Inspection on 28/11/07 for Landau Lodge

This inspection was carried out on 28th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Landau Lodge 30/06/09

Landau Lodge 04/06/08

Landau Lodge 06/06/07

Landau Lodge 30/06/06

Landau Lodge 14/03/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Landau Lodge Triton Road Kingston upon Hull East Yorkshire HU9 4HU Lead Inspector Christina Bettison Unannounced Inspection 28th November 2007 10:00 Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 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 Landau Lodge DS0000064712.V355084.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 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. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Landau Lodge Address Triton Road Kingston upon Hull East Yorkshire HU9 4HU 01482 781042 01482 781062 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) londonroad@tiscali.co.uk Milbury Care Services Ltd Mrs Kathleen Stephenson Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC. to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD. The maximum number of service users who can be accommodated is: 10 6th June 2007 2. Date of last inspection Brief Description of the Service: Milbury Care own and manage Landau Lodge. The home is registered to provide care and accommodation for up to 10 adults between the ages of 1865 who have a learning disability. The home is located to the east of Hull city centre and is purpose built. It is a six bedroom bungalow. All bedrooms are single with en suite facilities. Two of these have additional cooking facilities and can be used more as bed sits to promote independence. There is an office, large hallway, kitchen / dining room, laundry, quiet room and lounge. There is a sleep-in room for staff. There is wheelchair access throughout. In the grounds are four self contained bungalows providing individual accommodation for an additional 4 service users. The home has a garden to the side and rear. There is a car park area to the side with additional street parking. Weekly fees range from £1,400 per person per week to £1,750 per person per week. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit took place over 1 day in November 2007. Surveys were posted out prior to inspection; three were returned from relatives, seven returned from staff and two returned from people who live in the home. The Registered manager, deputy manager, one senior support worker and all of the staff who were on duty on the day of the visit were spoken to and all of the people who live there were seen. The interactions between staff and the people who live in the home were observed to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at records. Information received by us over the last twelve months was considered in forming a judgement as part of our inspection process. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire, all of which forms part of this inspection. The site visit was led by Regulation Inspector Mrs. T. Bettison, the visit lasted 8 1/2 hours. What the service does well: The people that live in the home and their relatives are provided with information that is easy to read so that they know what to expect from the home. People who might like to live at the home are able to visit and stay overnight to help them to decide if the home will be able to meet their needs or not. All of the people have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, staff assist people to visit their relatives making sure that family can keep in contact. A good recruitment policy is in place so that people are protected from harm. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 6 The people who live in the home and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. The staff are very committed and caring and treat people with respect and dignity. The staff appeared caring and treated people with respect and dignity. The home is comfortable and meets peoples individual needs and the kitchen is kept clean and people are helped to eat a healthy diet but also some foods that they like. Relatives told us;“we are very happy with the quality of care that our sister is receiving. She is happy, content and fulfilling her potential” “they manage my brothers obsessive and sometimes difficult behaviour. They have motivated him to go on holidays and outings” “the staff are very kind and caring and seem experienced” What has improved since the last inspection? What they could do better: One of the people that lives in the home told us;- Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 7 “I would like to move nearer to home” people who say they want to live somewhere else must be supported to do so. When new people are being considered to move into the home, the assessment must take into account their compatibility with other people living in the home. Staff told us;“I think more can be done when assessing new service users, e.g. compatibility” All of the people that live in the home must have a detailed plan and risk assessments and they must say what staff need to do to make sure all of their needs are met and that they are protected from harm. People need to have a plan of activities/interests and records kept to show that they are happening and staff need to help them to develop their skills in independent living. When people have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help them to take it. There needs to be enough staff in the home so that the staff can meet the needs of the people that live there and carry out all of their duties safely. Staff told us; “Sometimes there are only three staff on duty and no recruitment was done for the new person moving in, whose needs are different from the people who live in the home.” “in my opinion service users could receive more one to one support” “we need to be more person centred” “At the moment we have 4 people missing off the rota, 1 x senior support worker we have borrowed .To cover the posts 2 x support workers are covered by bank staff and overtime which is stretching the care staff team” “Staffing is a big issue, the company says there is enough but to get service users out on activities