Laburnum Lodge CQC

8/3/2019 Laburnum Lodge CQC

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Key inspection report

Care homes for older people

Name: Laburnum LodgeAddress: 2a Victoria Street

Littleport, Ely

Cambridgeshire

CB6 1LX

The quality rating for this care home is: zero star poor serviceA quality rating is our assessment of how well a care home 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 full review a key inspection.

Lead inspector: Date:Janie Buchanan 3 0 0 3 2 0 1 0


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Care Homes for Older People Page 2 of26

This is a review of quality of outcomes that people experience in this care home. We

believe high quality care should

Be safe

Have the right outcomes, including clinical outcomes

Be a good experience for the people that use it

Help prevent illness, and promote healthy, independent living

Be available to those who need it when they need it.

The first part of the review gives the overall quality rating for the care home:

3 stars - excellent

2 stars - good

1 star - adequate

0 star - poor

There is also a bar chart that gives a quick way of seeing the quality of care that the

home provides under key areas that matter to people.

There is a summary of what we think this service does well, what they have improved

on and, where it applies, what they need to do better. We use the national minimum

standards to describe the outcomes that people should experience. National minimum

standards are written by the Department of Health for each type of care service.

After the summary there is more detail about our findings. The following table explains

what you will see under each outcome area.

Outcome area (for example Choice of home)These are the outcomes that people staying in care homes should experience. They reflect the thingsthat people have said are important to them:

This box tells you the outcomes that we will always inspect against when we do a key

inspection.

This box tells you any additional outcomes that we may inspect against when we do akey inspection.

This is what people staying in this care home experience:

Judgement:

This box tells you our opinion of what we have looked at in this outcome area. We

will say whether it is excellent, good, adequate or poor.

Evidence:

This box describes the information we used to come to our judgement.


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We review the quality of the service against outcomes from the National Minimum

Standards (NMS). Those standards are written by the Department of Health for each

type of care service.

Copies of the National Minimum Standards Care Homes for Older People can be found

at www.dh.gov.uk or bought 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

The mission of the Care Quality Commission is to make care better for people by:

Regulating health and adult social care services to ensure quality and safety

standards, drive improvement and stamp out bad practice

Protecting the rights of people who use services, particularly the most

vulnerable and those detained under the Mental Health Act 1983

Providing accessible, trustworthy information on the quality of care and

services so people can make better decisions about their care and so that

commissioners and providers of services can improve services.

Providing independent public accountability on how commissioners and

providers of services are improving the quality of care and providing value

for money.

Reader Information

Document Purpose Inspection report

Author Care Quality Commission

Audience General public

Further copies from 0870 240 7535 (telephone order line)

Copyright Care Quality Commission 2010

This publication may be reproduced in whole or in part

in any format or medium for non-commercial purposes,provided that it is reproduced accurately and not usedin a derogatory manner or in a misleading context. Thesource should be acknowledged, by showing thepublication title and Care Quality Commission 2010.

Internet address www.cqc.org.uk
http://www.tso.co.uk/bookshophttp://www.tso.co.uk/bookshop


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Information about the care home

Name of care home: Laburnum Lodge

Address: 2a Victoria Street

Littleport, Ely

Cambridgeshire

CB6 1LXTelephone number: 01353860490

Fax number: 01353860845

Email address:

Provider web address:

Name of registered provider(s): Dr A Hassaan,Mrs S Hassaan

Name of registered manager (if applicable)

Type of registration: care home

Number of places registered: 22

Conditions of registration:

Category(ies) : Number of places (if applicable):

Under 65 Over 65

old age, not falling within any othercategory

0 22

Additional conditions:

Date of last inspection 2 8 1 0 2 0 0 9

Brief description of the care home

Laburnum Lodge is a two-storey house, that includes a single storey extension, which

provides accommodation, personal care and support to 22 older people. All but 3

bedrooms have ensuite facilties. The upper floor is accessed via stairs or a stair lift. A

garden is available to the rear of the building. The home is situated in the centre of the

village of Littleport and is close to shops, cafes, pubs and local amenities. A copy of the

most recent inspection report is available in the entrance way to the home. The

weekly charge is varies between 354 and 424 per week.


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Summary

This is an overview of what we found during the inspection.

