Inspection on 05/02/07 for The David Lewis College Residential Service

This inspection was carried out on 5th February 2007.

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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

The David Lewis College... 15/06/05

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 College Core Unit Mill Lane Warford Alderley Edge Cheshire SK9 7UD Lead Inspector David Jones Unannounced Inspection 5 6 7 and 26 February 2007 09:30 th th th th David Lewis Centre College Core Unit DS0000006653.V318438.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 David Lewis Centre College Core Unit DS0000006653.V318438.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. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service David Lewis Centre College Core Unit Address Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640000 01565 640100 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) David Lewis Centre Deborah Gittins Care Home 29 Category(ies) of Learning disability (29), Physical disability (29) registration, with number of places David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is registered for a maximum of 29 service users in the categories of LD (learning disabilities and PD (physical disabilities) aged between 16 & 25 years only. The 29 service users can be accommodated as follows: * A maximum of 19 in Elizabeth Maybin House. * A maximum of 6 in 9/10 Mill Lane * A maximum of 4 in 7/8 Mill Lane 6th March 2006 2. Date of last inspection Brief Description of the Service: The David Lewis Centre is a specialist service for children and adults who have epilepsy and associated conditions. It is in rural Cheshire in 170 acres of open grounds. The David Lewis Centre College Core Unit consists of 3 houses: 7/8 Mill Lane (4 places), 9/10 Mill Lane (6 places), and Elizabeth Maybin (19 places). Some of the students who attend the college have complex medical needs and also learning difficulties, and some require high levels of support and personal care. The service is designed to provide support for students with one or more of the following conditions: intractable epilepsy; moderate to severe learning difficulties; challenging behaviour and autistic tendencies. The David Lewis College provides a 24-hour curriculum, 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 and there is a range of specialist clinical services on site. Information about The David Lewis Centre College Core Unit including fees and charges and copies of the most recent inspection report can be acquired by contacting the centres administrative staff or the registered manager on 01565 640000. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the David Lewis Centre, including this service, took place on 5, 6 and 7 February 2007. The visit was carried out by a group of 5 inspectors who looked at various aspects of this home and the way the David Lewis Centre runs. The visit was just one part of the inspection. Before the visit, the manager of the home was asked to complete a questionnaire to provide CSCI with up to date information about the home. CSCI questionnaires were sent out for residents to fill in to find out what they think of the home. Other information received since the last key inspection was also reviewed. During the visit, various records were looked at; a tour of the David Lewis Centre, including this home, was carried out; and inspectors observed how residents and staff were working together. A number of residents and staff were spoken with. They gave their views and these have been included in this report. What the service does well: College Core Unit has good assessment and admissions procedures. New students are able to visit and stay at the College for a three-day assessment. They are given detailed information about the college and the residential houses. Some of the information is illustrated with pictures and diagrams or on a compact disc so all students can understand the information. This helps them to decide whether the college is the right place for them. Students can access a range of educational facilities both on and off site. They are offered opportunities to gain work experience and gain skills in preparing for employment. One student said that they wanted to become a secretary and were looking forward to working in an office. There is a programme for social and leisure activities. One student, who was at the end of their threeyear course at the College, said that they had learned how to be independent. They had previously lived with their parents but were looking forward to returning to their hometown to live with a group of younger adults in supported accommodation. They spoke about how their confidence had grown and they were pleased with their achievements and said their parents were also very pleased. Students are protected by the establishments’ recruitment procedures and are supported by a competent and qualified team of staff. Support workers and managers benefit from a comprehensive staff training, development and support programme. Students are complimentary about the qualities and skills David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 6 of the staff team. One student stated, “staff are skilled and knowledgeable especially regarding epilepsy”. Students benefit from a well run home. The manager is suitably experienced and qualified with considerable experience in the field of social care for people with epilepsy and or learning disabilities. Quality assurance is approached in a number of ways. The David Lewis College has a three-year development plan. Students, parents and stakeholders views are surveyed by a ‘satisfaction’ questionnaire and suggestions for development are welcomed. Managers and staff are able to demonstrate how they have responded to complaints and concerns by improving quality of the service provided and, where appropriate making services more responsive to the individual’s precise needs and requirements. Support workers were aware of equality and diversity issues and where able to discuss this in relation to person centred planning. Information provided by the registered manager indicates that plans are being made to raise the awareness