Inspection on 15/06/05 for The David Lewis College Residential Service

This inspection was carried out on 15th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The David Lewis College... 05/02/07

The David Lewis College... 06/03/06

The David Lewis College... 07/02/05

The David Lewis College... 26/04/04

The David Lewis College... 12/01/04

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Cuerden Grange Rest Home

Springfield Cottage

Parkside

Park Lodge

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

CARE HOME ADULTS 18-65 DAVID LEWIS CENTRE (UNIT 3) Mill Lane Warford, Alderley Edge SK9 7UD Lead Inspector Sue Dolley 2nd Inspector Judith Morton Announced 15-17 June 2005 09:00 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. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service David Lewis Centre (Unit 3) Address Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565-640000 01565 640100 enquiries@david lewis.org.uk David Lewis Organisation 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) registered managers to be proposed Care Home 42 Category(ies) of PD Physical Disability (42) registration, with number LD Learning Disabilities (42) of places DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This service is registered for a maximum of 42 service users in the categories of LD (learning disabilities) and PD (physical disabilities) aged between 16 and 25 years only 2 3 4 5 6 7 Up to 5 service users are to be accommodated in 50/51 Mill Lane Up to 19 service users are to be accommodated ar Elizabeth Maybin House Up to 6 service users are to be accommodated at 9/10 Mill Lane Up to 4 service users are to be accommodated at 7/8 Mill Lane Up to 8 service users are to be accommodated at Mullberry House 1 named service user over the age of 25 may be accommodated for a period of respite care in Elizabeth Maybin House Date of last inspection 7th, 8th and 9th February 2005 Brief Description of the Service: The David Lewis Centre is a specialist service for children and adults who have epilepsy, and associated conditions and problems. The centre is in rural Cheshire in 170 acres of grounds. Unit 3 consists 5 houses, these together with separate teaching accomodation form part of the David Lewis Further Education College. The college is a residential and day college. The inspection was of the 5 residential houses only.The houses include. 7/8 Mill Lane(4 places) 9/10 Mill Lane (6 places), 50/51 Mill Lane (5 places) Elizabeth Maybin (19 places), and Mulberry House (8 places).Some of the students who attend the college have complex medical needs and also learning difficulties, which in some cases require high levels of support. The service is designed to provide for students with one or more of the following: Intractable epilepsy Moderate to severe learning difficulties Challenging behaviour Autistic tendencies The David Lewis College offers a 24-hour cirriculum, which includes learning opportunities in the college, in the residential units, in the community and, where appropriate, on work experience placements. Individual programmes of residential support are available as 38 week placements or, with the inclusion respite care, 52week placements.There are a range of specialist clinical services on site. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection of the David Lewis Centre unit 3 was conducted over 3 days by two inspectors. Whilst many of the assessed National Minimum Standards were met or almost met, two standards were not met. Feedback was given to each house during the inspection and to all the houses in Unit 3 following the inspection. The majority of student comments were positive, indicating a good standard of care and positive relationships between students and staff members. A new report format was being developed and the supplementary standards for care homes relating to accommodating young people aged 16 and 17 have been considered during the inspection and in the production of this report. None of the students were aged 16 or 17. What the service does well: What has improved since the last inspection? Plans are underway to restructure the existing registration and to propose two service managers to become registered managers of the unit. Each will have management and support responsibilities for different houses within the unit. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 6 Currently a pilot project is ongoing which will lead to the introduction and use of a common care file across the site. This should significantly improve the standard of recording and organisation of student information. Across all houses daily reports accurately reflected the students situation and demonstrated continuity of care. Recording of administration of medication by staff members has improved and many students administer their own medication. Journal clubs have been introduced. These are open to all staff and provide staff with the opportunity to glean information on a wide variety of up to date information regarding care and support, medical developments and techniques etc. The journal clubs have proved to be a popular and useful resource for staff and give staff members the opportunity to hear professional speakers on a wide variety of topics to inform their practice. 