Archived: Laburnum House Limited

Following the inspection the provider sent us an action plan telling us what steps they were going to take to ensure compliance. The purpose of this inspection was to check if the provider had made the necessary improvements.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive to people's needs?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, with the staff supporting them, and from looking at records.

Is the service safe?

There had been an improvement in people's care records. Overall they contained enough information to guide staff on how people were to be safely cared for and supported.

Staff spoken with showed they had a very good understanding of the needs of the people they were supporting.

The home was a lot cleaner. There was a cleaning schedule in place that outlined the daily duties for staff involved in cleaning the environment, equipment and furniture. Systems were in place to prevent the spread of infection and help prevent contamination from one area of the home to another.

On this inspection we found that some improvements had been made to the environment. Some areas of the home had been redecorated and refurbished. We were told that the refurbishment of the home was 'a work in progress'.

There was no evidence to show the electrical installation within the home was safe. Electrical wiring can be a source of ignition and can give rise to electric shocks. Failing to have a safe electrical installation within the home places the health and safety of everybody at risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that the electrical installation within the home is safe.

Greater Manchester Fire and Rescue Service (GMFRS) visited the home following our inspection of 7 May 2014. One of the requirements made by GMFRS was that all staff must have training in fire prevention and evacuation procedures. Following the fire risk assessment of 24 June 2014, undertaken by an external contractor with previous experience within the fire service, management were required to ensure that all staff, especially those working alone at night were fully trained and capable of handling a fire emergency. Inspection of the training plan showed that five of the eleven staff had not received initial or updated fire training. Inspection of the staff roster showed that one of the staff without fire training worked alone at night. Failing to have staff trained in fire prevention and evacuation procedures places the health and safety of people at risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that all staff are trained in fire prevention and evacuation procedures.

Is the service caring?

We saw there was plenty of friendly chatter between the staff and the people who used the service. The people we talked with spoke positively of the staff's kindness and attitude. Comments made included; 'I feel wanted and I feel cared for. I have my independence and I am happy with that' and 'I'm okay and happy enough'.

Is the service effective?

Although records showed that the majority of staff had undertaken the essential training necessary to enable them to deliver safe, effective care and support, several staff needed initial or updated training. This was in relation to infection control, moving and handling, the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and fire evacuation procedures.

People we spoke with told us they were happy with the support they were given and that their needs were met.

Is the service responsive to people's needs?

Inspection of care records showed that people were referred to the appropriate healthcare professional when an issue of concern had been identified. One person had been referred to a dietician due to unexplained weight loss and another person told us about their visit to the local hospital to have some medical investigations.

Is the service well led?

The service has a manager who is registered with the Care Quality Commission. The manager however has been on leave from the home since January 2014. In the registered manager's absence the home has been managed by a deputy appointed by the provider.

We found the provider had failed to manage the risks relating to the health, welfare and safety of people who used the service and to others who worked or visited the home. The provider had also failed to have regard to the professional and expert advice given to them in respect of both the electrical and fire safety within the home.

During a previous inspection of the home in January 2014 we found that personal care records and records in relation to some aspects of the management of the home were not accurate and not up to date. After the inspection we made a compliance action requiring the provider to have systems in place that ensured people's care records and records in relation to the management of the home were accurate. Following the inspection the provider sent us an action plan telling us what steps they were going to take to make the necessary improvements.

During the inspection of the home in May 2014 we found there had been very little improvement. People were not protected against the risk of unsafe or inappropriate care and treatment because personal care records and records in relation to some aspects of the management of the home were not accurate and not up to date.

We served a Warning Notice following the May 2014 inspection to ensure that improvements were made quickly in order to protect people.

During this inspection we found the Warning Notice had been complied with. Overall the care records contained enough information to show how people were to be supported and cared for. Staff documented in the care plans if people were at risk of harm from any hazards. Staff then wrote down what action they would need to take to reduce or eliminate any identified risk. Information in the care records showed the staff at the home involved other health and social care professionals in the care and support of the people who used the service.

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

The care records did not contain enough information to show how people were to be safely supported and cared for.

The systems in place to control the spread of infection were not adequate. There were no clear procedures in place for the safe handling, storage and disposal of incontinence waste. Hand washing facilities were not adequate.

Some areas of the home were dirty and not well maintained. Mattresses and bed bases were badly stained and bed linen was in a poor condition. Carpets and flooring in some bedrooms were dirty and worn.

Following the inspection we were informed by Rochdale Local Authority that Environmental Health Officers from Rochdale and Bury had inspected the home. We were told they had identified issues in relation to infection control issues and that requirements had been made. We were told that a further visit would be undertaken by them to check compliance with the requirements.

We identified concerns in relation to gas, electrical and fire safety. Following the inspection we contacted Greater Manchester Fire and Rescue Service to inform them of our concerns.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that people are kept safe.

Is the service caring?

The care staff had a good understanding of people's needs and they had a relaxed and friendly rapport with the people using the service.

Is the service effective?

For the people who had a mental illness, there were not enough staff to promote their wellbeing and aid their recovery. There was no encouragement and support to provide appropriate activities or community involvement.

There was no evidence to show that staff had received or updated their training to ensure that safe and effective care could be provided.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring there are sufficient skilled staff provided to meet people's needs.

Is the service responsive?

People were not always referred to the appropriate healthcare professional when an issue of concern had been identified. Despite one person losing a large amount of weight in a short period of time no action had been taken to address the issue.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's health and welfare are protected.

Is the service well led?

Management failed to ensure systems were in place to help protect people against the risks of inappropriate or unsafe care.

Records in respect of the management of the home were either not available or were not accurate.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring records are accurate and systems are in place to help protect people from harm.

If you want to see the evidence supporting our summary please read our full report.

The systems in place to protect people who lacked the capacity to make decisions about their own care and support were not adequate. Staff were not able to demonstrate fully their understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The planning and delivery of care did not ensure that the individual needs of the people using the service were met.

Arrangements were not in place to ensure that people using the service were cared for by staff that were safely recruited and properly trained.

We found that sufficient numbers of care staff were not available at all times to ensure that the individual needs of the people using the service were met.

Systems were in place for monitoring the quality of the service provided within the home. They were not robust enough however, to identify the issues of concern we identified in relation to care records.

People were not protected against the risk of unsafe or inappropriate care and treatment because personal care records and records in relation to some aspects of the management of the home were not always accurate and up to date.