of equality and diversity amongst staff so as to ensure that the service remains sensitive to the race, culture, religion, age, disability, gender and sexuality of students and their families. This will give new students confidence that their needs will be understood and met. What has improved since the last inspection? Initial assessments are available on each student’s personal file including assessments obtained from the placing authority. This will help to make sure that a comprehensive assessment is made of each student’s needs and aspirations. Person centred care planning continues to be developed with staff benefiting from ongoing training and the introduction of ongoing audit and review. Progress is being made to the way in which residents’ medication is supplied and includes medication being available in their own home. The complaints procedure has been revised since the last inspection. The Student Handbooks include a copy of the complaints procedure. These are illustrated to make them easier for people with a learning disability to understand and can also be made available in a range formats to suit individual communication needs. A revised adult protection policy and procedure has been introduced across the David Lewis Centre. This ensures there is a co-ordinated approach to protecting vulnerable adults. The induction training course for new staff has been revised to incorporate ‘Skills for Care’ criteria and training standards and 52 of the support staff team have now acquired an NVQ in care at level 3. House managers are in the David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 7 process of working toward NVQ level four in care and significant progress is being made to meet staff training needs in all pertinent areas including challenging behaviour. This ensures that support workers and managers have the skills they need to carry out their duties and responsibilities effectively and meet students’ needs in an appropriate manner. 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. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 8 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 College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 9 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, 4 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Prospective students’ individual aspirations and needs are assessed. Services are centred on the needs, wishes and views of those who use them. EVIDENCE: All students responding to the CSCI survey stated that they had received enough information about the college before they moved in to help them decide whether or not it was the right place for them. The service users guide is illustrated with photographs, diagrams and symbols to make it easier to understand. It is also available in a range of other formats including an audio CD. This means that all potential students have access to relevant information about the college and the facilities and services provided. The college has established assessment and admissions procedures that are designed to involve the prospective student and place them at the centre of decision-making. When potential students are referred to the David Lewis Centre College Core Unit, a pre-assessment questionnaire is completed along with a home visit. Needs assessment documentation is obtained from placing authorities and this forms the basis for a three-day assessment. This is usually carried out at Elizabeth Maybin unit by qualified and experienced staff. Person centred plans are developed with the prospective student and their relatives David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 10 and members of the multidisciplinary team involved with the delivery of their care and education. Students who completed the CSCI surveys and those spoken with during the visit indicated that they were satisfied with the admissions processes and the development of their person centred plans. One student stated that they would wished to have known more about the house before moving in, like what their house mates are like. The registered manager acknowledges that new students attending for the first time have limited opportunity to meet their fellow housemates before the start of term. There is an open day and they have opportunity to meet other students during the three-day assessment but it is not always known, at this early stage, who they are likely to be sharing a house with. The registered manager advised that further consideration would be given as to how the admissions process may be improved to enable new students to meet their prospective housemates before the start of term. The introduction of person centred planning was seen to be a positive step forward by all staff and students spoken with. Discussion with one student indicated that they liked their person centred plan. They had been involved with developing it and were encouraged by it. They said, “they are helping me achieve my goals and getting a job and living independently” David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Students play an active role in planning the care and support they receive. They do not always have up to date information about arrangements for their care or are always involved when decisions are being made about their lives. EVIDENCE: The common care file read on College Core Unit provided detailed information about the student. The student confirmed that the person centred plan had been developed with their input and had been signed and agreed by them and a relative. The information provided was organised and accessible but some of it was irrelevant and out of date. Discussion with the student, their relative, support workers and managers confirmed that college staff and support staff were working enthusiastically to enable the student to explore and take advantage of opportunities for personal growth and development in accordance with their life goals but this progress was not reflected in the person centred plan. The person centred plan had been drafted and agreed in June 2006, and reviewed in the following David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 12 September and November but it had not been revised to reflect