Inspection on 29/07/05 for David Lewis Centre Supported Adult Living Unit

This inspection was carried out on 29th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

David Lewis Centre Supported... 05/02/07

David Lewis Centre Supported... 06/03/06

David Lewis Centre Supported... 08/03/05

David Lewis Centre Supported... 17/05/04

David Lewis Centre Supported... 15/03/04

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

CARE HOME ADULTS 18-65 David Lewis Centre Unit 2 Mill Lane Warford Alderley Edge Cheshire SK9 7UD Lead Inspector Julie Porter Announced 27,28,29 July 2005 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 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service David Lewis Centre Unit 2 Address Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640000 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) David Lewis Organisation Eileen Byrne Care Home 38 Category(ies) of LD Learning Disability 38 registration, with number LD(E) Learning disability over 65 5 of places PD Physical Disability 38 PD(E) Physical Disability over 65 5 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 38 service users to include:* Up to 38 Service users in the category of LD (learning disabilities) * Up to 38 service users in the category of PD (physical disabilities) * Up to 5 service users in the category of LD(E) (learning disabilities, 65 years and over) * Up to 5 service users in the category of PD(E) (physical disabilities, 65 years and over) 2 The registered number of places (38) are allocated to the 5 houses which make up Unit 2 of the David Lewis Centre, as follows:* Hutton House - 7 places * Winifred Comber - 15 places * Kenneth Faulkner - 11 places * 11 Mill Lane - 3 places * 12 Mill Lane - 2 places 3 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 4 The door between Numbers 11 and 12 Mill Lane must be kept locked at all times and appropriate staffing levels to meet the needs of the service users should be maintained in both houses at all times 5 The third bedroom on the first floor of 12 Mill Lane should be made into a sitting room for service users living in 12 Mill Lane 6 The registered provider must provide staff to meet the dependency needs of service users at all times and shall comply with any guidelines that may be issued through the Commission for Social Care Inspection Date of last inspection 07,08/03/05 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 5 Brief Description of the Service: David Lewis Centre Unit 2 consists of five separate houses; Hutton House (7 beds); Kenneth Faulkner Flats (11 beds); Winifred Comber House (15 beds) and 11 &12 Mill Lane (3 & 2 beds respectively). The Commission as a variation to the registration, in December 2004, approved the two additional beds at 12 Mill Lane. There is one registered manager for the five properties and in addition, each house has a manager responsible for the day-to-day running of the home.The houses are located in the grounds of the David Lewis Centre that is set in rural surroundings within travelling distance of Macclesfield and Knutsford. The extensive grounds provide opportunities for walking and recreation. Day training, college and leisure facilities are provided on site. David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three days and was conducted by two inspectors, Julie Porter and Judith Morton, on days two and three. The inspection involved a review of the records, a tour of the buildings, discussion with residents where possible, and discussion with all members of the support staff on duty during the inspection. Two completed CSCI comment cards were received. The house managers and the registered manager were available throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 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 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 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) 1-5 Information is provided to residents about the services available in each of the houses in the group, but residents’ needs must be assessed by the home’s staff before moving in to ensure that they can be met. EVIDENCE: Information was seen in Kenneth Faulkner Flats relevant to what was available for people living in that home, the staffing arrangements and what to do if the residents had any problems with the home. Brochures are produced using pictures and symbols. All the residents have lived at the David Lewis Centre for a number of years during which time they may move to other houses on the centre. One resident’s file checked at Mill Lane contained an assessment of their needs during their stay in another service. There was no evidence that staff from the home had carried out their own assessment to ensure that they could meet the persons’ needs. Before residents’ move in they have opportunities to visit the home and stay for meals. Nine residents’ files were checked across the five houses in the service. Of these four did not contain correct information regarding the terms of the resident’s stay in the home. See requirements 1 & 2 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6-9 Residents at the home are cared for by a team of staff who know them well and, although information about their needs is recorded, it is not always up to date which could result in residents not receiving the care they need if familiar staff are not around. EVIDENCE: Nine residents’ care plans were examined during the inspection. On the whole they were very informative and provided a history of the residents life so far. One care plan looked at in 11 Mill Lane did not contain up to date information about the resident’s needs as it referred to him living in another house. Kenneth Faulkner and Winifred Comber had good examples of monthly monitoring of the residents’ needs. See requirement 3 Assessments to reduce risks were detailed and provided information for staff in the management of risk. A review of residents’ files is being undertaken across the centre and this will address differences in recording between the houses. David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 10 A sample of residents’ meetings minutes was reviewed in Winifred Comber and showed they were well attended. David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11-14 & 17 Residents are able to chose and plan their activities so they have control over what they do in their daily lives. The home’s dining facilities were overcrowded and noisy, which could prevent residents from enjoying their meals in full. EVIDENCE: These standards were looked at on Kenneth Faulkner and Winifred Comber only. Nine of the residents living in Kenneth Faulkner Flats and ten residents living in Winfred Comber have one to one staff support. Activities were recorded on files and related to requests made at residents’ meetings for example swimming; cinema; walks, trips included, pub lunches; visit to the Blue Planet and individual choices relating to holidays. David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 12 Staff reported that improvements have been made in the quality of the food provided from the Centre’s main kitchen, although the home can still provide alternatives for the residents should they be unhappy with their meal. Due to the high levels of support required by the residents of the two houses and the size of the dining rooms residents were not able to dine in comfort or at their leisure. Improvements could be made by utilising space available in other areas of the homes. Two