not always” There needs to be a system of handover to staff who are coming on duty so that they know what has been happening in the home and any changes in peoples needs. Staff told us;- Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 8 “ Sometimes things change, it is not always passed on. Staff will say Oh I didn’t know” “People work in different ways some things need pulling together into procedures” All staff must be provided with basic and special training, e.g. NVQ level 2, how to deal with behaviour that may harm the people that live in the home or staff, how to protect people from harm, how to work with people who have autism and communication needs and to help them to meet the special needs of people. Staff told us;“the basic training is good but they are slow to put people on LDAF and NVQ” Peoples health needs must be written in a plan and staff must meet their complicated health needs and special health advice be followed. The home needs to be managed better so that all of the things that need to get better do. The system that helps to improve the standards in the home must work better, the staff and people that live in the home must be listened to and helped to make decisions about the running of the home. A relative told us “I think it is always a good thing to listen to the staff that work in the homes” 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. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 and 4 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed prior to admission, however consideration is not being given as to whether they are compatible to live with the other people in the home and whether the home is sufficiently resourced and staff have the skills to meet their needs. EVIDENCE: The home has a statement of purpose and service users guide, and people and their representatives are provided with information about the home. Since the previous inspection the service users guide and resident agreement has been reviewed and amended to state that Milbury care will make a contribution towards a holiday or a series of one day outings and that people will make a contribution of £8.00 towards transport. The holiday contribution is set at £200 per year and the manager and senior staff are aware of this. We were informed that the placing authorities have agreed to this within their contracting arrangements. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 11 There has been one new admission to the home since the previous inspection. The care file was examined as part of the site visit. This person had been admitted from an independent hospital and there were various reports from the hospital professionals however there was no evidence of a copy of the community care assessment and Local Authority care plan on file. However the home had completed their own basic assessment but this had failed to identify that the service user was out of the registration category. This person presents with very complex needs, but they are not learning disabled, their needs are not consistent with the homes statement of purpose and they are not compatible to live with the other people who live in the home. Staff told us;“Compatibility is a big issue, we have older people and younger people, one person who is very disruptive and removes their clothes constantly, this upsets others in the home and can be a trigger for difficult behaviour. People who live in the bungalows spend a lot of time in the main house adding to the pressures” None of their needs had been developed into a detailed plan, in the care file examined the information indicated that this person presents with behaviour that can be difficult to manage and can pose a significant risk to themselves and others and although risk assessments were in place and a management strategy in place, adequate numbers of staff are not being provided and staff had not received adequate training and did not feel skilled to meet their complex needs. In addition to this consideration has not been given as to whether the home is sufficiently resourced to meet all of the peoples needs prior to admission. The new person to the home was funded for 11 hours on a 1; 1 basis and no additional staff had been recruited or drafted in which meant that the home were significantly understaffed. (This is detailed further in the staffing section of this report) Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. 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. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are met on an informal basis by inadequate numbers of staff, the quality of the plans and risk assessments are very basic. These shortfalls have the potential to place people at risk and mean that their assessed needs are not met. EVIDENCE: There has been no significant improvement in the quality of the information provided to staff to help them meet the needs of the people that live in the home since the previous inspection. Staff told us Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 13 “You can’t find the information you need in the file they are a mess and doesn’t tell you what you need to know. Even basic information like opticians is not there” Everyone has a care file, however these are very disorganised, the inspector is aware that Milbury care are in the process of introducing new care planning paperwork however this has not yet been introduced at Landau lodge. The daily files contained more than one persons information and therefore does not protect peoples information and maintain their privacy, dignity and respect. Three care files were examined as part of the inspection process. The files were very untidy and disorganised and plans did not include everything that is detailed in the local authority assessment/care plan, they did not reflect the full range of needs and do not ensure that all aspects of health, personal and social care needs are identified and planned for and did not detail accurately what staff need to do to meet peoples needs. This has not changed since the previous inspection and gives serious cause for concern. The first care file examined was for a new admission; this person has complex needs, which