Inspection on 04/01/08 for Latham House

This inspection was carried out on 4th January 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 22 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 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 09/07/2008.

CARE HOME ADULTS 18-65 Latham House The Lane Wyboston Beds MK44 3AS Lead Inspector Andrea James Unannounced Inspection 4th January 2008 10:00 Latham House DS0000060512.V357552.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.V357552.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.V357552.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 Brookdale Healthcare Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Latham House DS0000060512.V357552.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. 7th August 2007 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 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 fees for this service range from £2347.00 - £3108.00 per week. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out 6 months after the last key inspection. The inspection was undertaken by two inspectors Andrea James and Nicky Hone. The inspection process lasted for 7.5 hours and the manager and the head of services were available to assist in the inspection process. The site visit was to assess compliance of the last inspection and undertake a full inspection in accordance with the National Minimum Standards (NMS). The Inspection process followed a case tracking methodology where a sample of people using the service was selected at random and their files inspected. Where possible the relatives of the people were interviewed over the telephone and a sample of care staff spoken to. The inspection report covers very little information about what the people said about the service, as all except for one person seen on the day was able to say what they felt about the service. The limitations were due to their cognitive and verbal abilities. The report also consists of information received from the management team and observations seen by both inspectors on the day of the inspection. We would like to thank the care staff, relatives, people who use the service and the management team for their co- operation in the inspection process. What the service does well: The home offered a stable environment to people using the service and relatives spoken to said the people receives satisfactory staff input and support. One relative described the care team as “absolutely brilliant”. The home employed various auxiliary staff that complimented the staff team to include a driver and a maintenance person; as a result people were able to access community resources using the two buses available throughout the day. The home had various procedures in place that should provide stimulation and protection for people using the service. Some resources were presented in a pictorial format that aimed to create a person centred approach to developing and maximising users independence. In most cases care staff were good at recording daily events and as such a clear audit trail could be kept of the users activities and interactions with others. The home also ensured that where possible people were able to maintain contact with their families and home visits were encouraged. Relatives spoken to said they were always made to feel welcome. Some relatives visited the Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 6 home on a weekly basis and commented that the staff are doing a “great job”. Records seem showed that the home valued the families input and photos of various family members were seen in peoples files to ensure users of the service had visible memories. Records inspected suggested annual reviews were undertaken for some users and relatives, carers and external professionals were invited to attend these reviews. The financial procedures for people using the service were satisfactorily maintained and recorded in the home. What has improved since the last inspection? What they could do better: Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 7 The service should ensure that: • People using the service have a full and comprehensive needs assessment and a care plan that clearly identifies the care interventions required. The health care needs of people using the service are identified and acted upon in a reactive way so as to prevent unnecessary discomfort. All staff receives training in order to ensure sufficient skills and competencies are available for people using the service. All areas of the home are decorated to ensure comfort and safety for people using the service. An environmental risk assessment is undertaken to ensure people are safe in all areas of the home. Effective monitoring systems are available to ensure the views of people using the service are monitored and analysed on a regular basis. All incidents that adversely affect the users are reported using the safeguarding procedures. All users of the service are issued with a contract that states the cost of the service and what the fees are for. This should also be in consultation with people who use the service and or their relatives. Structured activities should be recorded and adhered to in ensuring users peace of mind. People using the service should be enabled to maximise their independence in regards to meal preparation and choices. Efforts should be made to ensure the needs of all users are assessed and alternative placements found for users whose needs cannot be met at the home. Care staff are consistent in their approach to people using the service. • • • • • • • • • • • Latham House DS0000060512.V357552.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.V357552.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.V357552.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 &5. 