice. The monthly range of fees was not stated on the pre-inspection questionnaire and it is understood that these are based on individual assessed need. Extra charges are made for hairdressing, chiropody and newspapers/magazines. A copy of the previous inspection report is on display on the notice board in the home and the findings & outcomes are made known to residents at their meetings. Information in respect of the cost of a placement at the home was unavailable at the time of this inspection. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced Key inspection carried out on 26th June & 5th July 2007. As part of the inspection process each of the seven people who live at the home were provided with a ‘Have your say about’ survey, which staff were asked to assist to assist residents if needed to complete the areas where they could understand the questions and make a decision in respect of the choice of answers. However it none of these had been returned to the inspector at the time of completing this report. In addition the relatives of six residents living at the home, the residents general practitioner and other health professionals who are involved in the care for residents were contacted by post and given the opportunity to make comment about the home. Two relatives and two general practitioners responded and their comments and views have been incorporated into this report. Records including assessments, care plans, daily care notes, and medication records and risk assessment documents in respect of a number of people living at the home were examined. The homes manager, and three residents were spoken with and a number of records including duty rotas and staff recruitment files were examined. A tour of the premises was carried out. Key standards as identified in the intended outcomes sections of this report are inspected at each key inspection. Key standards are identified for each section of the report. Where other standards have not been assessed these will have been assessed at previous inspections. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk. The judgements made in this report are based upon the information collected during the site visit, the information provided by residents relatives and other relevant individuals, and other information received by the Commission from the home and other parties. Below is a brief summary of the findings of the inspection. More detail is contained within the main body of the report. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Where there are changes to the health of a person or where the level of support and care they require changes the plan of care must be updated do as to reflect these changes so that all staff in the home have up to date and accurate information. More could be done so as to provide more opportunities for residents for activities and there must be sufficient staff available to support residents when they wish to participate in activities outside of the home. The use of agency staff must not detract from the level of care and support that residents receive. Where a person has cause to make a complaint or raise concerns about the care of residents etc, these complaints must be dealt with in accordance with the homes policy and all records evidencing how the complaint was investigated, the findings and the outcomes must be maintained and made available for inspection upon request. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 7 Some work is needed to make the conservatory watertight and a more suitable place for residents to spend time in should they wish. The staffing levels at the home must be reviewed and staff must be employed in sufficient numbers so that the people living in the home are cared for in accordance with their needs and wishes. There must be evidence available to show that people are recruited to work in the home in a consistent and robust way and that all of the checks such as references, Criminal Records Bureau (CRB) disclosures are carried out before a person starts work at the home. Resident’s monies should be banked in an account, which is suited to the individual’s needs and wishes. From speaking with staff and relatives there appears to have been some uncertainty about the future of the home as there have been rumours circulating among staff and relatives. There does appear to have been some unrest among staff and there have clearly been pressures due to lack of staff. 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. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 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 Outcomes 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, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 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. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) 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. (YA NMS 4) 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area was not assessed on this occasion. There have been no new admissions to the home since the last key inspection therefore these standards have not been assessed on this occasion. EVIDENCE: Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care and support for some residents living in the home is good, however some people do not receive the level of care and support they require especially if their needs change. EVIDENCE: Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 11 Each person living at the home has a care plan written which describes the needs of the person and the support they require. The care plans for three of the seven people living at the home were examined. There was very clear and detailed information recorded for two of the three individuals including information about their lives prior to them moving into the home and about how they like to spend their days. Information about how each person is to be supported with mobility, personal care and other daily activities of living such as accessing amenities in the community were recorded. Care plans included pictorial references such as pictures of the equipment used to support residents. It was noted that the condition of one of the residents had deteriorated significantly in recent months so much so that the organisation had served notice to the resident as they felt they could no longer meet the person’s needs. The plan of care had not been revised with in light of the changes to the person’s condition such as their inability to use the bath, the need for one to one support etc. During the first day of the inspection a temporary agency staff was employed to provide one to one support for this resident. This member of staff was observed by the inspector to sit in front of the resident and read a newspaper without any interaction with the person who was calling and appeared to be distressed. Each person living at the home is registered with a local general practitioner and records are kept in respect of doctor’s visits and any treatment provided to the resident. Two of the resident’s general practitioners completed ‘Have your