Inspection on 30/06/09 for Landau Lodge

This inspection was carried out on 30th June 2009.

CQC found this care home to be providing an Adequate service.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Landau Lodge 04/06/08

Landau Lodge 28/11/07

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 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Landau Lodge Triton Road Kingston upon Hull East Yorkshire HU9 4HU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Wilkinson     Date: 3 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Landau Lodge Triton Road Kingston upon Hull East Yorkshire HU9 4HU 01482781042 01482781062 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.milburycare.com Milbury Care Services Ltd Name of registered manager (if applicable) Miss Melanie Jane Ward Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 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. Date of last inspection Brief description of the care home Landau Lodge is owned by Milbury Care and is registered to provide care and accommodation for up to 10 adults between the ages of 18-65 who have a learning disability. The home is purpose built and is located to the east of Hull city centre. The property is built over one floor and has six bedrooms; 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 a persons independence. There is an office, large hallway, kitchen/dining room, laundry, quiet room and lounge, Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 10 Brief description of the care home and a sleep-in room for staff. The property has wheelchair access throughout. The home has a garden to the side and rear and there is a car park to the side of the property with additional on-street parking. In the grounds there are four self-contained bungalows that provide individual accommodation for an additional four people who can live more independently but still with one to one support when needed. Information on the service is made available to current users of the service via the statement of purpose, the service users guide and the current inspection report. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 4th June 2008, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 10.00 am and ended at 5.15 pm. On the day of the site visit the inspector spoke on a one to one basis with one person living at the home, three members of staff and a health care professional. Inspection of the premises and close examination of a range of documentation, including two care plans, were also undertaken. The manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) from. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. As part of the inspection process we sent survey forms to residents, staff and health and social care professionals; four were returned by people living at the home, three were returned by staff and one was returned by a health care professional. Following Care Homes for Adults (18-65 years) Page 6 of 35 the day of the site visit, we telephoned other health care professionals to ask them about the service provided by the home. Comments from returned surveys and from discussions with people on and following the day of the site visit will be included (anonymously) throughout the report. The manager told us that the current fee for residential care is from £1427.27 to £1774.79 per week. At the end of this visit feedback was given to the deputy manager on our findings, including some of the requirements and recommendations that would be made in the key inspection report. Following the day of the site visit, feedback was also given to the homes manager and to the Operations manager. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? Some care plans are now a very detailed record of a persons individual strengths and needs and include the action to be taken by staff to ensure that all identified needs can be met. A risk assessment accompanies each area identified in the care plan. The remaining care plans now need to be brought up to this standard. Information about a persons religious and cultural needs are now identified in care plans so that their diverse needs can be met. People are now spending more time in the local community, for example, going out for walks and visiting local shops, pubs and cafes. Each person now has a weekly activity plan in place that records their leisure activities and appointments for the full week, including evening activities. Staff undertake medication training followed by a competency assessment to ensure that they are safe to administer medication; this protects people from the risk of harm. Information about as required (PRN) medication is now clearly recorded in care plans and with medication records. Staff now receive induction training and refresher training on a regular basis. Care Homes for Adults (18-65 years) Page 8 of 35 Staff tell us that they are having more regular supervision and feel more supported by the organisation. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standard 2 and Standard 3. People have a thorough care needs assessment prior to being offered a place at the home but there is a lack of confidence about the skills of some staff and their ability to meet the assessed needs of the people living at the home. Evidence: We examined two individual support plans in detail. One of these included a needs assessment for the person concerned that had been undertaken via a visit to their previous home. In both instances, information had been obtained from the previous care service and from the local authority commissioning the placement. The needs assessment undertaken by the home is thorough and includes all of the relevant information such as methods of communication, physical health care, mental health care, family/social contact, cultural and faith needs and assessment and management of risk. The manager is in the process of compiling new style care plans for all of the people living at the home. These are based on information gathered at the time of the initial Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: assessment and on information accumulated since that time from health care professionals and others, and record any potential restrictions on choice or freedom. Individual support plans evidence a wide variety of inputs from health and social care professionals, including behaviour management plans that have been developed by psychologists and community nurses from the learning disability team. It is also evident that the interests and needs of family carers have been taken into consideration when the support plans have been compiled. We saw that people had been given a copy of the service users guide