Inspection on 06/06/07 for Landau Lodge

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Landau Lodge 30/06/09

Landau Lodge 04/06/08

Landau Lodge 28/11/07

Landau Lodge 30/06/06

Landau Lodge 14/03/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Landau Lodge Triton Road Kingston upon Hull East Yorkshire HU9 4HU Lead Inspector Christina Bettison Key Inspection 6th June 2007 09:30 DS0000064712.V342253.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000064712.V342253.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000064712.V342253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Landau Lodge Address Triton Road Kingston upon Hull East Yorkshire HU9 4HU 01482 781042 01482 781062 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Care Services Ltd Mrs Kathleen Stephenson Care Home 10 Category(ies) of Learning disability (10) registration, with number of places DS0000064712.V342253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC. to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD. 2. The maximum number of service users who can be accommodated is: 10 9th November 2006 Date of last inspection Brief Description of the Service: Milbury Care own and manage Landau Lodge. The home is registered to provide care and accommodation for up to 10 adults between the ages of 1865 who have a learning disability. The home is located to the east of Hull city centre and is purpose built. It is a six bedroom bungalow. All bedrooms are single with en suite facilities. Two of these have additional cooking facilities and can be used more as bed sits to promote independence. There is an office, large hallway, kitchen / dining room, laundry, quiet room and lounge. There is a sleep-in room for staff. There is wheelchair access throughout. In the grounds are four self contained bungalows providing individual accommodation for an additional 4 service users. The home has a garden to the side and rear. There is a car park area to the side with additional street parking. Weekly fees range from £1,400 per person per week to £1,750 per person per week. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report DS0000064712.V342253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 1 day in June 2007. Relative surveys were posted out of which 3 were returned, 1 professional survey was returned and 1 staff survey from the manager was returned. At the site visit staff informed the inspector that they had returned surveys for the previous inspection but none of their issues raised had been resolved therefore they didn’t feel it was worthwhile to complete them again. However 8 staff were very keen to speak to the inspector and a lot of the site visit was spent talking to staff. During the visit the inspectors spoke to the deputy manager, eight staff, and service users and observed the interactions between staff and service users to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at some records. Information received by us over the last twelve months was considered in forming a judgement. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre-inspection questionnaire. The site visit was led by Regulation Inspector Mrs T Bettison, the visit lasted 8 hours. What the service does well: Service users and their relatives are provided with information that is easy to read so that they know what to expect from the home. One relative commented “The carers I have met have been keen on learning of my brothers needs so that they can do the best for him. It is not easy when my brother doesn’t speak. The carers are keen to help him with his talking. I feel the home is vast improvement in my brother’s life. The management and staff do very well. Very kind to me also”. Another commented “They care, whenever we visit the welcome is warm and people enjoying their lives and there is a real sense of making life fun, they could probably use more staff”. And another commented “ ………has come on in leaps and bounds since living at Landau Lodge. We have nothing but praise at the way staff and the home is run, we as parents are eternally grateful. Thank you to all concerned”. DS0000064712.V342253.R01.S.doc Version 5.2 Page 6 Service users have an assessment so that the staff know what they need to do to meet their needs. New service users are able to visit the home and stay overnight to help them to decide if the home will be able to meet their needs or not. All service users 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, making sure that family can keep in contact. A good recruitment policy is in place so that service users are protected from harm. Service users medicines are looked after well and staff assist service users to take their medicines safely. Service users and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. The staff are very committed and caring and treat service users with respect and dignity. The home is safe, comfortable and meets service users individual needs. What has improved since the last inspection? What they could do better: The guide for service users need be changed so that it says clearly what service users can expect from the home and when new people move into the home the manager needs to be sure that their needs can be met. Two service user surveys were returned. One service user commented both in the survey and in discussion with the inspector that she didn’t like living at the home, she didn’t feel safe and she didn’t fit it. Service users who say they want to live somewhere else must be supported to do so. All