significant changes and developments in the student’s life. The student was confused about some of the changes made. In one respect they felt that they had taken one step forward and two steps back. Staff had responded to the student’s concerns and had conducted a review in January 2007. This addressed some of the student’s concerns and in all respects was positive and forward-looking. It was clear that the student and their relatives were involved with decision making but the student was unable to remember everything that had been discussed at the review and the outcome of the review had not been confirmed in writing. This resulted in the student remaining concerned and uncertain about their future. A student’s common care file contained a behaviour management plan that had been reviewed on 14th December 2006. Support workers were asked about this but were not aware of its existence and could not think why it was in place. It transpired that it related to a previous period prior to December 2006 and was no longer relevant because the student did not have any current behaviour that would warrant such an approach. When reviewing care and support plans, managers and staff must confirm the relevance of the plan and amend or discontinue it if it is no longer relevant. This plan should be crossed through and marked as no longer relevant to remove any further misunderstanding. Support workers can show how they help students to make choices and involve them in all aspects of daily life. However one student said that support workers, who were of a similar age to the student, treated them like a child. They said that students have to ask staff if they can invite a friend to their room and felt that this was being treated as a child. Staff said that students only have to ask them and suggested this was a college rule. The registered manager confirmed that staff had misinterpreted the college rule, as students only have to tell support workers when they are inviting a friend to their room, they do not have to ask them. The manager advised that this issue would be addressed with staff through supervision and staff meetings. Risk assessment is central to the home’s assessment and care planning procedures and it is clear that students are enabled to take an element of calculated risk in the interests of an independent lifestyle. However it was noted that a student’s risk assessment was not revised when fundamental changes occurred including moving to a new premises where there were additional hazards for them, such as stairs. Potential hazards should be identified and controlled to ensure students’ health and well-being. Appropriate risk management strategies must be place that enable the students to be as safe as possible without restricting their choices. The multi-disciplinary team had met and made decisions about important aspects of a student’s life without the student being present. There may have been reasons why this happened in this way, but this was not clear from the David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 13 individual’s person centred plan. Discussion with support workers indicated that there was no reason to doubt the individual’s capacity to make their own decision so it was not clear why these matters had been discussed without the student taking part in the decision. The student’s person centred plan needs to reflect their capacity and their ability to make decisions. Where an assessment of an individual’s capacity is deemed appropriate, the reason for this must be recorded in the person centred plan along with the subsequent decision making rationale including who has been consulted on the matter and when. This will be a requirement of the Mental Capacity Act, which is to be implemented in April 2007. Decisions as to whether a student has capacity should not be discussed in their absence unless there are good reasons for this that are agreed with the individual and recorded in the person centred plan. This will make sure that students rights to make decisions are observed, protected and promoted. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Students are able to make choices about their life style, and are supported to develop their life skills. Social, educational, and recreational activities meet individuals’ expectations in the main. EVIDENCE: All students have access to an extended curriculum, which encourages them to practice and apply their new and emerging skills for life. In addition, there is a programme for social and leisure activities. One student, who was at the end of their three-year course at the College, said that they “had learned how to be independent”. They had previously lived with their parents but were looking forward to returning to their hometown to live with a group of younger adults in supported accommodation. They spoke about how their confidence had grown and they were pleased with their achievements and said their parents were also very pleased. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 15 Students can access a range of educational facilities both on and off site such as literacy, numeracy, communication, horticulture, creative arts, personal and social development, information technology, personal health and social education, citizenship and team enterprise. Care staff and education staff work closely together to enable students to reach their potential. Students are given opportunities to gain work experience and gain skills in preparing for employment. One student who wanted to become a secretary was looking forward to work experience in an office that was being arranged by college staff. Students state general satisfaction with activities other than at weekends when there seems to be a lack of opportunities because mini buses and/or drivers are not routinely available. Managers and staff are aware of the limited opportunities students have to use local community facilities because of the isolated location of the college and lack of public transport. Information provided as part of the inspection confirms that they are working to improve student’s opportunities for recreation and leisure. Two caravans in Wales have been purchased for holidays out of term or