We inspected Laburnum House on 22 and 23 August 2017. The inspection was unannounced.

We last inspected Laburnum house in June 2016 where we found breaches of three of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines management, infection control and governance of the service.

Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

During this inspection, we found improvements had been made. We made one recommendation. This was in relation to privacy and confidentiality.

Laburnum House is registered to provide personal care and accommodation for up to 34 people. There were 28 people using the service at the time of this inspection. Laburnum House is a purpose built care home situated close to the centre of Shaw in Oldham. Accommodation is provided in single rooms spread over two floors, with access to the upper floor provided by a passenger lift and stair lift. There are three good-sized communal areas on the ground floor. There is an area for parking at the front of the home and an enclosed garden to the rear.

The home had a manager who was currently going through the process of registering with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Since our last inspection in June 2016 the previous registered manager had left and a new manager had taken up the position in May 2017. They were in the process of registering with the CQC to manage the service.

The home was clean and free from any unpleasant odours. The communal areas were well maintained and decorated to a high standard. Procedures were in place to prevent and control the spread of infection. Environmental checks of the home, such as for the gas and electricity supply were up-to-date.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

Medicines were stored safely and were administered by staff who had received appropriate training and been assessed as competent to safely administer medicines.

Staff had undertaken training to provide them with the skills and knowledge required for their roles. They received regular supervision and an annual appraisal.

Staff encouraged people to make choices where they were able to and sought consent before undertaking care. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were happy with the choice and quality of food. Where people were found to be at risk of malnutrition they had been referred to a dietician for specialist help. People had good access to other health professionals when needed.

People were complimentary about the caring nature of the staff and our observations during the inspection confirmed this. Care plans, which were reviewed regularly, were detailed and reflected the needs of each individual.

There were a range of policies available for staff to refer to for guidance on best practice. Systems were in place to monitor the quality of the service and drive improvement.

This inspection took place on the 27 and 28 June 2016. Our visit on the 27 June was unannounced.

We last inspected Laburnum House in April 2014. At that inspection we found that the service was meeting all the regulations we assessed.

Laburnum House is a purpose built care home situated close to the centre of Shaw in Oldham. It provides accommodation for up to 34 people, some of whom have dementia. At the time of our inspection there were 31 people living at the home. Accommodation is provided in single rooms: 8 rooms have en-suite facilities, and is spread over two floors with access to the upper floor provided by a passenger lift. There are three lounges on the ground floor, with dining areas incorporated.

There is parking at the front of the home, and good-sized gardens with wheelchair access which are laid with lawn and flower beds. There is a paved seating area outside with garden furniture.

When we visited the service a registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines management, staff training, infection control and governance systems. You can see what action we told the provider to take at the back of the full version of this report.

Although we saw that medicines were administered safely, there was not a robust system in place to ensure that the application of medicinal creams was recorded correctly.

Although staff had undertaken a variety of training to ensure they had the skills and knowledge required to care for people, we found that not all staff were up-to-date with their annual mandatory training, such as infection control and safeguarding vulnerable adults. Staff received regular supervision which helped the registered manager monitor the standard of care provided by staff.

We saw that some staff did not always follow good infection control practices, as they wore long-sleeves at work and some staff wore jewellery, which may harbour bacteria. There was an unpleasant smell in the main lounge which the registered manager told us came from the carpet. We recommend that the service take steps to replace the carpet in this room.

Recruitment checks had been carried out on all staff to ensure that they were suitable to work in a care setting with vulnerable people, and we found that there were sufficient numbers of staff on duty to care for people living at the home.

The building was well-maintained and environmental checks of the home were up-to-date.

People were supported to eat and drink sufficient amounts to meet their needs and they told us the quality of food was good. A variety of activities were available for people to participate in.

People who used the service were unable to participate in any religious service in the home. A death in the local clergy had meant their regular visits to the home had discontinued. We recommended that the home take steps to re-establish contact with the local faith community so that people who use the service could be supported to actively express their faith if they wished. Subsequent to our inspection we were informed that a priest had visited the home on two occasions and conducted services and that this was to become a regular occurrence.

People we spoke with were complimentary about the staff and we saw kind and caring interactions between staff and people who used the service. People’s support plans were ‘person-centred’ and were reviewed regularly.

People were supported to maintain good health and where needed specialist healthcare professional were involved with their care.

The home had a suppor

Our inspection of Laburnum House was made up of a visit to the home by an inspector.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, hairdresser, the staff supporting them and looking at records. We also spoke by telephone with the district nurse and dietician and obtained a report produced after a quality monitoring visit from Oldham Social Services in March 2013.

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

Is the service safe?

People we spoke with told us that they were treated with respect by the staff team. One person told us “Absolutely – I am treated with respect”. One of the family members we spoke with said that they felt comfortable in leaving their relative at the home and that they were safe.

Training was in place to protect the people who lived at Laburnum House such as moving and handling, safeguarding adults and health and safety.