of the service users must have a plan and risk assessments and they must say what staff need to do to make sure service users needs are met and that DS0000064712.V342253.R01.S.doc Version 5.2 Page 7 they are protected from harm, plans need to include service users religious and cultural needs. Service users need to have a plan of activities/interests and records kept to show that they are happening and staff need to help service users to develop their skills in independent living. When service users have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help service users to take it. There needs to be enough staff in the home so that the staff can meet the needs of service users and carry out all of their duties safely. A professional commented, “I do have concerns about the skills of the support workers. The manager appears skilled and knowledgeable however some staff appear to have little insight into the needs of people whose behaviour challenges, The home would be better if staff stopped smoking in the garden around service users, record keeping of activities and use of 1:1 hours could be much clearer”. New staff need to do basic training (induction) in how to work with people with a learning disability within 6 weeks of starting the job and all staff must be provided with basic and special training, e.g. NVQ level 2, how to deal with behaviour that may harm service users or staff, how to protect service users from harm, how to work with people who have autism and communication needs and to help them to meet the special needs of the service users. Service users health needs must be written in a plan and staff must meet the complicated health needs of service users and special health advice be followed. The home needs to be managed better so that all of the things that need to get better do. The system that helps to improve the standards in the home must work better to make sure that everyone is involved in making decisions about the running of the home and improvements are made. 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. DS0000064712.V342253.R01.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 DS0000064712.V342253.R01.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): 1,2, 3 and 4 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to admission, information given may be misleading and consideration is not being given as whether the home is sufficiently resourced and staff have the skills to meet their needs. EVIDENCE: The home has a statement of purpose and service users guide, and service users and their representatives are provided with information about the home, however as detailed within this report the home are not providing everything that it detailed in the service guide and therefore it must be reviewed and amended to accurately reflect the service provided. There have been three new admissions to the home since the previous inspection. One of the care files was examined as part of the site visit. There was a copy of the community care assessment and Local Authority care plan on file. In addition to this the home had completed their own assessment. A professional stated in a returned survey “ The home always ask for copies of DS0000064712.V342253.R01.S.doc Version 5.2 Page 10 assessments and spend time with carers to gather information and arrange transitional visits”. However not all of the assessed needs had been developed into detailed service user plans, in the care file examined the service user presents with behaviour that can be difficult to manage and may pose a risk to themselves and others and there were no detailed risk assessments and management strategies in place and staff had not received adequate training and did not feel skilled to meet their complex needs. In addition to this consideration has not been given as to whether the home is sufficiently resourced to meet all of the service users needs prior to admission. One service user commented both in the survey and in discussion with the inspector that she didn’t like living at the home, she didn’t feel safe and she didn’t fit it. This service user must be supported by the provision of Advocacy services if she wishes to, to ensure that her wishes and views are responded to appropriately by the local authority. In addition to this on examination of the service user financial records it appeared that service users were paying for their own holidays, however in discussion with managers they confirmed that all service users are funded up to £200 towards the cost of a 5 day holiday or a series of one day outings by the organisation as part of the contract price. It states in the homes own Service User guide “Milbury will pay the costs and staffing for one 5- day holiday per year or 5 day outings”, however it does not specify the amount, the service user guide needs to be amended to accurately reflect what happens in practice. It was noted from the financial records and stated in the service user agreements that service users will pay a contribution towards the use of the home vehicle. The manager needs to ensure that this is an equitable arrangement as some service users don’t use the transport and some use it more than others. Where service users are expected to contribute towards the use of the vehicle this needs to be clearly stated in the service user guide and/or the statement of terms and conditions so that prospective service users and/or their representatives are aware of the cost of using the homes transport and are in agreement with it. DS0000064712.V342253.R01.