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 (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 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 DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 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) 1,2,3,4 and 5 Information is provided to prospective and existing students for them to make an informed choice about where to be cared for and continue their education. Needs assessments are thoroughly completed. The majority of students have a written contract/statement of terms and conditions and all have access to advocacy services. The process of students moving into the college provision is well managed to make sure individual needs are met and students quickly settle into their new environment. EVIDENCE: The David Lewis College and College Residential Service have produced a statement of purpose and function. This gives details about the care and support offered and describes each of the residential houses. The statement of purpose within Elizabeth Maybin was informative but contained a lot of unnecessary and complex information regarding medical conditions and procedures and the assessment process. Advice was given at feedback as some student handbooks contained some complex terminology and did not make use of symbols to aid the reader. Within 7 to 8 and 9 to 10 Mill Lane the student handbooks gave students outdated information about who to refer a complaint to. The information provided to students at Elizabeth Maybin did not include staff qualifications and students views and did not contain details of contracts, and fees. See Requirement 1. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 9 When potential students are referred to the David Lewis Centre college, a preassessment questionnaire is completed. A three-day assessment is carried out usually in Elizabeth Maybin unit or in Mulberry House by the college multidisciplinary team including input from the psychology, medical, education and residential care departments. Prior to deciding to offer placements other assessment documentation from placing authorities and other relevant professional bodies had been gathered and considered. The three - day assessment period is used as an introduction to the services and facilities along with an opportunity to students and families to attend an open day event. 14 care files were checked which showed thorough assessments of needs were taking place across all the houses within the unit. The assessments for diabetic care were extremely thorough. The risk assessments available in all houses were thoroughly completed and regularly reviewed. Pen pictures were well written, giving staff social history information, plus important information about each person to be cared for. Individual learning plans were in place to explain support needs in relation to education and daily living skills. Across all houses the descriptive and detailed daily reports accurately reflected the current situation for each student and demonstrated continuity of care. Local advocacy services and student support networks were advertised, with evidence of these facilities being utilised. Written information was available regarding the possible transfer of a student from one house to another and of transitional visits. Advice was given, as the records did not document the students perspective of the proposed plans. All students except two had a Schedule and Purchase Order/Statement of Terms and Conditions or Contract and action was taken during the inspection to try to rectify this. The contracts provided were not in a format/language appropriate to each service user’s need. See Requirement 2. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 10 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) 6,7,8,9 and 10 Students can access a range of healthcare facilities and their health and personal care needs are met well. Care file documentation is not fully completed in some cases and the standard of recording is inconsistent across the various houses. Students are enabled to make decisions and choices. They contribute to both their individual learning plans and care plans and are consulted on all aspects of college life. Risks are fully assessed and students are supported to take risks as part of an independent lifestyle. It is clear that confidentiality is maintained and staff members know when information can be shared. EVIDENCE: Whilst management action plans are in place to address a variety of needs and one student’s individual needs were identified regarding toileting, language and culture, no plans of care were recorded to address these needs. Some outdated information was included on file and some important information regarding action to be taken at onset of an erratic epilepsy pattern was difficult to find amongst a confusing amount of paperwork. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 11 For one student within another house, staff had researched differences in culture and beliefs, and were well informed and able to provide appropriate care and support. Within 7/ 8 Mill Lane the care files did not clearly identify the need for regular weight monitoring. Some students seemed to be weighed regularly, whilst others were weighed infrequently. The need for weight monitoring was not explained. The organisation, standard of recording and content of care file information differed from house to house. An example of a common care file piloted in Mulberry House was checked and the documentation was clear and well organised. In the future a common care file will be introduced across the David Lewis Centre site. Within Mulberry House care files provided information about individual wishes being respected. Student’s wishes and choices were accurately recorded and action had been taken to fully discuss choices with students. Outcomes of discussions were recorded to ensure staff were fully aware of individual needs and were able to provide individualised care and support. In 9/10 Mill Lane students had hand written their own individual learning plans and had outlined their aspirations and plans for the future. These plans had been signed and dated by the students and their key workers. Records of tutorial reviews were available to view and these also contained the views of students. Certificates of achievement were seen on care files. Students are given comprehensive up to date information about the policies, procedures, activities and services within