say about’ surveys. Both said that staff at the home contact them for advice and act upon this advice so as to manage and improve residents healthcare needs. One of the doctors said that residents healthcare needs are always met by the home, the other said that they usually are. Both doctors said that the resident’s privacy and dignity is always respected. In accordance with Regulation 37 of the Care Homes Regulations 2001 staff working at the home keep the Commission for Social Care Inspection informed of any event in the home, which affects the health or safety of the people who live there. Where the Commission has been informed of incidents such as a residents attempt to ‘self harm’ there was a detailed plan in place so as to enable staff working at the home to minimise the risks to the resident. However for the care plan for this resident had not been updated in light of a recent increase in this resident’s behaviour and did not include details of how this behaviour was to be managed. This resident’s family have expressed concerns about this and did not feel that proper action had been taken. One person’s mobility had deteriorated and the risk of them developing pressure sores had increased. There was evidence that staff support this resident so as to minimise these risks. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 12 None of the people living at the home are capable of safely retaining and administering their medicines and rely upon staff to ensure that they receive medicines, which have been prescribed for them. Medication Administration Records (MAR) for each person living at the home at the time of the inspection were examined. All records were well maintained and staff sign the records when medicines have been administered. Senior staff were advised that where they handwrite prescription entries on MAR that it is good practice for a second member of staff to check and countersign the entry so as to minimise the risk of error. Medicines are administered in a format which best suits their particular needs and liquid preparations are provided where a resident has difficulty in swallowing tablets. Residents come to the office where medicines are stored to receive their medicines and staff say that this is so that medicines can be administered in private. There was detailed information about medicines prescribed including possible adverse side effects. Medicines were stored safely and securely in the home. Each of the residents who were observed and spoken with during the day of the inspection looked clean, and dressed in clean and appropriate clothing. Both general practitioners and residents relatives who commented said that residents right to privacy is respected and that their dignity is promoted and maintained. There was no information recorded in the care plans examined as to residents wishes for how and where they would like to be supported and cared for in the event of deterioration in their health or as they reach the end of their lives. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 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. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 adequate. This judgement has been made using available evidence including a visit to this service. There are not enough opportunities for people living at the home to be kept occupied and active. EVIDENCE: On the first day of the inspection staff told the inspector that one resident had not been able to attend church that evening due to insufficient staff working in Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 14 the home. One resident who was spoken with was leaving to spend the weekend with their family. During that afternoon some activities had been provided for residents in the form of a music session provided by a musician who visits the home each week. Each resident has a plan for the activities, which they participate in each week. Records were available for six of the seven residents living in the home at the time of this inspection visit. From these records it was noted that one resident go out shopping once a week. One person attends the local adult community for music lessons one day per week, goes out for lunch one day a week, visits to the pub two evenings per week and arts and crafts one day per week One resident attends a local training centre two days per week. Residents have the opportunity to go out shopping usually on a Monday and to the cinema on Sundays. One of the residents needs have changed and their condition has deteriorated and they are no longer able to participate in the activities as per the plan. This plan had not been updated and there was no information available as to what activities this person can participate in and what support they needs from staff. On the first day of this inspection an agency member of staff was providing one to one support for this resident, however the person was observed to be sitting in front of the resident and reading a newspaper without any engagement or interaction with the resident. Records indicate that apart form a music session each week and crafts there is little in the way of activities provided for residents in the home. One residents relative who spoke with the inspector on the day of the inspection said that following discussions with the homes manager and staff that it had been agreed that a male care worker would be employed as the resident had expressed this preference. The homes manager denied this had been agreed. However from the information provided in the homes Annual Quality Assurance Assessment (AQAA) it was noted that a number of male residents had expressed a wish for more male support staff. One resident’s relative who completed a ‘Have your say about’ survey said that there is ‘not enough for residents to do in the home’ and that their relative ‘is often bored’ and that this boredom impacts upon the persons behaviour. This same relative also commented that staff do not always support the resident to telephone their family each week, as they would wish. The family also said that they are not always informed of important issues affecting the resident and that the resident is not always supported in maintaining telephone contact with his family. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 15 Some support staff were observed to interact and engage in a very positive way with residents. These staff tended to be ones who have worked at the home for a considerable length of time and who know the residents well. The homes manager said that residents have access to an ‘independent advocate’. However in conversation it later transpired that this individual in fact paid for other work by the organisation. This is wholly inappropriate as there may be a conflict of interest. The residents living at the home choose the menu of meals. Residents are encouraged to choose healthy meal options and staff working at the home prepare meals for residents. Where residents do not like the meal provided alternative meals options are offered. Residents are provided with hot and cold drinks, snacks etc during the day. However some restrictions on residents access to food is necessary and some foods are locked in cupboards, as some residents would eat all available food if they had free access. Residents have a ‘take away’ meal one evening each week, which is paid for out of the food budget. Residents have the opportunity to go out to local restaurants and pubs on occasions should they choose for meals which they pay for themselves. From the homes Annual Quality Assurance Assessment (AQAA) it was recorded that at the request of residents that menus were now being planned three days in advance rather than seven days as residents preferred to make a decision about what meals they would like nearer the time. However there was no evidence that this was happening at the time of this inspection. Staff keep records of the food intake of residents, however records indicate that staff do not always complete these records. Staff regularly monitor residents weights as part of promoting the residents health. On the first day of the inspection staff were observed to take their meals with residents and some staff were seen to engage with residents. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 16 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are not dealt with in accordance with the homes policy and some people do not feel that their concerns are acted upon in an appropriate way. EVIDENCE: The home has a policy and procedure for dealing with complaints. However this is not readily available for residents or visitors. Complaints and compliments are recorded in an A4 hard backed book. There have been no complaints recorded in respect of the home since the last key inspection. There were a number of compliments recorded. These were generally made by general practitioners and other health care professionals. One residents’ relative who was spoken with during the inspection said that they had raised issues of concern and attended meetings with the homes manager and that these issues had not been dealt with. This person said that they were not aware of the home complaints procedure and had they been aware would have raised their concerns using the homes policy. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 17 One relative who completed a ‘Have your say about’ survey commented that complaints and concerns are not always dealt appropriately. One relative who contacted the Commission by telephone said that the home was very good and that they had never had cause to complain. All staff working in the home have access to the homes policy for protection of vulnerable people from harm or abuse and the homes whistle bowing policy, which has been recently updated. Of the seven permanent members of staff working at the home at the time of this inspection three had received training in respect of protection of vulnerable people in November 2006, three had received this training in April/ May 2006 and one person had not received this training since 2004. There have been no allegations of abuse or staff misconduct since the last inspection. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 18 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 live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Laburnums provides a safe, clean and comfortable environment for residents and there are plans for redecoration of residents bedrooms. EVIDENCE: Each resident living in Laburnums has their own bedroom and recently some residents have expressed a wish to have bedrooms re-decorated and this is Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 19 being planned as part of the general programme for maintenance and redecoration for the home. Some of the communal areas on the ground floor have been redecorated. It was disappointing to note that the conservatory area, which was being used by a resident on the first day of the inspection, was cluttered with unused pieces of furniture and other debris. The roof to this area is not watertight and leaks when it rains. This means that the room is unsuitable for residents to use. Residents have access to a large garden area however staff said that this is not always used. Within the garden there is an outbuilding, which is used by residents to participate in art and craftwork. There were a number of paintings displayed around the communal areas of the home, which had been painted by residents, some of which have won awards. Residents have access to safe and comfortable communal spaces including a dining room and lounge area. On both days of the inspection the home was noted to be clean and free from any unpleasant odours. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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. This judgement has been made using available evidence including a visit to this service. The staffing levels are not sufficient for the needs of the people living in the home. The home could not evidence that staff are recruited in a consistent and robust in a way which protects the interests of people living in the home. EVIDENCE: The home employs seven fulltime staff. At the time of this inspection there were four staff vacancies for the home and the homes manager said that these positions had been advertised. Permanent staff working in the home are supported by a number of part time relief support workers and temporary staff from a local agency. There was no information available in respect of the recruitment, training and skills for agency staff who work at the home. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 21 It was identified in the homes Annual Quality Assurance Assessment (AQAA) that there are issues with the availability of staff and that this is particularly difficult at times where there are absences of staff due to illness or annual leave. The homes manager said that the staffing levels for the home are three during the day and two at night. Duty rotas were poorly maintained and it was not always clear what relief support / agency workers were on duty on certain days. The rota did not clearly indicate what agency staff were on duty. The homes manager was advised that staff duty rotas must be maintained in an orderly way, which clearly indicates when staff work at the home. Resident’s relatives who were spoken with on the day of the inspection and who completed ‘Have your say about’ surveys said that staffing levels and the reliance on agency staff has a detrimental effect on the support provided for residents. One relative said that some staff ‘do not appear to be interested in residents’ and that on one occasion when a member of agency staff had taken the resident to the cinema that the member of staff fell asleep. Of the seven fulltime staff working at the home four have achieved the National Vocational Qualification (NVQ) level 2/3 in care and the other three were undertaking this qualification. Four relief support workers had been recently recruited to work at the home. There were no records available at the home so as to evidence that these people had been recruited in a robust