and the complaints procedure in a picture bank format, making them more accessible. Care plans evidence that specialised services offered are demonstrably based on current good practice guidance. However, the home is promoted by the organisation as a specialist service for people with challenging behaviour but the feedback we have received from health care professionals suggests that some of the staff are not able to manage some of the behaviours presented by people living at the home. When asked, Do the care staff have the right skills and experience to support individuals social and health care needs?, a health care professional told us, My first few contacts with the home do not lead me to believe that they all have those skills needed. This view was supported by other health and social care profesionals that we spoke to or received surveys from. Staff were seen to communicate effectively with people living at the home on the day of the site visit and care plans record very clear information about a persons ability to communicate and methods of communication used. Some of the people living at the home have the support of independent advocates. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 6, 7 and 9. Not all peoples care plans are up to date and so they may be at risk of not having their health, social and emotional care needs met safely and in a way that they have chosen. Evidence: There is an individual plan of care in place for each person living at the home. A member of staff told us, The care plans are not up to date but the manager is working hard to get these plans to a much higher standard .... the care plans are improving to meet the standards required. We noted that the new care plans are very detailed and each area covered in the care plan has an accompanying risk assessment. However, it has been a requirement since March 2008 that detailed care plans should be developed and we are concerned that some of the people living at the home still have no updated care plan in place. The manager told us that she intends to produce a brief version of the care plan to be held in daily folders so that staff have a quick reference guide. Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: Care plans include information about how specialist requirements will be met, such as communication, planned interventions and therapeutic programmes. We were concerned that one person was having checks during the night every 15 minutes but that the form used to record these checks had spaces for hourly checks only. The care plan is not yet available in a language and format that people living at the home can understand but some of the content is available in symbol format, for example, the complaints procedure and the service users guide. Care plans are reviewed throughly on a monthly basis and formal reviews are held every year. Care plans should be reviewed formally every six months to ensure that information contained in them is current and that people are receiving the correct level of care. The view of family and friends is taken into consideration when care plans are compiled, and in some instances advocates have been involved. Details about a persons ability to make decisions is included in care plans, as well as a description of the level of assistance needed. For example, I can make choices about day to day preferences, routine and needs - offer alternatives to help me choose. The manager told us that Best Interest meetings have been held for two of the people living at the home and one is arranged for another resident next week. When asked in surveys if they are able to make decisions about what to do each day, three people responded always and one person responded sometimes. We did get some feedback from health care professionals that suggested that staff sometimes say that it was a persons choice not to do something, and that there seems to be a lack of understanding that it might not always be in a persons best interests to do what they choose. There are risk assessments in place for each area covered in the care plan, and all of these are specific to the person concerned. For example, one person has a fear of dogs and there is a very clear risk assessment in place that informs staff of the action to take when they are out with this person and see a dog. The aim of this risk assessment is to enable the person to go out into the local community with staff and to feel protected and safe. We noted that records included a photograph and a description of the person to assist the emergency services should they go missing from the home. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 12, 13, 15, 16 and 17. People spend their day in a way that reflects their hobbies, interests and capabilities and are supported by staff on a one to one basis for part or all of the day. Meal provision at the home meets peoples individual needs. Evidence: Care plans record a persons hobbies and interests prior to admission to the home and their current interests. Family and friends have been asked for their input into gathering this information. Everyone has an activity plan for the week and this records an activity for the morning, afternoon and evening on seven days per week. The manager told us that key workers now have monthly meetings (with service users present) to discuss which activities/new experiences have worked well and to plan future activities. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: All of the people living at the home have some one to one funding so this enables them to have individual activities with a member of staff. Activities include visits to the pub, shopping, a trip to McDonalds, going out for a walk and going for a drive in the homes vehicle. The manager told us that people now go out more into the local community and that this has been quite rewarding, as neighbours chat to people living at the home and staff when they go out. One person is going on holiday for three nights and will be supported on a 2:1 basis throughout their time away. We noted that people living at the home do not take part in activities with people who do not live at the home, for example, at day centres or adult education centres. People should have the opportunity to meet people outside of their home environment. One member of staff told us that all service users go out on a regular basis but that some staff dont persist i.e. if an outing or activity is not successful on the first occasion they try it, they tend to give up. Some service users have challenging behaviour - again, some staff dont persist in learning how to deal with this. Care plans evidence that links are maintained with family