CARE HOME ADULTS 18-65
67-71 Lansdowne Road Aylestone Leicester Leicestershire LE2 8AS Lead Inspector
Joanna Carrington Key Unannounced Inspection 11th December 2006 10:00 67-71 Lansdowne Road DS0000006412.V320747.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 67-71 Lansdowne Road DS0000006412.V320747.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. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 67-71 Lansdowne Road Address Aylestone Leicester Leicestershire LE2 8AS 0116 283 4025 0116 283 4025 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) Lansdowne Road Limited Ms Lesley Wakefield Care Home 28 Category(ies) of Learning disability (28) registration, with number of places 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No additional conditions of registration apply Date of last inspection 25th October 2005 Brief Description of the Service: 67-71 Lansdowne Road is registered to provide care and accommodation for up to twenty-eight adults with a learning disability. The home is divided into four self-contained units for service users with differing levels of need and ability. There is a large outdoor area to the rear of the property. The home is situated close to Aylestone Road and is approximately one mile from the city centre. A regular bus service to and from the centre can be accessed close to the home. A number of shops, parks and a leisure centre are located nearby. The fees for care and accommodation depend on assessed need and at the time of the inspection ranged from £317 to £916.53 per week. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s key inspection and took place over seven hours on 11th December 2006. The main method of inspection was called ‘case tracking’ which meant selecting three service users and tracking the quality of their care by checking records, discussion with them and with staff and observation of care practices. Altogether, four service users and two staff members were spoken with during the course of the inspection. Staff records were looked at and a partial tour of the premises also took place in order to assess environmental standards. Information gathered prior to the inspection has also been used to reach judgements about the quality of care. The registered manager was available for discussion and feedback throughout the inspection. What the service does well: What has improved since the last inspection?
67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 6 There are some improvements that are currently in progress. Care plans are being updated so that they are more person-centred. A recommendation has been added to this report for this work to continue for all people that live at the home. 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. 67-71 Lansdowne Road DS0000006412.V320747.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 67-71 Lansdowne Road DS0000006412.V320747.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): 2 Quality in this outcome area is good. The admissions procedure is good in ensuring the home is suitable in meeting prospective service users’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users case tracked had on their files comprehensive assessments of their needs. This included the placing authority’s community care assessments and those generated at the home. From discussion with staff and residents it was clear that these assessments reflected residents needs accurately. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. There are good arrangements in place for planning how needs and choices are met but more individualised records will aid this process. Service users are supported to take managed risks and to be in control of their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service users were selected to be case tracked because of a series of notifications that the Commission receiving relating to them. With regards to the issues highlighted in the notifications, on their files there are relevant care plans and risk assessments in place, that are reviewed monthly, in order to promote these service users’ independence and safety and to ensure the staff team support them with these issues appropriately. Staff members spoken with are fully aware of the individualised procedures they are to follow, as stated in the care plans. One service user case tracked has identified needs around communication and staff spoken with gave good examples of how they enable this service user to make choices in his life, for example with meals and activities. The service
67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 10 user has a communication plan, which tells staff how to know when he is in pain, or angry and it also states what will make him angry and what are his likes and dislikes. Service users spoken with confirmed they are happy with the level of support they get and are proud to be able to go out independently and have responsibilities in managing their own home, with the help of staff. It was noted that some of the care plans and risk assessments are standardised and contain the same information, as opposed to recording information that is specific to individuals. The registered manager explained that significant changes are being made to care plans right now, and some examples of new care plans were shown for one of the service users case tracked. As this work is not yet complete, a recommendation is made in respect of this. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 11 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, 15, 16 and 17 Quality in this outcome area is good. There is a commitment from the staff team in promoting service users’ rights and enabling service users’ to experience a fulfilling quality lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some service users have organised day services provided by staff employed at the home. On the day of the inspection there were painting activities in the morning then they went out for lunch. Other service users choose to go to college while others prefer not to have structured days. Two service users spoken with enjoy going out when they want to and seeing their friends but also enjoy going on organised trips. Service users have recently enjoyed a day out to the sea life centre and a service user spoken with said she likes going to the disco every week. One service user case tracked has one to one support with staff, and goes out for breakfast and a walk each morning. This is to help the service user not become withdrawn or isolated. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 12 On the day of the inspection a service user went to the shops with a staff member to buy her mum a birthday card. Staff members spoken with explained how they support service users to maintain contact with family and friends by writing letters to service users, using the telephone and by having regular visits. Staff were observed interacting with service users in a respectful and meaningful manner. Care plans clearly identify when there are restrictions on individuals’ liberty and freedom, and why this is necessary for their safety and protection. Menus seen on the day of the inspection and supplied with the pre-inspection questionnaire indicate that meals are varied and nutritious. Service users spoken with commented that the meals are nice. On the day of the inspection the meal was meatballs and pasta. Service users were observed enjoying their mealtime. It was noted in the food stocks that there is very little fresh vegetables, only frozen. A staff member stated that service users have asked for some fresh vegetables. This is made a recommendation. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 13 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. Service users’ health and personal care needs are well met and medicine management promotes the safety of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE:
There are care plans in place that identify how individuals’ personal care needs are met, including when only prompting is required. Service users’ spoken with confirmed they can go to bed when they wish. Appointment records on the care files seen indicate that the relevant health care professionals such as community nurses and psychiatrists are involved when appropriate. It is apparent from appointment records that service users have regular checks at the dentist and opticians. Weight is monitored monthly, for the promotion of good health. The medication administration records were looked at and appeared to be in order. There are clear instructions for how medicines are given and codes have been used that provide explanation when medicines have not been given as prescribed for example, if the service user has refused or they have been in hospital. Three drugs were audited and the quantities recorded tallied with what drugs remained. Training records and staff spoken with confirmed that they do not have responsibilities for administering medication until they have been trained.