college. Students have opportunities to participate in activities, which enable them to influence key decisions in the college units. Students were observed to air their views both individually and in group discussion. Student meetings take place in all the college houses on a monthly basis. Within Elizabeth Maybin the meeting minutes mainly appeared to be a reminder of house rules and did not contain evidence of any student discussion. It is suggested that separate house meetings and student meetings are held. At Mulberry House and 9/10 Mill Lane the records of student meetings were full and the minutes had been taken and typed by students. There is a high level of student and staff interaction and there was evidence of staff members and students jointly undertaking tasks and socialising together. Records of meetings with tutors, key workers and students provided students views about their levels of satisfaction or disappointment with their college programme, the college service, living arrangements and working relationships with staff members and peers. These records demonstrated how students are encouraged to express their views, participate and assert themselves. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 12 Care staff and college staff adopt a proactive approach to risk assessment and management with students. This helps to promote individual independence levels and confidence in approaching individual goals. Possible risks are assessed prior to admission and ongoing. In discussion with the students any relevant risk management strategies are agreed. They are then recorded in the individual care plans and reviewed as necessary. Student’s individual records are securely kept and are confidential. Staff know when confidential information must be shared with their managers or others. Although the current confidentiality policy was produced in April 2003 and awaits review, a confidentiality statement at the front of each care file reminds staff of their responsibilities with regard to keeping information confidential. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 13 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) 11,12,13,14,15,16, and 17 Staff members enable students to have opportunities to maintain and develop skills, which will aid their personal development and independent living. All achievements are recorded and acknowledged and students are clear about their achievements and goals for the future. Students are engaged in various leisure and social activities which promotes social interaction and individual interests. Student’s rights are respected and they feel they receive sufficient support, are listened to and consulted with. Staff members enable students to maintain important relationships. Although arrangements for meal provision vary from house to house, staff members ensure students have a healthy diet and eat sensibly. EVIDENCE: Staff enable students to have opportunities to maintain and develop social, emotional, communication and independent living skills. For students with communication difficulties, various forms of communication are explored and used. Students are encouraged to verbalise, use Makaton or eye pointing techniques and facial expressions as appropriate. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 14 Care file documentation provided details of all progress made by students and included certificates of achievements. Abilities were under constant review across all departments. Learning programmes on site include independent living skills and life skills, vocational training, literacy, numeracy, communication, horticulture, creative arts, personal and social development, information technology, personal health and social education, and team enterprise. All students have a personal development plan, which includes educational programmes, living skills, healthcare and medical needs and leisure programmes, all suited to the individual. Each student has both a course tutor and an identified key worker who work closely together to assist individual students to achieve their learning goals. An extended curriculum contributes to students’ programmes of learning. Within 7/8 Mill Lane and Mulberry House pictures and symbols were used on student timetables to show various planned activity within the houses and at college. This provided an aid to understanding. Timetables were on file and on display in bedrooms to provide visual prompts. Each student’s individual care file when checked contained educational history and identified any special educational needs and how they would be met. Students are given full access to educational facilities and are provided with facilities that are conducive to study. They are encouraged to do homework and given help if they wish. Staff members provide educational support and liaise closely with college staff to achieve learning objectives. Transition arrangements had been made for students whose placements were nearing completion. Some detail was available in the care files regarding the transition plans although full transition programmes are mainly held within college. See Recommendation 2. A recent planned development to provide computer facilities within a communal area at Elizabeth Maybin, will give students additional learning opportunities and further access to E mail, enabling them to maintain family links and friendships. The care files contained contact lists of all relevant people important to students. Any wishes/needs to maintain contacts were recorded and any practical assistance to help maintain these contacts was satisfactorily described. Payphones and office telephones are available for use across the site and some students have mobile phones. Students were observed visiting each other from neighbouring college houses and there was evidence of neighbourliness between the various houses. Staff members enable students’ integration into community life by helping them make use of services, facilities and activities in the local community. The David Lewis Centre has its own transport to enable students to access external activities and opportunities. Staff members and students confirmed that work placements, outings, and activities are arranged and that shopping trips and outings are also organised. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 15 Some students regularly attend courses at other local colleges for particular educational interests and leisure activities. Each college house keeps a record of activities undertaken on and off site during the daytime, evenings and at weekends. Many photographs of outings and events were available to view. It was clear from the information on the care files and timetables that activities provide a balance between free and managed time. Timetables showed daily routines, tasks to be completed in the houses and activities to promote independent living skills. Some arranged activities are experiential and leisure interests and areas in which students have talents or abilities are encouraged. Students confirmed that they have opportunity for time alone, for visiting others on site and to have shared interests. Students are offered a choice of suitable menus to meet their dietary needs. Choice was available at every mealtime. Mealtimes were relaxed and sociable events. Any particular nutritional needs were identified on care files, with support from a dietician. Each house has access to a food supply from a central store and to a selfcatering budget. Individual houses have different meal provision arrangements and choose to have all, some, or none of their food supplied from the central kitchen. Within Elizabeth Maybin lunch and evening meals are provided by the main centre kitchen and distributed from the serving areas in the kitchen/dining room. Breakfast is prepared within Elizabeth Maybin and students have access to the kitchen area with staff supervision. Staff members order sufficient portions of food from a weekly menu to ensure alternatives and choice. The house holds a store cupboard of food to promote choice and to enable students to participate in meal selection. Staff and students reported a recent improvement in the quality and presentation of the food from the central kitchen but stated that they were not always satisfied with the quantities available. Within the smaller college houses the level of promotion of independence skills was very high within the kitchen areas. Students, with varying levels of support have access to the kitchen areas. They are encouraged to plan menus, shop for food and prepare their own meals. Sometimes they prepare meals for others on a rota basis using an allocation of money for the household. Staff members seek appropriate advice if students consistently refuse to eat, over-eat or have other eating disorders. Healthy diets are encouraged, any known food allergies are recorded and staff members ensure weightmonitoring checks are made. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 16 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) 18,19 and 20 Students have access to a range of medical services and specialist support and their health and personal care needs are well looked after. Students are closely monitored and supported with potential health problems promptly addressed by the appropriate health care professionals. Recording of administration of medication by staff members has improved and many students administer their own medication. EVIDENCE: Personal support workers address individual personal needs with sensitivity whilst promoting independence linked to the personal learning goals. Staff members responded quickly, calmly, and appropriately when students had seizures, providing support with sensitivity and reassurance. Thorough and detailed plans of care were seen, with each student having access to input from a range of medical specialists and therapists when necessary. Aids and adaptations are provided within the residential college units following specialist assessment. Students have a choice of staff members who work with them and this enables students to receive personal support in the way they prefer and require. The David Lewis Centre provides medical care for its students, from a multi-disciplinary team including doctors, specialist nurses and a range of therapists. The two specialist nurses provide advice and support to students, care staff and family supporters. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 17 The care files checked indicated that all healthcare needs were identified and addressed and any healthcare concerns were documented and monitored. Students confirmed that personal and healthcare support is satisfactory. There was evidence of specialist assessments and treatment provided by dentists etc. Where needed, guidance and support regarding personal hygiene is provided. Care files contained evidence of routine health screening and of appropriate contraception. Care files also contained helpful information for care staff about many medical conditions. Care staff and college staff work together to provide appropriate sex education and support in preparation and in keeping with the students transition to adult status. This education is provided during personal health and social education classes. Students are advised either in small groups or individually about socially acceptable behaviour. The pharmacy department provides a full service to all residential units on site. This includes dispensing all medication for students, provision of drug information to care staff, nurses, and other medical professionals both inhouse and externally, monitoring medication administration in the units and attendance at consultant-led house meetings. Most of the medication administration records were checked. Advice was given during feedback as medication was regularly given later than prescribed for one student, although there was no indication that medical staff had agreed this. A nurse undertakes monthly drug audits on each house, with any staff members responsible for drug errors closely monitored. Since the last inspection there has been a noticeable improvement in the standard of recording, storage and administration of medication. Several students kept and administered their own medication in accordance with the Centre’s policy and after a thorough check of their ability and compliance. It is recommended that a photograph of the student be kept on their medication administration record to aid identification. See Recommendation 3. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 18 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 Complaints are not consistently recorded and information regarding complaints made and resolved is difficult to find. The majority of staff members have received adult protection training to help them safeguard students. Some child protection training is overdue. More care needs to be taken when recording student’s personal allowances to ensure students are further safeguarded. EVIDENCE: The statement of purpose and function includes a comprehensive state of the complaints procedures for The David Lewis Organisation and guidelines for handling complaints. The complaints logs and records were checked within each of the college houses and the standard of logging and recording complaints varied from house to house. The complaints information also needs updating to correctly advise the complainant of the person to complain to. See Recommendation 4. Procedures are in place for responding to suspicion or evidence of abuse or neglect to promote the safety and protection of students (including passing concerns to CSCI). Staff members have access to the Department of Health guidance ‘No Secrets’. The vast majority of staff have received adult protection training and some await planned refresher training. Whilst some staff await new child protection training, there is no agreed date for this. See Requirement 3. The college maintains a behaviour management policy, which includes physical restraint only as a last resort, reflecting the National Minimum Standards. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 19 Across the college houses, the students are provided with lockable facilities within their rooms for safe storage of money and valuables. Students are offered keys to their rooms in accordance with appropriate risk assessments. A sample check of personal allowance balances and records across the college residential units showed that records and balances were accurate. Receipts were kept, except on one occasion within Mulberry House. This error had not been spotted although several staff had signed to indicate that the balance and record had been checked and was accurate. One entry on a balance sheet had the signature of only one member of staff although the policy requires signatures from two staff members. See Requirement 4. Students across the centre are encouraged to operate savings accounts. Some students hold savings accounts at an internal banking facility operating within the recreation club. The finance personnel discreetly assist students to manage their accounts. The centre has a policy on countering bullying. This describes various forms of bullying and promotes the recording and reporting of such incidents. It also provides advice to staff members to counter bullying and to raise awareness. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 20 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) 24,25,26,27,28,29 and 30 Repairs, maintenance work, cleaning and health and safety matters need addressing in some areas to ensure students have a well-maintained, clean and safe environment in which to live. EVIDENCE: All communal areas were checked, together with most of the student’s private accommodation with permission. Students have single bedrooms; some students within Elizabeth Maybin and Mulberry House have en-suite facilities. All student bedrooms have space and study facilities. The plan of the premises is shown in the statement of purpose and function and shows all the bedrooms within the college residential unit to be in excess of 9.3 sq metres. The college houses provide accommodation, which is comfortable, bright and cheerful. The rooms have suitable light heating and ventilation. The smaller houses provide a homely environment, which is more difficult to achieve in Elizabeth Maybin. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 21 The physical environment within Mulberry House was very good. The majority of bedrooms have been personalised and the communal areas and corridor areas have been decorated with artwork and photographs of activities to provide an interesting environment in which to relax. During a tour of the premises the following issues were either noticed by the inspector or identified by students and need attention. At Elizabeth Maybin An en-suite room smelled strongly of urine, the walls and floor were stained with urine and there was a poor standard of hygiene in this room. Standards of hygiene and cleanliness were poor in many of the en-suite rooms. Used bar soap was present in the shower unit of one vacant room. Mould was present on two shower mats and two shower curtains. Shower sealant needed replacement in five rooms. There was cracked tiling to 1 shower and 4 showers needed re-grouting to tile work. The grouting to tile work near a hand washbasin in the kitchen was in need of replacement. The house manager confirmed there was insufficient time allocated to complete cleaning tasks to hard surfaces and within the en suite areas. The main lounge area is in need of redecoration. One bedroom door- frame