and friends and that they are involved appropriately in decision making, including the format of daily routines. On the day of the site visit we observed that people were able to choose when to be alone and when to be in company, and when not to join in activities. One person was feeling unhappy on the day of the site visit and staff did not try to persuade them to take part in their individual planned activities. The layout of the premises enables people to have access to and from the main building and to spend time in the garden safely; the property is fully enclosed. All apartments have en-suite facilities and this promotes privacy, dignity and independence. We noted that care plans include information about each persons responsibility for housekeeping tasks; these varied depending on the capabilities of the person concerned. Staff told us that there is a choice of meal at each meal time, and that people can have just what they fancy if they dont like either of the choices on offer. One member of staff recorded in a survey, Menus for meals are done on an individual preference taking into account service users needs, choice, likes and dislikes. The food menus are good and much better than they were on the last inspection. Any food and drink likes or dislikes are recorded in care plans, along with allergies and other special dietary needs. We observed that people are weighed on a regular basis as part of nutritional Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: screening and that food and fluid intake charts are kept when this is an identified need. The charts we saw were up to date and included details of the food and fluid taken and the quantities. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 18, 19 and 20. Care plans are a thorough record of a persons healthcare needs, including personal support, but there are some concerns about the ability of some staff to meet these. The administration of medication is well managed. Evidence: Care plans record thorough details of a persons need for assistance with personal care. This includes information about a persons usual routines, preferred time to get up, preferred time to go to bed etc. plus very detailed information on topics important to the individual concerned. Care plans record that people should be encouraged to undertake person care tasks themselves whenever they are capable of doing so. Each person has three or four key workers assigned to them so there is usually someone on duty who knows each individual well. On the day of the site visit one female had refused to get dressed so had to spend the whole day in their apartment/bedroom. There were male and female staff on duty but two male staff were assigned on different shifts to spend one to one time with this person. On one occasion the female left the bedroom and was stood in the corridor of Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: the home, observed by other people living there. The male carer had some difficulty persuading this person to return to their room and we noted that no other staff came to their assistance. A health care professional told us that, although they assist the service to develop behaviour management plans, they are not always followed by staff. For example, the behaviour management plan for this person states that they should be dressed as soon as they wake up and taken out in the homes vehicle. The consequence of the behaviour management plan not being consistently adhered to results in this person having to stay in their bedroom all day accompanied by a member of staff. Care plans record a persons input from various specialists such as psychologists, speech and language therapists, physiotherapists, the community team (learning disability) nurses and occupational therapists. We noted that people had been provided with equipment needed to aid their mobility, such as wheelchairs. The manager told us that there is now a follow-up appointments diary in use to ensure that people do not miss appointments with health care professionals. We saw that care plans include information about contact with GPs and other health care professionals, such as dentists, opticians and chiropodists, and that they also included information and advice for staff on how to accompany individuals to these appointments to ensure a successful outcome. A health care professional told us when asked if peoples health care needs are met, a gentleman is difficult to engage and be examined therefore seems to have not been pursued, despite him not having capacity to understand his health needs and requiring this to be done in his Best Interests. A recent complaint investigated by the home about an individuals health care needs not being met highlighted some areas of concern. Following the investigation of the complaint, some improvements have been made to the systems in place and to the recording of information in care plans. This includes the close monitoring of health care needs, such as regular weighing as part of nutritional screening. On the day of the site visit we examined medication administration records, the arrangements for the storage of medication, returns of medication to the pharmacy and staff training. Care plans record details of a persons prescribed medication and the reason why the medication has been prescribed - a copy of this document has been included with medication administration records; this is good practice. Recording on medication administration records was seen to be accurate, including the record of drugs received and detailed information about the use of PRN (as required) medication, and we noted that any handwritten entries on medication records had been signed by two members of staff to ensure accuracy. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: We were told that one drug that had been prescribed was a controlled drug; the Care Quality Commission (CQC) pharmacist inspector later confirmed that this was not a controlled drug. However, because the home believed that this was a controlled drug, we would have expected that it had been stored as such and that a controlled drugs book would be in use to record administration; this was not the case. There is a medication fridge in use and we noted that the temperature of the fridge and the medication cabinet was taken twice daily and recorded. There were two fans inside the medication room; these were both in use on the day of the site visit to keep the room at the required temperature. Any unused medication is returned to the pharmacy appropriately and recorded. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 22 and 23. People understand the complaints procedure in place at the home and staff training on safeguarding adults from abuse offers the people living at the home some protection from the risk of harm. Evidence: Each care plan that we examined had a copy of the complaints procedure included that was written in symbol format. All of the people living at the home who returned a survey to us told us that they knew who to speak to if they were not happy and how to make a complaint. One person added, my parents would act on my behalf. Staff told us in surveys and on the day of the site visit that they know what action to take should someone have concerns about the care provided by the home, and were able to explain in detail the action they would take. We examined the complaints log in place at the home. One record was of a complaint that had been passed to the home by the Care Quality Commission. The record included details of the complaint, details of the investigation undertaken by the home and the action taken. One of the resulting actions was that the protocol for responding to accidents or incidents was displayed on the notice board and staff were given an individual copy of this information to ensure that they take appropriate action should similar incidents occur in the future. We did not see any evidence that minor concerns or comments are recorded and dealt with; this would show people that people are listened to and that Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: appropriate actions are taken. Training records evidenced that most staff (all apart from two) have now undertaken training on safeguarding adults from abuse. In addition to this, six staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and three other staff are working towards either NVQ Level 2 or 3 in Care; the topic of abuse awareness is covered in these training awards. Staff have to sign to say that they have read and understood policies and procedures in place at the home, and this includes the policy on safeguarding adults from abuse. The deputy manager told us that this topic has been discussed at staff meetings and in staff supervision sessions. There have been four safeguarding referrals made to the local authority since the last key inspection. Three of these involved one service user causing harm to another service user and one included an allegation that further incidents of abuse had not been reported to the Care Quality Commission. We are concerned that situations arise at the home because people are not being allocated the one to one time that they are funded for. A fourth safeguarding referral was made as a result of a complaint that was received by the Care Quality Commission; this should have been referred to the local authority by the home under safeguarding adults protocols. We are not yet confident that staff at the home know when a safeguarding alert should be made to the local authority. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 24 and 30. Staff follow good hygiene practices and the home is maintained in a clean and hygienic condition, with the exception of unpleasant odours in two bedrooms that require action. The risk of cross infection is increased by staff undertaking care, domestic and catering tasks. Evidence: The property is purpose built and is suitable for the needs of the people living at the home. It is in keeping with the local community and is fitted with good quality domestic furnishings and fittings. There is no maintenance programme in place but, in general, the home is well maintained. Some staff told us that the organisation is slow to get things actioned and gave examples of some minor repairs that had been waiting a long time to be undertaken. Another member of stafff told us that managers have tightened up on cleaning rotas and that the home is much cleaner. On the day of the site visit all areas of the home were seen to be clean but there were offensive odours in two bedrooms. New flooring has been ordered for one bedroom as it was recognised that the carpet was soiled. The other bedroom had already been fitted with new flooring but the problem appeared to be in the bathroom; the member of staff told us about the particular problems of the person occupying this room and Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: we recommended that the material used to board in the bathroom appliances is replaced, as it is starting to rot along the bottom edge. The premises offer ample access to sunlight and arrangements for access to and from the building are suitable for the people living at the home. We were concerned that some of the doors from bedrooms into the garden are not alarmed. The garden is fully enclosed and people have hourly checks during the night, but they could hurt themselves and not be detected by staff for some time. Laundry facilities are situated in an area away from food storage and preparation areas. The floor and wall finishes are readily cleanable and there are hand washing facilities for staff. Washing machines and tumble dryers are suitable for use at the home. Training records evidenced that most staff (apart from some newly appointed staff) have undertaken training on infection control and we saw good hygiene practices being followed on the day of the site visit. However, we did note that paper towels had run out in the staff toilet and a fabric towel was being used; this increases the risk of cross infection and should be avoided. We have some concerns that staff are responsible for domestic and catering tasks as well as personal care. This may increase the risk of cross infection. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 32, 33, 34, 35 and 36. Staff receive appropriate training and supervision from their manager. There are not always enough staff on duty to ensure that people receive the one to one support they need and people tell us that not all staff have the skills to meet the complex needs of people living at the home. Evidence: Almost 50 of the staff group have now achieved NVQ Level 2 in Care - some staff are working towards this award and one person is working towards Level 3 in Care. A member of staff told us, I would like to see more NVQ work. Its allright doing mandatory training but a recognised national qualification would help staff more to understand their jobs and role. The manager told us that it is the policy of the organisation that staff must complete the LDQ (Learning Disability Qualification) award before they commence NVQ training, so this is in their hands to some extent. Staff undertake induction training and the organisation tell us that this meets Skills for Care requirements. In one instance recently a member of staff asked for an additional weeks