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. Some systems were in placed that ensured the people and their representatives were provided with sufficient information about the service but further development was needed to ensure all users have a comprehensive assessment of need and that individuals have contractual agreements that details the conditions of their placement, as a result users rights and best interest could be compromised. EVIDENCE: As part of this inspection, we looked at the files for four people. A copy of the Service User Guide (SUG) was seen on person A’s file. This has been produced in picture/symbol format, which was good, however, the words used were not suitable for the client group (for example, “staff will be trained to help you communicate using your preferred method”). The complaints procedure part of the SUG had not been updated to show changes of staff. We asked the manager whether it was any use to the people to have the SUG on a file they would not look at. There was limited evidence to suggest people received a comprehensive assessment prior to being offered their placements, and for the four files we inspected only one person had an assessment that looked at their current Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 11 needs. This was unfortunate as most of the people who live at the house have high needs and relatives commented that the staff team were inconsistent in their approach to people. We were disappointed to note that a needs assessment had not been undertaken even for people whose needs had changed and who are now posing more challenges to the service. One person who was assessed for alternative placement had no current needs identified. Although we were informed that a review had taken place, there was no evidence of this on file. The home failed to produce sufficient evidence to suggest people who live at the home had individual contracts. We were informed that generic contracts were agreed with the placing authorities and not with individuals. One relative we spoke to said he contributed to the care package but they were not given a contract to state what the fees paid were used for. We were presented with a new contractual policy that would be implemented to ensure users had contractual agreements. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 12 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 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 information and guidance for staff was not sufficient, correct or up to date enough for staff to provide a consistent level of care and support to each individual person, as a result users individual needs were not met. EVIDENCE: We inspected 4 care plan documentations. In general people’s behaviours were recorded along with daily activities, however the records we saw suggested that staff failed to identify triggers to the person’s behaviour, even though people were very explicit in their demands. Person A’s file contained an ‘Essential Lifestyle Plan’. This was written in picture/symbol format and contained some good information, but it was not signed or dated so we did not know if the information was still relevant. On this file we did not find a care plan. The manager and RI told us that a document titled ‘Care and Treatment Review’ is the care plan for person A. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 13 This did not contain sufficient detail to enable staff to offer consistent support to this person. The guidance used in this document, for example in the ‘Crisis Intervention Plan’ section, was not specific to the person and used identical words to the words used in another person’s plan. The guidance was also not correct: for example, there was no reference to using PRN (when necessary) medication, which we saw used for this person during the morning. The manager and RI also said there were guidelines for staff about the person’s daily routine: these were dated September 2005 and had not been reviewed or updated. We were pleased to see that a large number of risk assessments (more than 20 for person A) had been carried out on numerous activities, for example iceskating, horse-riding, bowling, bathing, using the bus and so on. Some of the guidance was adequate, however, some of the guidance was too vague, and not specific enough to that person. One piece of guidance we considered to be quite dangerous. In the risk assessment relating to bathing, staff were advised to “use mat or towel” on the floor to prevent slipping: a towel on the floor can be a slip hazard. In person B’s file we found records of meals consumed and behaviour charts and evidence where PRN medication was administered. For the month of December, 7 activities were recorded and with one exception all activities recorded that the person went for a drive. These activities were predominantly in the afternoon. Where gaps were seen the person had failed to leave the house: on all these occasions negative behaviours were displayed. Person B’s file also failed to have a care plan, risk assessment or needs assessment available. When we asked for the information we were then told that this information was in a pile in the office. The files were disorganised and it took an average of two hours to wade through one person’s paper work. As in Person A the risk assessments were generic and did not cover the day-to-day aspects of care intervention that would be required in such people’s care packages. There was no evidence that the people living at the home or their representatives were consulted about the care package. The information we saw was not specific or measurable, neither did it show how relevant the information was in meeting the person’s current needs. Person C had a lot of detail, including “Essential lifestyle plan”, photo of the person, picture of the activities the person enjoyed doing, service user questionnaire, complaints procedure and SUG. However there was no evidence that a review had been undertaken except in the care plan where it stated that one was due to take place on the 31.01.08. We found evidence that some risk assessments had been reviewed