The quality rating for this care home is: zero star poor service

Our judgement for each outcome:

Choice of home

Health and personal care

Daily life and social activities

Complaints and protection

Environment

Staffing

Management and administration

Poor Adequate Good Excellent

How we did our inspection:For this inspection we (The Care Quality Commission) visited the home and talked with

residents, staff, a visiting relative and the manager. We also telephoned anotherrelative after our visit. We undertook a tour of the premises to check on health andsafety, and viewed a sample of residents' medical administration records and otherrecords. We received 20 surveys completed by residents, their families and staff askingthem for their opinion of the service.The home has been subject to an additional inspection since its last key inspection dueto continued concerns about poor management and the quality of care being providedthere. Details of this report can be found on our website on www.cqc.org.uk. We havealso issued a warning letter and a statutory enforcement notice due to continued

failure to comply with the legal requirements made.7 legal requirements and 6 recommendations have been made as a result of this


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inspection.


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What the care home does well: Laburnum Lodge offers residents a small, homely environment in which to live.We received some positive comments about the home and its staff including: ' the staffall work hard to provide what I would consider good care for my mother'; 'staff arevery good with mum, always laughing with her'; ' they look after us well' and 'theatmosphere is easy going and relaxed'.

What has improved since the last inspection?

There have been some improvements in the home since we last inspected:A system is now in place to obtain and retain adequate supplies of medicines forresidents so that they can be given them as and when prescribed.The manager's shifts are now recorded on the duty rota so there is an accurate recordof the hours she works and so that staff know when she is going to be available in thehome.

We are now notified of any events and incidents affecting the well being of residents inthe home.Fire doors are no longer pinned back so that they close freely and residents areprotected in the event of a fire.

What they could do better:

There is still much this home needs to do to improve its standards:

New residents must be issued with a contract at the point of moving into the home (nomatter how long or short their stay) so that they have a clear understanding of theterms and conditions of their stay there and the fees payable.Residents, or their advocates, must be actively involved in reviewing their care plansso they are consulted about their care.There must be much more detailed information about how residents' specific needs,such as diabetes, are to be managed so that staff have the guidance they need to offerconsistent and comprehensive care.

Hand written additions to residents' printed medication records must be signed, datedand checked by a second person to ensure their accuracy and so that there is a clearaudit trail of who has instructed what.All staff must receive regular supervision to ensure they are working properly and sothey feel supported.Laundry systems in the home need to improve so that residents 'clothes are bettermaintained.

Residents must be able to lock their bedroom doors so that their privacy and securitycan be maintained.


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Mealtimes must be better organised so that residents food is not left to get cold andunappetising.A record of all complaints and concerns raised by residents and their families must bekept, which includes details of any investigation and any action taken.The results of residents' surveys should be published and made available to residents,

their representatives and other interested parties. Minutes of residents' meetingsshould be shared with them.All items of food stored in the kitchen must be dated so that staff know it is still freshand usable. The home's freezer must be defrosted regularly to ensure it operateseffectively and stores food safely.Care staff's access to the kitchen must be limited to prevent the risk of cross infection.Those that do need to enter must wash their hands before handling any kitchenequipment or food.

The home continues to operate without a registered manager and therefore we havenot had the opportunity to assess the manager's ability, knowledge and experience tomanage a home. This is of particular concern as the home remains a poorly ratedservice, with much to do to raise its standards for residents living there.

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 on page 4.

The report of this inspection is available from our website www.cqc.org.uk.

You can get printed copies from [email protected] or by telephoning our

order line 0870 240 7535.


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Details of our findingsContents

Choice of home (standards 1 - 6)

Health and personal care (standards 7 - 11)

Daily life and social activities (standards 12 - 15)

Complaints and protection (standards 16 - 18)

Environment (standards 19 - 26)

Staffing (standards 27 - 30)

Management and administration (standards 31 - 38)

Outstanding statutory requirementsRequirements and recommendations from this inspection


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Choice of homeThese are the outcomes that people staying in care homes should experience. Theyreflect the things that people have said are important to them:People are confident that the care home can support them. This is because there is an

accurate assessment of their needs that they, or people close to them, have been

involved in. This tells the home all about them and the support they need. People who

stay at the home only for intermediate care, have a clear assessment that includes a

plan on what they hope for and want to achieve when they return home.