was in need of redecoration due to recent unfinished repair work. There had been a leak to one ceiling, another ceiling needed repair and a ceiling vent in an en-suite room was without a cover. In a vacant room an over-bed light was without a light bulb. A wheeling shower chair was unevenly balanced within a shower tray and created a hazard. One bedroom was in need of redecoration as wallpaper was scraped and missing in several areas. There was leakage from a dryer and a flood to the cellar area. The door to the cellar area was left unlocked. There was no lock to the toilet door adjacent to a small lounge/meeting area, which had formerly been a bedroom. A window handle to this lounge window was broken. There was no covering to the office window overlooking the main lounge. A lounge door was wedged open with a towel. The kitchen door and the dining room door to the flat were also wedged open. At 7/8 Mill Lane A shower curtain did not reach across the length of the shower rail, which can create a hazard when water flows onto the floor. One shower curtain did not reach to more than half the length of the shower rail. 2 bath mats had mould on them. A student reported that a bath mat did not securely affix to the bath and created a hazard. One student requested a towel rail and picture hooks. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 22 At 9/10 Mill Lane New bedroom furniture was on order. A bathroom ceiling had slight cracking and needs repair possibly due to a leak. Only one shower facility is available within this house and as the student occupation changes, the need for an additional shower will be kept under review. At 50/51 Mill Lane One bedroom carpet is in need of replacement due to staining near the sink area. Maintenance issues, monitoring of premises, fire precautions and cleaning arrangements were discussed at length during feedback. See Requirements 5,6,7,8,9,10 and 11. A range of comfortable shared space is available for students within the college houses. There is ample outdoor space on site for a range of activities. The centre’s physiotherapy department addresses individual mobility needs. Mobility aids in bathrooms were appropriately maintained. No new disability equipment has been provided since the last inspection. Mulberry House and Elizabeth Maybin have automatic doors to the main entrances. Mulberry House has a range of well-equipped bathrooms with suitable bathing systems in place. Appropriate policies are in place within the houses for food safety and laundry, with cleaning schedules and records in place. The cleaning arrangements in Elizabeth Maybin as previously mentioned are inadequate. Guidance notes are available to staff members regarding health and safety and infection control. Staff members sign to show they have read these documents. A Control of Substances Hazardous to Health assessment file was available in each house, which contained a chemical inventory and biological hazards and data sheets. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 23 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) 31,32,33,34,35and 36 Staff members are trained, experienced and competent to care for the students. Staffing shortages, are covered by existing staff members and agency staff to ensure students care needs are met. Satisfactory written references must be obtained for prospective staff members to safeguard students. Staff members meet regularly together to share information and each member of staff is closely observed during their work and well supported by regular supervision. EVIDENCE: Person specifications and descriptions are available. Staff members were able to clearly describe their roles and responsibilities. Staff members are aware of their own limitations and know when it is appropriate to involve someone else with more specific expertise. Lines of accountability are clear within the college provision. In discussion with students and from written comments it was clear that staff members get to know and develop a good relationship with the students they support. A lot of interaction exists between staff and students and staff members are able to meet needs in a highly supportive and flexible way, whilst encouraging independence. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 24 Staff members were approachable and comfortable with the students. Staff are interested and motivated and have a good knowledge of the disabilities and specific conditions of the students. Advice was given during feedback regarding an incident of inconsistency of approach and inappropriate communication to various students within one house. The staffing rotas for the college houses were checked and were satisfactory. A particularly good example in 9/10 Mill Lane outlined additional information regarding staff meetings, supervision and training. Night time management arrangements involve one staff member from a team of three, visiting the college and adult houses on a rota basis to spot check, monitor the service provided and support staff. An informative handbook for agency staff has been produced and contains pertinent information about the care service provided by the college. The staff team at Mulberry House are supported by a number of regular agency staff. Collective lists of agency staff members had been produced to show that staff had undergone recruitment checks. Advice was given at feedback, as the name of the supplying agency was not provided in all cases. Within each house, photographs of all regular staff members were on display to aid identification and recognition. Across all the college houses there was a thorough staff induction process, regular staff appraisals a developing system of formal supervision. Staff members continue to be encouraged to complete NVQ training and have shown a commitment to appropriate training, development and qualification. 