67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 14 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. Service users are enabled to complain and feel that their views will be listened to. Service users will only be fully protected once all staff are aware of their responsibilities in accordance with Safeguarding Adults policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users spoken with know how to make a complaint and feel assured that their concerns are taken seriously and acted on. The Complaints Procedure is displayed in a format using symbols which makes it more accessible to service users. There has been one complaint since last inspection. Records seen indicate that this complaint was responded to appropriately and has been resolved. Training records show that all staff members have training on adult abuse. A learning need nonetheless was identified during the inspection. When given a scenario and asked how to respond one staff member did not have an understanding of their responsibility to inform their manager when a service user discloses abuse, and when confidential information must be shared on a need to know basis. A recommendation to address this is made in the report. There are ongoing adult protection issues concerning a service user case tracked. Their care plans and other relevant documentation seen confirm that a multi-agency approach is being taken in line with local safeguarding adults policy and procedures. The community learning disability team are working with staff at the home and the service user in promoting their safety and protection.
67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 15 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 poor. Although it is clean and hygienic more urgent attention to the environment is required so that it is safe, comfortable and homely for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On a partial tour of the premises the environment appeared clean however, there were parts of the home where there were strong malodours. The laundry facilities are neither adequate nor appropriate to the needs of service users. The washing machine in the house where service users are more independent is out of order. Domestic washers and driers are supplied in the main laundry room and are not appropriate to meet the needs of service users. There is no ventilation in the laundry room and the conditions in there when the washing machines are in use, is hot and damp. Throughout the home, in communal areas and in bedrooms the carpets are worn, look dirty and are very stained. Furniture in communal areas and in the bedrooms seen is old, torn and in urgent need of replacing. In the main lounge an unused incontinence sheet had been left placed on an armchair, which does not promote service users’ dignity.
67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 16 Work to the general décor and environment has been an issue at the last two inspections. Due to the extent of work still to be done a requirement in respect of the above is made in this report. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. Service users benefit from a well trained and supported staff team and recruitment practices protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The training records seen indicate that all staff receive the necessary mandatory training and updates, such as fire safety, infection control and first aid. Other courses that are relevant to the needs of service users are accessed. A staff member spoken with said that training opportunities are ‘fantastic’ and reported that recent training on autism and bi-polar disorder has been invaluable in supporting service users with these needs. The preinspection questionnaire states that fifty percent of the staff team are already qualified to at least National Vocational Qualification (NVQ) level 2. An NVQ assessor was visiting on the afternoon of the inspection to assess other staff that are in the process of acquiring the qualification. Four staff files were randomly selected and all were found to contain evidence of two written references and a satisfactory criminal record bureau check, before each staff member commenced their employment. Staff have regular supervision, which is an important element of their support. Supervision records were seen on the selected files. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 18 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, 39 and 42 Quality in this outcome area is good. The home is well run, with the views of service users and stakeholders underpinning developments to the service. The health, safety and welfare of service users is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager has been registered with the Commission for Social Care Inspection. There are different ways that the quality of the service is monitored in the home. The views of service users are obtained from their house meetings where service users can say what they think and share ideas and any problems. Questionnaires are also given out to service users and relatives, which ask about particular aspects regarding the running of the home. Questionnaires are due to go out. The registered manager carries out regular checks on health and safety, records and the environment. Quality audits carried out internally have recognised the urgent need for the décor and
67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 19 furnishings to be updated, as identified at this inspection. Monthlyunannounced visits are also carried out, in line with Care Home Regulations. It was observed on a tour of the premises that all substances hazardous to health are stored securely in accordance with COSHH regulations. The preinspection questionnaire indicates that the servicing of equipment and electrical and gas systems are all up to date. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 20 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 21 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 YA24 Regulation 16, 23 Requirement Ensure that the environment is well-maintained and adequate furniture and furnishings are provided. Supply to the Commission by the timescale a maintenance and renewal plan, which includes completion dates for the necessary work. This must include: 1. Stained carpets 2. Elimination of malodours 3. Provision of new furniture in communal areas and bedrooms 4. General decor Timescale for action 11/02/07 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 22 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. 3. 4. Refer to Standard YA6 YA17 YA23 YA30 Good Practice Recommendations Ensure that the care plan format used allows for more personalised information / a person-centred approach. Supply some fresh vegetables as well as frozen. Ensure all staff are aware of their responsibilities in accordance with Safeguarding Adults and Whistle blowing procedures. Ensure laundry facilities are appropriate to the needs of services users. Industrial washing machine is more appropriate. 67-71 Lansdowne Road DS0000006412.V320747.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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
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