People can decide whether the care home can meet their support and accommodation

needs. This is because they, or people close to them, have been able to visit the home

and have got full, clear, accurate and up to date information about the home. If they

decide to stay in the home they know about their rights and responsibilities because

there is an easy to understand contract or statement of terms and conditions betweenthem and the care home that includes how much they will pay and what the home

provides for the money.


Judgement:

People using this service experience adequate quality outcomes in this area. We havemade this judgement using a range of evidence, including a visit to this service.

People's needs are assessed before they move into the home, so they can be assured

they will be met there.

Evidence:

The manager, or the deputy, assess all prospective residents to ensure their needs

can be met at the home and we viewed basic pre-admission assessments on the files

we checked. Residents who completed our survey told us they did receive enough

information about the home to help them decide if it was the right place for them. One

relative told us her mother came and stayed at the home for a whole day so she could

properly assess its facilities before moving in.

We checked the files for two recently admitted residents and noted they had not been

issued with any contract or any information about the terms and conditions of their

stay there. The manager stated she didn't realise that residents who came to stay for

a short while required a contract.


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Health and personal careThese are the outcomes that people staying in care homes should experience. Theyreflect the things that people have said are important to them:Peoples health, personal and social care needs are met. The home has a plan of care

that the person, or someone close to them, has been involved in making. If they take

medicine, they manage it themselves if they can. If they cannot manage their

medicine, the care home supports them with it, in a safe way. Peoples right to privacy

is respected and the support they get from staff is given in a way that maintains their

dignity.

If people are approaching the end of their life, the care home will respect their choices

and help them feel comfortable and secure. They, and people close to them, are

reassured that their death will be handled with sensitivity, dignity and respect, and

take account of their spiritual and cultural wishes.


Judgement:


Residents are not involved in planning and reviewing their care needs, and theirlaundry is not always washed carefully.

Evidence:

We viewed the care plans for three residents. Two of these were good with detailed

information about residents' needs and what staff must do to meet them. However,

another plan stated that the resident had type 2 diabetes, that they must have a

diabetic diet and that staff must monitor their food. However there was no information

for staff on what food they could and couldn't eat; how they were to monitor their

food; how the diabetes affected them; what signs to look out for in case they became

hyper/hypoglycemic, and what staff must do if so. Although the plans had been

reviewed every month so that changes in residents' needs could be picked up, there

was little evidence to show that residents had been actively involved in reviewing their

care or had agreed to any changes made, despite them being very able to do so. One

relative told us that, although being very involved in her mother's care, she had never

been involved in reviewing her mother's plan.


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Evidence:

Residents we spoke to told us that they were happy with how staff assisted them and

the care they received, however we noted one resident with unsightly chin whiskers

that had not been attended to.

Two relatives told us of problems with laundry. One reported: 'my relative has

recently moved to this home and the family has experienced mix up of laundry andsome coloured being washed with non coloured. Another stated: 'we are really

concerned that my aunt needs to maintain her dignity and pride. Her washing is clean

but it all seems to be washed together therefore the whites are now grey'.

During our visit on 19 January 2010 we found that residents had not been given their

medication as prescribed and two residents had not received important medication for

a number of days. We served a statutory enforcement notice as a result. During this

visit we found that medication practices had improved and consider this notice to be

complied with. However, we did note that some hand written additions to the printed

medication records had not been signed or dated.


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Daily life and social activitiesThese are the outcomes that people staying in care homes should experience. Theyreflect the things that people have said are important to them:Each person is treated as an individual and the care home is responsive to his or her

race, culture, religion, age, disability, gender and sexual orientation. They are part of

their local community. The care home supports people to follow personal interests and

activities. People are able to keep in touch with family, friends and representatives.

They are as independent as they can be, lead their chosen lifestyle and have the

opportunity to make the most of their abilities. People have nutritious and attractive

meals and snacks, at a time and place to suit them.

There are no additional outcomes.


Judgement:


Residents have access to some activities to keep them stimulated but the standard of

food and how it is served needs to improve.

