Care Home: Laburnum House

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What the care home does well This unannounced inspection visit did not look at all the aspects of care provided at Laburnum House, However no evidence was seen during the visit to suggest that the standards of care had deteriorated since the last key inspection. The written care plans give good information about the needs of individual service users and the way in which staff are expected to meet those identified needs. Staff know people well and understand their individual needs. Access is provided to medical services in a timely manner. Service users and their representatives are able to influence the way their care needs are met, and can raise any concerns or complaints. The pleasant and welcoming attitude of the staff team was valued by service users and visitors. What the care home could do better: Several aspects of the receipt, storage and administration of medication needed to be undertaken more rigorously. This included ensuring that hand written records of medication are checked for accuracy and signed by two people, that medication is given according to the directions and that controlled drugs are stored securely. A central record of formal and informal complaints or comments, should be maintained. This would help to both identify any pattern of problems which could then be improved, and to demonstrate the home`s openness and willingness to receive and resolve concerns. Random inspection report Care homes for older people Name: Address: Laburnum House Laburnum Avenue Shaw Oldham OL2 8RS three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Steve Chick Date: 2 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: Laburnum House Laburnum Avenue Shaw Oldham OL2 8RS 01706847846 01706881624 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Laburnum House Shaw Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 34 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 34 Date of last inspection Brief description of the care home Laburnum House is a purpose built care home, which is owned by Laburnum House (Shaw) Ltd. It is registered to provide care for older people and has seven places for people who have dementia. The ownership of the home changed hands in December Care Homes for Older People Page 2 of 10 Brief description of the care home 2008. The home is situated close to bus routes and local amenities in the centre of Shaw, Oldham. Accommodation for service users is provided on the ground and first floors of the building. A passenger lift has been installed between these two floors. There are 34 single bedrooms, and en-suite facilities are provided in eight of the rooms. Three lounge areas are provided where residents may also eat. The home is well maintained, both internally and externally. The gardens are attractively laid out and accessible to service users. Private car parking is available, as well as on street parking. The fees, as at May 2010 ranged from £394 to £405, details of what is covered by the fees can be obtained from the manager. The providers make information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the most recent inspection report is made available by the manager. Care Homes for Older People Page 3 of 10 What we found: We conducted a random inspection of Laburnum House on 20th May 2010 as part of our regulatory responsibility. We did this to see if there had been any significant changes in the delivery of the services provided and if any of those changes impacted negatively on the service users or affected the quality rating given at the last Key inspection in 2007. At the last key inspection the quality rating given to the service was 3 star. This means the people who use this service were experiencing excellent quality outcomes. Since that time we have asked the registered provider to complete an Annual Quality Assurance Audit (AQAA) each year . The AQAA is a self-assessment document that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information. We had also received completed surveys from seven service users, eight relatives of service users and four staff members. We have undertaken an Annual Service Review (ASR) each year since the last key inspection. An ASR does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review. This random inspection was unannounced and focused mainly on outcomes for service users in connection with their health and personal care, and the way in which the home manages complaints and protects the people who live there. We interviewed in private, two service users, two staff and six relatives who were visiting. We also spoke in private with two visiting professionals. We also spoke with the manager. We looked at a sample of records relating to health and personal care of service users and complaints and protection. All service users files which we looked at had a written copy of a care plan giving information about the needs and ways of meeting those needs, for that specific individual. There was good documentary evidence that these care plans are regularly reviewed and if necessary the assessments and strategies for working with the individual are changed. We saw one example where an amendment to the way of working had been updated in the review section of the file, but not in the actual care plan. Discussion with the manager indicated that staff understood the way the files were structured and would know to check in the review section. Staff who we spoke to were confident that the combination of written information, verbal handovers at each shift and the generally good communication between staff meant that they were kept up to date with the changing needs of service users. Relatives who we spoke to were generally positive about the care provided. Some visitors thought more staff