do not fall under the learning disability diagnosis. The file contained various reports from the specialist in their previous placement and identified significant ways of managing their difficult behaviours. Risk assessments had been completed for fire, misuse of sharp utensils and non-compliance with medication. However the actions to be taken to minimise the risk on most state;- staff vigilance, this cannot be achieved within the current staff provided therefore people are not being protected from the risk of harm. The home are funded for 1;1 staff support for 11 hours per day for this person. The staff support had not been provided (see staffing section of this report) and although the person had been visiting previously and had been admitted 9 days prior to the site visit there was no evidence on file of a detailed care plan or behaviour management strategies. In another care file examined there was a very basic plan that covered foot care, bathing routine, food and drink, breakfast routine and the use of a wheelchair. This person has high level of support needs and the plan did not cover all identified needs. A FACS review had been carried out in July of this year that identified the need for a speech and language assessment, a referral to a consultant (although it did indicate what for) and involvement of the welfare rights team for issues relating to benefits and money, none of these areas had been addressed and were not included in a plan of care. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 14 A number of risk assessments had been completed for risk of choking, hitting out at others, use of the wheelchair, fire, trips and falls, food poisoning, scalding and leaving a moving vehicle. However the actions to be taken to minimise the risk on most state;- staff vigilance, this cannot be achieved within the current staff provided therefore people are not being protected from the risk of harm. It was noted at the previous inspection “In this service users CCA/Care plan completed by the local authority it detailed a service user with significant care and support needs, restricted mobility, full support with personal care and dressing, limited verbal communication and use of makaton, epilepsy and prone to dry skin and presentation of behaviours that are significant challenging and may pose a risk to themselves or others. It also states that the service user has a good relationship with his dad and enjoys regular visits. However the homes service user plan only included a personal care plan that stated he needed two staff for safety but no other detail and a plan for diet and nutrition, in addition there was basic activity plan produced in picture format. In addition to this was a psychology assessment that recommended a structured activity schedule due to the service user diagnosis of autism, increase the use of makaton signing, attention to sensory impairments and detailed a whole range of behaviours that would by difficult to manage, including hitting, punching, biting, throwing objects, damaging property and self harming, none of which had been transferred into a detailed behaviour management strategy agreed by a multi agency team.” Since the previous inspection some of these areas had been developed into a care plan, covering; bathing, teeth cleaning, diet and nutrition and mobility and a more robust behaviour management strategy is now in place. However there are still huge gaps and omissions in the care plan. A review had taken place in October of this year. This file contained a blank document for the preparation of a communication passport however it had not been started and this person has significant communication deficits and needs. There was a basic health action plan however areas of health need had not been sufficiently detailed in the care plan and there has been minimal input from the health authority/community team learning disability in the development of health screening or health action plans and there was no evidence of outcomes of monitoring of health needs. This is detailed further in the health section of this report. Where people display behaviours that can be difficult to manage plans have now been prepared by the home that are much more detailed and the staff have been supported by the CTLD in the preparation of these. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 15 However the home have still not completed protocols for the administration of all medication administered on a PRN basis, these need to be detailed and specify which medication, how much and if more can be administered when and how much and in what circumstances. There were serious omissions in the care files examined, very poor quality or no care plans that detail all needs and including areas of cultural and religious needs, diet and nutrition, communication needs, mobility issues and did not include administration of medication PRN, no systematic monitoring of incidents of presenting behaviour, no health action plans and lack of documented health provision and support and outcomes. Discussion with staff and relatives suggested that peoples basic care needs were being met even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. People are at risk of not having their care needs met if these informal systems break down. In addition to this although staff appeared willing and very caring, they are not provided in adequate numbers and some still do not have the skills, knowledge and confidence to meet peoples complex needs as the training provided is still not sufficient in respect of the needs of the people living in the home. In addition to this people are admitted who do fit in with the homes statement of purpose and therefore staff are not skilled in this areas of work. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12, 13, 14, 15, 16 and 17 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. A lack of activities within the home and community, inadequate numbers of staff and poor record keeping does not evidence that people have the opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. EVIDENCE: There has been little improvement in this area since the previous inspection. The inadequate numbers of staff in the home seriously hinders the opportunities for enabling people to go out or pursue hobbies and interests in the home and there is still little or no supporting documentation to evidence that people’s needs in this area had been identified, planned for and therefore met. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 17 Without exception all staff spoken to said it was still extremely difficult to get people out into the community as a number of them require 2;1 staffing to ensure their safety and that of the general public. There was very little information on care files as to how the home are enabling people to maintain and /or develop new skills and how their interests and /or hobbies are being supported and a lack of records of activities undertaken. The majority of people that live in the home have limited verbal communication to express their choices and wishes and promote their independence. Any restrictions are not documented within their care plan. The care staff currently do all of the shopping, cooking and cleaning. The kitchen on the day of the inspection was found to be much cleaner and a routine has been established for ensuring its ongoing cleanliness. At the previous inspection the inspector was informed that the budget for food is inadequate; the weekly allowance is £210, which is allocated as £30 per person per week but also feeds the staff that are on duty which can be up to 6 staff. Staff stated that they constantly run out of food and there is no allowance for treats. The food budget must be reviewed and amended to ensure it is sufficient to feed all of the people in the home and meet their individual diverse needs/likes and dislikes. In addition to this we were informed that when people go out for the day they have to pay for their own meals. This must be reviewed as people in 24 hour residential care are entitled to a minimum of 3 meals per day as part of their contact price. The diet and nutritional needs of people must be detailed in their plan and include their likes and dislikes. Most of the people that live in the home are very dependent and present behaviours that may pose a risk to themselves and others. The current staffing provision is inadequate to meet their complex needs and does not allow for the full range of activities, promoting independence and meaningful interactions to be provided. Discussion with staff and records indicated that family and friends are able to visit the home and can use any of the communal facilities or the persons bedroom. There is no restriction on visiting times. Staff told us;- Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 18 “The vehicle is totally inappropriate, 3 people need a wheelchair when they go out and it is difficult to get them in and out of the vehicle, this was raised in a meeting in June this year but no action was taken” Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience poor outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People’s health and personal care needs are not being fully identified, planned and met. These shortfalls have the potential to place people at risk of harm. EVIDENCE: There has been no improvement in the quality of the information in this area; plans and supporting documents relating to health needs are still very basic. There was evidence that health professionals are providing some services to the people, i.e. psychology, consultant neurologist, consultant psychiatrist, however needs are not being adequately identified, planned for and outcomes are not recorded therefore it is difficult to evidence if needs are being met. The Community team learning disability has been approached to assist in health screening however none of the people had been screened at the time of the visit. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 20 We were informed that none of the people had a health action plan and none of the peoples health needs had been included in a plan of care. The new deputy manager has taken over the responsibility of the medication and is completely overhauling the systems. She commented that there were a number of areas of concern that she was addressing. The medication systems were not examined at this visit. The inspector was informed that staff were completing administration of medication training with Lloyds pharmacy, the manager provides the training, staff complete the workbooks which is marked by Lloyds however they had still not had their competency assessed. Some people are prescribed medication for pain relief, constipation and for behaviour management purposes. The protocols for the administration of medication on a “as and when required” basis need to be clearer so that staff know when to administer PRN medication and when second doses can be given. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The provision of increased training and more robust behaviour management plans means that people are better protected from the risk of harm however the unsatisfactory staffing arrangements, poor care and health plans means that people are still not fully protected from harm whilst in the care home. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. Some of the people that live in the home present behaviour that may pose a risk to themselves and others. Staff spoken to said that they had received updated training in how to manage difficult behaviour and the behaviour management plans had been reviewed and amended and were more robust giving staff clearer guidance Incidents of people assaulting each other in the home had significantly reduced and staff said they were being more vigilant and felt more confident. Examination of staff files evidenced that staff had now completed their induction and probationary interviews were taking place. Other areas identified as lacking in the home have the potential for placing people at risk of harm. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience poor outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides people with comfortable surroundings in which to live, however areas of the houses are shabby and in need of repair and redecoration and areas of maintenance have not been attended to meaning that the house is not safe. EVIDENCE: The home is located to the east of Hull city centre and is purpose built. It consists of a six bedroom bungalow and four one bedroomed bungalows in the grounds. All bedrooms in the main bungalow are single with en suite facilities. Two of these have additional cooking facilities and can be used more as bed sits to promote independence. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 23 There is an office, large hallway, kitchen / dining room, laundry, quiet room and lounge. There is a sleep-in room for staff. There is wheelchair access throughout. In the grounds are four self contained bungalows providing individual accommodation for an additional 4 service users. The home has a garden to the side and rear. There is a car park area to the side with additional street parking. The home is spacious and comfortable for the people that live there and has a “lived in” feel about it. Because the staff are responsible for all the cleaning, cooking and care it is difficult for staff to prioritise the work load and all staff spoken to stated that peoples needs came first. The registered person must review the staff hours provided and the roles and deployment of staff to ensure that all times the peoples needs are met and the home is kept clean and hygienic for the people that live there. The TVs did not have a very good picture and staff said that it was a problem with the aerials, this must be addressed. The manager had submitted an AQAA however had not completed the section on maintenance of equipment therefore as part of the site visit we examined the maintenance and servicing records; • • • • • • • • • Premises electrical circuits- no records were available PAT tests- 30/8/06 - out of date Fire detection and fighting equipment 21/5/07 Fire drills – undertaken monthly Fire alarm – weekly tests undertaken Emergency call equipment- no records were available Heating system- a warning device notice has been issued that the gas pipes are too small for the installation and work needs doing. Gas appliances- No records available Legionella – the home had file however no tests had been undertaken for over a year, the manager has raised this with H/Q. Areas of maintenance and servicing must be attended to. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35, 36 People who use the service experience poor outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the all of the complex and diverse needs of the people that live in the home and both mandatory and specialised training is unsatisfactory placing people at risk. EVIDENCE: Despite a requirement being made at the previous inspection to review and amend the staffing provision in the home, this has not been actioned. Since the previous inspection the deputy manager has left, and three staff were suspended pending a disciplinary investigation. This left the home with significant gaps in the rota to fill therefore the home have had to use high numbers of bank and agency staff to fill the gaps in the rota. The inspector was informed that the home has 20 staff in total, comprising of • • 1x Registered manager 1x deputy manager (recently appointed) DS0000064712.V355084.R01.S.doc Version 5.2 Page 25 Landau Lodge • • • 2x senior support workers Day support workers Night support workers The registered manager works supernumerary. The rota evidenced that there are usually 5 support workers allocated per day shift - am and 6 support workers per day shift - pm. There are also 2 waking night staff and a staff member sleeping in. However rotas examined and discussion with staff indicated that this does not always happen and sometimes the home are left with 4 staff on a shift. Staff stated that when staff go on training their hours are not back filled in the home and when staff support people out in the community 2;1 this leaves the home short of staff. Staff told us;“I think there should be 5 staff in a morning and 6 staff in the afternoon, but we run short a lot of the time, often leaving only 4 staff on a shift” “ There are times when we only have 3 staff on duty” “Issues are raised with managers about the shortage of staff but they don’t listen or act, there is a high use of agency staff” “Staffing is still a problem” “If staff go on training they are not backfilled” The deputy manager informed us that prior to the new admission the home should have 695 hours per week. A recent new admission is allocated and funded for 11 hours per day 1;1 staff support, however no new staff had been recruited to prior to this person being admitted therefore the home is significantly understaffed. On the day of the visit there were 5 staff on duty at 3.30pm, one person went out with two members of staff, and another member of staff was 1;1 with another person, leaving 2 staff with 5 people. The new person should have had 11 hours one to one but a member of staff spoken to said he had worked 4 hours with him that day and that would be all the one to one support he would get all day. This clearly demonstrates that there are not enough staff on duty to meet the assessed needs of the people living in the home. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 26 Staff have the responsibility of cleaning bedrooms bathrooms and all communal areas, the preparation, cooking and serving and cleaning up after 3 meals per day, supporting people to attend appointments, activities, undertake shopping and gardening and in addition to this attend to the care needs of the people that live in the home. An immediate requirement notice was issued on the day of the visit requiring the management to ensure that a minimum of 8 staff are on duty per shift. A follow up meeting was held with Paul Constable on 18/12/07 and an agreement reached to provide 6 staff per morning and evening shifts and an additional floating member of staff across daytime hours giving 7 staff. The manager is to remain supernumerary and a review of staffing and management arrangements is to be undertaken. A recently appointed member of staff told us that they had had a basic induction and had started their LDAF induction. They had been attending