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Inspection on 08/10/05 for Leabrook House Nursing Home

Also see our care home review for Leabrook House Nursing Home for more information

This inspection was carried out on 8th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Home provides a very comfortable and homely environment in which Staff deliver well planned `person centred` care through a process of close liaison between the Resident, their Relatives/Advocates and Staff of the Home. Worthy of special mention, particularly bearing in mind the level of dependency of many Residents, are efforts made to enable Residents to maintain and develop links with the community beyond the Home. Also commendable is the Home`s on-going commitment to enabling staff training and development.

What has improved since the last inspection?

Revised systems have been introduced in relation to the administration of medicines, which are required in response to occasional need by individual Residents. New arrangements have been introduced for daily recording of medicine `fridge` temperatures, involving use of a digital minimum/maximum thermometer. All newly appointed Staff are now subject to POVA (Protection of Vulnerable Adults) prior to receipt of a full enhanced CRB (Criminal Record Bureau) check.

What the care home could do better:

Observation during the Inspection, together with verbal and written comments made by Residents and Relatives, suggests there appears nothing of significance, to which the Home`s Owners, Manager and Staff might turn their attentions.

CARE HOME ADULTS 18-65 Leabrook House Nursing Home 180/181 Leabrook Road Tipton West Midlands DY4 0DY Lead Inspector Keith Salmon Announced Inspection 8th November 2005 09:00 Leabrook House Nursing Home DS0000004788.V254348.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 Leabrook House Nursing Home DS0000004788.V254348.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. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Leabrook House Nursing Home Address 180/181 Leabrook Road Tipton West Midlands DY4 0DY 0121 556 5685 0121 556 5685 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) Mrs Veronica Lovell Mr James William Lovell Julia Handley Care Home 31 Category(ies) of Learning disability over 65 years of age (3), registration, with number Mental disorder, excluding learning disability or of places dementia (4), Physical disability (24), Physical disability over 65 years of age (23) Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 3 LD(E), 4 MD, 24 PD, 23 PD(E) Up to 10 day care places for LD/PD One service user in the category LD(E) may be under 65 years of age and also be DE and will remain until such time that the service user reaches the age of 65 or the placement is terminated. Date of last inspection Brief Description of the Service: Leabrook House is situated on the Tipton/Wednesbury border, close to the towns of West Bromwich, Walsall, and Wolverhampton. It is within easy reach of several motorway/main road networks, with good availability of public transport. The Home offers 31 single occupancy rooms, most of which have en-suite toilet facilities, with some benefiting from the addition of an en-suite shower. There are a range of services and facilities available to Service Users including:entertainment and recreational activities, various aids and adaptations, complimentary and relaxation therapies, a swimming/hydrotherapy pool and an excellent catering service. The Home also provides a 10 place day-care facility for younger adults with specific nursing needs. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection commenced at 09.00, was undertaken by one Inspector and of 5.5 hours duration. This Report is a product of observations made during a tour of the Home, discussions with Residents (9), Relatives (3) the Proprietor/Registered Manager and Staff members, together with a review of care related documentation, including staff recruitment/deployment records, and a range of documents/records reflecting the general operation of the Home. High standards of direct care provision and overall management are provided in a friendly and open atmosphere for Residents, who are generally of a high dependency client group. The quality of care is strongly reflected in comments by Residents and Relatives, which included… “The care my Mother receives here is exceptional…”, “Nothing is too much trouble…”, “The staff do everything they can to help me get out and about by myself – I really appreciate that…”, “The care and support is exceptional…”, “…The Home is always clean and tidy…” “The food here is wonderful …”, “My Relative is very happy here and I go home secure that she is well cared for...”, “I have lived here for years and am very happy…” What the service does well: What has improved since the last inspection? What they could do better: Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 6 Observation during the Inspection, together with verbal and written comments made by Residents and Relatives, suggests there appears nothing of significance, to which the Home’s Owners, Manager and Staff might turn their attentions. 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. Leabrook House Nursing Home DS0000004788.V254348.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 Leabrook House Nursing Home DS0000004788.V254348.