CARE HOME ADULTS 18-65
Loppington House Wem Shrewsbury Shrops SY4 5NF Lead Inspector
Janet Oxley Unannounced 21 June 2005 10.00
st 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 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 Stationary 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. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Loppington House Address Loppington, Wem, Shrewsbury SY4 5NF 01939233926 01939 235255 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Loppington House Ltd Peter James Warburton PC Care Home 36 Category(ies) of Learning Disability - 36 registration, with number of places Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14 February 2005 Brief Description of the Service: Loppington House is a further education unit and adult centre established in 1983.The establishment is situated in the rural North Shropshire countryside close to the small market town of Wem and just 14 miles away from the historic town of Shrewsbury. Loppington House is registered with the Commission of Social Care Inspection (CSCI) to provide accommodation and care for a maximum of thirty six people with a learning disability. The accommodation comprises of a main house, which provides the education resources on the ground floor and residential accommodation on the first floor, two detached houses in the grounds and two bungalows. In addition there is a small swimming pool, an office and a separate flat that accommodates up to six visitors. Loppington House Ltd owns the home and the Registered Provider is its Director, Mr Paul Harris. Mr Peter Warburton is the Registered Manager.The company own and manage two additional registered care homes for people with a learning disability in Whittington and in Wem. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and commenced at 9.45am. It included observing activity within the home, inspecting the premises, looking at records and case tracking and talking to 7 staff. The Registered Provider, Manager and staff on duty were welcoming and helpful throughout the inspection. It was found that the National Minimum Standards assessed had been met with only minor exceptions and that the overall quality of care provided was satisfactory. All service users appeared happy, content and well cared for and those who were able expressed satisfaction with their quality of life at the home. Visitors, relatives and visiting professionals have also expressed satisfaction with the service and care the service users are receiving and have been complimentary regarding the management and care practices at the home. What the service does well:
This is a home and further education unit for adults with learning difficulties where the service users are looked after well. The staff respect the service users, provide a stimulating environment and follow detailed individual care plans, the documentation and format of which is focused on improvement and development, encouraging each to maintain and improve skill levels and take part in a wide variety of activities that they evidently enjoy and benefit from. The building and grounds provide a pleasant and personalised environment to live in. It was evident through discussions with staff and manager that there are clear lines of accountability within the homes management structure and through discussions and observations it was considered that the management approach created an open and positive atmosphere from which the service users benefit. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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.
Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The policies and procedures that are in place, and have been professionally followed, ensure that the home undertakes all necessary assessments for successful and satisfactory admissions to take place. EVIDENCE: In the past year only one person has been admitted to Loppington, that was in January 2005, before the last inspection when perusal of the service users file evidenced that a comprehensive pre-admission assessment had been undertaken by the Registered Manager and the Head of Education. The assessment took place at the prospective service users’ previous placement. The organisation had obtained two education reports. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Each service user has a comprehensive and updated care plan, which includes aspects of daily living and care they require. Staff evidently respect service users rights and there is a constant monitoring and review process to ensure their identified needs are being met and individualised care given. EVIDENCE: Individual care plans continue to be improved and the Manager has attended training in Personal Centred Planning. These plans are regularly reviewed and all significant professionals are involved. The organisation has commissioned an external speech and language team to develop individual skills and to train all the staff in the use of Makaton. At the time of this inspection it had been identified that the home could no longer meet the needs of one service user, whose health had significantly deteriorated and it was considered that the home was working sensitively and professionally with the placing authority to find an alternative and satisfactory placement for the individual, who has lived at Loppington House for many years. Advocacy services are now well used and the registered provider is the Chairman of the PCAS advocacy service. Risk assessments are undertaken prior to admission and are ongoing.
Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 16 and 17. The lifestyle of the service users living at this home is good and through a framework of activities, independence, personal and social skills they are encouraged to develop. Family ties are maintained and regular visits home and meetings with relatives are encouraged and supported. EVIDENCE: Loppington House provides an educational centre on site that is inspected by the Office for Standards in Education (Ofsted). Service users were seen to be actively engaged in a number of activities and skill groups. A number of service users’ attend educational courses at Telford College and the organisation has a retail shop and workshop based in Wem. Transport is provided by the home and the service users have access to two minibuses and two people carriers for visits and participating in the local community. Observation and discussions indicated that the routines in the home continue to promote independence and individual choices as far as possible.
Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 11 The menus and the meal seen indicated that the catering provided in the home continues to be excellent, a healthy eating award has been obtained and fresh produce from the garden, attended to by the service users, is used. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The health and personal needs of service users are well met with evidence of regular review and of good multi disciplinary working taking place on a regular basis. EVIDENCE: Service user’s records and discussions with staff indicated that the staff continue to carefully monitor health needs, make appropriate referrals and appointments to health care professionals. The Management and staff have recently engaged the help and advice of a number of Health Care Professionals for a service user whose health has significantly deteriorated The support of Doctors and Consultants for all service users is ongoing Behavioural changes of service users are also carefully monitored and plans and risk assessments for activities are in place. At the time of this inspection it appeared that all aspects of the administration, recording and securing of medication was satisfactory apart from there being two items of out of date medicines in the medicine cupboard. The Medical Liaison Officer for Loppington has sought advice from the CSCI Pharmacist Inspector when necessary. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Loppinton House has appropriate policies and procedures in place for the protection of service users. EVIDENCE: No complaints have been received since the last inspection. A full complaints procedure is available and given that a number of the current service users would have some difficulty understanding the concept of a complaint it was evident that staff are sensitive and have developed methods to identify what service users like, dislike or object to and explore new avenues in efforts to overcome the difficulties. Robust procedures are in place to protect service users from abuse and are included in all aspects of staff training. The Adult Protection Procedure has been satisfactorily followed within the last year. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The standard of the environment within the home is generally satisfactory, providing service users with a good place live. Necessary improvements have been identified and are in hand. EVIDENCE: Although the accommodation provided overall is satisfactory, the main house in particular, is in need of some refurbishment and a full environmental audit of the premises took place on 15.02.05 by senior managers of the organisation. A number of bathrooms are in the process of being refurbished and there is an ongoing redecoration and replacement carpet plan. The laundry is also now in need of refurbishment. Grounds are accessible and well maintained. Many of the service users are involved in horticultural projects and use part of the grounds for this purpose. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Service users are supported by a well trained and committed staff group who appear to be meeting the needs of each individual in a sensitive and professional manner. EVIDENCE: A variety of training has been undertaken and staff on duty indicated that they were sensitive to the service users complex needs and that their attitudes and practice were monitored and supervised by the management. 87 of staff have now completed NVQ2 and 6 staff are to commence NVQ3 in the near future. Full training profiles are maintained. Annual appraisals take place, regular recorded supervision sessions are undertaken and staff meetings are held on a regular basis. Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 There are clear lines of accountability within the homes management structure and the management approach creates an open and positive atmosphere from which the service users benefit. The home regularly reviews aspects of its performance and meets the requirements of the Fire Officer and Health and Safety Officer, promoting the health, safety and welfare of the service users. EVIDENCE: The Manager is fully quailfied and experienced. The manner in which Mr Harris, the Manager, service users and staff responded to this inspection indicated that a sound management approach is in place and that staff are committed to achieving best practice and to developing equal opportunities. Health and Safety matters appeared satisfactory with the exception of toxic materials being left unsupervised and there being an unsatisfactory method of decanting some cleaning materials. All necessary records required are maintained and an external organisation carried out a Health and Safety inspection on 21/03/05.
Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Loppington House Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 18 No Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard 20.6 30.2 and 30.4. 42.4 Regulation 13(2) 13(3) 12(1) Requirement That all out of date medicines be disposed of correctly. That the laundry be refurbished to comply with the regulations. That the use of all toxic substances comply with the Control of Substances Hazardous to Health Regulations (COSHH) 1999. Timescale for action With immediate effect. 30/12/05 With immediate effect. 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. Refer to Standard Good Practice Recommendations Loppington House E56 S20698 Loppington UI 210605 V220135 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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