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 poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are met on an informal basis by inadequate numbers of staff, the quality of the service user plans and risk assessments are very basic. These shortfalls have the potential to place people at risk and mean that service users assessed needs are not met. EVIDENCE: All service users have a care file, and the inspector is aware that Milbury care are in the process of introducing new service user planning paperwork. All placing/funding authorities were contacted and they confirmed what staffing requirements are expected as part of the funding arrangements to meet service users complex needs, this is detailed further in the staffing section of this report. DS0000064712.V342253.R01.S.doc Version 5.2 Page 12 Two care files were examined as part of the inspection process. The service user plans did not include everything that is detailed in the local authority assessment/care plan, they did not reflect the full range of needs and do not ensure that all aspects of health, personal and social care needs are identified and planned for and did not detail accurately what staff need to do to meet service users needs. In one care file examined there was a very basic service user plan that did not cover all identified needs and there was only one risk assessments completed for managing his epilepsy. In this service users CCA/Care plan completed by the local authority it detailed a service user with significant care and support needs, restricted mobility, full support with personal care and dressing, limited verbal communication and use of makaton, epilepsy and prone to dry skin and presentation of behaviours that are significant challenging and may pose a risk to themselves or others. It also states that the service user has a good relationship with his dad and enjoys regular visits. However the homes service user plan only included a personal care plan that stated he needed two staff for safety but no other detail and a plan for diet and nutrition, in addition there was basic activity plan produced in picture format. In addition to this was a psychology assessment that recommended a structured activity schedule due to the service user diagnosis of autism, increase the use of makaton signing, attention to sensory impairments and detailed a whole range of behaviours that would by difficult to manage, including hitting, punching, biting, throwing objects, damaging property and self harming, none of which had been transferred into a detailed behaviour management strategy agreed by a multi agency team. There was no evidence of a review having taken place on this file. There was a basic health action plan however areas of health need had not been sufficiently detailed in the service user plan and there has been no input from the health authority/community team learning disability in the development of health screening or health action plans and there was no evidence of outcomes of monitoring of health needs. This is detailed further in the health section of this report. Where service user display behaviours that can be difficult to manage and specific techniques or methods of communication are needed in order to minimise the risks there were behaviour management strategies completed by the health authority, however the home had not completed their own and although there were protocols in place for the administration of medication on a PRN basis, these were not detailed enough and did not specify which medication, how much and if more can be administered when and how much and in what circumstances. DS0000064712.V342253.R01.S.doc Version 5.2 Page 13 In another care file examined for a service user admitted on 22/01/07 there was no service user plan, and no risk assessments in the file. As detailed in the LA CCA/Care plan this service user is autistic, has behaviour that can be difficult to manage, good verbal communication skills but this can sometimes be inappropriate and needs to be managed especially whilst in the community, needs guidance and prompting with bath temperatures and washing their hair and with domestic tasks, needs support with finances, shopping, and has no road safety skills. This service user likes to lead a very active lifestyle they like to walk, go to the gym, swimming, music, baking, karaoke and craftwork. The only evidence of a service user plan was one for the use of public transport as a learning/development opportunity, however this was devised on 17/5/07 and planned for two weeks and to be reviewed, there were no records of outcomes, no risk assessment and no review taken place. Areas of health need had not been detailed either in the form of a service user plan or health action plan and there was no evidence of outcomes or monitoring of health needs again this is detailed further in the health section of this report. There was a behaviour management strategy provided by the health authority but the home had not developed their own. This service user lives in one of the bungalows in the grounds and she had been reviewed on 14/3/07 and it was stated that there should be 30 minutes checks however there were no records to evidence that this was taking place. There were serious omissions in the care files examined, poor or no service user plans detailing all needs and including areas of cultural and religious needs, diet and nutrition, communication needs, mobility issues, poor attention to risk assessments, behaviour management guidelines did not include administration of medication PRN, no systematic monitoring of incidents of presenting behaviour, no health action plans and lack of documented health provision and support and outcomes. Discussion with staff and relatives suggested that service users basic care needs were being met even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Service users are at risk of not having their care needs met if these informal systems break down. In addition to this although staff appeared willing and very caring, they are not provided in adequate numbers and some did not appear to have the skills, knowledge and confidence to meet service users complex needs. DS0000064712.V342253.R01.