Inspection on 01/07/08 for Latham House

This inspection was carried out on 1st July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Latham House 27/11/08

Latham House 04/01/08

Latham House 07/08/07

Latham House 20/09/06

Latham House 22/11/05

Latham House 23/08/05

Latham House 07/03/05

Latham House 21/12/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Latham House The Lane Wyboston Beds MK44 3AS Lead Inspector Andrea James Unannounced Inspection 1st July 2008 10:00 Latham House DS0000060512.V367576.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 Latham House DS0000060512.V367576.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. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Latham House Address The Lane Wyboston Beds MK44 3AS 01480 470470 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) psouthgate@brookdalecare.co.uk na Brookdale Healthcare Limited Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Maximum number of service users: 12 Gender: Male and Female Ages: 18-65 Up to 12 Service Users with a Mental Disorder may be accommodated where this is associated with a Learning Disability. Date of last inspection Brief Description of the Service: Latham House is registered as a 12-bedded house and its exterior is in keeping with the rural neighbourhood. It is situated on the outskirts of the village of Wyboston, close to the market town of St. Neots. There are good community facilities available and the home provides transport to staff and service users to travel from the village to nearby towns. The home is split into 2 units for the people using the service aged between 18 and 65 years who have Autistic Spectrum Disorder and associated challenging needs. All of the bedrooms are single and en-suite. Each unit has a lounge and dining room. The units shared the laundry facilities. The home has recently changed the way meals are prepared. They are now cooked in the adjoining hospital, owned by Brookdale Healthcare, and delivered to Latham House. The maximum fee for this service is £2978.00 per week. Latham House DS0000060512.V367576.R01.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 a 0 star. This means that people will use this service experience poor quality outcomes. This inspection was undertaken on the 1st of July 2008 by Andrea James and Angela Dalton. The acting manager was not present and as a result the team leader assisted in the inspection process. The inspection process lasted for seven hours meaning 14 inspecting hours was undertaken for this inspection. The inspection process followed a case tracking methodology where samples of people using the service were randomly selected their files and records were inspected and where possible their key workers spoken to. The report consists of information received from people using the service, care staff, management team and surveys received from the home. The information received from the people using the service was limited because of their level of communication skills. We would like to thank the people using the service, the care staff, and the team leader for the co- operation and contribution to the inspection process. What the service does well: The service focuses on users individual needs and offered a stable environment to 6 people with varied learning disabilities. The home have developed a person centred approach to identifying individuals aims and goals, this was presented in a pictorial format. People using the service said “yes I like it here” when asked how they enjoyed the home. Staff were observed taking three users to snoozeloon on the day of the inspection and users were excited and appeared happy to undertake this activity. On that morning some users were also escorted to undertake personal shopping. One user was unable to communicate verbally her feelings but held hands and danced with the inspector when asked if she was happy here. The home employed various auxiliary staff that complemented the staff team to include a driver who also works as a maintenance person, as a result people were able to access community resources using the two buses are available throughout the day. The staff team were friendly and welcoming and the complimentary of their working environment. Staff spoken to said they felt confident in meeting the Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 6 changing needs of people who use the service. Care staff were observed to respect users privacy and dignity. We observed carers knocking on users doors before entering their bedrooms and speaking to them respectfully. In most cases staff were good at recording daily events and as such a clear audit trail could be kept of the use of activities and interactions with others. The home also ensured also ensured that where possible people were able to maintain contact with their families and home visits were encouraged. What has improved since the last inspection? Since the last inspection a new acting manager have taken over the management responsibilities. The number of people using the service have also been reduced from 12 to 6. We were also informed that some staff members had left the organisation and new employees have been recruited to complement the staff team. The home had complied with some requirements, which meant that people using the service received a comprehensive assessment of need and care plans were updated to be more specific and easier to understand. Arrangements were also made to ensure risk assessments were current and reflective of peoples needs. The service had also made improvements in some areas of the home. Since the last inspection arrangements were made to install adaptations to bathrooms in minimising the risks of trips and falls to people using the service. Records inspected showed that training was also undertaken by several members of the staff team these included infection control, safeguarding and medication competency training. The home received six monthly audits and we were informed that regular regulation 26 visits were undertaken to maintain good standards of care. We were informed that several staff have commenced their induction which is to be completed over a 12 week basis and will also be an element of their NVQ unit. Staff spoken to commented that the home was very proactive in getting them to undertake this piece of work. The home fully met 12 of their 21 requirements from the last inspection and 4 were partially met. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 7 What they could do better: They should ensure that all users have the same opportunity to participate in day-to-day activities in accordance with the care plan implemented and meeting their individual needs. Arrangements must also be made to ensure the health care needs of people are assessed and recognised and procedures are in place to address such issues in a proactive manner. They should make proper provision for the health and welfare of people by ensuring that prescribed medicines for people in the home are given in accordance with the doctors instructions as specified by the pharmacy issuing the medicine. They should also implement satisfactory procedures for the safe administration of PRN medication for individual people to make it clear at what doses care staff should administer on each occasion. Sufficient medication should also be maintained in the home to prevent users having to wait long periods without any medication. Theres also a need to ensure medication Administration records are satisfactorily completed in accordance with individual prescription instructions. Effective quality assurance systems also need to be developed in order to monitor and analyse the views of people using the service. Some staff commented that the communication within the staff team was poor which affected the people using the service for example care delivery would change and some members of the team would only hear through the “grapevine”. The service should ensure satisfactory temperatures are maintained throughout the home to ensure comfort. On the day of the inspection the temperature in areas of the home was very hot and at 11 a.m. one room measured 27°. The home should also ensure that enough food is available for people to have a snack if and when required; there were also no cooking facilities available on the day of the inspection. The home should also make further improvements to the environmental standards to make it homely and welcoming. The staff recruitment records should be consistent to ensure the safety of people using the service would not be compromised. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 8 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. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2. People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence to include a visit to this service. Satisfactory systems were in place to ensure people and their representatives’ received sufficient information about the service and a comprehensive assessment was undertaken for all users, as a result user’s needs were identified. EVIDENCE: The home had reviewed their Statement of Purpose and Service Users Guide and the guide was presented in a pictorial format to meet the needs of people who use the service. We inspected a sample of peoples filed and found satisfactory assessments which were comprehensive and reflected detailed information of the users. Some user’s documents showed that the assessment was undertaken by internal professionals but some failed to identify the author and the date of implementation. Latham House DS0000060512.V367576.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, 8&9. People who use the service experience an adequate quality outcome in this area. This judgement has been made using available evidence including a visit to this service. Some care planning procedures had improved that impacted positively on people using the service, however further development was needed to make better the care plans and ensure all users have the same ability to make decisions, as a result the outcome for some users in regards to their life style choices was not good. EVIDENCE: Care plans were comprehensive and informative. Lifestyle plans had been devised and were in pictoral form and simple language so that people who use the service could understand them. Professionals had worked with staff to ensure comprehensive information was recorded about meeting individual needs. All aspects of care had been thoroughly explored so that consistency of care delivery could be assured. Staff were observed to be following the care plan and diffusing potentially challenging behaviour with the exception of restraint being used. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 12 Restraint is being implemented within the home to deal with challenging behaviour. Incident reports reflect this is the case frequently. No mention was made of when restraint was considered necessary within the care plan or how it featured as part of the behavioural guidelines. A five a day period restraint had been used on four occasions. Care plan files were heavy and not designed for people who use the service although the potential for this to happen is available. Risk assessments were thorough and comprehensive. It was easy to understand what action to take to monitor and manage risks. We saw evidence to support that staff were able to implement guidance. It was good to see individual time table implemented to reflect user’s needs but disappointing to note that due to insufficient staffing levels activities had to be cancelled or changed. There is no assessment regarding the practice of locking internal doors within the home and how this impacts upon fire safety and deprivation of liberty. There was also a need to ensure the care plan documentation reflect the health care needs and guidelines for particular individuals. There was no evidence of medication guidelines for the administration of PRN