would make the care even better by providing more activities and a potentially quicker response to meeting needs which were not urgent. All visitors spoke positively about the staff team. Comments about the staff included always approachable and dead helpful, very caring friendly staff staff are nice. Most relatives we spoke to felt involved in decision making and discussions about their relatives care. Professional visitors who we spoke to were equally positive about aspects of care of which they were aware. One told us they were impressed with the level of knowledge staff had Care Homes for Older People Page 4 of 10 about each service user, as an individual person. There was documentary evidence that service users have access to the full range of medical services available in the community. We saw one example in the written records where an observed change in an individuals behaviour had quickly resulted in an appropriate request for medical intervention and assessment. Staff told us that they were confident that doctors are always called if necessary and that instructions left by medical personnel are communicated and followed. Relatives who we asked were confident that medical support was obtained, if necessary, and in a timely manner. We looked at a small selection of medication administration records (MAR) these were generally appropriately maintained but some areas needed improvement. The home uses a blister pack monitored dosage system provided by a pharmacist together with a preprinted MAR sheet for each service user. The effective use of MAR sheets helps to ensure the safety of service users in connection with the use of medication and as an audit trail so that the home can demonstrate the right dose of the right medication had been given to the right person at the right time. An example was seen where a new MAR sheet did not appear to be checked for accuracy. An example was seen where handwritten additions to a MAR sheet had not been signed by two people to confirm the accuracy of the information. An example was seen where although the directions for the medication required it to be given 30 to 60 minutes before food the MAR sheet indicated it had been given at 10:00. It was not clear from discussion with staff whether this was an error in recording or administering the medication. Controlled drug records were being maintained in a looseleaf folder which, while presenting as accurate, did not provide a safe, secure and permanent record. This is particularly important with controlled drugs as they are liable to misuse. These controlled drugs were seen to be kept in locked cupboards, but the cupboards did not appear to offer the current legally required level of security. The home had a written complaints procedure which needed to be updated to clarify how people can contact the current owners if necessary. We looked at the complaints log which did not appear to provide a record of all complaints received. The function of the complaints log is to keep a central record which can be easily accessed by management, of all concerns and complaints. This is to provide both an audit and quality assurance tool and to enable the home to demonstrate that it deals with concerns and complaints in an open and responsive manner. We were aware of a number of concerns, since the previous key inspection, which had been passed to the local authority to investigate. We understand that the management and owners at Laburnum House cooperated fully with the local authoritys investigations. All relatives and staff who we asked were confident that any complaint any service user may have would be appropriately dealt with by the management of the home. All visitors who we asked, expressed confidence that people living at the home were safe, in that they were protected from abuse or exploitation. We were shown the training matrix maintained by the manager which indicated that most staff had received training in the protection of vulnerable adults (POVA). The manager Care Homes for Older People Page 5 of 10 also informed us that the home has a copy of the Oldham multiagency procedures which details action which need to be taken should a safeguarding concern be identified. Staff who we asked presented as being clear about their responsibilities to report any allegations or suspicions of abuse and, if necessary, whistle blow. Staff who we asked told us that they believed that people living at Laburnum house were safe. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The responsible person must 08/07/2010 ensure that the records relating to controlled drugs are maintained in a permanent format. This is to ensure that the management and safe keeping of controlled drugs can be demonstrated 2 9 13 The responsible person must 08/09/2010 ensure that controlled drugs are stored in a cupboard that meets the requirements of the law. This will help prevent mishandling and misuse. 3 9 13 The responsible person must 08/07/2010 ensure that medicines are given to people as prescribed This is important because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 16 22 The responsible person must 08/07/2010 ensure that the complaints procedure is updated to include information about how the current owners can be contacted. This is to ensure that anyone can take any complaint to the owners if necessary. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The responsible person should ensure that any hand written records of medication type, dose, and directions, are checked and signed for by two people. The Responsible Person should ensure that a central record of all complaints, including informal ones, is kept so that any developing patterns can be identified and addressed. 2 16 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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