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, 14, 15, 16 and 17 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. A lack of activities within the home and community and poor record keeping does not evidence that service users have the opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. EVIDENCE: Service users or within the evidence that and therefore are not being provided with a range of activities, either in-house community there were little or no supporting documentation to service users needs in this area had been identified, planned for met. DS0000064712.V342253.R01.S.doc Version 5.2 Page 15 Without exception all staff spoken to said it was extremely difficult to get service users out into the community as a number of them require 2;1 staffing to ensure their safety and that of the general public. There was a basic activity plan on the wall of the office but the inspector was informed that it rarely takes place in practice. The inspector was informed that for their holidays, one of the service users is going to Center Parcs, two service users recently went to Blackpool and four of the service user are going to stay in the caravan at Patrington Haven provided by Milbury care. There was no evidence available to demonstrate how service users had been enabled to make a choice about where they would like to go for their holidays and therefore it is difficult to ascertain if their individual diverse needs are being met. There was very little information on care files as to how the home are enabling service users to maintain and/or develop new skills and how there interest and/or hobbies are being supported and a lack of records of activities undertaken. Discussion with staff and records indicated that family and friends are able to visit the home and can use any of the communal facilities or the service users bedroom. There is no restriction on visiting times. The majority of service users users have limited verbal communication to express their choices and wishes and promote their independence. Any restrictions are not documented within their service user plan. The care staff currently do all of the shopping, cooking and cleaning. The kitchen on the day of the inspection was found to be very dirty, there were crumbs and split food all around and the cooker was dirty. In addition the waste bin had all dried food stuck to it and smelt. At approximately 2.30 in the afternoon there were lunchtime pots and pans left out unwashed. Packets of food were open in the fridge and had not been covered over and dated as to when it had been opened. In addition there were bottles of sauces that had not been dated when opened. The inspector was informed that the budget for food is inadequate; the weekly allowance is £210, which is allocated as £30 per service user per week but also feeds the staff that are on duty which can be up to 6 staff. Staff stated that they constantly run out of food and there is no allowance for treats. On the day of inspection there was not a lot of food stored in the cupboards or fridge/freezer. The senior carer had gone out that morning to buy items to make sandwiches for lunch. Staff stated that it can take 2 staff up to 2 hours to prepare, cook and serve the evening meal. DS0000064712.V342253.R01.S.doc Version 5.2 Page 16 The diet and nutritional needs of service users needs to be detailed in service users plan and include their likes and dislikes. Most of the current service users are very dependent and present behaviours that may pose a risk to themselves and others. The current staffing structure is inadequate to meet the complex needs of service users and does not allow for the full range of activities, promoting independence and meaningful interactions to be provided. In addition to this the staff are not able to ensure that the house and kitchen are kept clean and hazard free. DS0000064712.V342253.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service user’s health and personal care needs are not being fully identified, planned and met. These shortfalls have the potential to place service users at risk of harm. EVIDENCE: Service users plans and supporting documents relating to health needs are very basic. There was evidence that health professionals are providing some services to the service users, i.e. psychology, consultant neurologist, consultant psychiatrist, however needs are not being adequately identified, planned for and outcomes are not recorded therefore it is difficult to evidence if needs are being met. There has been no health screening undertaken by the community nurse and although one of the service users had a health action plan this had come from a previous placement and was very basic with no outcomes recorded, in DS0000064712.V342253.R01.S.doc