medication and the weight of people were not monitored since the beginning of 2008. There was also a need to ensure all care plans are signed and dated. There was sufficient evidence to suggest some people were able to make decisions and participate in aspects of the home. Care staff were observed taking one person to the kitchen to choose a snack while others taken to access community activities. However for some users the decision making process was not evidence. One user’s bed clothing was taken off and stored away in an attempt to keep the user from going back to bed. Staff spoken to said the bedding was returned in the evening this user was seen lying in the communal chairs throughout the day. The records seen suggested good risk management was in place. The document detailed current management priorities which gave staff good guidance on how to manage behaviour, including risk of assault and arson and the level of risk was also identified to show it if was high medium or low. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 13 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 &17. People who use this service experience an adequate quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. The lifestyle opportunities for some people in the home gave opportunity for personal development, appropriate activities and family involvement but further development was needed to ensure meals and snacks are readily available and all users have the same opportunities to fulfilling leisure activities, as a result some users did not have a fulfilled lifestyle. EVIDENCE: Despite half of the house no longer being in use the space was not being utilised by people who use the service. The majority of staff were observed to be sitting with people who use the service or monitoring them. It was a hot day and people who use the service who had not gone out were pacing or sitting. A game of darts was observed but at times it appeared staff were waiting for behaviour to occur rather than engaging with people who use the Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 14 service. Some users were observed not to have left the house for the duration of the inspection process. Plans are being arranged to develop more individual activities but the confined space at Latham House may result in challenging behaviour occurring more frequently because people have little privacy/ space. Three people who use the service were going out for an afternoon activity but there were insufficient staff to support a remaining person who wished to join them. This resulted in an individual becoming upset and frustrated, which could have been avoided. Care plans reflected that staff frequently deals with situations in a reactive manner, as resources are not available to deal with them proactively. Activities are dependant upon adequate staffing levels being available and compromise the norm for people who use the service. On the day of the inspection 6 staff were available but in the community some users required 2 to 1 staffing. There was evidence that people were taken to access the community via their mini bus and care staff commented that some users are able to go to restaurants and public places. One person when asked if he liked his activities, smiled. Meals continue to be prepared by the central kitchen and no cooker is available. Fruit and cereals are in the kitchen but little else. The contents of the fridge were separate portions of jam and marmalade but no bread was available; 3 carrots; 1 large tub of margarine; 1 iceberg lettuce; 1 tub of marmite; milk; yoghurts and 11 litre cartons of assorted fruit juices. Cereal containers did not all have lids fitted to them. None of the food in the fridge, freezer or elsewhere in the kitchen had opening dates on to reflect how long they had been in use. Swing bins had lids missing and rubbish was visible and presented the risk of cross infection and poor hygiene. The limited readily availability of food in the home reflected negatively on one user who at 11:30 am kept saying “dinner, dinner”, and was clearly getting agitated. The care staff took this user to the kitchen but he did not want anything offered to him from the limited stock and so had to wait until 12:30 to get something to eat. The meals were prepared from the canteen of the near by hospital. The contents of meals seen appeared to be balanced, as they provided protein, carbohydrates and vegetables. All appeared to have enjoyed the meals. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 15 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 &20. People who use this service experience a poor quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. Some systems were in place to support users in meeting their emotional health need but poor medication practices were seen, as a result users were at risk. EVIDENCE: Some staff were observed to work with people who use the service in a gentle and kind manner. They clearly understood individual needs. Other staff were observed to talk about people who use the service in front of them as though they were not present and using the third person. Whilst in the medication room one inspector heard a member of staff shouting at a person who said to the user ‘get to your room.’ The situation escalated quickly and additional staff were required before calming. Medication instructions were unclear and not being followed correctly. New Medication Administration Record (MAR) sheets had been commenced when new medication had been delivered mid cycle. The reverse of two sheets was being completed for recording the reason why as required (PRN) medication was administered out of sequence. Page numbers were not reflective of how many MAR sheets were in use. An anti psychotic drug had been prescribed but Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 16 the number of tablets administered was not recorded; only ‘four tablets in 24 hours as required’ was recorded on the MAR sheet for one person. Records reflected that over a 13 days period 7 doses of 2 tablets, not 1, had been given. On one occasion medication had been given and not signed for on the front of the MAR sheet. In some cases two medication records were being used interchangeably. This happened when medication already transferred to a new Mar sheet was also being recorded on the old Mar sheet that was still in use for other medication. Another person who uses the service taking the same medication and instructions stated ‘take one up to four times a day as required’. Records showed that over a 15 day period 2 tablets had been given instead of one on 8 occasions. When staff were asked how they could determine how much to give they replied” I just look into his eyes”, no guidance about the dosage of medication to be administered was available for PRN medication. Staff spoken to said some users received PRN medication before they were taken out on trips to ensure they were calm. We saw guidelines for the administration of anti psychotic medication on an as required basis for three people who use the service. All guidelines were identical not accounting for individual requirements or reflecting needs identified in care plans or risk assessments. For one user only two tablets were in stock, when the person was able to have up to four in a day. The staff said new medication stock was to arrive at the home by the end of the week. Medication had also been out of stock and not given for nine days to three people who use the service. One staff member told us pain relief was being given to a service user who complained of stomach ache and later had diarrhoea. Laxatives continued to be administered and on the daily notes the diet consisted of fruits, weetabix and yoghurt all foods that would worsen the situation. One user LT had been prescribed medicated cream to be administered but this was not signed as given and was seen in the stock cupboard. This medication was on the MAR sheet but no evidence that this had been discontinued or administered. For this user it was evident that the lactulose supply had run out from the 09/06/08 to the 19/06/08, resulting in the user being without medication for 10 days. This may cause unnecessary discomfort and pain due to the side effects to other medication given and due to their limited communication skills could result in heightened anxiety and distress to the user. We requested copies of prescriptions but none was available as they are not kept. Staff said the scripts were with the pharmacist as new stocks were due two days after the inspection. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 17 Safeguarding alerts were made in regards to people having to go without medication for long periods of time and medication being used as a restraint for people before they are taken out into the community. There were documents in the care plan to suggest people were able to visit the chiropodist, doctors and opticians but the records appeared outdated as the dates seen were all from 2007. Latham House DS0000060512.V367576.R01.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 &23. People who use the service experience a good quality outcome in this are. We have made this judgement using a range of evidence to include a visit to the service. Policies and procedures were in place for receiving and dealing with complaints and addressing issues that may affect the wellbeing of people using the service as a result users were safeguarded. EVIDENCE: The home had a complaint policy and procedures were in place to deal with complaints satisfactorily. The complaints form for people using the service were presented in a pictorial format but the numbers of people to be contacted if they needed to complain was not available. The team leader spoken to said no complaints have been received since the last inspection except for one received from us the commission about a care staff physically assaulting a person who uses the service. This is in the process of investigation using the safeguarding procedures. Training records seen suggested 12 of the 15 staff had received safeguarding training in 2008. The home has been reporting incidences through the safeguarding process in recent months. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 19 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): 24,25,26,27 &30. People who use the service experience a poor quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. The home was adequately decorated for its stated purpose but further development was needed to ensure people using the service receive comfort; as a result the best interests of people who use the service are not assured. EVIDENCE: On arrival to the home we were given a tour. In general some improvements were made to the environment. In one person’s room the sink unit was replaced and hand rails placed in the bathrooms to ensure users risk of falling was minimised. However some aspects of the home were in need of attention. On entering the home there were several staff lockers situated at the front door which detracted from the homeliness of the environment. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 20 The majority of bedrooms were spartan and reminiscent of those in long stay hospitals. Beds were covered in plastic and in few rooms had curtains. One bedroom had transfers and pictures and one had personal photographs. Although people who use the service have complex needs the environment lacks evidence of a specialist provision. Mainstream provisions will not always meet the needs of people who use the service and suitable alternatives should be explored and expertise sought where necessary. Nail heads were visible on drawers and doors where repairs had been made. Black marker pen had been used to write instructions on doors and drawers. This does not illustrate staff are mindful of individuals’ dignity and that they are working in a homely environment. Two bedrooms had evidence of water damage from recent roof leaks. It was apparent that water had run down light switches and may have entered the electrics. One person who uses the service has bedding removed in the morning (which may need washing). Bedding is not returned and the bed remains unmade as a deterrent to going to bed as this ensures the individual stays up. Staff provided us with this information and the bed was unmade during the inspection. On the unused side of the house the television cabinet had a padlock fitted. This did not look homely and again alternatives should be sought. The garden has no area of shelter and on a hot day (as on the day of inspection) the garden furniture has no shade available. There is a conservatory but it has no blinds and gets uncomfortably hot. This was true of other areas of the home. A currently unused bedroom measured 27ºC at 11am but reflected conditions on the top floor throughout the building. A communal bathroom had no toilet paper, soap or handtowels available. Hand towels were not present in bedroom ensuite facilities. This does not ensure good infection control or observe dignity. The general cleanliness of the home was satisfactory but strong smell of urine was identified in one person’s room. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 21 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): 31, 32,33,34,35 &36. People who use the service experience an adequate quality outcome in this area. We have made this judgement using available evidence including a visit to this service. People using the service benefited from a dedicated and trained staff team but further development was needed to ensure satisfactory recruitment and supervision is undertaken, as a result the protection of people using the service could be compromised. EVIDENCE: Since the last inspection several of the staff team have left a total of 8. The management have weeded the team in order to improve effectiveness. The home has 15 care staff to include the manager and as a result the home is in the process of recruiting. The current ratio stands at 6 care staff to 6 users but staff have commented that at times they only have 5 staff and it impacts on the users as some people needed to have a 2 to 1 ratio when out in the community. The rotas inspected showed that the home used on average of 115 hours of agency cover per week. The providers stated that they only use 15 of agency cover in previous months. The staff team all spoke positively about the changes since the last inspection. One said “we get lots of training now, and the manager is very supportive”. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 22 But the experience for another staff spoken to was that, “the communication among the team needed to be better, as sometimes things would change and you only her about it through the grape vine. From observation we saw that some carers had better competency and skills to meet the needs of people using the service while others needed further training. The training records seen suggested several mandatory training courses have been undertaken by the team to include safeguarding, infection control health and safety and record keeping. There was no collative evidence to show how many carers had achieved their NVQ level 2 or above but the team leader was able to say 4 for sure had this qualification. Those spoken to on the day did not have the qualification but spoke about their induction that they were due to complete in order to start their NVQ qualification. We inspected three staff files and found that most of the information required was available with the exception of two files where one failed to have any references, and another had no application form. The supervisions records seen suggested that staff did not get regular supervision. Files seen showed that only one supervision was undertaken since January 2008 in one case and no evidence of any supervision in the others. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 23 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, 38, 39, 42&43. People who use the service experience a poor quality outcome in this area. We have made this judgement using a range of evidence to include a visit to the service. The current management input has benefited the service but further development is needed to safeguard people using the service, as a result the best interests of people who use the service are not assured. EVIDENCE: Since the last inspection a new acting manager have taken up the management responsibility for the service. She has submitted her application for registration and have made positive changes that have benefited the people using the service. She arrived at the home in the beginning of April 2008 and on the visit undertaken on the 25th of April she spoke positively of the changes she envisaged making. The manager was off sick on the day of this inspection. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 24 On this visit the care staff spoke positively about her management skills and feels the changes have benefited the people using the service. However some practices within the home are still a cause for concern in regards to safeguarding the people who use the service. The medication procedures and policies for example needs further development to ensure clear auditing and monitoring of the procedures are safe, as highlighted in the personal and healthcare support section of this report. There was evidence that staff received regular staff meetings and notes seen suggested the team focused on the needs of the people using the service. The quality assurance processes within the home were in need of further development. Some work has been undertaken by the performance manager but the information was not available on the day of the inspection. Information received after the inspection showed that a monitoring exercise was undertaken to seek the views of relatives of people using the service but this was collative of all the Brookdale