for this person accessing the community. However, a risk of self harm and suicidal tendencies were prominent in the care notes but had not been addressed in the care plan as an Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 14 intervention even where this was seen as a high risk. The risk assessments in this file had not been reviewed since 2006. Records indicated this person was very demanding on the service and we identified recorded incidents for the 23/9, 20/9, 31/10, 1/11, 20/11, 19/11, 5/11, 20/12, 24/12, 1/1 and the 30/12, which all indicated that the person was either verbally or physically challenging. The daily notes for these days suggested very limited activities were organised despite having a planned activities programme. As in other files we inspected, the care plan was not specific: for example no triggers were highlighted to show when the person was likely to become suicidal or challenge the service. The care plans were not measurable in identifying how many care staff were needed to assist in a task. Person C had a comprehensive assessment carried out by their social worker prior to admission but the home had not undertaken their own assessment. As a result we could not assess care plan documentation to be holistic in it contents. The details of the care plan also used words that could be misinterpreted for example “when person becomes anxious”, with no guidance as to what “anxious” means for this person. Person D had a much smaller care plan documentation and like the others several pictures of families and the things the person enjoyed doing was placed in the files. It was also impressive to see that a comprehensive assessment was undertaken after the person was admitted to the home, although not completed. There was evidence that the person received a review in March 2006 and we saw monthly reports on file that stated a copy to be sent to relatives. This person’s cultural and religious needs were addressed although it did not say how the service would meet these needs. This file had several risk assessments that were again generic in nature but there was no date for reviews. There was evidence to suggest the care the person received was inconsistent from staff member to staff member. For example one staff would take the person back to their bedroom if there were signs that he would challenge his environment, where others worked in a more reactive manner. This was also an observation made by relatives when we spoke to them. One relative said some staff has no “Empathy”; “There is a group of staff that is really dedicated while others don’t care”. The records suggested that although individual people’s needs were highlighted through various means, there was little evidence that people were able to make decisions about their lives. This was shown through the lack of activities mentioned in the report, and also cares staff we spoke to said people were not able to freely access and prepare meals, as they would like to. This was concerning as the ethos of the home was to maximise independence where possible. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 15 Two people who live here had a better experience in this area and for them the outcome was different as they were able to choose various furnishings to decorate their rooms and clearly identify what they wanted from the service. Relatives we spoke to for these people commented that they were able to make decisions about some aspects of their lives. There was evidence to suggest people were able to participate in some aspects of their lives but again this was only limited to a few people. For those people we case tracked the outcome for them was poor as they were not encouraged to develop their independence. We were informed that TEACCH programme was implemented but this again was not evidenced in the daily lives that people lived. The home carried out several risk assessments for people in order to ensure they were able to participate in community activities. However, in some cases they were not clear or had not been reviewed and therefore begs the question how relevant they were to the day-to-day lifestyles of the people who live at Latham House. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 16 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): 11,13,14,15,16, & 17. 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. Our evidence showed that people were not offered sufficient opportunities for activities, based on their individual needs and hopes, as a result they were not able to maximise their independence and develop personally and as a result their life style choices were limited. EVIDENCE: On person A’s file we found a ‘Timetable of Activities’ folder. There were four of these documents, which we assumed were plans for activities for the month: two were not dated; the other two were dated January 2006 and March 2006. A ‘Managing Challenging Behaviours’ document, dated 07/03/07 stated that person A “should be provided with a structured timetable of meaningful Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 17 activities to reduce his boredom”. On 17/12/07 person A was seen by a psychologist who recommended “more activities and structure to the day”. In spite of this, records showed us that person A has little opportunity for meaningful activities. The record showed that activities only took place either morning or afternoon, with nothing recorded for the evenings. For the thirteen periods (that is, morning and afternoon) from 18/12/07 to 24/12/07 he had been swimming, bowling, shopping and to the snoozelen. He had also been for a drive, three times, and had helped clean the van. This is a total of 8 activities, meaning there were five periods (plus six evenings) when he had done nothing. From 26/12/07 to 03/01/08 the only activity had been undertaken was to go for a drive every day (twice on one day), sometimes having a snack while out. (See Personal and Healthcare section of this report). On