Version 5.2 Page 18 addition service user did not have detailed service user plans relating to health needs. In this Health Action Plan it stated that a best of interest meeting needed to be arranged to discuss the use of restrictive physical intervention for medical check ups however this did not appear to have taken place. A staff member informed the inspector that she had noted in the communication book that one of the service user had a loose tooth and that it had been bleeding, however no one appeared to have taken responsibility for ensuring the service user received dental treatment, this service user did not have a dentist identified in their care file and had not been for over a year. In general the medication appeared to be well managed and one of the senior support workers had overall responsibility for its management. The home stored medication securely. The inspector was informed that staff were completing administration of medication training with Lloyds pharmacy, the manager provides the training, staff complete the workbooks which is marked by Lloyds however they had not had their competency assessed. All medication was signed into the home and there were no missed signatures on the medication administration records observed. Stock control was managed and medication was returned to the pharmacy when no longer in use. Some service users are prescribed medication for pain relief and for behaviour management purposes. The protocols for the administration of medication on a “as and when required” basis need to be clearer so that staff know when to administer PRN medication and when second doses can be given. DS0000064712.V342253.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints system and procedures for safeguarding adults however these are not being followed and due to the unsatisfactory staffing arrangements, poor service user plans, and behaviour management guidelines and lack of training service users are not protected from harm whilst in the care home. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. Some of the service users present behaviour that may pose a risk to themselves and others and some of the staff files examined evidenced that staff have not received training in how to manage service users in times of distress and high anxiety and where staff had received training this does not appear to have been effective as they did not all feel confident. From examination of records and discussion with staff it became apparent that one of the service users has on occasions assaulted staff and other service users, in February of this year he punched a service user in the mouth causing a split lip, bleeding and swelling. In January of this year he kicked a service user, in March of this year he slapped the same service user and again in May of this year he slapped the same service user across the head causing her to fall over. There has not been effective recording of these incidents; they have DS0000064712.V342253.R01.S.doc Version 5.2 Page 20 not been reported to the Local authority under the safeguarding adults procedures and they have not been reported to CSCI under regulation 37. In addition to this the staff team have not been given enough guidance/training on how to intervene to protect service users and themselves. One member of staff spoken to stated that they had “had no probationary period/interviews, no induction (not even basic fire induction), received no supervision and has had no mandatory training and no service specific training and had no previous experience of care work”. This member of staff clearly did not understand their responsibilities with regard to managing behaviours and had been attacked by a service user and had very little support. Examination of staff files further evidenced that three staff had not completed their induction and there was no evidence of probationary interviews having taken place. Another staff member commented that “we don’t have enough staff, know we are not perfect, we have to pull service users off each other to protect them and us, the NVCI training doesn’t cover what we need, don’t feel skilled”. Another staff member commented “there’s never enough staff on duty, not all staff have the same standards, I regular think of leaving but don’t because of the commitment to service users, service users are funded 1:1 but don’t get it, service users don’t go out, we have very brief staff meetings, staff morale is very low. Staff try their best in a bad situation”. Another staff member commented “activities don’t happen, training is poor and doesn’t reflect service users needs, the service is not run in the best interests of service users, the food budget is not enough to feed 11/12 people 3 meals a day and the night staff. The staff are very well meaning and care for service user however we are regularly short of staff on the rota. It is mostly weekends and bank holidays when staff don’t turn in and there is no cover”. In addition to this on examination of the service user financial records it was noted that service user are paying for their own holidays, this needs to be investigated as service user are entitled to a 7 day holiday or a series of one day outings paid for by the organisation as part of the contract price. It clearly states in the homes own Service User guide “Milbury will pay the costs and staffing for one 5-day holiday per year or 5 day outings”, however it does not appear to be happening in practice. It was also noted from the financial records and stated in the homes Service User guide that service users will have to pay for “a contribution of £8.00 per week for the use of the home vehicle” this is not an equitable arrangement as some service users don’t use the transport and some use it more than others. DS0000064712.V342253.R01.S.doc Version 5.2 Page 21 The location of the home, the service being provided in separate bungalows, the unsatisfactory staffing arrangements, poor quality and lack of service user plans, poor attention to health needs and outcomes and inappropriate financial practices means that service users are not protected from harm and/or exploitation whilst in the care home. (These areas are explained further in environment, management and staffing) and give cause for serious concern. DS0000064712.V342253.