Inspection on 06/03/06 for David Lewis Centre Adult Assessment Unit

This inspection was carried out on 6th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

David Lewis Centre Adult... 05/03/07

David Lewis Centre Adult... 28/06/05

David Lewis Centre Adult... 03/02/05

David Lewis Centre Adult... 16/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 David Lewis Centre Adult Assessment Unit Assessment Unit Mill Lane Warford Alderley Edge Cheshire SK9 7UD Lead Inspector Helena Dennett Announced Inspection 6th March 2006 09:30 David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service David Lewis Centre Adult Assessment Unit Address 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) Assessment Unit Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640159 01565 640355 lynnsharrock@davidlewis.org.uk David Lewis Organisation Miss Lynn Sharrock Care Home 9 Category(ies) of Learning disability (9), Mental disorder, registration, with number excluding learning disability or dementia (9), of places Physical disability (2) David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This service is registered for a maximum of 9 service users who suffer from seizure disorders to include: * Up to 9 service users in the category of MD (mental disorder excluding learning disability or dementia) * Up to 9 service users in the category of LD (learning disability) * Up to 1 service users in the category of PD (physical disability) * One named service user in the category PD (physical disability) under the age of 18 years The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The registered manager must obtain a nationally recognised qualification, at Level 4 NVQ or equivalent, in management before 1st April 2005 Service users accommodated for short stay periods must be 18 years and above Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 28th June 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: The David Lewis centre is set in 170 acres of land and has a village atmosphere. The Centre’s drives are tree lined and there are extensive wellmaintained garden gardens and playing fields. There is a swimming pool, gymnasium, workshops and a social club. There is also a school and college on the site. The grounds are pleasant and well cared for. The Adult Assessment Unit is a nine-bedded unit and its purpose is to provide an informal environment for detailed assessment of adults with complex epilepsy and other associated problems. The unit has nine single rooms, including one suitable for disabled persons, and two video telemetry rooms. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service was inspected as part of an announced co-ordinated inspection of all the DLC services registered with CSCI. The purpose of this approach was to evaluate the effectiveness of the Centre in supporting each unit to improve outcomes for the people who live there. The co-ordinated inspection took place over five days and involved a team of eight inspection personnel from CSCI, including a service inspector, a regulation manager, a pharmacist and regulatory inspectors. The inspection also focused on how national minimum standards were being met across the registered services and what progress had been made to meet requirements from the last round of inspections carried out in the period from April to August 2005. As part of the preparation for the inspection, the management staff at the David Lewis Centre produced self - assessment reports which summarised practice in the individual registered units and for the whole of the service. Before the start of the inspection, the inspection team carried out a number of surveys with placing agencies, parents, carers, service users and staff. During the inspection, the service inspector and regulation manager carried out a schedule of interviews with representatives of the Trustees, senior staff, operational managers and staff responsible for clinical, administrative and technical support to the centre. The inspection process included: tours of the premises; discussions with service users and their carers; meetings with senior centre managers and staff; visits to the centre laundry, transport and the central kitchen; meetings with clinical staff; and included an evening visit. The process enabled the inspection team to obtain a clear understanding of the factors influencing development and from the evidence gathered the team were able to form judgements on the quality and effectiveness of the services provided and the outcomes for those receiving services at the David Lewis Centre. The purpose of the Adult Assessment Unit is to provide an informal environment for the detailed assessment of adults with complex epilepsy and other associated problems. Video Telemetry is used. This involves staying in a specificially equipped room (usually overnight) whilst the video records the patient’s activities and the EEG records brain activity. Due to the nature of the treatment and the fact that patients stay between two and six weeks, some of the national minimum standards are not applicable to this unit. The people spoken with referred to themselves and others on the unit as ‘patients’. Therefore this term is used throughout the report. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 6 What the service does well: 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. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 the following standard(s): 1&2 The statement of purpose does not provide accurate information on the age range of patients that can be admitted to the unit, so may be misleading. An assessment by healthcare professionals is always completed before referral to the unit so that patients’ needs can be met when admitted. EVIDENCE: The statement of purpose states that the unit can admit 16-18 year old persons for assessment. This is not in line with the current registration of the unit and must be changed so that potential patients are not provided with inaccurate information. The previous manager’s name is also identified on the statement of purpose. This needs to be changed. Patients are admitted for assessment from various parts of the country. The unit accepts referrals from consultants. Where possible, the unit staff try to visit patients in their own homes before admission. See Requirement 1. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 8 & 9. The individual care plans provided comprehensive details of the care and treatment necessary so that patients are confident that their needs will be met. Patients are consulted and agreement sought on the restrictions placed on them so that a thorough assessment of their needs can be made. EVIDENCE: Two of the patients spoken with were very positive about the unit. They were very positive about the assessment process and confirmed that restrictions placed on them whilst undergoing the assessment process had been discussed in full with them. Individual plans of care were in place for each patient on the unit. One patient’s care file was looked at in detail. There were individual care plans in place. These were found to be very comprehensive, containing all relevant information on the health and well being of the patient, kept up to date, and current. Records of healthcare professionals involvement were maintained. The daily records were comprehensive and detailed. Risk assessments were in place. The care files were kept securely so that confidentiality is maintained. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 the following standard(s): 12, 16 & 17 There are enough activities offered around the Centre to meet the needs of the patients and to keep them stimulated. Within the constraints of their treatment, patients can choose how they spend their time, which enables them to keep control over their lives. Visitors are welcomed at any reasonable time and there is a marked improvement in the catering service with the standard of food much improved so that patients can maintain a healthy diet. EVIDENCE: There is a range of activities at the David Lewis Centre that patients can access depending on the assessment process and treatment they require. Video-telemetry is used as a diagnostic tool and does affect the daily life of the patient who is undergoing this type of assessment. This is agreed and consent given before the treatment starts. There is a large comfortable lounge on the unit for patients to use, a pool table next to the dining area and outdoor areas for walks etc. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 11 Patients said that their visitors are welcomed at any reasonable time of the day. Members of staff confirmed that the food, including the choice and quality of meals, has improved since the last inspection. The patients spoken with said that the food was ‘marvellous’. 95 of the food offered to service users and patients using the centre is now fresh produce. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 & 20 Patients on the unit are given the appropriate personal and healthcare support they need to make sure that their needs are met in full during their stay on the unit. EVIDENCE: The patients spoken with said that the staff on the unit were excellent. They felt their privacy, dignity and choice were maintained as far as possible within the constraints of their treatment. One patient said that the stay on the Adult Assessment Unit has made a difference to her life. There was evidence in the plan of care that staff were meeting the physical and emotional needs of the patients. Diagnostic tests are undertaken as deemed necessary by staff on the unit. The David Lewis Centre Medicines Management Policy was approved and implemented on 6th September 2005. The CSCI pharmacist within the inspection team has recently studied the policy and a number of areas for change and improvement are currently under discussion. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 the following standard(s): 22 & 23 There is a complaints policy but no clear procedure for staff to follow. The Centre’s policies and procedures for protecting residents are unsatisfactory and do not consistently safeguard service users. EVIDENCE: Although there have been no complaints made to the unit since the last inspection, some issues relating to the handling of complaints across the centre were identified. The complaints policy being used in this unit is not the same as the Centre’s complaints policy. Following discussion with the manager of the protection and social work department, it was clear that there is a lack of clarity in distinguishing between issues of adult protection and concerns. Discussions with the Senior Behavioural Support Advisor and the Clinical Psychologist provided evidence of a new behaviour management strategy being developed to be introduced throughout the Centre. Currently carers of adults receive training in different models of physical intervention. See Requirement 2. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 the following standard(s): 24 & 30 The environment is well maintained, clean and tidy, with a programme of decoration in place to ensure that it is comfortable for patients to use. EVIDENCE: A programme of decoration is in place. Some of the bedroom furniture has been replaced since the last inspection. Parts of the corridors have been decorated with plans to complete this in the near future. . There is a separate dining room situated off the kitchenette with a pool table at the back of the room. Bedrooms are not homely as they are clinical in appearance. Staff of the unit commented in the information provided before the inspection: ‘The AAU is not a long stay unit and due to the nature of our assessments we maintain that it is not appropriate to become too homely. Pictures on walls, ornaments in bedrooms can be used as weapons during ictal/post ictal behaviours. However we do encourage patients to bring in small personal belongings.’ The manager confirmed that a review of the cleaning rotas has been undertaken to ensure that the unit is kept clean and tidy. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. There were enough staff on duty to meet the needs of the residents. Although most staff have had training to be competent to do their jobs, several members of care staff have not had training in dealing with patients with mental health needs so may not be able to meet their needs adequately. EVIDENCE: Staffing levels are adequate to meet the needs of the patients. Patients were very complimentary about the staff. Members of staff said that they are offered training regularly but none of the care staff has attended training on mental health needs of patients. This was a recommendation made at the last inspection. The staff survey returned to the CSCI before the inspection indicated that staff feel well supported on the unit and that regular supervision sessions take place. The appraisal system is currently under review with an expectation that a new system will commence April/May 06. A sample of nursing staff personnel records who worked at the centre was examined. There was no evidence that nurses’ PIN numbers with the Nursing and Midwifery Council are checked by the David Lewis Centre before David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 16 employment. There was no health declaration or record of immunisation/vaccination for some of the registered nurses. See Requirement 3 & Recommendation 1. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 42 The unit is well run, with trained staff and carers providing good care and treatment for patients. The induction and training of staff is well co-ordinated by the training centre so that staff have a basic level of competence when they start work in the unit. The trustee board and centre directors are actively engaged in developing a clear vision for the service and prioritising developmental areas and projects. EVIDENCE: The registered manager of the Adult Assessment Unit has resigned her position since the last inspection. An acting manger is in post until a new manager has been appointed. The acting manager knows the unit. Patients said that all the staff are approachable. Staff and patient meetings are held regularly. Staff meetings for nursing staff and care staff are also held regularly. The David Lewis Centre has its own training centre on the site that coordinates the induction and foundation programmes for all staff. The induction David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 18 process has been developed into a two week programme, which is relevant and comprehensive. There are written policies and procedures in place for the Centre and the unit. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 19 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 2 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x X X X 3 X David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 20 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 Standard YA1 Regulation 4 Requirement Timescale for action 31/05/06 2 YA22 22 3 YA34 19 The statement of purpose must be changed to ensure that it contains up to date and accurate information on the services the unit provides that is in line with registration of the home. The registered person must 01/05/06 ensure that the complaints policy used on the Adult Assessment Unit is the same as the policy used across the Centre. All the necessary checks 31/05/06 identified under this regulation must be carried out before a member of staff is employed to work at the home 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 YA35 Good Practice Recommendations Training on mental health should be provided to care staff. David Lewis Centre Adult Assessment Unit DS0000018800.V277724.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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