No training however had taken place with regard to the Mental Capacity Act and Deprivation of Liberty Safeguards. However we discussed this with the deputy manager who demonstrated some knowledge and understanding about ‘best interest’ meetings which are necessary should a person not have the capacity to make major decisions about their care and well-being. We spoke with one of the senior care workers who was not aware of the requirements of the Mental Capacity Act. We discussed with the deputy manager the need for training with regard to the Mental Capacity so that all senior staff and managers have a full awareness of the Mental Capacity Act. This knowledge could them be cascaded down to other care workers to ensure that people are fully protected when decisions are necessary regarding their health and personal care needs.

Laburnum House was clean, safe and hygienic. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk.

The recruitment procedure contained all the necessary processes such obtaining references and police checks to ensure that as far as possible only suitable people were employed. We were told that the home had a low staff turnover and that there had only been one new member of staff in the last twelve months.

All but one member of staff had a National Vocational Qualification. With the exception of MCA training other training was in place and mostly undertaken though e-learning distance learning packages. This helped to ensure that the staff team had the qualifications and skills to meet people’s needs.

We were told by the people at Laburnum House that for the most part there was enough staff on duty to meet their needs. We were also told that new care workers were in the process of being recruited as the number of people living at Laburnum House had increased and the home was now full. This meant that the management of Laburnum House were acting responsibly to ensure that there would always be sufficient staff on duty.

Is the service effective?

One person told us “They (staff) look after me really well”. The family members we spoke with said that they were kept informed about their relatives care. They also told us that if they felt they had any concerns they were comfortable in talking with the Manager.

We saw from the care plans and talking with other health care professionals who visited the home; district nurse and dietician that people received appropriate care to meet their needs.

The home was purpose built which meant that there were wide corridors, toilets and doorways which allowed easy access for those people who may use a wheelchair. There was also a hoist, assisted bath and shower room in place.

Is the service caring?

People told us that they had no concerns about the care they received. One person told us “They always do what I want them to do.” One person did tell us that they thought some people were made a ‘fuss of’ more than others. However everyone we spoke with said that that they could get up when they wanted and go to bed when they wanted. There was choice for the main meal apart from Wednesday and Friday but an alternative would be provided if someone did not like the meal being served.

A family member told us “I had looked at a few homes but liked this one the best – people were friendly and just couldn’t do enough”.

No one we spoke with including other healthcare professionals said that they had any concerns about the care provided.

Is the service responsive?

We saw that people’s needs were assessed before they were admitted to the home to ensure that their needs could be met.

We saw risk assessments in place that reflected the persons care needs to ensure that they received appropriate care. The risk assessments were reviewed monthly by the Manager to ensure that they were up to date. We also saw a letter from a family member that had been written in response to the manager’s request for views on their relatives care plan.

We were told that a care worker was designated to organise activities each afternoon between 2pm and 4pm. Also a trip to Blackpool and a local garden centre had taken place the previous summer. Bingo and one to one sessions took place within the home. One of the family members played dominoes with their relative during their visit. We did see from the results of a previous survey conducted by the managers that some people thought that the activities on offer could be improved.

Is the service well-led?

We saw that Laburnum House had obtained the International Standardisation Organisation (ISO) accreditation award. We also saw that Laburnum House had the Investors in People Award. Both of these awards are given to an organisations who meet a set of standards to improve their performance and realise their objectives through the good management and development of their people.

The awards are reviewed every few years. The service had recently been audited for the ISO award and there next review will take place in 2017.

The Investors in People award is scheduled for review in June 2014.

We were also shown completed questionnaires that had been sent to the people who used the service and/or family members asking for their views and opinions of the care provided.

We were told by one of the family members we spoke with that anything that they may bring to the attention of the Manager was always dealt with.

We spoke with three people living at the home. One person told us they had "no complaints" about the food they were served. The others said the food was "lovely" and they "enjoy every meal we have".

Staff had completed training on safeguarding vulnerable adults. They were supported by internal policies and procedures to help the identify the possibility of abuse and prevent it before it occurred. Copies of the Oldham Local Authority safeguarding policy were readily available to staff, people living at the home and visitors.

The provider had appropriate arrangements in place to manage medicines safely and effectively. All the staff dispensing medications were trained to do so.

The Manager told us there was low staff turnover. There were sufficient numbers of suitably qualified, skilled and experienced people on duty to meet the needs of those living at the home. The provider was able to respond to unexpected changes in circumstances.

All members of staff had supervision sessions every six months and an annual appraisal. We saw that staff had completed mandatory training in subjects such as manual handling and fire safety. Staff were offered National Vocational Qualification (NVQ) training.

During our inspection we spoke with three people who lived at Laburnum House Shaw Limited. One of the people we spoke with told us they went on different trips and had choices about how they spent their day. They commented "At my age I want to get as much in as I can" and another said "[The staff] tend to know when I need help. They do very well"

All the people we spoke with told us they were treated with respect by care workers. One person said "Everyone here is very kind and good" and another said "I don't know how [the staff] have the patience with us, but they have".

When asked if there were enough staff one of the people we spoke with said "There's more than enough staff to look after us" and another said "Staff are very quick, you don't have to wait". We spoke with one person who said "[The staff] come as quickly as they can but sometimes they're exceptionally busy".

We saw the results of the home's satisfaction survey that was carried out in August 2012. Most people rated the attitude of staff to people as 'excellent'. This this rating was also given by most people when asked their opinion about being kept informed and involved.