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides service users with comfortable surroundings in which to live, however areas of the houses are shabby and in need of repair and redecoration. EVIDENCE: The home is located to the east of Hull city centre and is purpose built. It consists of a six bedroom bungalow and four one bedroomed bungalows in the grounds. All bedrooms in the main bungalow are single with en suite facilities. Two of these have additional cooking facilities and can be used more as bed sits to promote independence. 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. DS0000064712.V342253.R01.S.doc Version 5.2 Page 23 In the grounds are four self contained bungalows providing individual accommodation for an additional 4 service users. The home has a garden to the side and rear. There is a car park area to the side with additional street parking. The home is spacious, comfortable and safe for the service users that live there and has a “lived in” feel about it. Because the staff are responsible for all the cleaning, cooking and care it is difficult for staff to prioritise the work load and all staff spoken to stated that service users needs came first. Therefore on the day of inspection, there were unmade beds and bathrooms that hadn’t been cleaned and the kitchen was very dirty. The registered person must review the staff hours provided and the roles and deployment of staff to ensure that all times the service users needs are met and the home is kept clean and hygienic for the people that live there. DS0000064712.V342253.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35, 36 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the needs of the service users, staff are not being adequately supervised and both mandatory and specialised training is unsatisfactory placing service user at risk. EVIDENCE: The inspector was informed that the home has 20 staff in total, comprising of • • • • • 1x Registered manager 1x deputy manager 2x senior support workers day support workers night support workers The rota evidenced that there are 5 support workers allocated per day shift am and 6 support workers per day shift - pm. There are also 2 waking night staff and a staff member sleeping in. DS0000064712.V342253.R01.S.doc Version 5.2 Page 25 The home currently has seven service users living at the home and all placing/funding authorities were contacted and they confirmed that:• • • • • • One service user is funded for 1:1 staff for 14 hours per day 7.30 am to 11.00pm and 2:1 to go out. One service user is funded for 1:1 staffing for 7 hours per day x 7 days One service user is funded for 1:1 staffing for 8 hours per day x 5 days One service user is funded for 1:1 staffing for 9 hours per day x 7 days Two service user are funded for 1:1 staffing for 5 hours per day x 7 days One service user is funded for 1:1 staffing for 14 hours per day x 7 days This clearly demonstrates that there are not enough staff on duty to meet the assessed needs of the service users. Staff have the responsibility of cleaning bedrooms bathrooms and all communal areas, the preparation, cooking and serving and cleaning up after 3 meals per day, supporting service user to attend appointments, activities, undertake shopping and gardening and in addition to this attend to the care needs of service users. In addition to this staff state that when they sleep in, on occasions they are woken up at 5.00 am to support the service users in the main house whilst one staff goes to assist a service user in the bungalow to have bath. They are then tired during the day shift and not fit for duty. Eight staff were spoken to on the day of inspection and without exception all staff including deputy and seniors commented that more staff would improve the standard of the service to the service users and improve their quality of lives. One member of staff spoken to stated that they had “had no probationary period/interviews, no induction (not even basic fire induction), received no supervision and has had no mandatory training and no service specific training and had no previous experience of care work”. This member of staff clearly did not understand their responsibilities with regard to managing behaviours and had been attacked by a service user and said they had had very little support, an incident report had been completed. Examination of staff files further evidenced that three staff had not completed their induction and there was little evidence of probationary interviews having taken place. Another staff member commented that “we don’t have enough staff, we know we are not perfect, we have to pull service users off each other to protect them and us, the NVCI training