training and had done managing challenging behaviour and felt skilled enough to undertake their role. They thought there should be 6 or 7 staff on duty but said there were never that many staff on duty. 5 staff files were examined in the course of the inspection. All had completed application forms, had 2 satisfactory references but two CRB clearances were missing from the files. Out of the 5 staff files examined, staff had received three supervision sessions since the previous inspection however there was still no evidence of staff appraisals/individual training profiles. All staff were not up to date with their mandatory training, none of staff had completed training in infection control. Only a couple of staff had completed safeguarding adults training. The inspector was informed that the Elbox electronic system had been introduced in the home and all staff will now be using this method to update some of their mandatory training and complete NVQ and LDAF. The people that live in the home have presenting needs in communication deficits, autism, sensory impairments and present behaviours that may pose a risk to themselves or others, there was little evidence that staff had received updated training in these areas that met their identified training needs, there was new person in the home that has Aspergers syndrome however none of the staff have received training in this specific area. A training plan was not available and the home does not have 50 of staff qualified to NVQ level 2. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 27 The registered person is required to review the staffing structure and care staff hours provided in the home to ensure that they can meet the complex needs of the people that live in the home and to ensure that staff are appropriately trained for their role. The registered person is also required to ensure that staff are up to date with all mandatory training and service specific training is provided in autism and aspergers syndrome, effective communication skills, managing behaviour that may pose a risk to themselves or others, medication training that includes a competency assessment, safeguarding adults, equality and diversity, values and attitudes and effective recording. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People who use the service experience poor outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is unsatisfactory and does not demonstrate that it is acting in the best interests of the people that live there. EVIDENCE: Landau Lodge is part of Milbury Care Services which is a national provider of care and support services for people with a learning disability. Milbury is part of the Paragon Health Care group, which is a UK wide organisation that specialises in providing a range of services to vulnerable people. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 29 The manager of the service informed us that she has handed in her notice to the company and will be leaving by the end of December. There has been little improvement in the home and the majority of the requirements issued at the previous inspection remain outstanding. Staff told us;“it is too much of a mess, needs a big shake up, this site needs major help and support” There is a lack of detailed care plans and guidelines, poor attention to providing both mandatory and service specific training. The restrictions of the current staffing structure and number of care hours provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of the duties required to ensure that peoples complex personal, health and safety needs are met and that a range of activities are provided that meet their diverse needs. The manager had submitted an AQAA however had not completed the section on maintenance of equipment therefore as part of the site visit we examined the maintenance and servicing records; • • • • • • • • • Premises electrical circuits- no records were available PAT tests- 30/8/06 - out of date Fire detection and fighting equipment 21/5/07 Fire drills – undertaken monthly Fire alarm – weekly tests undertaken Emergency call equipment- no records were available Heating system- a warning device notice has been issued that the gas pipes are too small for the installation and work needs doing. Gas appliances- No records available Legionella – the home had file however no tests had been undertaken for over a year, the manager has raised this with H/Q. Milbury care services have a QA system, which includes regular audits and monitoring of the service culminating in an annual service review. The area manager undertakes regulation 26 visit on a monthly basis however this has failed to be effective in highlighting the areas for improvement. None of the QA documentation was examined by the inspector during the site visit. Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 2 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 2 32 1 33 1 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 1 2 LIFESTYLES Standard No Score 11 1 12 2 13 1 14 1 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 x 1 x x x x 1 x Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 31 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 YA2 Regulation 14 Requirement Timescale for action 29/11/07 2. YA3 12 (2) 3. YA6 15 and 17 4. YA6 15 and 17 The registered person must ensure that the assessment of people is kept under review so that people are not admitted if the home are unable to meet their assessed needs. (Timescale of 30/09/07 not met) The registered person must 29/11/07 ensure that people are enabled to make choices about where they live through the provision of independent advocacy services (if they so wish). (Timescale of 07/06/07 not met) The registered person must 31/03/08 ensure that service user plans are developed and agreed with people and must detail the action to be taken by staff so that they can meet their personal, health and welfare needs. (Timescale of 30/09/07 not met) The registered person must 31/03/08 ensure that people are reviewed at least 6 monthly and plans are updated to reflect changing needs so that staff are aware of DS0000064712.V355084.R01.S.doc Version 5.2 Landau Lodge Page 32 