at weekends and they are hoping to recruit more drivers to improve access to local community facilities. One relative raised concerns about a lack of activities after college that resulted in the student spending a lot of time being left to their own devices watching DVDs. Staff had responded positively to these concerns and were seen to be striking an appropriate balance between encouraging the student to take part in activities that were beneficial to their personal development or choosing to do their own thing and having time to themselves. Students are offered a healthy diet and most of those asked said that they always or usually like their meals. They take part in ordinary domestic tasks around the house including cooking and washing the pots after a meal. Those who live in the smaller houses have opportunities to join in cooking and preparing meals. One student who lives at Elizabeth Maybin said the kitchen facilities were inadequate so staff can only allow a small number of students to cook at any one time. The registered manager advised that plans were being made to improve the kitchen facilities at Elizabeth Maybin to ensure enough working space and equipment is available for all students to develop their cooking skills. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. The health and personal care that students receive is based on their individual needs but recording, monitoring and review is poor. Students are not always treated with respect. EVIDENCE: Students and their relatives were generally complimentary about the standards of care and support received. Support workers were said to be knowledgeable about students’ needs and preferences and skilled in their approach. Various examples of good practice were observed. In one instance support workers were seen to offer discreet prompts to enable a small group of students to complete domestic tasks as independently as possible with the minimum of fuss and intervention from staff. The same support workers were also seen to help one student with making decisions about how they may wish to spend their spare time. They recognised the student’s rights to make their own decisions but made sure they were aware of their options and had weighed the information before coming to a conclusion. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 17 There were areas relating to the delivery of personal care that required further development. One student’s person centred plan indicated that it had been necessary for staff to go into the bathroom when the student was bathing for safety reasons. The person centred plan was a year out of out of date and did not reflect current bathing arrangements or confirm the need to promote privacy and dignity. These issues need to be reflected in the person centred plan. This is especially important when support workers need to enter the bathroom or support students with intimate personal care tasks. This will help to ensure that students’ needs are consistently met in way that suits them best. One student said that staff are knowledgeable and skilled but added that some support workers shout, had made snotty remarks, had spoken down to students and had made weird comments. This, especially the weird comments, had worried them. The registered manager undertook to investigate this matter to make sure that students are treated with respect and are spoken to in an appropriate manner as adults. There was conflicting recording of an accident that had occurred where a student had suffered injuries to their face. One record indicated that the student had injured their forehead whilst another record of the same incident made no mention of the forehead but indicated that the injury was to their lip. Managers and support workers must ensure that all records regarding the care and support of students are accurate and sufficiently detailed to make sure that the individual is safeguarded and their needs met. The students’ specialist health needs, including epilepsy and dietary requirements, are clearly recorded in their person centred plans and health action plans. These give a comprehensive overview of the individuals health needs and are valuable for health monitoring, as they will alert support workers to significant health changes. Since the key inspection of February 2006 managers of the David Lewis Centre have met with representatives of the Commission for Social Care Inspection, the Healthcare Commission, the Royal Pharmaceutical Society of Great Britain and the local Primary Care Trust to discuss the best way of supplying its residents with medicines, based on a community model. This is more appropriate than the hospital model used previously. An action plan is in place and is being put into practice to ensure the necessary changes take place within an agreed timescale. Arrangements to address students’ health and personal care needs regarding epilepsy are usually confirmed on the respective individual’s person centred plan and on the medication administration record. Where rescue medication has been prescribed on an as required basis, the protocol for administration is usually detailed on the medication administration record so care workers can find it immediately if a student has a severe epileptic seizure. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 18 In one students’ case, the protocol for the administration of rescue medication was not clearly recorded. Three staff members were asked about the protocol for the administration of rescue medication for this student and each gave a different answer. The circumstances in which this student may require rescue medication are extremely complex and support workers are required to use their judgement against a range of variables. The registered manager said that the doctor prescribing the medication did not wish to write a tighter protocol due to the complexity of the student’s seizures.. Whilst it is entirely appropriate for staff to use their judgement when considering the administration of medication on an as and when required basis, especially if the student is incapacitated by the seizure, it is important that support workers have all the information they need to administer medication in a safe and appropriate manner. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a site visit to the service. People who use the service are able to express their concerns, and have access to a complaints procedure and are safeguarded from abuse. Some complainants do not have confidence that complaints will be addressed satisfactorily. EVIDENCE: The complaints procedure has been revised and re-established since the last inspection. The Student Handbooks include a copy of the complaints procedure. These are illustrated to make them easier to understand and can also be made available in a range formats to suit individual communication needs. The majority of students asked during the inspection where aware of the complaints procedure, although one student said that they did not have confidence that appropriate action would be taken to address concerns and complaints. Complaints records indicate that thirteen complaints had been received since the last inspection. Most had been investigated, substantiated, acted upon and responded to within 28 days. Reading of complaints records and discussion with the registered manager confirmed that there is a positive attitude to receiving and addressing complaints within College Core. However, whilst action had been taken to address certain aspects of a complaint from a relative of a student, other aspects of the complaint had become protracted and the complainant had not received a satisfactory David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 20 response to a letter written before Christmas. Another complainant was dissatisfied with the way their complaint had been handled. In reviewing this with the registered manager it was apparent that the response they had been given was too vague. It was also noted that a complaint made by a student during the inspection was not recorded in full or satisfactorily investigated. Action must be taken to make sure that complaints are recorded in the appropriate detail and thoroughly investigated so students and their representatives have confidence in the complaints procedure and feel their views are acted upon and taken seriously. Adult protection procedures have been revised since the last inspection and are much improved. They are robust and include a “Whistle Blowing Policy”. They reflect local multi-agency policies and procedures including the involvement of the Police and passing concerns on to the local authority and CSCI in accordance with the Public Interest Disclosure Act and the Department of Health Guidance No Secrets. Staff have to report any suspicions or allegations of abuse directly to the David Lewis Centre’s social work department so that appropriate action can be co-ordinated and monitored. The records kept by the social work department were checked and were seen to be thorough. The organisation has responded appropriately to all recent adult protection issues. However, one incident that occurred in June 2006 was reported to the police but not to the local authority under adult protection procedures or to the Commission for Social Care Inspection. Managers had considered whether the matter should have been reported to the local authority at the time but had concluded that this was not warranted because it was deemed a “behavioural” incident between two students. Managers are now clear that any assault is to be reported under adult protection procedures. All future incidents of this type or any evidence or suspicion of abuse will be reported to the local authority and the Commission for Social Care Inspection under the new procedure without delay. Information provided by the registered manager indicates that policies and procedures for handling students’ money are currently under review. This will ensure the students’ rights are respected and acknowledged and a robust system is in place to ensure the safety of money when handling transactions. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a site visit to the service. Students live in live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The houses of the College Core Unit provide accommodation which is comfortable, bright and cheerful. All students have single bedrooms. In Elizabeth Maybin, all bedrooms have en-suite showers and there are two additional shared bathrooms. Students are able to personalise their own rooms. A range of comfortable communal space is provided and there is ample outdoor space on site for a range of activities. Each house has a garden. One student said that they were not happy living at Elizabeth Maybin. They said, “it’s not rubbish but it’s not cool”, “it’s kind of un-cool”. They explained that it is considered as the starting place. It is where the three-day assessments take place, so it is the first step where people move on from not where they stay all the time. The registered manager said that she is aware that Elizabeth Maybin has this image which is one held by other staff at the David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 22 college. She is of the view that this image is unfair and unwarranted because it will adversely affect the people who live at Elizabeth Maybin. There is no stepping stone system at the college. Students are allocated to each house depending on their needs and circumstances. Elizabeth Maybin has certain advantages because it is all on one level and is accessible to people with a physical disability and suitable for those who are unable to use stairs safely. The manager said that she has resolved to improve the image of Elizabeth Maybin. She is of the view that a sixteen-bed unit is not conducive with the home’s aims and objectives and changes to the layout to provide two smaller units have been considered. This could improve the image of Elizabeth Maybin and bring it in line with students’ expectations of a “Cool place to live”. The premises were found to be in a good state of repair and internal decoration. House managers receive monthly records of maintenance work either completed or outstanding to enable them to ensure jobs are being completed. 