induction training as they did not feel confident in working with people unsupervisied and this was agreed to by the home; this is good practice. A member of staff told us, When I started at Landau Lodge I had no experience of the residents Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: that were living there or about to move in. The firm gave me all the relevant information they had. The El-box also enabled me to complete courses that helped me with induction. Voyage induction and care induction standards are now available on the El-box. A member of staff told us in a survey, overall, training is good - not perfect and all up to date but most staff have met their mandatory training. Training records evidence that staff undertake training on topics relevant to the people living at the home such as non-crisis intervention, epilepsy, autism, diabetes and intensive interaction - this training is done with a behaviour therapist from either the organisation or the community team learning disability and involves training on how to manage the behaviours of an individual living at the home. The manager said that a speech and language therapist is also due to do some intensive interaction training with staff. A member of staff told us, we have had a service user with Aspergers and I felt we should have had more specialist training before they came. Health care professionals and staff have told us that skill levels vary between the staff group - some staff are very experienced and are able to carry out the care and the interventions needed but other staff do not seem able to do so. One member of staff told us, my worry is that there are one or two staff that seem to discourage people or put them down for trying. The deputy manager explained to us that it is difficult for new staff to gain the experience needed to work with some people living at the home, as the challenging behaviour they display is spasmodic so they could be working at the home for some time before they come across it. The manager told us that she has rearranged the staff rota so that there is always a mix of experienced and new staff on duty so that there would always be someone on duty who had had experience of dealing with a specific behaviour. Records evidence that staff still need to undertake training on equality and diversity, as recommended at the last key inspection. The manager told us that all of the people living at the home have 1:1 funding for seven days per week. The amount of hours funded 1:1 varies from 5 hours per day to 14 hours per day. The staff rota records that there are either four, five or six staff on duty; the manager told us that they aim to always have five staff on duty. However, if all six people living at the home have some 1:1 funding each day, we consider that there should be six staff on duty plus the manager. As previously recorded, there is a gender mix amongst the staff group but that does Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: not necessarily result in someone of the same gender working with a person; more consideration should be taken in respect of the privacy and dignity aspects of allocating staff to work alongside a person living at the home. We were also concerned about the uninterrupted work with individuals. Support staff are currently responsible for the provision of meals. We noted that, if a colleague called for assistance, the person preparing the meal would have to turn off the cooker and hob and ask the residents with them in the kitchen/dining room to leave due to the risk of scalding and being left unsupervised with equipment that could cause people harm. Staff told us that this creates some confusion for people if it does occur. Staff tell us that they are fed up of the high sickness levels at the home - one person told us when asked how the service could improve, Be more strict about sickness this does really have an impact on the service. There are people here who are not willing to pick up overtime which puts a strain on those who do. This will have an effect on service users. We do have a new manager and she is trying to sort things out. The manager said that she has created a four week rota and staff now know when they will be working and when they will be having days off. The manager said that this has reduced sickness levels. We examined the recruitment records for two new members of staff. These evidence that an application form is completed that gives details of previous experience, qualifications and training, employment history, a criminal conviction declaration and details of two referees. In both instances, two written references and a satisfactory CRB check had been obtained prior to people commencing work at the home. This ensures that only people who are considered safe to work with vulnerable people are employed at the home and protects people from the risk of harm. Staff tell us that they now receive formal supervision on a more regular basis and it is expected that the home will achieve the requirement for staff to have supervision with a manager six times per year. The three staff that returned a survey to us that they meet with their manager regularly to discuss how they are working. One person added, the manager and deputy are always available to give me support, either formally or informally. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 37, 39 and 42. People tell us that the manager is working hard to make the required improvements at the home. Health and safety for people living and working at the home is promoted via the policies and procedures in place but staff training does not necessarily result in a skilled and competent staff group. Evidence: There has been a lack of consistency in the past regarding management arrangements at the home and the home has never risen above a quality rating of adequate. A new manager has been appointed and she has appropriate qualifications in Care and Management at NVQ Level 4 or equivalent, and there is evidence that she keeps her practice up to date; she was attending management training on the day of the site visit and has also attended training recently on Deprivation of Liberty, Autism, the Mental Capacity Act and person centred planning. The manager told us the week after this site visit that she has submitted her application to the Care Quality Commission for registration as the manager of Landau Lodge. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Health care professionals and staff told us that the manager and deputy manager are working hard to make improvements at the home and we acknowledge that some improvements have been made. However, there are continuing concerns about low staffing levels, the environment and health care needs not being fully met. The Annual Quality Assurance Assessment completed by the manager prior to the inspection informs us that staff meetings and key worker group meetings take place on a monthly basis. The manager told us that surveys were sent out to family, staff and health and social care professionals six months ago and that any actions needed as a result of the feedback received were undertaken at the time. We were told that surveys are due to be sent out again in July 2009. We examined some of the health and safety documentation held at the home. There are appropriate policies and procedures in place, environmental risk assessments have been completed and fire safety arrangements are good - in house fire tests and drills take place consistently and the fire system has been checked by an authorised person. There is a gas safety certificate in place, bath hoists have been serviced and water temperatures are tested on a regular basis. We noted that regular checks take place on the safety of wheelchairs used by people living at the home and that all chemicals used for cleaning, laundry etc. are stored in a locked cupboard. A health and safety monthly checklist was seen to be completed up to 13/11/08 and then ceased; this should be reinstated. Staff have training on health and safety topics as part of their induction training and then receive regular updates. As previously recorded, there are some concerns that staff training opportunities have not always resulted in a staff group that have the skills and competencies to carry out their role safely, and in turn, protect people from the risk of harm. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 15 and 17 The registered person must 30/09/2008 ensure that detailed care plans are developed and agreed with people and must detail the action to be taken by staff so that they can meet all of their personal health and welfare needs. (Timescale of 31/09/08 not met) Some care plans have been updated and reviewed but the remaining care plans have not been updated within agreed timescales. All people living at the home must have a thorough care plan in place so that staff are working with up to date information. Care Homes for Adults (18-65 years) Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 18 The registered person must be able to demonstrate the homes capacity to meet the assessed needs of people admitted to the home and must not admit or retain people whose needs they cannot meet. Staff employed must have the skills required to meet the needs of the people living at the home to ensure that individual support plans can be met. 10/08/2009 2 18 12 Behaviour management 17/08/2009 plans that have been developed to guide staff on how to deal with particular behaviours must be adhered to. Behaviour management plans must be followed consistently to be successful. Care Homes for Adults (18-65 years) Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 18 12 The arrangments in place for 17/08/2009 assistance with personal care or intimate contact must take gender issues into consideration. Personal care must be conducted in a manner which respects the privacy and dignity of the people living at the home. 4 23 13 Safeguarding alerts must be made to the local authority as per agreed protocols. This is needed to ensure that all allegations or incidents of abuse are investigated appropriately, to protect people from the risk of harm. 20/08/2009 5 33 18 There must be sufficient numbers of staff on duty to meet the one to one requirements of the people living at the home. This is needed to ensure that people receive the care that is agreed in their individual support plan. 30/08/2009 6 33 18 Staff must have the skills 30/08/2009 needed to meet the needs of the people living at the home. This is so that all areas of Care Homes for Adults (18-65 years) Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the care package, including behaviour management plans, can be adhered to consistently. 7 35 18 Managers must confirm that 30/08/2009 training sessions undertaken by staff have been understood and that staff are able to put their learning into practice. This is needed to ensure that staff have the skills needed to carry out their role effectively. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should be reviewed formally every six months to ensure that staff are working with an up to date record of a persons individual care needs. Consideration should be given to the possibility of people taking part in activities with other people who do not live at the home. People should be supported to have contact with appropriate health care professionals when it is in their best interests, even when this creates difficulties. One drug was believed by staff to be a controlled drug. However, it was not stored or recorded as such. Managers should ensure that they and all staff are clear about when to treat medication as a controlled drug, and what this entails. It would be good practice to record peoples comments and concerns and any action taken; this evidences that the 2 15 3 19 4 20 5 22 Care Homes for Adults (18-65 years) Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations views of the people living at the home are listened to. 6 24 Consideration should be given to all doors leading from bedrooms/apartments into the garden being alarmed so that staff are alerted if people leave the premises. There should be a maintenance programme in place to evidence that there a plans for the on-going maintenance and decoration of the building. Paper towels provide more protection against the risk of cross infection and should be used whenever possible. The home should be free from unpleasant odours. Consideration should be given to the employment of ancillary staff so that care staff can spend their full time on shift supporting the people living at the home, and to reduce the risk of harm, including cross infection. Staff should undertake training on equality and diversity to ensure that they understand the varying needs of people living at the home and how these could be met. There should be consistency in management arrangements at the home. The manager should ensure that training promoted at the home results in a staff group who work in a safe way; this would protect people living at the home from the risk of harm. Health and safety monthly audits should be reinstated to evidence that managers are monitoring that the systems in place are being used effectively. 7 24 8 30 9 33 10 35 11 12 37 42 13 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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