Evidence:

Residents are encouraged to maintain daily living skills: one told us she enjoys helping

staff with washing the dishes, setting the tables and folding clothes and we saw

another resident hoovering the carpet after lunch. There is a daily events schedule

which includes activities such as dominoes, knitting ,cards, cake decoration and arm

chair exercises. There are regular visits to a lunch club organised by the young people

of Littleport and 8 residents recently visited Church Farm. One resident regularlyattends a weekly bingo club in the village. The home has recently purchased a games

machine for residents to use. Despite this however, one relative commented: 'we

understand that daily activities are planned but this seldom happens. The staff when

not busy could talk more to the old folk instead of sitting outside smoking'. Another

reported: 'Patients just sit around not doing much. More brain stimulation/activities

required'. Residents who completed our survey told us that they would like more time

with staff, one stated: 'the staff could spend more 1 to 1 time with me and others'.

Another: 'a bit more personal attention from staff'.


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Evidence:

Lunch on the day we visited consisted of Shepherd's Pie with leeks and carrots, or

ham and cheese salad. The food was presented well and one relative told us: 'it's

unusually good today'. Residents we spoke to told us they enjoyed the meals at the

home. However another relative commented: 'better quality food is needed. Burgers

hot dogs and cheesy chips are not good. The food is cheap most of the time'. We

toured the kitchen and noted large amounts of frozen supermarket value brand mince,chicken, fish and scampi. Comments from the home's own survey included: ' I would

like more salads and greens, the veg is overcooked and could be more imaginative',

and 'meals not warm enough'. We sat and chatted with residents as they had their

lunch and noted that the pudding was served very shortly after the main course had

been and was left on the table to get cold whilst residents finished their main course.

We talked to another resident in her bedroom: her dessert was left standing for a

period of about 15 minutes whilst she ate her main course allowing it to get cold and

the custard unappetising


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Complaints and protectionThese are the outcomes that people staying in care homes should experience. Theyreflect the things that people have said are important to them:If people have concerns with their care, they or people close to them know how to

complain. Any concern is looked into and action taken to put things right. The care

home safeguards people from abuse and neglect and takes action to follow up any

allegations.

Peoples legal rights are protected, including being able to vote in elections.


Judgement:People using this service experience adequate quality outcomes in this area. We havemade this judgement using a range of evidence, including a visit to this service.

Residents' and relatives' complaints are not handled professionally.

Evidence:

The complaints procedure is displayed around the home (although not in places easily

seen by residents) and information about how to complain is included in the home's

statement of purpose and residents' guide. Most residents who completed our survey

told us they knew how to make a formal complaint.

One person whom we talked to during our inspection told us they had recently raised

a serious complaint about the cleanliness of their relative's room. However we could

find no evidence that their complaint had been recorded, investigated and resolved

satisfactorily. One anonymous complainer told us: 'I reported months ago that there

were ants in the kitchen bathroom and toilet but no action has been taken'. Onceagain we could find no evidence that this issue had been recorded, although there was

evidence that it had been addressed. One relative we spoke told us she had raised

concerns about her mother needing help to eat her lunch due to her bad eyesight, but

that staff at the home had not responded to this, or offered alternative ways to help

her mother eat.

We viewed the home's complaints log book which was empty: the manager stated she

does not keep a record of the complaints she receives, or any investigation or action

taken in their light.


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Evidence:

All staff have recently undergone training in protecting vulnerable adults however their

knowledge of reporting procedures and other agencies involved in protecting people

was limited. Although the home has put up information about how to report incidents

in its entranceway the information it contains is not fully in line with local reporting

procedures


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EnvironmentThese are the outcomes that people staying in care homes should experience. Theyreflect the things that people have said are important to them:People stay in a safe and well-maintained home that is homely, clean, pleasant and

hygienic.

People stay in a home that has enough space and facilities for them to lead the life

they choose and to meet their needs. The home makes sure they have the right

specialist equipment that encourages and promotes their independence. Their room

feels like their own, it is comfortable and they feel safe when they use it.


Judgement:


Residents live in a home in need of better maintenance.

Evidence:

We undertook a tour of the premises. The exterior entranceway to the home looks

shabby and neglected. Brick work is falling away from the wall and the wooden

handrail up the ramp is rotting and potentially dangerous to use. One relative told us:

'roadway into the parking area I notice a number of cigarette ends lying around-

general tidy up of this area is required'. Another wrote on the home's own survey:

'front and back door access could do with some improvements and the exterior area

looks a bit drab and run down'.