the day we inspected, ice-skating had been cancelled. The manager explained that the residents were not able to do activities like ice-skating and bowling during the school holidays because the venues were too crowded. However, no other activity had been planned to replace the ice-skating. Eventually it was decided that everyone would go out for a drive and have a picnic, but it took an hour and a half from when people were told they were going out (11.30), to when they actually left (13.00). We also saw similar issues relating to lack of motivation in the files of person B and person C. When we toured the building at 11am several people were seen lying on their beds without any staff intervention. One person only came out to have his meal or medication and went back to his room. This person was later seen pacing the floor rapidly. There was evidence to suggest people were taken into the community via their mini busses but it appeared that staff did not allow people to interact with the community. Care staff we spoke to said they never let people go into public places, except to use the toilet, because they are too disruptive. When we asked if people are able to have lunch out, staff said only in the park or on the bus. There was evidence to suggest people who live at Latham House have regular family contact and where possible some people were enabled to have home visits. Most of the relatives we spoke to said they were made to feel welcome and that the manager was very approachable and had the ability to listen. As previously mentioned the records we inspected suggested that people were able to participate in appropriate leisure activities. However, daily records show that this happens very rarely and the activities were limited to drives out in the bus irrespective of what else the person may wish to do. Records we saw suggested people are offered a balanced diet. On the day of the inspection people had a large amount of protein carbohydrate and vegetables. Everyone seemed to have enjoyed the meal. However one Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 18 relative felt that food provided was very high in fat and could further add to people’s anxiety. Care staff we spoke to also commented that in this area the Standards of the care home had fallen. The meals were prepared from the canteen that also facilitated the near by hospital. There were restrictions in place so that people were not able to access the kitchen facilities despite everyone having one to one staffing. When we looked in the fridges and cupboards in Latham House, there were only yoghurts, fruits, milk and cereals available. There was little evidence to suggest people were encouraged to plan or prepare their own meals or beverages, other than person A, who prepares his own breakfast. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 19 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 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. Some systems were in place to ensure users were protected in regards to the administration of medication, however further development was needed to ensure the PRN procedures are made clear and the health care needs and personal support people receive are satisfactory, as a result people were at risk. EVIDENCE: The records we inspected suggested the people using the service received personal support to carry out tasks but according to daily records this was limited to one person being able to make his own breakfast. The manager said some people were able do cookery but this was not evidenced in the daily notes, activity programme or by staff and users spoken to. One user was seen being supported to attend the doctors after she sustained a broken arm. When we arrived we were told that person A was suffering from an abscess in his mouth. He had seen the dentist and was waiting for an appointment to have the abscess drained. Staff felt this person was getting more distressed Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 20 because of pain, which he was not able to communicate to them. The manager said he was being given pain relief. When we checked his file, there was no care plan about the abscess. We only found a reference to the problem on a daily record in mid-December. We also noted that he had only been given pain relief 9 times in 10 days (he could have had pain relief 40 times in that period): the pain relief was given at the same time as his other PRN medication (see below) on several of these occasions. Person A was prescribed Lorazepam 1mg “1 or 2 tablets twice a day when needed”. There were no guidelines for staff on when this medicine should be given, or whether they should give one or two. He had been given 2 tablets eight times in ten days. From his daily record, the times he needed something to help him calm down were often linked to not going out. There were documents on the file to record healthcare matters, for example visits to the chiropodist, dentist, doctor, optician and so on. In person A’s file it was recorded that he had seen the chiropodist in April 2007; the form for dental visits was blank (and yet we knew he had been to the dentist in midDecember (see above)); the form for hospital visits was blank (but there was a letter referring to him having attended a neurology clinic in January 2006); according to the form for doctor’s visits he had not seen the doctor since 02/04/07 (yet we found evidence elsewhere that he had been seen by his psychologist on 17/12/07.) We looked briefly at the medication storage in one side of the house. The cupboard was reasonably tidy, stock of medicines such as Lactulose, were at a satisfactory level and we did not find any out of date stock. Medications such as creams should be stored separately to medicines, which were taken by mouth. There was a metal cash tin in the cupboard labelled ‘external medicines’: staff did not know what it was for and could not find the key for it. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 21 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 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. Procedures were in place for dealing with complaints but further development was needed to ensure all users receive responses to any concerns or complaints within the timescales and that all incidents that affects the wellbeing of the people are reported, as a result some people could be at risk. EVIDENCE: The manager said there has only been one complaint since our last inspection: she showed us the file where all complaints, and the letters and so on that go went with them were kept. One relative said she made several complaints but received no response. Another relative said she had some issues of concern and at first when she informed the home nothing was done but she went back to them and spoke with the manager and her concerns were resolved. Training records showed that not all staff have had POVA (now called Safeguarding Adults - SOVA) training. It was clear from the events we witnessed at the home that staff are failing to keep the residents safe. Some records we inspected showed that people received severe personal injuries that were at times unexplained and these had not been reported under SOVA. Some of the people who live at the home had been given PRN medication after an outburst. This suggests an incident occurred but again there were no referrals made. Social workers commented that the home failed to report some incidents that adversely affected people. The management team we spoke to disputed what they understood to be reportable incidents, as this Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 22 group of people would incur incidents on a daily basis. They felt that only cases worthy of a person attending hospital should be reported. This was also highlighted in the last inspection report in the form of a requirement. On the day of the inspection one person displayed behaviour that was challenging and he sustained facial injuries that broke the skin, and at the end of the inspection no record was made of the incident which took place at 11am that morning. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 23 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): 24,25,26,27,28,29 &30. People who use this service experience a poor quality outcome in this area. We have made this judgment using a range of evidence to include a visit to the service. The home’s premises were suitable for its stated purpose in regards to accessibility, however further development was needed to ensure the collective and individual needs of all the people are met in a comfortable, safe and homely way, as a result the present condition of the home could detract from the homeliness required of the people. EVIDENCE: When we arrived, the manager told us the whole building had been decorated. When we walked round the house we noted that the decoration consisted of a coat of paint on the walls. Other paintwork was scuffed and chipped and there was little to make shared areas of the house look homely. We noted that staff had worked hard in some of the bedrooms to make them very personal to the person who lived there. Other rooms were quite bare. Staff told us that some people do not like anything in their rooms and will tear down anything that is Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 24 put up if they do not want it. This they said made it difficult to maintain a welcoming environment for them. Several rooms smelled very strongly of urine. Some areas of the home, particularly the shower rooms and bathrooms were not clean, with soap scum and mould on the tiles, flooring and so on. Most of the toilet bowls we saw were very dirty, going black under the water line where they had not been cleaned properly. One person’s shower hose was held together with a disposable glove. Several sink units looked old and black around the edges. Watermarks were visible in two areas of the home and several door handles were coming away from the door. In one half of the home, all the bedroom doors were propped open with various objects such as wash baskets, and chests of drawers. Water temperature in one bathroom was excessively hot and there were no grab rails available in either the shower room or the bathroom despite one person falling and receiving several bruises as a result of slipping in a wet bath. The communal areas of the home namely the dinning areas were also unwelcoming as the chairs in the dining area were torn and appeared uncomfortable to sit on. The lounges however appeared more homely and users were seen watching television. The general cleanliness of the home was of a poor standard. Some areas of the kitchen were not clean enough, for example the tiles where the cooker had been; the corners of the floor; and the sink. The shower rooms and bathroom floors also appeared stained with black ground in dirt visible on the surfaces of the floor and some walls. We asked the manager and RI if they employed a cleaner and were informed that the night staff were expected to clean the home. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 25 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 a range of evidence to include a visit to the service. The people using the service were safeguarded by the recruitment and training of the staff team but further development was needed to ensure care staff work in a consistent and planned way and they receive better support and supervision, as a result people’s needs could be compromised. EVIDENCE: The manager told us that several staff had left since our last inspection in August 2007, and several new staff had been employed. Three new staff were due to start on Monday after our inspection, although the manager said for the first few days they would be doing their induction course. The manager said there were usually 12 staff on duty during the day, and 4 at night. On the day we visited there were 11 staff as one person had rung in sick and no cover could be found. The home uses quite a lot of agency staff. One care staff informed us that most of the time they struggle because not all the staff are qualified. This was also an observation communicated to us by one relative. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 26 One of the people who live at Latham House need two staff at all times. This was in place on the day we visited, however, staff did not seem to be using the opportunity to do anything constructive with this person: just following him around to make sure other people were safe. We looked at the personnel files for four staff. The files were not very well organised, however, the majority of information the home must have about the employee before they start work was in place, including two written references, a Criminal Record Bureau (CRB) check, identification and a full employment history. We talked with the manager about staff training. She explained that the company now has a training manager and new computer software which keeps track of which staff need to do which courses. The records in the home were not up to date enough for us to know if staff had received adequate training, however, the manager got the records for us from the computer before the end of the inspection. These showed that the majority of staff have done most of the courses they need to do, however, the manager must make sure that all staff have received all necessary training. All staff now have a large ‘Learning and Development’ file. We saw the files for two staff. These contained a comprehensive induction workbook, and certificates for any courses the person has been on. Some of the information in the files was not up to date, for example one person had one certificate for fire safety awareness training, which was only valid to the 28/03/06. A record printed off the computer showed that 9 out of 22 staff (41 ) have an NVQ (National Vocational Qualification) in care. We were also shown a training plan for January 2008 which showed that a great deal of training is available for all the staff who work for the company (Brookdale): a record printed from the computer showed that staff from Latham House are booked onto eleven of the sessions. The last inspection identified that care staff needed to be trained in “Safeguarding” of vulnerable adults and to date that had not been achieved. Staff we spoke to said they felt able to meet the needs of people using the service but relatives felt that they were not always competent in their service delivery. One relative said, “ the staff do not know how to identify triggers and cannot say what the reasons were for a persons behaviour”. One example given was one person was vomiting black guile and this was not reported to the GP or the relatives. When we asked the management team about this issue, they were hopeful that the new systems due to be implemented, namely the “Tidal Model” would equip carers to be able to have clearer working objectives. Relatives were concerned that some of the staff were not satisfactorily trained. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 27 At the last inspection we noted that staff were not getting an adequate number of supervision sessions. At this inspection the manager and RI told us that the manager had found she was not able to supervise all the staff. She and the senior staff have recently done a course on supervision so will now start to make sure that staff have the number of supervision sessions as recommended by the NMS (National Minimum Standards). Latham House DS0000060512.V357552.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): 37,38,39,42 &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 management of the service is not good enough to keep people safe and does not give people a good quality of life; further development is also needed in the homes ability to seek the views of the people who use the service and to ensure their safety at all times, as a result users are at risk. EVIDENCE: The acting manager has been in post now for nearly I year. She was a qualified midwife and has embarked on her Registered Managers Award, which she said she was due to complete in the near future. Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 29 She also said she had applied for her registration of the service and has not had a response. This was investigated and the registration team has failed to find any evidence that the application was received. The manager spoke positively about the service and about the plans set out in their audit which was sent to us after the site visit stating new members of staff who will assist in the management of the home for example in supervision and care plan auditing. Some relatives spoken to said that the manager was very approachable one said she was a “ good listener”, one relative felt that the manager did not have effective communication skills and only spoke at you. One relative explained that the communication skills from the home was very poor, she explained that “when you are told that something would be done its never done and so you have to go back to them”, another relative said the staff at the home are “very defensive”. One care staff commented that the communication between management and staff was “one way”. The quality assurance procedures in the home needed further development, as the views of people using the service were not obtained. There was evidence that residents meetings was held in November 2007 but the results of these meeting were not used to effect assurance system. The RI said he carried out 6 monthly audits on the home in regards to the environment and the care plans. He admitted that surveys had not been undertaken but was due to commence this procedure in the near future. He also said the organisation had employed a performance manager who would be effective in this area within the home. The home has a health and safety policy but some procedures seen suggested the people using the service could be at risk. There was evidence that several disposable gloves were left in communal bathrooms and one bathroom tap dispensed hot water that could burn people using the service. We checked some of the records the home is required to keep. These included tests of the fire alarm and emergency lighting systems, which were satisfactory. On the day of the inspection the fire authorities visited to review the current fire risk assessment. Latham House DS0000060512.V357552.