residents’ care plans referred to them disliking noise and crowded situations and they were observed during the inspection becoming agitated particularly during mealtime. One gentleman would not spend time in the dining room and did not eat lunch. See requirement 4 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18-19 The residents have lived at the centre for a long time and all known each other well, and are supported by a staff team who know them well so their care is provided in the way they prefer. EVIDENCE: The care plans checked stated the ways in which residents prefer to be supported, for example “likes a bath not a shower”. In Kenneth Faulkner Flats one care plan states “prefers time alone in the bathroom”. Balancing privacy for residents against the risks due to them having epilepsy is achieved with the use of a privacy curtain. Residents care plans provided evidence that health care professionals were involved with their care: for example; investigations due to weight loss at hospital and using the services of the smoking cessation clinic. Residents have their eye care monitored by a local optician; however for residents who have limited verbal communication alternatives need to be sought as a matter of urgency. See requirement 5 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22-23 Residents who are able know who to speak with and know that their opinions are listened to. There are policies and training available to staff on adult protection but the home cannot show that staff have undertaken training on awareness of protection of adults from abuse, which may leave residents at risk of abuse or poor practice. EVIDENCE: Two complaints were reviewed and had been responded to appropriately. One of the house managers discussed verbal complaints made by residents. As these are not recorded, the home cannot demonstrate how they have been dealt with. See recommendation 1 The minutes of a residents’ meeting in Hutton House had been typed by one of the residents; the possibility of developing this so that residents set the agenda and chaired the meetings was discussed. Records of residents’ finances were checked at Hutton House and were being kept appropriately. The manager’s checking sheet was seen as good practice. Adult Protection training is available to staff although not all staff working in the home have attended. Staff working with residents needing one to one support reported it was difficult to attend training due to the hours they need to work with residents and this will need to be addressed. See requirement 6 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24-30 Residents live in a homely environment that is clean and fresh. EVIDENCE: Maintenance in the home can still take time to complete, through the estates department of the centre, and the house manager will need to keep a check on the length of time it takes to complete repairs, particularly in relation to health and safety. A number of issued were identified during the inspection. The registered manager has a planned rolling maintenance programme which will address repairs and renewals, and improve the environment for the residents. On the day of the inspection the houses were clean and fresh. Although the shared areas in the houses would appear to be sufficient for the number of people who live there, due to the high staffing levels necessary to support residents the lounges and dining rooms become very busy and noisy during peak times. See requirement 4 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 16 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) 31-36 Staff in the home have worked there for a number of years and have developed a knowledge of the residents’ needs so they know the most appropriate ways to meet those needs. EVIDENCE: The centre offers a comprehensive training programme for staff although evidence could not be provided to demonstrate that all staff had undertaken mandatory training, or specialist training relating to the work they perform. See requirement 7 Nine staff files were checked during the inspection and on four occasions, the required vetting of new staff through POVA first had not been followed. An immediate requirement notice was issued. See requirement 8 Staff reported that they receive informal supervision on a day-to-day basis and that house managers are available for guidance and support as required. Formal supervision is not consistent across the five houses. See recommendation 2 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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) 38 & 42 Staff enjoy the work they do and feel supported by the management structure in the home. However staff and service users are vulnerable if staff do not receive training relating to health and safety. EVIDENCE: Staff spoken with during the inspection were enthusiastic regarding the recent changes in management and felt that they were supported and encouraged to contribute to the running of the home. A sample of the records was checked across the five houses which make up Unit 2. All house managers and the registered manager were available during the inspection. Accident records were not kept in sequence in Kenneth Faulkner. Risk assessments had not been regularly reviewed in Mill Lane or Hutton House. All staff had not completed mandatory training in relation to health and safety, fire, first aid or moving and handling across the service. See requirement 6 &7 David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 18 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 3 2 2 3 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x 2 Standard No 31 32 33 34 35 36 Score 3 2 3 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 David Lewis Centre Unit 2 Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 2 x F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 19 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 2 Regulation 14 Requirement Residents needs must be assessed before they move in to ensure that their needs can be met at the home. Residents must be provided with up to date terms and conditions each time they move. Residents care plans must be reviewed regularly and kept up to date with current information. Space should be utilised to best effect particularly relating to the dining areas in Kenneth Faulkner and Winifred Comber Service users must have access to optical screening All staff must receive training in relation to adult protection Staff must receive training relating to the work they perform CRB disclosures must be applied for and POVA first checks obtained before new staff being working in houses. Timescale for action ongoing 2. 3. 4. 5 6 17 5 14 23 31/10/05 & ongoing 31/10/05 31/10/05 5. 6. 7. 8. 19 23 32 34 13 13 18 19 31/10/05 31/12/05 31/12/05 Immediate David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 20 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 22 36 Good Practice Recommendations A record should be kept of all verbal complaints made by residents, with the action taken and the outcome. Staff should receive formal supervision by a person qualified to do so at a minimum of six times per year David Lewis Centre Unit 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection UNIT D, OFF RUDHEATH WAY GADBROOK PARK NORTHWICH CHESHIRE 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 2 F51 F01 DLC Unit S6647 V240537 290705 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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