services and Latham house’s statistics was difficult to analyse in its entirety. There was no evidence to suggest the people using the service had a forum in which to make their views and wishes known. The providers commented that is was difficult to collect feedback as most of the users were non-verbal but had designed discovery groups that sought the likes and dislikes of people who use the service. This however was not presented on the day of the inspection. The home had satisfactory health and safety procedures in place and fire books inspected suggested regular fire tests and drills were undertaken. The water temperatures were satisfactorily maintained and staff spoken to said they received health and safety training. The temperature control measures in the home were unsatisfactory and could be seen to be uncomfortable for people on hot summer’s day. This could be heightened by the use of the industrial tumble driers situated in the middle of the home that only has a small extractor fan. On the day of the inspection areas of the home measured 27 degrees. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 25 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 One sstaffCHOICE OF HOME Standard No Score 1 3 2 3 3 X 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 2 25 1 26 1 27 2 28 x 29 x 30 2 STAFFING Standard No Score 31 3 32 2 33 2 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 x LIFESTYLES Standard No Score 11 2 12 3 13 2 14 2 15 2 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 x 1 2 1 x x 3 1 Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1) Requirement All aspects of people’s health care needs must be reflected in the care plans and kept under review. All care plans must be dated and involvement with interested parties recorded to ensure they are aware of all interventions. Timescale for action 30/08/08 2. YA6 15 (1) 30/08/08 3. YA14 16 (2) (n) All the people using the service must be stimulated through sufficient activities tailored to meeting their individual needs. This was partially met. Previous timescale: 30/02/08 30/08/08 4 YA17 12 (1) (a) A variety of snacks must be made available for consumption by people using the service at all times to DS0000060512.V367576.R01.S.doc 30/07/08 Latham House Version 5.2 Page 27 5 YA18 12 (2) and 12 (4) (a) 6 YA20 13 (2) 7 YA20 13 (2) 8 YA20 13 (2) 9. YA20 13 (2) ensure their dietary needs are met. All people using the service must have their dignity choice and independence respected to enable them to live a fulfilled life. Suitable arrangements must be in place for the administration of medicines to people by workers at the home in accordance with individual prescription instructions to ensure that they receive their prescribed medication. Suitable arrangements must be made to ensure people are not given restraint medication before being taken out into the community: to prevent abuse of people who use the service. Sufficient medication stock must be maintained in the home at all times, to prevent users having to go without medication for long periods of time. The use of PRN medication must be clear and the use of guidelines are recorded for individual persons that reflect their specific needs. This is a repeat requirement. Enforcement action is being considered. Previous timescale of 28/02/08/ and 25/04/08 not met. 30/07/08 30/07/08 30/07/08 30/07/08 25/06/08 10 YA24 23 (2) (p) Arrangements must be made to ensure temperature control measures are in place to maintain comfort for the DS0000060512.V367576.R01.S.doc 30/07/08 Latham House Version 5.2 Page 28 people at all times. 11. YA24 23 (2) (a) (b) All areas of the home must be decorated to present a welcoming and homely environment that meets the collective needs of people using the service. Previous timescale: 30/10/07 and 30/06/08. This requirement was partially. 30/06/08 12. YA26 23 (c) All bedrooms must have sufficient furnishings and fittings suitable to meet the individual lifestyles of the people. Arrangements must be made to remove offensive odours from identified areas of the home. All staff employed in the home must have satisfactory references and application forms on file to ensure all people receiving the service are safeguarded. All staff must receive regular supervision at least 6 per year to ensure staff are competent to meet the needs of people who use the service. Audits on medication policies and procedures must be recorded and reviewed to ensure people receive their medication. Effective quality assurance systems must be implemented that seeks and monitors the views of the people using the service. Previous timescale DS0000060512.V367576.R01.S.doc 30/09/08 13 YA30 23 (2) (d) 30/08/08 14 YA34 19 (1) 30/07/08 15 YA36 18 (2) 30/08/08 16 YA37 24 (1) 30/07/08 17. YA39 24 (1) (a) (b) 30/08/08 Latham House Version 5.2 Page 29 30/10/07 and 25/04/08 18. YA20 13(2)17(1)(a) Records of the prescribing and administration of medicines must be accurate and up to date. Previous timescale: 25/04/08. 30/07/08 19. YA28 23(2)(o) The garden must be safe and 30/10/08 well maintained so that people have a welcoming and pleasant outdoor space to use when they want to. Previous timescale :30/06/08 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 YA5 Good Practice Recommendations Arrangements should be made to ensure a written costed contract/statement of terms and conditions is obtained between the home and individual users. Not assessed on this inspection. All people using the home should be able to participate in the day-to-day running of the home. Arrangements should be made to employ a domestic staff to undertake the daily cleanliness of the home. 2 YA8 3. YA30 Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 30 4 YA32 Arrangements should be made to ensure at least 50 of the staff team are trained in NVQ level 2 or equivalent. Latham House DS0000060512.V367576.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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