7/8 Mill has been redecorated including both bedrooms and communal areas and appropriate light diffusers have been fitted in the kitchen and laundry on 9/10 Mill Lane. An office area was located at the rear of the lounges in both 7/8 and 9/10 Mill Lane. These office areas detract from the otherwise domestic nature of the houses. Staff spoken with said they are exploring other more suitable places for the office including making use of box rooms, utility rooms and outhouses. One of the ‘box rooms’ on the first floor in 7-8 Mill Lane was being used as an office base for the ‘College Nurse’. Staff did not really know why this was the case other than lack of administrative space at DLC. Consideration should be given to relocating the nurse in the main college or office block and the box room could be used as the home’s office. This would create a better environment for service users and staff. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Students are supported by competent and qualified staff and are protected by thorough staff recruitment procedures. EVIDENCE: Students are protected by the organisation’s recruitment procedures. A number of staff recruitment records chosen at random confirmed that the David Lewis Centre operates thorough recruitment procedures that meet the requirements of the regulations and incorporate equal opportunities and anti discriminatory practice. Staff are employed in accordance with the code of conduct set by the General Social Care Council and are provided with a copy of the code. All required recruitment checks are obtained before staff start to work with the students. Students are supported by a competent and qualified team of staff. Support workers and managers benefit from a comprehensive staff training and development programme. The induction course for new staff has been revised to incorporate ‘Skills for Care’ criteria and training standards and information provided by the registered manager confirmed that 52 of the support staff David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 24 team have an NVQ in care at level 3. Training is delivered via the centre’s training centre offering both mandatory and other specialist training. All staff members have individual training and development files so house managers are able to monitor and keep track of training and developments. Staff training records held by house managers confirm staff training is progressing satisfactorily in all areas including fire training, first aid, resuscitation, challenging behaviour, person centred planning, moving and handling, food hygiene, child protection and adult protection. Some staff groups have already met training targets in some areas including fire training, moving and handling, first aid and challenging behaviour. Students’ benefit from a well supported staff team. Information provided by the registered manager indicates that significant progress has been made in the recruitment of permanent staff to improve consistency and continuity of care. Support workers present as an effective team and said that they receive regular supervision. They said they appreciate the support and guidance provided by the management team. Senior staff have had the benefit of training in supervision and appraisal and all staff have had an annual appraisal. Performance is assessed, training needs identified and objectives have been set. Students are complimentary about the qualities and skills of the staff team. One student stated, “staff are skilled and knowledgeable especially regarding epilepsy”. Support workers were aware of equality and diversity issues and where able to discuss this in relation to person centred planning. Information provided by the registered manager indicates that plans are being made to raise the awareness of equality and diversity amongst staff so as to ensure that the service remains sensitive to the race, culture, religion, age, disability, gender and sexuality of students and their families. This will help to ensure that students and their families needs are understood and met. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 25 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. This judgement has been made using available evidence including a site visit to the service. College Core is managed in the best interests of students. The manager is competent, qualified and suitably experienced. EVIDENCE: Students benefit from a well run home. The registered manager is suitably qualified with considerable experience in the field of social care for people with epilepsy and or learning disabilities. She has a range of qualifications including the Registered Managers award in management and care at NVQ level 4 and a BTech National Diploma in Social Care. There are clear lines of accountability within the DLC from support worker up through the line management to the Chief Executive. Each house in College Core Unit has a designated staff team of support workers headed by a house manager. House managers report directly to the registered manager who David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 26 maintains responsibility for and an overview of the delivery of care in each unit. Information provided indicates that all house managers are either pursuing or have acquired an NVQ level four in care since the last inspection. Other developments include the introduction of key performance indicators for house managers to acknowledge and benchmark key areas of competence and identify areas for development. Information provided and discussion with the registered manager, house managers and support workers indicates that the DLC is developing awareness of its strengths and areas for further development. Managers and staff are encouraged to explore opportunities for further development in the interests of providing a service that continues to meet the needs of the people who use it by making the best use of available resources. Quality assurance is approached in a number of ways. The David Lewis College has a three-year development plan. Students’, parents’ and other stakeholders’ views are surveyed by a ‘satisfaction’ questionnaire and suggestions for development are welcomed. Managers and staff are able to demonstrate how they have responded to complaints and concerns by improving quality of the service provided and, where appropriate making services