doesn’t cover what we need, don’t feel skilled”. DS0000064712.V342253.R01.S.doc Version 5.2 Page 26 Another staff member commented “there’s never enough staff on duty, not all staff have the same standards, I regularly think of leaving but don’t because of the commitment to service users, service users are funded 1:1 but don’t get it, service users don’t go out, we have very brief staff meetings, staff morale is very low. Staff try their best in a bad situation”. Another staff member commented “activities don’t happen, training is poor and doesn’t reflect service users needs, the service is not run in the best interests of service users, the food budget is not enough to feed 11/12 people 3 meals a day and the night staff. The staff are very well meaning and care for service user however we are regularly short of staff on the rota. It is mostly weekends and bank holidays when staff don’t turn in and there is no cover”. 5 staff files were examined in the course of the inspection. All had completed application forms, had 2 satisfactory references and CRB clearances prior to commencing employment. Three of the staff had started their probationary interviews and basic induction, however neither of these had completed their induction and had it signed off. Most staff had only had two supervision sessions since February and July of 2006 and there was no evidence of staff appraisals/individual training profiles. The manager must ensure that new staff are given basic induction into the home on commencement and commence LDAF induction and complete it within 6 weeks of commencing employment and that Millbury’s policy and procedure regarding probationary periods are followed. Staff were not up to date with their mandatory training, e.g. infection control, first aid and fire safety. Only a couple of staff had completed safeguarding adults training. Service users have presenting needs in communication deficits, autism, sensory impairments and present behaviours that may pose a risk to themselves or others, there was little evidence that staff had received updated training in these areas that met their identified training needs. A training plan was not available and the home does not have 50 of staff qualified to NVQ level 2. The registered person is required to review the staffing structure and care staff hours provided in the home to ensure that they can meet the complex needs of the service users and to ensure that staff are appropriately trained for their role. The registered person is also required to ensure that staff are up to date with all mandatory training and service specific training is provided in autism, DS0000064712.V342253.R01.S.doc Version 5.2 Page 27 effective communication skills, managing behaviour that may pose a risk to themselves or others, medication training that includes a competency assessment, safeguarding adults, equality and diversity, values and attitudes and effective recording. DS0000064712.V342253.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is unsatisfactory and does not demonstrate that it is acting in the best interests of the service users that live there. EVIDENCE: Landau Lodge is part of Milbury Care Services which is a national provider of care and support services for people with a learning disability. Milbury is part of the Paragon Health Care group, which is a UK wide organisation that specialises in providing a range of services to vulnerable people. DS0000064712.V342253.R01.S.doc Version 5.2 Page 29 The manager of the service is relatively new in post and is registered with the CSCI. She was not on duty at the home on the day of the site visit. All staff spoken to spoke highly of the manager and said she was supportive and approachable and is trying her best. However there is a lack of detailed service user plans and guidelines, poor attention to providing both mandatory and service specific training. Risk has not been managed effectively and therefore service users are not being protected from harm. Incidences of behaviour management are not being managed appropriately and recorded and monitored and no action has been taken to address this. The restrictions of the current staffing structure and number of care hours provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of the duties required to ensure that service users complex personal, health and safety needs are met and that a range of activities are provided that meet their diverse needs. As part of the inspection the manager completed the CSCI Annual Quality Assurance Assessment that indicated that all maintenance had been adhered to as follows:• • • • • • Premises electrical circuits- 27/04/07 PAT tests- 30/08/06 Fire detection and fighting equipment 27/04/07 Emergency call equipment- 27/04/07 Heating system- 22/06/06 Gas appliances- 22/06/06 None of the above where examined by the inspector on the site visit. Milbury care services have a QA system, which includes regular audits and monitoring of the service culminating in an annual service review. The area manager undertakes regulation 26 visit on a monthly basis however this has failed to be effective in highlighting the areas for improvement. None of the QA documentation was examined by the inspector during the site visit. DS0000064712.V342253.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 2 32 1 33 1 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 x LIFESTYLES Standard No Score 11 1 12 1 13 1 14 1 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 x 2 x x x x 1 x DS0000064712.V342253.