62 of the present staff will have NVQ qualification, other relevant qualifications or be working towards the NVQ award by April 2006. The centre’s personnel department manages the recruitment of care staff. Two new staff members had been appointed to the college service since the last inspection and the recruitment procedures were checked. All appropriate recruitment checks had been undertaken except that one reference form that had been supplied and accepted had not been fully completed and did not supply satisfactory or sufficient information. See Requirement 12. Sample training records were checked with Mulberry House and Elizabeth Maybin. Details of staff training were provided from the pre-inspection questionnaire and observed from an evidence file. The records showed a range of training had taken place and was being planned. This training included induction, mandatory and specialist training. All new staff members attend a four - day induction course at the training centre on site within their first month of employment. Individual training and development records were well maintained and training certificates were provided. A staff training pack was seen which provided an introduction to working within the college provision and the David Lewis Centre in general. The mentoring and appraisal of new staff was explained, and training checklists identified all training completed. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 25 Induction training for staff includes training specific to their work and their role. Induction training for staff members includes guidance on child and adult protection and all staff members are made aware of the ‘No secrets’ documentation. More specialist protection training is provided to staff according to their caring role and relevant to the age group of the persons cared for. Supervision proformas showed supervision was thorough, covering a range of relevant topics including a section to record action points from each supervision session. Staff members confirmed that they receive day-to-day support and that supervision is regularly planned and provided. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 26 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) 37,39,40,41 and 42, Clear lines of accountability exist with Unit 3. The processes of managing the unit are open and transparent and students feel they can approach the staff and management to discuss any issues. Improvements need to be made in the recording of accidents and fire training to provide full and accurate information. EVIDENCE: The two proposed registered managers have achieved NVQ level 4 and have other relevant qualifications. The house managers with Elizabeth Maybin and Mulberry House are supernumerary whilst those managers within the three smaller units confirmed that they do not have set supernumerary time identified and agreed. See Recommendation 5. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 27 The David Lewis College has a three-year development plan for 2005 –2008 entitled ‘Success for All’. The statement of purpose and function also sets out how the David Lewis Centre aims to ensure quality within the College residential service, including undertaking continuous self-monitoring inspection visits. A system of buddy monitoring visits has been developed. House managers from across the centre routinely undertake monitoring visits to each of the college residential houses. Reports of these regular quality-monitoring visits were available to view within each of the college residential houses. This provided evidence of delegates assessing against the National Minimum Standards and of them identifying action to be taken to address any shortfalls. The monitoring visits and records have helped to identify difficulties at an early stage and have brought about consistency in the management and recording within the houses. It was noted that some monitoring records do not include the date of the actual visit and some visits span a two -month period. To further improve quality assurance student satisfaction surveys could be introduced with the results published and made available to students, their representatives and other interested parties including CSCI. See Recommendation 6. The proposed registered managers confirmed that many policies and procedures are under review. A policy manager is now in post and is undertaking the review process. A timescale for completion regarding the review and production of new policies and procedures should be advised to CSCI and copies supplied to CSCI upon completion. See Recommendation 7. A pilot project was nearing completion, which, will lead to the introduction of a common care file across the centre. A working copy of this was seen and provided information which was well organised in a clear format. The common care files will provide staff with an opportunity to maintain and update records on the computer and will lead to much improved consistency and clarity of record keeping across the centre. Good practice across the houses included the completion of thorough daily records to keep care staff aware of the changing needs of students and to facilitate continuity of care. Within Mulberry House a log of incoming and outgoing phone calls lead to good communication between staff students and family carers. Home records are well maintained and securely kept. Students can access their records and information held about them by the home, and opportunities are given to help maintain their personal records. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 28 House managers receive advice and support in the field of health and safety from centre personnel. Support staff members have completed mandatory training programmes for moving and handling, first aid, and behaviour management. The centre health and safety officer had completed risk assessments regarding the premises, and support staff members refer to these. Within Elizabeth Maybin some health and safety works had been undertaken yet the records did not indicate that the works had been completed and advice was given regarding this. Fire risk review reports were available at each house. Although fire training had taken place some of the records within Elizabeth Maybin did not indicate the names of the staff members or students participating. See Requirement 13. Advice was given at 9 to 10 Mill Lane, as a fire evacuation was due. At Mulberry House staff were advised that the weekly fire alarm records did not have the correct heading and carried the name of the previous unit, which had occupied the premises. The emergency lighting was regularly checked across the houses. However when asked, the majority of staff on duty at Elizabeth Maybin did not know how to test the emergency lighting or how this operated. There were insufficient well-maintained torches available. See Recommendation 8. Risk assessments had taken place and controls put in place to reduce any identified risks relating to the premises, personal care and community access. The house managers arrange for the prompt notification of significant events to the CSCI and other relevant authorities. The accident records were checked on each house. Within Elizabeth Maybin the accident records were not completed fully with sufficient information. As 8 of 26 did not contain sufficient information this indicated a need for staff training. See Requirement 14. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 29 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 2 3 3 2 2 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 2 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 4 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 DAVID LEWIS CENTRE (UNIT 3) Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 2 3 1 x F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 30 Yes 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 1 Regulation 4 Requirement The statement of purpose must contain the detail as outlined in Schedule 1 of The Care Homes Regulations 2001. Where a local authority has made arrangements for the provision of accomodation, nursing or personal care to the student at a care home, a copy of the agreement must be supplied to the student specifying the arrangements made.(This requirement remains outstanding from the previous inspection in February 2005). Ensure all staff members receive child protection training. Ensure an accurate record of student money is kept and that balances and records are regularly checked. Ensure that the care home is kept free from offensive odours. Make suitable arrangements for maintaining satisfactory standards of hygiene. Ensure that the premises are kept in a good state of repair internally. Timescale for action 31.08.05 2. 5 5 31.08.05 3. 4. 23 23 18 17 30.09.05 31.08.05 5. 6. 7. 24 24 24 16 16 23 31.07.05 31.08.05 31.08.05 DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 31 8. 9. 10. 11. 24 26 24 24 23 16 23 13 12. 13. 14. 34 42 42 19 17 17 Ensure all parts of the home are kept clean and reasonably decorated. Provide the items for rooms occupied by students that are identified under Standard 26. Ensure all staff take suitable fire precautions and refrain from wedging open doors. Ensure that the door to the cellar area remains locked and does not present a hazard to student safety. Ensure that two satisfactory written references are obtained for each prospective employee. Keep a full and accurate record of all staff and students attending fire training. Keep full and accurate records of any accident affecting a student in the home and of any other incident in the home which is detremental to the health or welfare of the student. 31.08.05 31.08.05 31.07.05 31.07.05 31.07.05 31.07.05 31.07.05 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 5 Good Practice Recommendations Each student should have a copy of the contract in a format/language appropriate to their needs, and /or reasonable efforts should be made to explain the contract to the student. Copies of the full transition programmes should be kept in college ,in the house and with the student concerned. Keep a photograph of the student on their medication administration record to aid identification. Ensure that all complaints logs are fully completed ann give an indication of the outcome and location of more detailed information. Ensure that the complaints information is updated to accuratley identify the compalints contact within the David Lewis Centre. F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 32 2. 3. 4. 13 20 22 DAVID LEWIS CENTRE (UNIT 3) 5. 6. 37 39 7. 40 8. 42 Review the supernumery time available to house managers to ensure there is sufficient time agreed and available to complete management tasks and responsibilities. Ensure that the date of visit is included on the quality monitoring visit records and introduce student satisfaction surveys with published results made available to students, their representatives and other interested parties including CSCI. A timescale for completion regarding the review and production of new policies and procedures should be advised to CSCI and copies supplied to CSCI upon completion. Ensure that staff on duty know how to test the emergency lighting and how this is this operated and that sufficient well maintained torches are available. DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 33 Commission for Social Care Inspection Unit D, Off Rudheath Lane 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. Extracts may not be used or reproduced without the express permission of CSCI DAVID LEWIS CENTRE (UNIT 3) F51 F01 S6653 DLC Unit3 V223391 150605 Stage 4.doc Version 1.30 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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