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): 1,2,3 & 5. Wherever possible prospective Residents (or if this is not possible their Relatives/Advocates) are enabled to reach an informed choice, and to fully understand the service they may expect to receive, prior to taking up residency. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. Staff are enabled to provide the type and quality of care required by Residents. All Residents receive an individual written service provision contract. EVIDENCE: The Home has a Statement of Purpose and User Guide, both of which are concise, easy to read and contain content, which meet the requirements of the Standard. Service Users are provided with a Statement of Terms and Conditions detailing the accommodation to be provided. Evidence from 5 randomly selected Care Plans, and discussions with Residents and their Relatives, clearly showed the Registered Manager assesses all prospective Residents prior to admission. Leabrook House Nursing Home DS0000004788.V254348.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): 6,7 & 9. Care needs are comprehensively identified in Care Plans and acted upon through clearly stated, and current, instructions and interventions. Care Plans are regularly reviewed and revised as necessary. Residents are enabled, and supported, in conducting their lives at risk levels consistent with individual capability. EVIDENCE: Many of the Residents at Leabrook House have very complex nursing and general care needs. A random sampling of ten Care Plans showed related Care Planning documentation to be well organised, current, clearly written and comprehensively encompassed the range of ‘care areas’ necessary to ensure the delivery of care appropriate to the needs of each Resident. Care Plans also demonstrated evidence of Residents being closely involved in decisions regarding their lifestyle. Residents spoken with confirmed this was so. The Home has developed a comprehensive set of individual and generic risk assessments, including:- pressure area relief, nutrition, cot-sides use, bedroom door locks. The Inspector observed evidence that risk assessments are reviewed on a regular basis. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 10 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): 12,13,14 & 17. The Home provides an interesting range of activities that are appropriate to Residents’ needs, wishes and capabilities. The Home actively supports residents in maintaining/developing links with relatives and the wider community. The Home provides a daily choice of attractive and nutritious meals for which Catering Staff are to be commended. EVIDENCE: Observation and discussion with Management and Residents showed routines are flexible to suit the needs of individuals. An open visiting policy is operated with Relatives/Friends being encouraged to become involved in the service delivery, and Residents/Visitors confirmed this to be so. One Resident described to the Inspector how he frequently travels to neighbouring townships using his electric chair and public transport. Residents were at pains to stress how much they appreciate the range and quality of food provided at the Home. There is strong evidence of support for residents wishing to engage with the local community e.g. theme nights, trips out using the Home’s mini-buses, progressive mobility, visiting entertainers, twice weekly religious services, plus activities focussed on the individual, which include shopping trips, visits to the local pub, use of complementary therapy and ‘relaxation’ rooms. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 11 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): 18,19 & 20. Personal support is provided to ensure the principles of privacy, dignity and independence are maintained, and physical and emotional health needs are met. The storage, administration, and disposal of medicines are in accordance with accepted good practice. EVIDENCE: Observation, and discussions with Residents and Relatives provided clear evidence that Residents are enabled to conduct their lives as they wish. These areas include rising and retiring when they wish, choosing to remain in their bedrooms or use ‘public’ areas, whether to participate in activities, choosing their own clothing, hairstyle or make-up. The Home operates a ‘named nurse system’ with specific responsibilities for particular individuals. Registered General Nurses, and Registered Nurses for People with Learning Disability, provide nursing care within the Home, with external specialists used as needed. Generally, the manner in which Staff meet Residents’ complex nursing care needs is to be commended. Inspection of the medicine storage provision, and medicine administration records, demonstrated the Home’s practices meet the guidelines of the Royal Pharmaceutical Society, including the recent introduction of a digital thermometer for daily recording of medicines’ ‘fridge’ minimum/maximum temperatures. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 12 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 interests of Residents are protected through ready access to the Home’s Complaints Procedure and to the availability of information relating to advocacy services. Staff are clearly aware of their role in protecting Residents from abuse. EVIDENCE: A clear and concise Complaints Procedure is displayed in the main hallway, which includes reference to the Commission for Social Care Inspection as the regulatory body, together with contact details. Information relating to the use of advocacy services is also displayed. Policies relating to the protection of Residents from abuse were observed to be in place and readily accessible, these included, ‘Whistle Blowing’, ‘Abuse Awareness’ and ‘Adult Protection’. Staff training files indicated that Staff had received training in respect of these Policies. The Home maintains a meticulous system for recording complaints, though none had been lodged since the previous Inspection. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 13 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): 24,28,29 & 30. The Home provides a comfortable and ‘homely’ environment for Residents. Specialist equipment, consistent with the needs of the Residents and the demands of tasks carried out by Care Staff, is available to facilitate comprehensive and appropriate provision of care. The standard of cleanliness in the Home is commendable. EVIDENCE: There are several lounge/sitting and dining areas offering a variety of size and outlook. Furniture in lounge and dining areas are of good order and present a ‘domestic’ ambience. The specialist equipment, available to facilitate provision of care, e.g. hoists, wheelchairs, stand-aids, appeared to be in good working order, is consistent with the needs of Service Users, and the demands of tasks carried out by Care Staff. The Home has a full range of maintenance contracts in place, and an on-going refurbishment/redecoration programme. Most of the Residents present with very high levels of dependency and, as part of this, many have unavoidable problems with continence. It is a measure of Home’s success in managing these issues that the general ambience of the Home is clearly one of freshness and cleanliness, for which all Staff involved are to be commended. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 14 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): 31,32,33,34,35 & 36. Staff were clear as to their individual roles and responsibilities. Staff numbers and skill-mix on duty were consistent with that shown on the rota, and were sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are consistent with the safeguarding of Residents. The commitment of the Home to providing supervision and training for Staff is exemplary. EVIDENCE: The current staffing rota, and those from the immediately preceding weeks, were examined. Staffing numbers and skill-mix enable a service provision, which meets the care needs of the Service Users. In addition, when judged necessary by the Manager, e.g. periods of peak activity and/or increased dependency, funds are available to increase staffing to meet those needs. Staff Personal Files demonstrated evidence of full compliance with the Standard and Schedule 2 of the Regulations. Staff are subject to a thorough, and relevant, orientation/induction programme, which is followed by comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘simple infection control’. In addition, the Home enjoys an excellent record for the continuing development of Care Staff, and supporting Staff in undertaking appropriate training based on a well-structured plan for determining individual training needs. The current level of NVQ Level 2 attainment (53 of Carer Staff) reflects a very positive approach to enabling skills development. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 15 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): 37,38,39 & 42. The Registered Manager is an experienced Registered Nurse who also holds NVQ Level 4 in Management. Residents and Relatives are able to directly influence the quality of care provided. Health and Safety Policies/Procedures/Practices are satisfactory, and COSHH requirements are satisfactorily met. EVIDENCE: The views of Residents/Visitors, obtained during the Inspection, together with survey feedback cards received from Residents, Relatives, and Clinical Professionals indicate the Registered Manager is competent and the Home is well managed. Residents and Relatives also confirmed that their comments and opinions, relating to the running of the Home, are welcomed, listened to, and acted upon. Documentation indicated regular maintenance and servicing of equipment is routinely undertaken, and appropriately recorded. Records are maintained relating to the checking of the hot water supply to baths, and hot water tested during the Inspection was found to be within accepted limits. COSHH data sheets were up-to-date. Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 16 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 3 3 3 x 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 3 4 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 4 CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Leabrook House Nursing Home Score 3 4 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x DS0000004788.V254348.R01.S.doc Version 5.0 Page 17 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Leabrook House Nursing Home DS0000004788.V254348.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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. 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