The inside of the home was generally clean, tidy and comfortable however, we notedthe following shortfalls: a number of rooms did not have a bedside light so that

residents could read at night or turn their light off safely and independently; room 4

had a strong unpleasnat smell; a number of radiator covers were badly stained and

unsightly; the paintwork in room 12 was scuffed; and the lock on room 14 was broken

not allowing the resident to lock their bedroom for privacy and security.

We observed staff coming in and out of the home's kitchen throughout the day having

delivered personal care to residents, without washing their hands or wearing

protective clothing such as aprons, to prevent the risk of cross infection.


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StaffingThese are the outcomes that people staying in care homes should experience. Theyreflect the things that people have said are important to them:People have safe and appropriate support as there are enough competent staff on duty

at all times. They have confidence in the staff at the home because checks have been

done to make sure that they are suitable to care for them. Their needs are met and

they are cared for by staff who get the relevant training and support from their

managers.

There are no additional outcomes.


Judgement:

People using this service experience good quality outcomes in this area. We havemade this judgement using a range of evidence, including a visit to this service.

Residents' needs are met by trained staff in sufficient numbers.

Evidence:

There are two care staff on duty during the day and one care staff at night to meet

the needs of 13 residents currently. The manager and a deputy also work daily

Monday to Friday and there is a cook and domestic cleaner as well. Residents we

spoke to told us there were staff available when they needed them and we observed

staff responding quickly to residents' requests. One relative told us: ' the carers are

generally prompt in being asked for assistance by their patients'.

We checked a sample of staff training files which showed us they had received

appropriate training. The home has organised recent training for staff on protectingvulnerable adults, fire safety and food hygiene. Staff we spoke to told us they received

training relevant to their role, although one staff member told us she had received a

very poor induction when she started working at the home.

We checked the personnel files for two recently recruited members of staff and found

that appropriate pre-employment checks and references had been undertaken before

they had been employed. We received an anonymous allegation that a carer at the

home had a criminal record which might make them unsuitable to work with

vulnerable adults. On investigation we could find no evidence of this amongst the


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Evidence:

home's permanent staff but advised the manger to contact the agency that supplies

the home with temporary staff.


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Management and administrationThese are the outcomes that people staying in care homes should experience. Theyreflect the things that people have said are important to them:People have confidence in the care home because it is led and managed appropriately.

People control their own money and choose how they spend it. If they or someone

close to them cannot manage their money, it is managed by the care home in their

best interests. The environment is safe for people and staff because appropriate health

and safety practices are carried out.

People get the right support from the care home because the manager runs it

appropriately with an open approach that makes them feel valued and respected. The

people staying at the home are safeguarded because it follows clear financial and

accounting procedures, keeps records appropriately and ensures their staff understand

the way things should be done. They get the right care because the staff aresupervised and supported by their managers.


Judgement:

People using this service experience poor quality outcomes in this area. We havemade this judgement using a range of evidence, including a visit to this service.

Residents live in a poorly managed home.

Evidence:

At our last key inspection on 28 October 2009 we made 10 legal requirements. We

visited again on 19 January 20101 and found that the home had still failed to comply

with requirements concerning medication, fire safety and notifying us of incidents

affecting the well being of residents. We sent the home a warning letter and also

served a statutory enforcement notice concerning medication. This notice has now

been complied with.

There has not been a registered manager at the home now for nearly two years. In

June last year we sent the home a warning letter about this. The current manager of

the home has submitted an application to become the registered manager on three

occasions: each time the Commission has had to return that application without

considering it because it has been incomplete. The new manager has poor knowledge

of the national minimum standards for care homes. At our inspection of 19 January


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Evidence:

2010 we had concerns about the availability and attendance of the manager at the

home, however staff we spoke to during this visit told us she that is around a lot more

and the shifts she works are now recorded on the duty rota.

At our inspection of 19 January 2010 we made a requirement that staff must receive

regular formal supervision. We asked to see the supervision records for one memberof staff on duty and these could not be found. The manager was unsure whether or

not this member of staff had received any.