and consistent way or that all of the checks as required by regulation had been carried out so as to determine the fitness of the person to work in the home. There was evidence that a Criminal Records Bureau (CRB) disclosure had been obtained for two of the four staff but there were no other records available. The organisation has a programme for staff training and development, which includes core training such as moving & handling, fire safety awareness and training in respect of protecting vulnerable people from abuse, harm or neglect. In addition there is training provided for managing aggressive behaviour, key working, caring for people who have schizophrenia, epilepsy and learning disabilities. It was recorded in the homes Annual Quality Assurance Assessment that there has been issues with accessing training through the organisation as demand exceeds places available and also that due to the pressures of lack of staff support at the home it has been difficult for staff to attend training. Some staff working at the home have not received fire safety training or training in respect of protecting residents from abuse since 2004. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 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. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 7 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Laburnums is not managed in a consistent way so as to best serve the interests of the people who live there. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home has not had a registered manager for a number of years. On first day of the inspection staff informed the inspector that the manager had been promoted to work as an operations manager for the organisation. On the second day of the inspection the inspector met with the homes deputy manager who had applied for the post as manager and was to be interviewed soon after the date of the inspection. Following on from the inspection the Commission was informed that this person had been successful in their application as manager for the home. The newly appointed manager had completed the homes Annual Quality Assurance Assessment (AQAA). This had been completed in a way, which identified all of the areas where the home provides a good level of service, areas where improvement is needed and where there are barriers to achieving these improvements and plans for the future. There are regular residents meetings where residents can express their views about the home and make suggestions as to what they would like changed. At the time of this inspection there was no evidence that there is a system in place for regularly reviewing the quality of service provided which includes the views of residents, their relatives, health and social care professionals and any other stakeholders. Each person living at the home has access to approximately £30 per week and this is held in the home on behalf of residents. There are procedures for checking monies at the beginning of each shift so as to minimise the risk of errors or mishandling. Records indicate that some residents have large amounts of money in bank / building society accounts. Staff said that payments such as benefits etc should be paid into one account and when the balance of this account reaches a certain amount that that the surplus money is to be transferred into a savings account. However it was not evident that this occurs in practice. It was also not clear as to what rate if any of interest these accounts attract and whether the accounts are the best option for resident’s money. Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 24 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 1 36 2 37 X 38 X Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4&5 Requirement The Registered Person must include in the Statement of Purpose for the home the relevant qualifications & experience of the manager, as well as bedroom sizes. (Sched. 1).The Service User’s Guide must include the amount & method of payment of fees. This standard was not assessed on this occasion and will be carried forward to the next inspection. 2. OP7 15(2) The plan of care for each person living at the home must be kept under review and amended at any time where there is a change to the condition of the persons or the level of support that they need. Where risks to the health, safety or general wellbeing of a person have been identified the plan to minimise these risks must be kept under review and amended at any time when there is a change to the level of risk or the support that the person needs. DS0000015444.V339801.R01.S.doc Timescale for action 31/08/07 30/09/07 3. OP8 13(4) (b) (c) 30/09/07 Laburnums Version 5.2 Page 26 4 YA14 16 92) (m) (n) 5. OP16 22 6. OP27 18 (1) (a) (b) 7. OP29 19 Sched. 2 Arrangements must be made so as to ensure that residents are provided with suitable opportunities for occupation, personal development and social interaction, which are suited to the needs and wishes of the individual. Complaints and concerns must be received and dealt with in accordance with the homes complaints policy. Staff must be employed in the home in sufficient numbers so that people living there receive the level of support and care which they need dependent upon any changes to their condition and needs. All of the checks as required by regulation such as references, Criminal Records Bureau (CRB) disclosures etc must be carried out for a person before they are employed to work at the home. Evidence of these checks must be available for inspection upon request. (Previous timescale of 31/12/05 & 01/08/06 have not been met). 31/10/07 30/09/07 30/09/07 30/09/07 8. OP30 18 (1) (c) All staff working in the home 31/10/07 must receive training appropriate to the work they are to perform and the needs of the people living in the home. A system must be implemented for periodically reviewing, maintaining and improving where necessary the quality of services provided by the home. 31/10/07 9. OP33 24 Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 27 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 OP11 Good Practice Recommendations Wherever it is possible and appropriate residents wishes for how they would like to be cared for should they become unwell or as they reach the end of their lives should be recorded. It is recommended as good practice that staff working in the home undertake periodically training in respect of protecting people who may be vulnerable from abuse, harm and neglect. The conservatory needs to be maintained so that it is suitable for use by residents. The arrangements for how resident’s monies are deposited into various accounts should be reviewed with the resident or their representative so as to ensure that these arrangements are in the best interests of the individual. 2. OP18 3. 4. OP19 OP35 Laburnums DS0000015444.V339801.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 © 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. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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