more responsive to the individual’s precise needs and requirements. Person centred planning, when conducted effectively, puts the student and their representatives at the centre of decision-making. Students and their representatives are invited to attend an annual review, which focuses on the quality of service delivered. Where possible students are asked to contribute to the written reports that form the basis of the review to help them express their views and wishes. All students have three way tutorials, involving the student, tutor and key worker. These tutorials review how the college is supporting students to make progress and assistance is provided to help them set goals and personal objectives. Regular student meetings take place on the houses to give students the opportunity to take part in the day to day running of the houses and enable them to select and plan social activities. The David Lewis Centre’s health and safety officer has responsibility for health and safety training for staff on induction, for updates on training and for risk assessments relating to the houses. The records he held on fire safety training, including phased evacuation, were incomplete and did not correspond with the records held in the individual houses. There was insufficient evidence, therefore, to confirm that all staff are receiving their mandatory fire safety training. There are lengthy delays in referring recommendations and requirements made by the fire officer to the David Lewis Centre’s maintenance department for action. Records are retained in the maintenance department of the David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 27 completed work but no process is in place to ensure that the work is monitored by the health and safety officer. Fire risk assessments produced by the Centre were completed a number of years ago and reviewed following the fire officer’s visit. The reviews have been written as audits of the premises and should now be supported by a fire risk assessment in line with current guidance. The health and safety officer has an audit programme for the houses to cover fire safety tests, COSHH etc that will take place every 4 – 6 months. However, these haven’t started yet – the first one will take place within the next few months. Accident records are completed in the houses and copies are sent to the health and safety officer to monitor. He collates the information and reports each month to the Chief Executive of the David Lewis Centre. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 28 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 3 4 3 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 X 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 X X 2 X David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15 (2) Timescale for action Care plans must be reviewed and 30/04/07 revised, in consultation with service users and their representatives, as and when circumstances change. All potential hazards to service 30/04/07 users must be identified and as far as possible all unnecessary risks must be eliminated. Risk assessments must be kept under review and revised as and when circumstances change. Records made about the delivery 30/04/07 of care including accident records must be accurate and up to date, so as to ensure their relevance and usefulness in connection with the delivery of care and meeting service users’ needs. The changes to provide 31/12/07 medication as outlined in the David Lewis Centre’s action plan must be implemented without undue delay. Appropriate arrangements for 15/04/07 the safe administration of rescue medication in the home must be made, including making sure that staff are provided with DS0000006653.V318438.R01.S.doc Version 5.2 Page 30 Requirement 2 YA9 14 (4) (a) (b) and (c). 3 YA18 17 (3) (a) 4 YA20 13 (2) 5 YA20 13 (2) David Lewis Centre College Core Unit 6 YA22 22 (3) written information as to when and in what circumstances the medication should be administered. Any complaint made under the complaints procedure must be fully investigated in accordance with the complaints procedure. 30/04/07 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. Refer to Standard YA4 YA7 Good Practice Recommendations Ways of enabling new students to meet their housemates before the start of the new term should be explored. Action should be taken to make sure that support workers interpret college rules appropriately so as to avoid inadvertent and unwarranted restrictions being placed upon students’ rights to make decisions. Each student’s person centred plan should record their capacity to make decisions. Where an assessment of an individual’s capacity is deemed appropriate the reason for this should be recorded in the person centred plan along with the subsequent decision making rationale including who has been consulted on the matter, why and when. Decisions as to whether a student has capacity to make a decision should not be discussed in their absence unless there are good reasons for this that are agreed with the individual and recorded in the person centred plan. Action should be taken to find ways to improve the range of social and recreational activities in the community for students, particularly at the weekends. Arrangements to preserve and promote the privacy and dignity of students should be detailed on their person centred plan so the individual’s needs are met and so staff can achieve continuity and consistency in the delivery of care. Action should be taken to relocate the office areas, including the first floor nurses office, in 7/8 and 9/10 Mill Lane to improve living and working conditions for students and staff. The fire audits should be supported by revised fire risk DS0000006653.V318438.R01.S.doc Version 5.2 Page 31 3 YA7 4 5 YA14 YA18 6 YA24 7 YA42 David Lewis Centre College Core Unit assessments in line with current guidance from the fire officer. David Lewis Centre College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 © 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 College Core Unit DS0000006653.V318438.R01.S.doc Version 5.2 Page 33 - 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. 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