The home does hold regular residents' meetings, however copies of these minutes

were not available for us to view. The manager stated that minutes are not shared

with residents, thereby denying them the chance to check what is written is accurate

and that any decisions made are acted upon. The home does send out questionnaires

to residents and their visitors to get feedback about its service. We looked at these

and amongst some positive comments we noted a number of concerns regarding the

home's shabby exterior, the quality of the food, the lack of entertainment, and

inadequate heating had been raised. It was not clear what action, if any, the manager

had taken to address these concerns. The results of this survey had not been

published or shared with residents and their visitors.

The home holds money for some residents. We checked a sample of cash sheets and

receipts during our inspection of 19 January 2010 and found these to be satisfactory

with appropriate records and receipts kept to show how residents' money had beenspent.

We checked a number of records in relation to health and safety including fire alarm

tests, emergency lighting, water temperatures and stair lift which showed us the home

checks and services its equipment to ensure its safety. We undertook a tour of the

kitchen and noted that there were undated items of food stored in the kitchen fridge

and that the home's freezer needed defrosting to ensure it operates effectively.


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Are there any outstanding requirements from the last inspection?

Yes R No

Outstanding statutory requirementsThese are requirements that were set at the previous inspection, but have still notbeen met. They say what the registered person had to do to meet the Care StandardsAct 2000, Care Homes Regulations 2001 and the National Minimum Standards.

No. Standard Regulation Requirement Timescale foraction

1 36 18 Staff must receive formalsupervision.

You must do this so their

working practices can bemonitored, their trainingneeds identified and so theyfeel supported.

01/03/2010


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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 requirementsThese requirements set out what the registered person must do to meet the CareStandards Act 2000, Care Homes Regulations 2001 and the National MinimumStandards. The registered person(s) must do this within the timescales we have set.

No.Standard Regulation Requirement Timescale foraction

1 2 5 Residents must be issued

with a contract of residence

at the point of moving into

the home.

You must do this to ensure

that they have information

about the terms andcondition of their stay and

the fees payable.

03/05/2010

2 7 15 Residents, or their

advocates must be actively

involved in reviewing their

care plans.

You must do this so they are

involved in decisions about

their care

01/06/2010

3 7 15 Residents' care plans must

be more detailed to reflect

all their health needs.

You must do this so staff

have the information they

need to provide residents

with comprehensive and

consistent care

01/06/2010


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Statutory requirementsThese requirements set out what the registered person must do to meet the CareStandards Act 2000, Care Homes Regulations 2001 and the National MinimumStandards. The registered person(s) must do this within the timescales we have set.

No. Standard Regulation Requirement Timescale foraction

4 16 22 A written record of all

complaints received , along

with their investigation and

outcome must be kept.


that residents' complaints

are monitored and

responded to professionally.

03/05/2010

5 24 23 Residents must be able tolock their bedroom doors.

You must to do this to

ensure they have privacy

and security.

01/06/2010

6 33 24 The results of any surveys

or reviews of care conducted

by the home must be made

available to residents.


residents get feedback about

the service which they

receive and to ensure that

any concerns raised are

dealt with.

01/06/2010

7 38 13 Any foodstuffs stored in thehome's fridge must be

dated.


that residents receive fresh

and safe food.

03/05/2010


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RecommendationsThese recommendations are taken from the best practice described in the NationalMinimum Standards and the registered person(s) should consider them as a way ofimproving their service.

No Refer to Standard Good Practice Recommendations

1 9 Hand written additions to the printed MAR sheets should be

signed and dated and checked by a second person toensure their accuracy.

2 10 Laundry systems at the home should be reviewed to ensurethat residents' clothing is washed correctly.

3 14 The serving of meals should be reviewed to ensure thatresidents receive their food whilst it is still hot.

4 18 Information about how to deal with adult protectionconcerns should be updated so it is line with local reportingguidelines.

5 26 Access to the kitchen by care staff must be limited toprevent the spread of infection.

6 33 Minutes of residents' meetings should be shared with allthose who attended.


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Helpline:

Telephone: 03000 616161Email: [email protected]: 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.

Copyright (2009) Care Quality Commission (CQC). This publication may be

reproduced in whole or in part, free of charge, in any format or medium provided that it

is not used for commercial gain. This consent is subject to the material being

reproduced accurately and on proviso that it is not used in a derogatory manner or

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title and date of publication of the document specified.

Documents

Laburnum Lodge CQC