Inspection on 04/06/08 for Landau Lodge

This inspection was carried out on 4th June 2008.

CSCI 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 11 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 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 28/09/2008.

CARE HOME ADULTS 18-65 Landau Lodge Triton Road Kingston upon Hull East Yorkshire HU9 4HU Lead Inspector Christina Bettison Key Unannounced Inspection 4th June 2008 09:30 Landau Lodge DS0000064712.V362378.R02.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.V362378.R02.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.V362378.R02.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 Vacant – Kerry Shepherd – Temporary Manager Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Landau Lodge DS0000064712.V362378.R02.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 28th November 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 £1,575 per person per week to £1,875 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.V362378.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. As part of this inspection surveys were posted out; four were returned from relatives, one was returned from a professional that visits the home, none returned from staff and eight returned from people who live in the home. The site visit took place over one day in June 2008 from 9.15am to 4.30pm. The manager, two senior support officers and all of the staff who were on duty on the day of the visit were spoken to and some of the people who were in on the day of the visit 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. We 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 the inspection process. Prior to the visit we referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed Annual Quality Assurance Assessment all of which forms part of this inspection. 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. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 6 The home is comfortable and meets people’s individual needs and the kitchen is kept clean and people are helped to eat a healthy diet but also some foods that they like. The staff and managers know that they need to make sure that people are protected from harm and know what to do if someone is harmed. A good recruitment policy is in place so that staff employed are safe to work with the people that live in the home. The people that live in the home and their relatives (who speak up on their behalf) are listened to and staff make sure they take action to sort problems out quickly. Relatives are made to feel very welcome in the home. What has improved since the last inspection? There is a new manager in place who has helped the home to change and make lots of improvements in the standard of care provided to make sure peoples needs are met. When new people are being considered to move into the home, the assessment now takes into account their compatibility with other people living in the home. All of the people that live in the home now have a plan and some risk assessments that say what staff need to do to make sure all of their needs are met and that they are protected from harm, these still need some further improvement. People now have a basic plan of activities/interests and people are now being helped to enjoy activities that they like, both in the house and out in the community, this means they have an interesting life and do not get bored. The medicines are well looked after. The home now has a permanent team of staff that are trained and the home now always has six staff on per shift, this means that they are able to meet people’s needs. New staff joining the home have been helped to get to know the people and what their needs are and have been given basic instruction in the running of the home and the rules. Training has been provided to all staff to make sure all staff are up to date with basic training in moving and assisting, basic first aid, basic food hygiene, infection control and fire awareness and some special training has been provided to all staff e.g. how to deal with behaviour that may harm people or staff and to help them to meet people’s special needs. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 7 The staff appeared caring and treated people with respect and dignity. What they could do better: 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.V362378.R02.S.doc Version 5.2 Page 8 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.V362378.R02.S.doc Version 5.2 Page 9 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): 2 and 3 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. Peoples needs are assessed prior to admission, and consideration is being given as to whether they are compatible to live/mix with the other people in the home. EVIDENCE: The home is currently registered for up to 10 people within the main house and bungalows in the grounds. The home currently has 4 people living in the main house and 3 people in the bungalows. However we were informed by the manager that they do not intend to fill the vacant two beds in the main house as it is felt that the needs of the people living at the home are too complex that to introduce more people would create an unmanageable situation. This has been agreed verbally by the senior management team of the organisation. There has been no new admissions to the home since the previous inspection, however it was noted at the previous inspection that someone had been admitted to the home that had needs that the home couldn’t meet. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 10 This person has now been re assessed so that the home have a clearer understanding of their needs, in addition to this support from the organisations behavioural therapist has been made available to provide specialised training for staff and assistance in drawing up behaviour management plans and guidelines. Stricter guidelines have been put in place for the people that live in the bungalows so that they do not enter the main house unless invited; this has created a much calmer environment and helped to reduce the number of incidents of assaults between the people living in the home. A person who had told us at the previous inspection that they wished to move out of the home and move back to be nearer their family has now been supported by the independent advocacy services to achieve this and has now moved out of the home. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 11 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are generally met and representatives have been consulted, and the quality of the service user plans and other supporting documentation are much improved however these need to be further improved and maintained to ensure that peoples changing needs continue to be met. EVIDENCE: We were informed that a lot of work has been put in to prepare detailed service users plans and other supporting documentation and that the deadline for completion was the end of June 2008. Three care files were examined as part of this site visit and all three included an individual plan detailing some elements of peoples needs. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 12 In addition to this additional plans had been developed that were very detailed and gave staff clear instruction in how care was to be delivered. These included morning and evening routines, how to manage difficult behaviours, likes and dislikes, activities etc. In one plan examined there was good detail in place for aspects of independent living such as; - household chores, laundry, making drinks etc and good management plans to direct the person to use their own coping skills in times of anxiety, in addition to this areas of personal care, medication and finance had been covered, however there were still gaps in diet and nutrition, culture and faith needs and decision making. Another plan covered communication, medication, finance and very detailed personal care plans covering bathing, teeth brushing and shaving, however elements not yet covered included culture and faith needs, personal and family contact and independent living. The third plan examined covered independent living, communication, medication, personal care, diet and nutrition and family contact all written in a person centred way. However as this person is very independent there is a need for more robust risk assessments to be in place and these were not found to be adequate. Staff told us;“I haven’t been here long, staff showed me what to do and I looked at the care plans, some are better than others” “Care plans are improved, we have worked hard on them” “care plans are better, if anyone new came they would know what to do for people, they would get a good picture” There were no detailed health action plans in any of the files examined (this is covered further in the health and personal care section of this report) Risk assessments were in place for a wide range of events and activities that may pose a risk to people living in the home, however a number of these needed further work because they had not been completed properly, they had not been scored properly and there was no indication of where a risk remained. Not all areas that pose a risk to people had been covered, i.e. one person is prone to self neglect and is very vulnerable whilst out alone in the community and also self medicates, these areas had not been risk assessed. Where decisions needed to be taken for staff to act in the best interests of people, best of interest meetings had been held which involved relevant professionals, relatives, staff and the person themselves. A record of these Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 13 meetings was held on file. Some staff have received training in the mental capacity act. We acknowledge the huge amount of work that has gone in to complete all the plans and tidy up care files however further work now needs to continue to ensure the improvements are maintained and plans further developed and some thought given to accessibility of plans for the people that live in the home. People who live in the home told us; “If I don’t want to do something I will go to my room or walk away when staff offer me things” “When my carers explain to me that I am going out, if I want to go I will put my shoes on, if I want to stay in I will go to my room” Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 14 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, 15, 16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A range of activities provided within the home and community mean that people have the opportunity to participate in activities however inadequate planning and recording does not evidence that these activities fully meet peoples individual needs, wants and aspirations. EVIDENCE: Three care files were examined during the site visit and all files contained activity plans, however these were basic and staff told us that although people were getting out more they have not implemented the activity plans yet. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 15 In addition to this one person had lots of structured activities planned for mornings and staff told us that that this person is not an early riser and would benefit from activities in an afternoon. Activity plans needs to be better thought out and planned in a person centred way to reflect peoples interests, hobbies, likes and dislikes and fit in with their lifestyle choices. People who live in the home told us; “I like doing jigsaws and the staff help me with this, but I like swimming and would like to go more often” However it was clear due to the increase of staff resources that people are being assisted to get out and about more and one person who displays behaviours that are not conducive to group living, spends a lot of time in their room. This person now had a structured intensive interaction programme where staff go in their room and spend an hour on structured activities; all staff take a turn in this. Later in the day this person came out of their room and in their own way indicated that they wanted to go out for a ride on the bus to which staff responded. This person appeared much more settled and happy than on previous inspection visits. We were told that holidays were being planned for people based on what had been learnt from experiences the previous year. Some people will be going to Blackpool. Some to a Haven camp site in a caravan and some of the people will probably have days out as this suits them better. Observations indicated that on the whole staff members interact very well with the people that live in the home. There was a warm, friendly and relaxed atmosphere in the houses during the course of the Visit. Menus were planned but were subject to change if people preferred alternatives. Menus reflected that staff promoted a healthy eating menu and tried to balance this with people’s likes/dislikes and special treats on occasions. The staff members generally prepare the meals with people helping if they were able to or wanted to. The environmental health assessment increased the homes score from 75-85, a B but still a good improvement on the previous score. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 16 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health needs are generally met and the medication is managed well, however the lack of health screening, health action plans and poor recording of outcomes does not evidence that all of peoples health needs are met. EVIDENCE: There has been minimal 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, GP, dentist and chiropody however needs are not being adequately identified, planned for and outcomes are not recorded well therefore it is difficult to evidence if needs are being fully met. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 17 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. The new care plan format had a section for detailing peoples health needs however the only detail recorded was how to support people to attend appointments and this was very repetitive. There were no plans for each area of health need. The manager stated that they were following guidance given from the organisation. None of the people had a detailed health action plan and none of the peoples health needs had been included in a plan of care. In one of the care files examined the person has epilepsy and there was no evidence of an epilepsy management plan completed by the epilepsy nurse and the home had not prepared their own in how to guide staff in what to do in the event of a seizure. The new deputy manager has taken over the responsibility of the medication and has completely overhauled the systems. The medication systems were examined at this visit and appeared to be satisfactory. The majority of staff have still not completed the full administration of medication training, although most have completed a basic awareness raising. We were told that this was planned and once staff complete the workbooks the manager will assess their competency. Some people are prescribed medication for pain relief, constipation and for behaviour management purposes. Some of the protocols for the administration of medication on a “as and when required” basis had been updated and amended but not all, all of the protocols need to be clearer so that staff know when to administer PRN medication and when second doses can be given. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 18 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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The increase of staff resources and development of care plans means that peoples needs are now being met, and the home has a complaints system, whistle blowing policy and procedures to ensure protection of people from the risk of harm which are all now being used effectively to ensure issues raised are looked into and resolved and people are protected form the risk of harm. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. There have been no complaints to either the home or CSCI since the previous inspection and the home have had 3 compliments, 1 thank-you card from a relative and another thank-you card from a new member of staff thanking the staff team for their support and another from a relative; “Thank you all for doing such a good job in looking after my son. He’s improved such a lot all down to you, keep up the good work” 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 Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 19 management plans had been reviewed and amended and were more robust giving staff clearer guidance There have been 3 safeguarding adult’s referrals made to the LA since the previous inspection, all relating to people who live in the home assaulting each other, however incidents of this nature had significantly reduced and staff said they were being more vigilant and felt more confident. Examination of staff files evidenced that new staff were completing their induction and probationary interviews were taking place. From the care files examined it was evident that people that self harm or display behaviours that are difficult to manage now have behaviour management guidelines. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. From discussion with staff and staff training records it was evident that most of the staff including the manager and senor staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this and some staff have completed mental capacity act training. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 20 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live that meet their individual needs and lifestyles, however the organisations slow response to requests from the manager comprises this. EVIDENCE: The home is located to the east of Hull city centre and is purpose built. It consists of a six bedroom bungalow/main house 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.V362378.R02.S.doc Version 5.2 Page 21 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 new manager has been very pro active in addressing all the issues highlighted at the previous inspection relating to the environment. The home is spacious and comfortable for the people that live there and has a “lived in” feel about it. Staff are responsible for all the cleaning, cooking and care however the increase in the staff resource has enabled the staff to be able to undertake all of the tasks associated with their role. All of the knocked and damaged plasterwork has been attended to and on the day of the visit new waterproof and hard wearing flooring was being fitted to the main entrance and hallways. One of the rooms has been transformed into a therapeutic environment with soft furnishings and lights and music, to enable people to have somewhere else to go other than the main lounge. However the majority of staff spoken and the manager all raised the ongoing problem of one of the bedrooms. The room had terrible mal odour that was very strong and when the door was opened the smell permeated throughout the main house, the manager had requested refurbishment of the room, new flooring and bathroom re fit, however the organisation had said it would be early 2009 when this would be attended to. This is clearly unacceptable as the person who uses this room is not being provided with safe, clean and odour free private space. People who live in the home told us; “It smells” Staff told us; “One room smells awful” “One room is awful- the smell” Following telephone calls made to the area operations manager it was arranged to have the work completed by the 13th June 2008. This must be completed by the agreed time. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 22 The TVs did not have a very good picture and staff said that it was a problem with the aerials, this must be addressed. As part of the site visit we examined the maintenance and servicing records; • • • • • • • • • • • Premises electrical circuits- 7/7/06 for 5 years PAT tests- 10/07 Fire detection and fighting equipment- 12/5/08 Fire drills – undertaken monthly Fire alarm – weekly tests undertaken Emergency call equipment- no records were available Heating system- 3/6/08 and a date agreed to complete works required. Gas appliances- 3/6/08 Legionella – 14/2/08 and assessed as low risk. Wheelchair checks- weekly Water temperatures- weekly Baths – due for service – this is planned Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 23 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 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current staffing arrangements are much improved and now provide sufficient staff to meet the needs of the people who live in the home. The training and supervision of staff needs to continue to improve to ensure that peoples needs continue to be met. EVIDENCE: Previous inspections, a complaint received and a high number of safeguarding adults incidents highlighted a number of concerns relating to inadequate numbers and deployment of staff, inadequate action from previous management and staff and some poor care practices. An immediate requirement notice was issued on the 28/11/07 requiring the management to ensure that a minimum of 8 staff are on duty per shift. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 24 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. A random inspection visit was carried out on the 14/2/08 because the CSCI had received an anonymous complaint that on that day the home was severely understaffed with only 3 staff on duty. At this time the manager and staff confirmed that on this particular day the home had only three staff on duty, despite a previous agreement being made between CSCI and Paul Constable – Responsible Person that there would be 6 staff per morning and afternoon shifts and an additional member of staff working across the day time and rotas and discussions with staff and managers confirmed that that they were hardly ever staffed up to 7. Once again an immediate requirement notice was issued to ensure that staff numbers were kept at 7. Since then the management team have worked very hard to resolve the staffing issues, a number of staff have left the employment of the organisation and numbers of staff have been recruited both permanent and bank, in addition to this agency staff have been used to fill the gaps in the rota whilst recruitment and induction is completed. Because one of the people who lived at the home has moved out the manager confirmed that she regularly reviews the staffing numbers and at the present time they are staffed to 6 staff per morning and afternoon shifts and two waking night staff. The inspector was informed that the home has 21 staff in total, comprising of • • • • • 1x manager (not yet registered with CSCI works supernumerary) 1x deputy manager 4x senior support workers 11 x day support workers 4 x night support workers The rota evidenced that there are 6 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. Staff files evidenced that recruitment was robust and all staff had completed application forms, 2 references, identification that they were eligible to work in this country and satisfactory CRB clearances. Most of the staff was seen to be up to date with their mandatory training and additional service specific training had been provided, some staff had completed Autism and aspergers syndrome, diabetes care, intensive Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 25 interaction and equality and diversity. All staff have completed safeguarding adults training and the seniors and deputy are planned to undertake the managers safeguarding training. Staff are commencing on medication training and will be completing the Buccal midazolan and stesilid training Appraisals are being planned and we were told that now seniors have completed the training in how to conduct supervision sessions, it is expected that supervison will happen more regularly. Only 25 of staff have achieved NVQ level 2. People who live in the home told us;“Not all of the staff have treated me well in the past” “I love the staff they are all very nice to me” Staff told us; “Morale is a lot better, staff seem more settled” “Staffing has improved, we’ve always got 6 on, this means that incidents of challenging behaviour has reduced and service users are more settled” “We have good team” “Much improvement, staffing levels much better, service users have a better quality of life” “There’s been lots of improvement, always 6 staff on duty, that’s a lot better, staff morale is much better and the team is better, bank staff provide support when we need it. There is a much better atmosphere and service users are more settled” Professionals told us;“Problems were highlighted with staff skills, improvements in the training programme have begun” Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 26 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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Significant improvements have been made in the development of care plans, staffing numbers and competence and the provision of training and the appointment of a new manager of the service will give the staff leadership and support and means the peoples needs will be met in a well managed service. EVIDENCE: Landau lodge is part of Milbury/Voyage Care Services which is a national provider of care and support services for people with a learning disability. Milbury/Voyage 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.V362378.R02.S.doc Version 5.2 Page 27 This home has suffered in the past from significant failings in the previous management arrangements and the staffing situation at the home was in crisis. In addition to this poor quality paperwork meant that staff did not have the necessary guidance and the people who live in the home were not having their needs met and were at risk of harm. However a new