Care Home: Laburnums

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What the care home does well The manager is experienced, dedicated and professional and she has a positive impact on staff motivation and the care given to residents. Staff listen to individuals and support them in a positive and caring manner. Residents look well cared for and staff interaction is good. The manager is very keen to ensure that the service at the home develops positively and that outcomes for residents are good. The staff team is stable and the level of experience with the resident group is good. The number of staff with a relevant qualification is increasing and staff training is good. What has improved since the last inspection? The new manager has had a positive impact on the staff team and the overall development of the quality of life for the resident who live at the Laburnums. The manager has developed most of important documentation for residents into a person centred style and is encouraging people who live at the home to be involved within decisions, to be consulted and informed about changes on a regular basis. To help with this process a news letter for the home has been put into place. Regular residents meetings go ahead, as well as monthly key worker meetings. Care plans have been improved upon and are now person centred. Health care is monitored more efficiently and staff style of recording daily notes and reviewing information has been improved upon. Risk assessments have been reviewed and are relevant to the areas that they need to address. The management team at the Laburnums have all had supervision and appraisal training to enable them to monitor practice more efficiently. The manager has sent out quality assurance monitoring surveys and as a result from feedback has implemented things which people have asked for and dealt with any concerns raised. Equality and diversity is being developed in terms of staff training, raising awareness amongst the residents and involving them in every day aspects of the home. The organisation has developed a new complaints procedure, which is also available in a pictorial format. Along side this the statement of purpose, service user guide is all available in different languages and communication formats and has just been reviewed. New staff have been acquired for the home and relief staff employed so that the service does not rely on agency cover only. The dining room has had new flooring, furniture and the lounge has had new carpet and the ground floor is being gradually redecorated and improved upon. Some people have recently had their bedrooms redecorated. All requirements from the last report have been achieved. What the care home could do better: Risk assessments are to a good standard, however they could be further developed by providing information to inform us why some risks would be positive for individuals to take. Additionally when individuals` behaviour restricts choices, documentation around infringement of rights should be developed and put into place for all residents. The AQAA returned although overall good, in parts could be more in depth. As well as the in-house induction process, new staff need to follow the `Skills for Care sector` criteria for induction. CARE HOME ADULTS 18-65 Laburnums 20 Chalkwell Avenue Westcliff On Sea Essex SS0 8NA Lead Inspector Sarah Hannington Unannounced Inspection 28th May 2008 09:30 Laburnums DS0000015444.V365674.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 Laburnums DS0000015444.V365674.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. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laburnums Address 20 Chalkwell Avenue Westcliff On Sea Essex SS0 8NA 01702 477898 01702 480679 sheena.archer@east-living.co.uk 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) East Homes Limited Sheena Archer Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care and accommodation to be provided to persons between the age of 18 and 65 with a learning disability. 29th June 2007 Date of last inspection Brief Description of the Service: Laburnums are registered to provide personal care and accommodation to nine residents whose primary need of care is learning disability. Residents Currently living at Laburnums are in the older age range, with the majority being over 65 years of age. It has been considered appropriate, therefore, to focus the inspection on the Older People’s Standards. Accommodation is provided in a larger style three-storey house in a residential area. A shaft lift has been provided. The type and style of property provides plenty of space for service users and has a large garden area. It is close to local shops and main bus routes. Varieties of social recreational activities/events are available. All service users have their own bedrooms, which are decorated and personalised to individual preference and choice. The monthly range of fees was not stated on the pre-inspection questionnaire and it is understood that these are based on individual assessed need. Extra charges are made for hairdressing, chiropody and newspapers/magazines. A copy of the previous inspection report is on display on the notice board in the home and the findings & outcomes are made known to residents at their meetings. Fees are based on individual assessment of need. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 Star. This means the people who use this service experience excellent quality outcomes. The site visit took place over six hours and was carried out as part of the annual inspection programme for this home. This visit was conducted with assistance from the manager. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. The site visit also focused on any requirements and recommendations from the last key inspection. We looked at all of the information that we have received, or asked for since the last key inspection. We asked the manager to complete an Annual Quality Assurance Assessment (AQAA) form. This form is for the manager to look at and write down how well it meets the outcomes of the people who live at the Laburnums. The manager has gained views from all interested parties through surveys being sent out to relatives, people who live in the home, staff and other professionals, on how they think the service is run. We looked at the report that was written about the home at the last key inspection, this was when an inspector went to the home and spent time with people who live at Laburnums, staff and management and any professionals or relatives that may of been visiting that day. What the service does well: What has improved since the last inspection? The new manager has had a positive impact on the staff team and the overall development of the quality of life for the resident who live at the Laburnums. The manager has developed most of important documentation for residents Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 6 into a person centred style and is encouraging people who live at the home to be involved within decisions, to be consulted and informed about changes on a regular basis. To help with this process a news letter for the home has been put into place. Regular residents meetings go ahead, as well as monthly key worker meetings. Care plans have been improved upon and are now person centred. Health care is monitored more efficiently and staff style of recording daily notes and reviewing information has been improved upon. Risk assessments have been reviewed and are relevant to the areas that they need to address. The management team at the Laburnums have all had supervision and appraisal training to enable them to monitor practice more efficiently. The manager has sent out quality assurance monitoring surveys and as a result from feedback has implemented things which people have asked for and dealt with any concerns raised. Equality and diversity is being developed in terms of staff training, raising awareness amongst the residents and involving them in every day aspects of the home. The organisation has developed a new complaints procedure, which is also available in a pictorial format. Along side this the statement of purpose, service user guide is all available in different languages and communication formats and has just been reviewed. New staff have been acquired for the home and relief staff employed so that the service does not rely on agency cover only. The dining room has had new flooring, furniture and the lounge has had new carpet and the ground floor is being gradually redecorated and improved upon. Some people have recently had their bedrooms redecorated. All requirements from the last report have been achieved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 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 Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A robust assessment process reassures residents that their needs will be met before they move to the home. EVIDENCE: Manager states in AQAA that, ‘The statement of purpose and service users guide have been updated and recorded onto an audio CD.’ The statement of purpose and service user guide is to a good standard, very clear in what services it can provide, such as, accommodation, facilities, location and what the area offers, the organisation and what staff the home provides, qualifications and admissions processes, as well as, many other useful pieces of information one would want to know before making a decision to see if the Laburnums would be a suitable service or a home in which a person would want to live. The manager has innovative ideas around using different forms of communication to get information across to any new potential residents. For example recently the service have produced an audio cd and if need be the statement of purpose and service user guide can be produced in different languages, Braille, as well as pictorial. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 9 Manager states in AQAA that, ‘we have carried out thorough assessments for all new residents’. We looked at the files of two of the people most recently admitted to the home and noted that there were initial assessments from the referring social worker. These initial assessments are reflected within the home’s assessment. The home’s assessment process is thorough and covers all areas such as, resident’s details, important information relating to health, support needs and other useful and essential information. As part of this process the manager uses a procedure where as, new potential residents are assessed for compatibility with the rest of the people who live there. Additionally the current residents are updated on any new people moving into the home via residents meeting or on a day-to-day basis when things happen, this is good practice. Documentation in assessments showed that some consultation had been undertaken with residents and their families. Manager states in AQAA that, ‘ we have had two new residents move in and they have had the opportunity to have several visits before hand to ensure that they are compatible with the home and that it is the place they want to live.’ A resident who recently moved into the home stated that, ‘ I came to visit the home many times before I moved in and met the staff and other residents.’ Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 10 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care and support for all residents living in the home is good. EVIDENCE: The Manager states in AQAA that, ‘each service user has their own health action plan, care and support document, risk assessments and essential lifestyle plan.’ Within four of the care plans looked at, they all had relevant risk assessments linked to the assessed individual need. Each care plan looked at included a comprehensive risk assessment, which is reviewed regularly. Where there are restrictions, the manager needs to ensure that documentation is developed further to clearly show that decisions which have been made with the agreement of the person or their representative and are recorded accurately. Additionally the manager could highlight not only the disadvantages of risk taking, but also the benefits to individuals by allowing an acceptable level of risk. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 11 Throughout documentation looked at, it showed us that there had been some degree of involvement with the resident or their representative in this process. For example in some support plans, they made statements, such as, ‘ this person does usually have a cup of tea at… but may want a change of routine.’ ‘When using the toilet this person should be left on their own for a while to maintain their privacy and dignity.’ ‘This person will hold the shower head away until they find an acceptable temperature that they like to use.’ Again within daily notes one stated, ‘ this person was escorted to lakeside for clothes shopping. They went in a number of shops and chose the items of clothing that they wanted. We had a good chat about shopping and then had supper out together. This person said that they had thoroughly enjoyed their day out.’ And then goes on to further show the interaction between staff and resident. This documentation shows us that the staff recognise how important it is to encourage people to take control and make decisions over their lives. The Manager states in the AQAA that, ‘the service users are able to personalise their bedrooms to their taste.’ A resident stated that they had their room recently decorated and that they had chosen the colour. The Manager states in the AQAA that, ‘A good range of foods are available.’ The majority of residents stated that they liked the food offered and that it was of their choice. They also informed us that they went shopping, helped with the preparation of meals and cooked small snacks. The Manager states in the AQAA that, ‘ the menu is planned with input from the service users and the menu board is now pictorial.’ Throughout the home there were plenty of pictorial references for people to use, such as, a pictorial rota of staff, menus and activity boards. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for residents to participate in activities, which are suited to their needs and wishes, are available. EVIDENCE: Laburnums is situated within a lovely residential area of Westcliff and is very close to local amenities. The home provides a people carrier and there are plenty of bus routes near by. The majority of residents spoken with stated that they used the community regularly such as, the local shops, banks, hairdressers, pubs, going for walks along the sea front, opposite is a big park that they frequently use. Residents felt overall that staff supported them well when they wanted to access any of these local amenities. The Manager states in the AQAA that, ‘Every service user has an activity opportunities sheet/planner which is updated every month after discussion with the individual.’ Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 13 Recently the manager has concentrated a large part of her time in developing activities for the people who live at Laburnums. Looking though documentation and speaking with individuals, it is apparent that all residents are involved in some meaningful daytime activities of their own choice. One person’s file that had specific physical and communication needs file was looked at as part of this site inspection. This documentation showed us that the home provided subjects that are tailor made according to this persons interests, diverse needs, capabilities and also encouraged this individual to recognise their potential and to explore and maintain skills. All care plans that we looked at around activities had made a realistic attempt at involving people who live at the laburnums in the planning of their lifestyle and quality of their life. Residents informed me that they had been at times supported in finding occupational opportunities and did use the local community frequently. Other people informed us that they attended local colleges and day centres. Documentation showed us that residents had access to a wide range of facilities within their local area, such as, local places of worship, cafes, pubs, shops, local library, and leisure facilities. The manager and team showed through documentation, discussion and through the AQAA returned to us that they are committed to the principles of inclusion of the promotion for people who live at the Laburnums to use the local community. The Manager states in the AQAA that, ‘Service users participate in a wide range of activities both in house and in the community such as: theatre trips, meals out, walks, cooking sessions, arts and crafts, music sessions, daily living skills support.’ The majority of residents stated that they were supported in using the homes phone to keep in contact with family and friends, had their own mail to open, staff knocked on their bedrooms doors before entering, spoke to them with respect, staff supported them in cleaning rooms, carrying out their laundry and maintaining general skills which gave them greater independence. Residents informed us that they used the local cinema, theatre and evening clubs. One resident spoken with informed us that they had recently got into contact with old friends that they had initially lost contact with and staff had supported them in re-establishing these friendships. The Manager states in the AQAA that, ‘Residents are provided with a range of choices surrounding lifestyle such as: when to go to bed/get up, meal times and venues, activity choices etc.’ The majority of the residents spoken with stated that, ‘I can get up and go to bed when I want.’ ‘ I help out with my laundry.’ ‘ staff support me in cleaning Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 14 my room.’ The Manager states in the AQAA that, ‘Every service user has the opportunity to go on a yearly holiday with support from staff.’ A resident stated that, ‘ I go on holiday with staff that I like and choose where I go.’ Visitors are made very welcome and the staff are friendly. Residents stated that they are encouraged to visit and have friends and family over to their home. The new manager has recently introduced resident to new foods from around the world and this happens once a month. Part of this is to look at the music, culture and have a map of the world and pins are put into areas that have been covered. Residents spoken with told us that they thought this is a good idea and looked forward to this. General menus are in a format of the resident’s choice. Residents’ informed us that if a meal did not appeal to one of them, then an alternative meal would be provided. During the lunchtime period observation showed that residents were listened to in terms of quality and dislikes of food. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents assessed needs are in good care plans that give staff the necessary information to provide good care outcomes. EVIDENCE: The Manager states in the AQAA that, ‘Service users receive good support with their healthcare needs and staff have built up a good partnerships with outside healthcare agencies such as district nursing services and occupational therapists. The four health care plans looked at were based on person centred planning and updated regularly. All care plans looked at contained information such as weight monitoring, fluid in takes, falls, dementia and individual support for communication. All daily notes, professional visits (such as GP’s, hospital visits), general recording of the changing needs in care plans and risk assessments are in place and clearly cross referenced. Recording of appointments, district nurses visiting and general sharing of information amongst the team is to a good standard. This showed us that issues are picked up on and actioned within an acceptable time scale. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 16 The Manager states in the AQAA that, ‘We are thorough with our updating of information in the care and support documents and also in the service users person centred plans.’ Discussion with the team around involvement of residents in everyday routines showed us that staff actively encourages residents to retain skills. Observation showed that staff are patient in encouraging individuals to retain skills and maintain independence. The daily notes informed us that staff recorded well. Residents spoken with felt that they were well cared for and that staff supported them appropriately. Policy and procedures are in place for the correct receipt, recording, storage and handling, administration and disposal of medications. Any medication changes had been recorded accurately. All MAR record sheets had been correctly recorded, signed for and there were no gaps in vital information needed. The administration records are maintained in accordance with agreed procedures and the royal pharmaceutical legislation. Evidence of documentation, training, and the fact that there have been no incidents reported around medication issues or practice would suggest that medication is kept to a strict protocol and is maintained consistently to a good standard. A Monitored medication dosage system is in place for each resident. Medication is stored in a lockable cabinet. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 17 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a pictorial complaints procedure and they are protected by staff knowledge and training around safeguarding. EVIDENCE: Manager states in AQAA that, ‘East Thames has an accessible format complaints policy.’ Within the service, the manager and staff ensure that resident’s views and any concerns are taken on board and dealt with. This is done in a number of ways such as, on a day-to-day basis, through the key worker role, residents meetings, reviews and quality assurance surveys. The policy and procedures around complaints is to a good standard. The service users guide and service user guide has a clear guidance for all people to use. There have been no complaints made to the home or reported to the CSCI office since the last inspection. The manager has a good complaints procedure in place. All complaints are recorded, maintained and outcomes recorded. A service user complaints procedure is available in a format of their communication choice. The majority of residents spoken with state that they felt overall the manager and staff listened to them and felt that if they raised a concern then it had been dealt with satisfactory. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 18 The Manager states in the AQAA that, ‘All staff have received Safe Guarding training and are updated when required.’ All staff have attended safe guarding (protection of vulnerable adults) training. Speaking with staff they a good awareness around these issues. Safe guarding training forms part of the induction process for all new staff. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely and comfortable environment, which suits their needs. EVIDENCE: The laburnums offer residents plenty of space both inside and outside of the home. Towards the back of the house is a large garden. Residents spoken with told us that they like to use this area in the good weather and that they had some of the arts and crafts they had made put into the garden as ornaments. Some residents also helped out with the maintenance of some small patches of shrubbery and flowers, which they enjoyed. Also within the garden is a small hut called the ‘den’ in which activities on a 1-1 are carried out with an activities coordinator that visits once a week. This allows some of the residents who choose not to go out that often, space away from the home environment. The garden itself is maintained to a high standard and is accessible for wheel chair users. The home has recently had a few maintenance issues, one being asbestos found within a small seating area on the first floor bay. However, this has been Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 20 dealt with quickly and carried out to a safe standard, without any inconvenience to the residents. This area is still being refurbished. Highlighted in the last site inspection report is that the conservatory roof is leaking water in and presently this is being rectified with the whole conservatory being replaced. This work will be carried out shortly and when completed will provide the residents with another big area to use. The ground floor of the home and some of the resident’s bedrooms have recently been repainted and redecorated. Additionally there is an action plan that addresses general maintenance issue so that the up keep of the service as a whole is gradually addressed and put into place. Staff and residents informed us that they are consulted with regarding re-decoration, colour schemes and choices of new furniture. The Manager states in the AQAA that, ‘We strive to maintain a clean and tidy environment at Laburnums at all times: this is done by both service users and staff members.’ There is a good cleaning programme in place. On the day of inspection, the home was observed to be clean, tidy and odour free. The management has a good infection control policy and all staff have training to encourage staff to reduce the risk of infection. The Manager states in the AQAA that, ‘All service users have bedrooms that are decorated to their individualised tastes and requirements.’ Individual’s rooms were clean and personalised. All residents had the necessary furniture and equipment that they needed. The home offers plenty of bathrooms and toilets facilities. There is a lift in place to access the home fully. Within the kitchen, the surfaces have been lowered so that any wheel chair users can participate in the preparation and cooking of meals. The Manager states in the AQAA that, ‘Laburnums strives to be a homely environment: e.g. there are pictures produced by the service users on al the walls of the home.’ Through out the home residents have had a say in how the home is decorated, in many of the areas looked at peoples artwork decorated the walls of the home. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered positive relationships by well-supported and caring staff. Residents are protected by staff recruitment, induction and training. EVIDENCE: The staff team came across as friendly helpful and caring towards the residents. One of the staff spoken with took time out to raise money for the residents and put this into an area that would benefit them. For example, money raised in the past has provided the residents with a small path and the ‘den’ (hut/shed) that is used away from the home and kitted out for the use of 1-1 activities. Speaking with staff there is future plans to raise money to provide future facilities of their choice that people will enjoy. The Manager states in the AQAA that, ‘We have a committed staff team at Laburnums Staff have attended a variety of training courses and attend regular updates for training when needed.’ Many of the staff spoken to had been at the home for a number of years and provided stability for the residents at Laburnums. The new staff spoken with Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 22 came across as caring, knowledgeable and well supported. Training opportunities for all staff are good and include manual handling, health and safety, first aid, dementia awareness, fire awareness, safeguarding and infection control. Staff spoken with reflected that courses undertaken had developed a better understanding of the residents that they worked with. With the present staff team in place the service meets with its criteria for 50 of its staff team to be NVQ qualified. The Manager states in the AQAA that, ‘Staff receive regular superivison and appraisal sessions.’ Supervision notes were present within folders and annual appraisals are carried out for all staff. Staff spoken with confirmed that there are regular meetings, individual supervisions and hand over meetings (sharing of information) on each change over of shifts. Manager states in AQAA that, ‘Rotas are produced well in advanced and over time shifts are divided fairly between staff members.’ There is a new staffing structure that is due to be put into place. This will be beneficial to residents’ as the staff numbers will be used when needed at peak times and provide better senior cover on each shift. At present, there are three vacancies that are presently being recruited for. The staff rota showed that permanent staff and the organisations own ‘bank’ staff do cover any gaps when need be. The manager maintains a robust recruitment procedure. The file of the most recently recruited member of staff file was sampled; the information was available. Pova 1st checks and CRB are in place before a contract of employment and start date was offered to staff. New staff shadow the more experienced staff for a period of weeks, this practice gave them a chance to build a rapport with individuals and get to know their needs well, before working independently. The induction of new staff consists of basic in house issues. The manager still needs to implement alongside the basic induction staff receive, the ‘skills for care’ induction process which is a reflective workbook that covers all basic training needs such as, fire safety, health and safety, safe guarding and should be completed within a period of time of new staff being recruited. This would aid new staff to further refresh and gain knowledge, which is