Inspection on 22/11/05 for Latham House

This inspection was carried out on 22nd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 3 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 01/07/08

Latham House 04/01/08

Latham House 07/08/07

Latham House 20/09/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Latham House The Lane Wyboston Beds MK44 3AS Lead Inspector Linda Cappello Unannounced Inspection 22nd November 2005 11:45 Latham House DS0000060512.V266489.R01.S.doc Version 5.0 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.V266489.R01.S.doc Version 5.0 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.V266489.R01.S.doc Version 5.0 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) rhughes@brookdalecare.co.uk Brookdale Healthcare Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Latham House DS0000060512.V266489.R01.S.doc Version 5.0 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. 23rd August 2005 Date of last inspection Brief Description of the Service: Latham House is 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 6 service users 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 laundry facilities are shared by the units. 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. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the lunchtime period and afternoon on 22nd November 2005 and was carried out by Linda Cappello and Louise Trainor, Regulatory Inspectors. The new manager, Kate Houseago, was available to help the inspectors throughout. The purpose of the inspection was to review whether the requirements issued following the last inspection had been met and to also to review those key standards which were not assessed previously. There had been a recent meeting of the neighbouring village residents with the local Member of Parliament to air their concerns about some incidents which had occurred and the issues arising from the meeting were also followed up during this inspection. A neighbour who had made a specific complaint in relation to the home was also interviewed. During the inspection the care of two residents was tracked by examining their care records and talking to staff. It was not possible to interview the residents but they, and their interaction with staff, were observed throughout the inspection. A power cut occurred during the inspection and staff were observed to deal promptly and effectively with this. This report should be read in conjunction with the report issued on 23rd August 2005. The inspectors are grateful for the help given by the staff at the home during the inspection. What the service does well: This home has been found to give good care to its residents and to work very hard to make sure that residents are given choice about what they want to do. The staff are also very careful to make sure that they have thought about whether residents may be at risk of hurting themselves while they are doing activities. They help residents to join in a lot of different activities and take them out nearly every day. The staff help residents to make their own decisions about things whenever this is possible. The home gives medicines to the residents in a safe way. The home also tries to deal with any complaints quickly. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 7 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.V266489.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed during the previous inspection. EVIDENCE: Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 Residents are given appropriate assistance to make decisions about their lives and strategies are put in place to minimize risk for residents so that they can live as independent a lifestyle as possible. EVIDENCE: The home uses Essential Lifestyle Planning which shows that staff have made considerable effort to establish what each resident likes and enjoys. This information is used to assist residents to make choices about what they would like to do, for example, in activities. Staff encourage residents to experience new activities and assess their responses. Pictures are then used with each resident so that they can express a need or preference. The home has access to excellent support with communication by specialist staff and this enables the residents to participate in decisions about their lives. There were risk assessments in place in relation to all aspects of residents’ lives. There had been problems recently as one resident had been running to a nearby field and trying to touch the horses. The owner of the horses felt this was placing the resident at risk and did not feel that the home was taking appropriate action to protect the resident. This and other neighbours were Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 10 also concerned about some incidents involving patients from Milton Park which is the hospital owned by Brookdale Healthcare and which is adjacent to Latham House. These concerns resulted in a meeting with the local Member of Parliament in the village. A representative from the Commission for Social Care Inspection attended but none of the other invited representatives attended. The risks highlighted at this meeting and in a letter of complaint were assessed during the inspection and it was found that the home had now put measures in place which should prevent the resident from being able to run across the road to the horses. The owner of the horses had complained that there was a delay in the home addressing the concerns and it was found that the home had been assessing why this new behaviour was occurring and identifying what the appropriate response would be. An appropriate management plan had been drawn up and this included strategies with the resident and practical measures such as raising the height of the perimeter fence. None of the measures taken to minimise the risk to this resident appeared to be having a detrimental effect on the other residents. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 16 Residents are encouraged and enabled to take part in appropriate activities and staff respect resident’s rights and responsibilities. EVIDENCE: Residents’ wishes about activities are recorded in their Essential Lifestyle Plans and programmes have been drawn up for each day to include these activities. Staff also take photographs of residents participating in these activities so that the pictures can be used to offer further choice to residents, to show residents what they are going to do next and to review a resident’s progress. Evidence was seen of residents taking part in activities such as horse riding, swimming and bowling. Staff also take residents who are interested to a local outdoor activities centre, and to a local lake for walking or bird watching. There is a strong emphasis on finding out what each resident enjoys and then finding appropriate local resources. Residents are also encouraged to experience new activities to see if they enjoy them and their responses are monitored so that staff know whether to offer the experience again. All of the activities undertaken are backed up by the appropriate assessment of risk. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 12 Residents are not routinely given a key to their bedrooms but the manager said they could have one if they wanted one and if they were assessed as being able to hold a key without risk. The home should review whether some residents are able to have a key. However, in other respects, staff do ensure that the routines of the home promote independence and individual choice. For example, one resident has a preference for staying in his room. A routine has now been developed to allow him an appropriate amount of time alone in his room but he is encouraged to come out for periods where he can mix with other residents and take part in activities. Throughout the inspection, staff were observed to be interacting in a calm, friendly but professional way with residents, encouraging them and advising them. Residents can have safe access to the grounds because of the high fence but the space is very restricted. Staff do, however, take residents out in the minibus every day to places where there is space. The main doors of the home are secure to protect the residents and this is made clear in the Statement of Purpose. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The home’s systems in relation to medication protect residents, overall. EVIDENCE: Following the last inspection, the home was required to make sure that it was clear to staff when to give residents medication which was prescribed to be given as required. The records of two residents were examined and it was found that the required protocols were now in place. The home had not, yet, however, addressed the issue of residents giving consent to have staff administering medication to them or risk assessing why residents cannot administer their own medication. This should now be actioned by the home. The systems in relation to the administration of medication were found to be safe and only staff who have been trained in the safe administration of medication undertake the task. There is a photograph of the member of staff responsible for medication on each shift displayed on the residents’ noticeboard. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The home has a complaints procedure and has developed ways of making sure residents’ views are listened to. The way in which restraints are recorded needs further improvement to ensure residents are protected. EVIDENCE: The concerns which were expressed by local residents have been discussed in relation to Standard 9 above and this is the only complaint which the home has received. The neighbours did not feel that they had been listened to or that appropriate action had been taken. It was apparent, however, that the manager had taken note of the concerns and had undertaken further assessments of the resident concerned and asked for additional specialist support. Following the re-assessment of his behaviour, appropriate measures had been put in place to prevent the resident from placing himself at risk. The home may need to consider the relationship they have with neighbours and identify ways in which this can be improved. This would need to include staff at the adjacent hospital to achieve maximum positive effect. The home uses a variety of methods to ensure that residents’ views are heard by staff and acted upon and these have been discussed elsewhere, however, their views about the home are not, currently, routinely gathered. Following the last inspection, the home was required to record any restraints which take place in the format prescribed by the Department of Health guidelines. This still needs to be fully actioned by the home, although the incident reports have been revised to include more information about the nature of the restraint. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed during the previous inspection. EVIDENCE: Although these standards were not fully assessed on this occasion, the manager was advised to ensure that the front door of the home is kept closed, even though leaving it open does not directly compromise the safety of residents. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 The recruitment practice of the home is not sufficiently robust to protect residents. EVIDENCE: Recruitment processes at this home have given rise to concern since its opening and these were reviewed again during this inspection. The home had recently started 12 new members of staff and their recruitment records were assessed. It was found that there was no evidence that references had been robustly verified for some new staff, where the credentials, identity or relationship of the referee were unclear or of potential concern. It was also noted that a reference for the wrong member of staff had been sent to one referee. There was also no clear evidence of the process by which the manager had decided to employ staff particularly when a criminal history was revealed. Further work must also be done to improve the evidence of applicants’ right to work in this country. Following the last inspection, it was recommended that staff receive an annual appraisal of their progress and development needs, however, this had not begun at the time of this inspection Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The home does not have a satisfactory Quality Assurance process so that the views of residents and their relatives do not underpin the home’s review and development. EVIDENCE: The home does not currently have a full Quality Assurance system although the inspectors were shown a questionnaire which is designed to be used by residents. The manager was advised to encourage relatives or other representatives to help residents to fill these in rather than staff. There was, however, evidence of the last inspection report being discussed with staff and residents. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 1 x 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Latham House Score X X 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x DS0000060512.V266489.R01.S.doc Version 5.0 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13(8) Requirement Each restraint must be recorded according to the Department of Health guidelines. Original timescale of 30th September 2005 was not met All information and documents listed in Schedule 2 must be obtained in respect of every staff member. Specifically, the source of references and permission to work in this country must be robustly verified. The decision made that staff are suitable for employment must be clearly evidenced. Original timescale of 30th September 2005 was not met. A system for reviewing and improving the quality of care provided at the home must be established and maintained which includes consultation with residents and their representatives. Timescale for action 31/12/05 2. YA34 19(1)b Sch2 31/12/05 3 YA39 24 31/03/06 Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA16 YA20 YA36 Good Practice Recommendations The ability of each resident to hold a key to their bedroom should be reviewed. A risk assessment must be carried out in relation to selfmedication and a consent form completed for each resident to whom medication is administered by staff. All staff should benefit from an annual appraisal of their performance and training needs. Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 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 Latham House DS0000060512.V266489.R01.S.doc Version 5.0 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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