manager has been drafted in and managers and staff have worked hard in improving the standards at the home and working towards meeting all statutory requirements from the previous inspections. Significant improvements have been made in the development of care plans, staffing numbers and competence and the provision of training. (See the main body of this report) The manager has her NVQ level 4 and the registered managers awards, she was very knowledgably about all of the people that live in the home and very supportive of her staff. She clearly puts the needs of the people at the forefront of everything she does. She has been asked to manage this home in addition to the sister home next door and the deputy manager will be expected to undertake the daily management of the home. This will need to be reviewed to ensure that the management of both homes is effective. The QA process was not examined at this inspection as the manager told us that the home still needs time to fully implement this within the home and ensure that they engage fully with the staff team, stakeholders, people who use the service and relatives and listen to their concerns and take action to make improvements within the home. Relatives told us; “There have been a number of senior staff changes, we do believe that the new management structure is starting to address the problems in a very professional way and time will be needed to turn things around” “Under the new management structure communication was sparse but it is now improving” “At the moment we are giving the new management team the opportunity to turn things around. It is commendable that the manager and deputy are working hard to get things back on track” “We are pleased and grateful with the care and support our relative receives. In your care they have come in leaps and bounds, thank you so much” Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 28 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 x 2 3 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 2 x x 3 x Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 29 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 and 17 Requirement The registered person must 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 31/03/08 not met, timescale extended) The registered person must ensure that there are individual risk assessments available that are maintained and reviewed so that people are protected from the risk of harm. (Timescale of 31/03/08 not met, timescale extended) The registered person must ensure that peoples religious and cultural needs are identified and planned for so that their diverse needs are met. These must be incorporated into the service user plan and records maintained. (Timescale of 31/03/08 not met, Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 30 Timescale for action 30/09/08 2 YA9 13 and 17 30/09/08 3. YA11 16 (3) 30/09/08 timescale extended) 4. YA12 16 (2 m and n) The Registered person must ensure that people are given the opportunity to participate in further education and /or ongoing informal teaching programmes so that people are able to continue learning new skills. 30/09/08 5. YA13 16 (2 m and n) These must be incorporated into the service user plan and records maintained. The Registered person must 30/09/08 ensure that people are given the opportunity to participate in the community both locally and further afield so that they have an interesting and varied life and do not get bored. These must be incorporated into the service user plan and records maintained. (Timescale of 31/03/08 not met, timescale extended) 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 so that they have an interesting and varied life and do not get bored. These must be incorporated into the service user plan and records maintained. (Timescale of 31/03/08 not met, timescale extended) The registered person must 30/09/08 ensure that peoples health needs are identified, planned for and met by the provision of health screening, plans and good DS0000064712.V362378.R02.S.doc Version 5.2 Page 31 6 YA14 16 30/09/08 7 YA19 13 Landau Lodge 8 YA20 13 records kept of outcomes so that the people who live in the home are protected from the risk of harm. The registered person must ensure that where medications are administered PRN that guidelines for the administration are written up and followed by staff so that the people who live in the home are protected from the risk of harm. (Timescale of 31/12/07 not met, timescale extended) The registered person must ensure that staff have received training in the management of medication and that they are assessed as competent so that the people who live in the home are protected from the risk of harm. (Timescale of 15/02/08 not met, timescale extended) The registered person must ensure that there is a training plan for the home and that all staff receive specialised training in meeting the complex needs of service users with a learning disability, i.e. Autism Communication skills How to deal with service users that present with difficult behaviour Equality and diversity Medication competence so that the people who live in the home are protected from the risk of harm. (Timescale of 15/02/08 not met, timescale extended) The registered person must DS0000064712.V362378.R02.S.doc 30/09/08 9. YA20 13 and 15 30/09/08 10. YA35 18 30/09/08 11. YA36 18 30/09/08 Page 32 Landau Lodge Version 5.2 ensure that staff receive supervision at least 6 x per year so that they are supported in their job and can meets peoples needs. (Timescale of 15/02/08 not met, timescale extended) 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. 2 3 Refer to Standard YA32 YA30 YA39 Good Practice Recommendations The registered person should ensure that at least 50 of staff are qualified to NVQ level 2 so that the staff team are trained and competent to undertake their role. The registered person should ensure that the home is kept clean, hygienic and free from offensive odours throughout so that people live in a nice environment. The registered person should ensure that the QA processes are fully implemented within the home so that staff, people who live in the home, professionals and relatives are given the opportunity to comment about the running of the home and improvements are made. Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Landau Lodge DS0000064712.V362378.R02.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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