essential to their role, and also enable the management to monitor staff performance and progress within the expected probationary period. One area that could strengthening is the induction procedure although to a good standard which includes the in house induction, staff shadowing the more Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 23 experienced staff. The manager needs to ensure that all new staff follows the reflective learning as required by the skills for care guidance. However new staff spoken with showed us that knowledge and induction had equipped them with the skills needed to work with residents effectively and safely. The home provides a key worker system. Key workers work closely with the residents’ families and friends and act as advocates for individuals. Additionally the key worker support people with arranging holidays, purchasing clothing and following up any health issues. The majority of residents felt that the staff supported them very well and that they liked the staff that worked at Laburnums. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 24 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 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management of the home is stable which ensures the health, safety and welfare of all residents. EVIDENCE: The Manager states in the AQAA that, ‘There is a dedicate management team in place.’ The recently appointed manager has been in post for the last six months. Previous to this she has been the deputy manager for a number of years at the Laburnums. This post is only temporary as the previous manager is on secondment for another role within the organisation. At present there has been no timescale set to this. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 25 The current manager is RMA (Registered Managers Award) and NVQ 4 qualified. Additionally the manager has a degree in multi-media, which has been put to full use when working with the residents and their communication needs. For example, a news letter has recently been produced, which gives the residents, friends and family a chance to catch up with events and useful information that is taking place, for example in the recent news letter it introduced the new staff recently appointed, including their experience, the results of the recent surveys, upcoming events and a memorial of a resident who recently passed away. A new audio CD has been made available regarding the service users guide. All menu’s, staff rota’s and activities have been changed over to a picture format. Most documentation is gradually being changed to a form of the communication that suits all residents. Minutes of the residents meeting are typed up in a format of the residents choosing. Overall the service is moulding itself around the needs and wants of the resident group. Residents spoken with are clearly involved in the running of the home and staff are documenting this within daily notes to a fuller degree. Through discussion with the manager it is clear that enthusiasm, dedication, drive to improve the service and a good philosophy of care is present and being put into practice. Additonally the office documentation is well organised and documentation is clear, concise and easily available. The manager has clearly made a positive impact on how the team are delivering the quality of care and at consulting and involving the residents to be part of the services future development and has showed us that she is highly organsied within this role. Quality assurance is to a high standard and a document is produced with the out comes and the action being taken as a result of the feedback. Health and safety is maintained through good policy and procedures and all certificates required relating to this are in place. Additionally the staff and residents regularly practice fire drills and each person has a good risk assessment relating to this. The Manager states in the AQAA that, ‘Training is available for management staff: two have completed Fundamentals of Management course and one is enrolled on NVQ 4 programme.’ For part of the site inspection the area manager was present and through discussion it was clear that the manager gets appropriate support necessary for the furute improvement of the service. Additonally it is noted that the organisation has rectified some of the areas for improvements highlighted in the last inspection report and that there are many environmental and general plans to improve the Laburnums presently taking place and for the future. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 26 The Manager states in the AQAA that, ‘Managers meetings are held on a regular basis: management meetings are held at Laburnums, and deptuy and manager also attend East Living/East Thames management meetings.’ Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 27 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 4 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 4 3 X X 3 X Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001, and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation Sch 3 (p)(q) Requirement That any restrictions on residents choices is clearly recorded onto a format (infringements of rights) to evidence why this is necessary to restrict a persons freedom and that the decision is clearly thought out. Timescale for action 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA35 YA41 Good Practice Recommendations That the induction process for all new staff needs to follow the ‘Skills for Care sector’ criteria for induction. That the annual AQAA is filled out fully so that CSCI can fully evaluate the quality of service provided as part of the inspection process. Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Laburnums DS0000015444.V365674.R01.S.doc Version 5.2 Page 30 - 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. 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