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 1 2 1 3 X 4 X 5 1 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 2 26 1 27 1 28 2 29 2 30 1 STAFFING Standard No Score 31 3 32 1 33 2 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 1 x LIFESTYLES Standard No Score 11 1 12 X 13 1 14 1 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 x 1 2 1 X X 1 1 Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 31 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 YA2 Regulation 14 (1) (2) Requirement Arrangements must be made to ensure all users have a comprehensive assessment of need undertaken that reflects their current needs. Improvements must be made to the peoples care plans to illustrate clear care interventions and consultation. All users must have a current and updated care plan that is specific and easy to understand. Arrangements must be made to demonstrate how people are able to participate in the day-today running of the home. Arrangements must be made to ensure risk assessments are current and specific in identifying unnecessary risk to the people. Opportunities must be made to ensure people are able to develop personal and emotional living skills. Arrangements must be made to ensure the people using the service are stimulated through sufficient activities tailored to meeting their individual needs. Arrangements must be made to DS0000060512.V357552.R01.S.doc Timescale for action 28/02/08 2 YA6 15 (1) 28/02/08 3 4 YA6 YA8 15 (1) 16 (2) (m) (n) 13 (4) (b) 28/02/08 28/02/08 5 YA9 28/02/08 6 YA11 16 (2) (m) 16 (2) (n) 28/02/08 7 YA14 28/02/08 8 YA19 13 (1) (b) 20/01/08 Page 32 Latham House Version 5.2 9 YA20 13 (2) 10 YA22 22 (1) (3) (4) ensure the health care needs of people are assessed, recognised and procedures are in place to address them in a proactive manner. Arrangements must be made to 28/02/08 ensure the use of PRN medication is clear and individual guidelines are recorded for individual persons. Arrangements must be made to 28/02/08 ensure clear and effective complaints procedures are implemented that includes the stages, timescales and the process to enable users to know how and who to complain to. A clear audit trail must be evident. Previous timescale 30/09/07 The manager must ensure 28/02/08 ‘Safeguarding’ training is offered to all care staff. Previous timescales: 31/10/06 and 30/10/07 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 Arrangements must be made to ensure all bedrooms have sufficient furnishings and fittings suitable to meet the individual lifestyles of the people. Arrangements must be made to ensure the people using the service are provided with suitable toilets and bathroom facilities that is assessed to meeting their needs and is in good decorative/ working order. Arrangements must be made to DS0000060512.V357552.R01.S.doc 11. YA23 13(6) 12. YA24 23 (2) (a) (b) 28/02/08 13 YA26 23 (c) 28/02/08 14 YA27 23 (2) (b) 30/03/08 15 YA29 23 (2) (n) 30/03/08 Page 33 Latham House Version 5.2 16 YA30 23 (2) (d) 17 YA32 18 (1) (a) 18. YA35 18 (1) (i) assess individual persons for adaptations and have these installed around the home. Arrangements must be made to eliminate all offensive odours and make the environment clean. All staff must be trained to have the skills and competencies needed to meet the changing needs of the people using the service. Arrangements must be made to ensure all staff are trained in Risk Assessments and Infection Control. Previous timescale 30/10/07 Arrangements must be made to ensure all staff receives regular support and supervision. The manager must ensure CSCI is notified of any event in the home that may adversely affect the wellbeing or safety of any service user. Previous timescales:31/10/06 and 30/09/07 Effective quality assurance systems must be implemented that seeks and monitors the views of the people using the service. Previous timescale 30/10/07 Arrangements must be made to ensure all hot waters distilled from taps are at a safe temperature for users that will not cause scalding or burns. 28/02/08 30/03/08 28/02/08 19 20. YA36 YA37 18 (2) 37(1)(e) 28/02/08 28/02/08 21. YA39 24 (1) (a) (b) 28/03/08 22. YA42 13 (4) (a) 30/01/08 Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 34 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. Refer to Standard YA1 YA5 Good Practice Recommendations Arrangements should be made to ensure Service user Guides are reviewed and made more user friendly for the people using the service. Arrangements should be made to ensure a written costed contract/statement of terms and conditions is obtained between the home and individual users. Arrangements should be made to ensure all risk assessments receive regular reviews and dates are recorded on assessment documentation. Arrangements should be made to ensure people using the service are able to maximise their independence in regards to meal preparation and choices. Arrangements should be made to employ a domestic staff to undertake the daily cleanliness of the home. Arrangements should be made to ensure all staff are trained in the procedures to follow for controlled drugs. Arrangements should be made to ensure the application for the acting manager is submitted. 3. YA9 4. 5. 6. 7. YA17 YA30 YA20 YA43 Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Latham House DS0000060512.V357552.R01.S.doc Version 5.2 Page 36 - 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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