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? no 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 YA1 Regulation 5 (1) Requirement The registered person must review and amend the service users guide to ensure that it accurately reflects the service provided. The registered person must ensure that the assessment of service users is kept under review and service users must not be admitted if the home are unable to meet their assessed needs. The registered person must ensure that service users are enabled to make choices about where they live through the provision of independent advocacy services (if they so wish). The registered person must ensure that service user plans are developed and agreed with service users and must detail the action to be taken by staff to meet their personal, health and welfare needs. The registered person must ensure that service users are reviewed at least 6 monthly and DS0000064712.V342253.R01.S.doc Timescale for action 30/09/07 2 YA2 14 30/09/07 3 YA3 12 (2) 07/06/07 4 YA6 15 and 17 30/09/07 5 YA6 15 and 17 31/08/07 Version 5.2 Page 32 6 YA7 13 (6 and 7) 7 YA9 13 and 17 8 YA11 16 (3) 9 YA12 YA13 YA14 16 (2 m and n) 10 YA18 18 11 YA19 13 12 YA20 13 and 15 plans are updated to reflect changing needs. The registered must ensure that where service users display behaviours that are difficult to manage or there are any limitations or restrictions on facilities, choice or human rights to prevent self harm or abuse or harm to others that this is agreed by a multi agency meeting and documented appropriately. The registered person must ensure that there are individual and generic risk assessments available that are maintained and reviewed. The registered person must ensure that service users religious and cultural needs are identified planned for and met. The Registered person must ensure that activities are identified, planned for and provided that meet the diverse needs of the service users and meet their assessed needs. These must be incorporated into the service user plan and records maintained. The registered person must ensure that service users are provided with sensitive and flexible staff support to maximise their privacy, dignity independence and control. The registered person must ensure that service users complex health needs are met by the provision of health screening, health action plans and access to health professionals. The registered person must ensure that where medications are administered PRN that guidelines for administration are DS0000064712.V342253.R01.S.doc 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 Version 5.2 Page 33 written up and followed by staff. 13 YA20 13 and 15 The registered person must ensure that staff have received training the management of medication and that they are assessed as competent. The registered person must ensure that all staff receive training in safeguarding adults and that all requirements are met to ensure service users are protected from harm. The registered person must ensure that when service users are assaulted by other service users that this is referred to the local authority as per the safeguarding adults procedures and CSCI must be notified as per regulation 37. The registered person must review the arrangements for the payment of holidays, payment of transport and payment for staff meals and ensure that this is accurately reflected in the service user agreements/service user guide and/or statement of terms and conditions to ensure that service users are not at risk of financial exploitation. The registered person must ensure that staff fulfil the aims of the organisation and home and respect service users individual needs with respect to gender, age, cultural background and personal interests. The registered person must ensure that all new staff are registered on and complete induction to LDAF standards within 6 weeks of appointment. The registered person must ensure that there is a training plan for the home and that staff receive specialised training in meeting the complex needs of DS0000064712.V342253.R01.S.doc 30/09/07 14 YA23 13 (2 6) 30/09/07 15 YA23 13 (2 6) 37 07/06/07 16 YA23 13 (2 6) 30/09/07 17 YA31 12 (4) 30/09/07 18 YA32 18 30/06/07 19 YA32 18 30/11/07 Version 5.2 Page 34 20 YA33 18 21 YA34 18 22 23 YA36 YA37 18 8 24 YA42 23 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 • Safeguarding adults • Medication competence The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support service users assessed needs at all times. Staffing levels must be regularly reviewed to reflect service users changing needs. The registered person must ensure that new staff are subject to probationary periods and written evidence available that regular reviews have taken place. The registered person must ensure that staff receive supervision at least 6 x per year. The registered person must ensure that the home is managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to. The registered person must ensure that the staff are up to date with their mandatory training. 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 DS0000064712.V342253.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA32 Good Practice Recommendations The registered person should ensure that at least 50 of staff are qualified to NVQ level 2 DS0000064712.V342253.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000064712.V342253.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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