5. YA9 13 and 17 6 YA10 15 and 17 7 YA11 16 (3) 8 YA12 16 (2 m and n) peoples changing needs and are able to meet them. (Timescale of 31/08/07 not met) The registered person must ensure that there are individual and generic risk assessments available that are maintained and reviewed so that people are protected from the risk of harm. (Timescale of 30/09/07 not met) The registered person must ensure that peoples information is stored in accordance with the Data Protection Act so that peoples individual information is kept confidential and their privacy and dignity is maintained. The registered person must ensure that people’s religious and cultural needs are identified and planned for so that their diverse needs are met. (Timescale of 30/09/07 not met) The Registered person must ensure that people are given the opportunity to participate in further education and that benefits/finance problems are addressed with the relevant qualified people. 31/03/08 29/11/07 31/03/08 31/03/08 9 YA13 16 (2 m and n) These must be incorporated into the service user plan and records maintained. (Timescale of 30/09/07 not met) 31/03/08 The Registered person must ensure that people are given the opportunity to participate in the local community with staff support. These must be incorporated into the service user plan and records Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 33 10 YA14 16 (2 m and n) maintained. (Timescale of 30/09/07 not met) The Registered person must ensure that leisure activities are identified, planned for and provided that meet the diverse needs of the people that live in the home and meet their assessed needs. These must be incorporated into the service user plan and records maintained. (Timescale of 30/09/07 not met) The registered person must ensure that people are provided with sensitive and flexible staff supports to maximise their privacy, dignity independence and control. (Timescale of 30/09/07 not met) The registered person must ensure that peoples needs and likes/dislikes regarding food preferences are incorporated in to their plan and their nutritional needs are met. The registered person must ensure that peoples complex health needs are met by the provision of health screening, health action plans and access to health professionals. (Timescale of 30/09/07 not met) The registered person must ensure that where medications are administered PRN that guidelines for administration are written up and followed by staff. (Timescale of 30/09/07 not met) The registered person must ensure that staff have received training in the management of DS0000064712.V355084.R01.S.doc 31/03/08 11 YA18 18 29/11/07 12 YA17 13 31/03/08 13 YA19 13 31/03/08 14 YA20 13 and 15 31/12/07 15 YA20 13 and 15 31/12/07 Landau Lodge Version 5.2 Page 34 16 YA23 13 (2 6) 17 18 YA24 YA31 23 12 (4) 19 YA32 18 20 YA33 18 medication and that they are assessed as competent. (Timescale of 30/09/07 not met) The registered person must ensure that all staff receive training in safeguarding adults and that all requirements are met to ensure people are protected from harm. (Timescale of 30/09/07 not met) The registered person must ensure that the home is safe and well maintained at all times. The registered person must ensure that staff fulfil the aims of the organisation and home and respect peoples individual needs with respect to gender, age, cultural background and personal interests. (Timescale of 30/09/07 not met) The registered person must ensure that there is a training plan for the home and that staff receive specialised training in meeting the complex needs of people with a learning disability, i.e. Autism/Aspergers syndrome Communication skills How to deal with people that present with difficult behaviour Equality and diversity Safeguarding adults Medication competence (Timescale of 30/11/07 not met) The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support peoples assessed needs at all times. Staffing levels must be regularly reviewed to reflect changing needs. DS0000064712.V355084.R01.S.doc 31/12/07 31/03/08 31/03/08 31/03/08 29/11/07 Landau Lodge Version 5.2 Page 35 21 YA34 18 22 YA35 18 23 YA37 8 24 YA42 23 25 YA42 23 (Timescale of 30/09/07` not met) An immediate requirement notice was left to this effect. The registered person must ensure that staff have a satisfactory CRB clearance on file prior to commencing employment. The registered person must ensure that staff have an individual training profile and an annual appraisal. The registered person must ensure that the home is managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to. (Timescale of 30/09/07 not met) The registered person must ensure that the staff are up to date with their mandatory training. (Timescale of 30/09/07 not met) The registered person must ensure that the following maintenance and servicing is undertaken and records are available to evidence this;• • • • • • Premises electrical circuits PAT tests Emergency call equipment Heating system Gas appliances Legionella 29/11/07 31/03/08 29/11/07 31/12/07 29/11/07 Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 36 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 YA17 Good Practice Recommendations The registered person should review the system for paying for lunches for people that live in the home when they are out of the home to ensure that their lunch is included as part of the contract price. The registered person should review the budget for food to ensure it is sufficient to meet the needs of the people that live in the home. The registered person should introduce a handover system for staff coming on duty to ensure consistency and continuity of support for the people who live in the home. The registered person should ensure that the TV aerials function properly to ensure a good TV picture. The registered person should ensure that at least 50 of staff are qualified to NVQ level 2 The registered person should review the vehicle provided to ensure that it is suitable for the people that need to use it 2 3 4 5 6 YA17 YA18 YA24 YA32 YA42 Landau Lodge DS0000064712.V355084.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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