Inspection on 06/03/06 for David Lewis Centre Supported Adult Living Unit

This inspection was carried out on 6th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

David Lewis Centre Supported... 29/07/05

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 Inspection 6th March 2006 09:30 David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 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 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 Organisation Eileen Byrne Care Home 38 Category(ies) of Learning disability (38), Learning disability over registration, with number 65 years of age (5), Physical disability (38), of places Physical disability over 65 years of age (5) David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 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) 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 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The 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 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 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 29th July 2005 2. 3. 4. 5. 6. Date of last inspection 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). There is one registered manager for the whole unit 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 which 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 DS0000006647.V278258.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home was inspected as part of an announced co-ordinated inspection of all the DLC services registered with CSCI. The purpose of this approach was to evaluate the effectiveness of the Centre in supporting each unit to improve outcomes for the people who live there. The co-ordinated inspection took place over five days and involved a team of eight inspection personnel from CSCI, including a service inspector, a regulation manager, a pharmacist and regulatory inspectors. The inspection also focused on how national minimum standards were being met across the registered services and what progress had been made to meet requirements from the last round of inspections carried out in the period from April to August 2005. As part of the preparation for the inspection, the management staff at the David Lewis Centre produced self - assessment reports which summarised practice in the individual registered units and for the whole of the service. Before the start of the inspection, the inspection team carried out a number of surveys with placing agencies, parents, carers, service users and staff. During the inspection, the service inspector and regulation manager carried out a schedule of interviews with representatives of the Trustees, senior staff, operational managers and staff responsible for clinical, administrative and technical support to the centre. The inspection process included: tours of the premises; discussions with service users and their carers; meetings with senior centre managers and staff; visits to the centre laundry, transport and the central kitchen; meetings with clinical staff; and included an evening visit. The process enabled the inspection team to obtain a clear understanding of the factors influencing development and from the evidence gathered the team were able to form judgements on the quality and effectiveness of the services provided and the outcomes for those receiving services at the David Lewis Centre. What the service does well: Good documentation was in place to demonstrate the level of support and familiarisation visits for a resident moving to another organisation. The trustee board and centre directors are actively engaged in developing a clear vision for the David Lewis Centre services and are prioritising developmental areas and projects. Service users have access to the multi-disciplinary team who ensure needs are addressed and met. The routine, close contact with expert medical care provides a degree of security for carers and staff from placing agencies. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 6 Service users have access to arrange of healthcare facilities on site. Valuable medical support is available to complement residents’ needs. 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 DS0000006647.V278258.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Information is provided to residents about the services available in each of the houses in the group, but the residents’ needs must be assessed by each home to ensure that they can be met. EVIDENCE: One residents’ file that was checked at the inspection contained personal information that identified his home as another residence on the David Lewis Centre. There was no further information regarding the decision to move to Mill Lane. Assessment documentation was not available to demonstrate why the resident moved and how their needs could be met in the new home. This is an outstanding requirement from the last inspection. See Requirements 1& 2 David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 The common care files and person centred plans being implemented at the David Lewis Centre were being used in this unit but inaccurate and out of date information in some of them could result in residents not receiving the best possible support. EVIDENCE: Three care files were checked in three of the houses that comprise the Unit. On all three files a person centred plan (PCP) was in place. The plans varied in quality; one PCP was very detailed and specific to the resident’s needs but the information as to who had contributed to the plan was misleading. A Consent to Treatment form had been completed but was not signed by the parent. See Requirement 3 One PCP was incomplete in respect of the actions needed to meet the resident’s needs. The original assessment provided information that the resident was inappropriately placed at the David Lewis Centre and some good work was in place to familiarise and support the resident with a move to another service. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 10 Personal information about one person identified that he lived in a different house. Further information was available on the common care file that was neither signed nor dated and therefore it was not possible to be assured the information was current. This is an outstanding requirement from the last inspection. See Requirement 4 One PCP clearly identified the likes and dislikes of the resident, and their preferences in respect of the support needed for daily living. Some information was available in respect of the risks involved. Further work is needed to cover all the risks relating to this person’s lifestyle. See Requirement 5 David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 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 the following standard(s): 17 Residents spoken with enjoy the food provided from the main kitchen and the menu planning offers good quality balanced meals. EVIDENCE: Food for the residents in all but one of the houses of Unit 2 is provided from the David Lewis Centre’s main kitchen. Residents and staff reported that there have been significant improvements to the quality and choice of food. The new catering manager has increased the range of meals available and 95 fresh produce is now used. Kenneth Faulkner Flats and Winifred Comber have adapted the spaces in each of the homes to provide more comfortable environments for the residents to eat in. The catering manager is looking to provide training for residents in respect of menu planning, nutrition and cookery. This can only be seen as a benefit to those residents who do some cooking and a new opportunity for those residents who wish to learn to cook for themselves. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Residents have access to a range of medical services and support so their health and personal care needs are met and the David Lewis Centre Medicines Management Policy is currently under discussion so that the residents’ medication can continues to be handled in a safe way that is best for them. EVIDENCE: The David Lewis Centre Medicines Management Policy was approved and implemented on 6th September 2005. The CSCI pharmacist within the inspection team has recently studied the policy and a number of areas for change are currently under discussion. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Although there are arrangements in place for safeguarding service users, these were found to be unsystematic, and the arrangements for safeguarding service users’ personal finances needed to be developed further. The Centre’s complaints policy and procedure need revising to ensure the systematic management and handling of complaints so that service users’ concerns are seen to be fully addressed. In the absence of suitable recording the home cannot demonstrate that the complaints procedure is effective. EVIDENCE: One resident’s file that was checked during the inspection did not contain any information or reference to a recent adult protection issue. These records are held within the Centre’s Social Work department. Records for two further incidents for different residents from this registered service were seen. Information recorded was incomplete and did not thoroughly identify the outcome. The processes were assessed as unsystematic and did not follow the local guidance for protection of vulnerable adults. See Requirement 6 The Centre has a protection and social work team on site. The team is responsible for the oversight of internal protection practice and liaison with the relevant professional bodies. Discussion with the manager of the protection and social work team indicated that there is a lack of clarity in differentiating between issues of protection and general concerns and an unsystematic approach by management staff regarding communication, liaison and management of concerns complaints and allegations. The internal adult protection records need a clearer indexing and reference system. Case recording must be thorough, all records must clearly identify all staff members involved and must include all the outcomes of adult protection cases. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 14 A review of training records in relation to Adult Protection confirmed that not all staff have undertaken training. This is an outstanding requirement from the last inspection. See Requirement 7 Discussions with the Centre’s Senior Behavioural Support Advisor and the Clinical Psychologist confirmed that a new behaviour management model was being developed for the David Lewis Centre and they plan to submit it to the British Institute for Learning Disabilities (BILD) for accreditation. Currently, staff caring for adults at the centre have received training in different models of physical intervention. Staff members in some of the houses for adults have received breakaway training in the past. There was no recent evidence of training in this area. In other houses for adults at the David Lewis Centre, staff members are using control and restraint methods which are not appropriate in social care settings. Some centre staff have received training in de-escaltion techniques within the ‘Timian’ model of practice. This programme is accredited with the British Institute for Learning Disabilities (B.I.L.D.). Care staff receive this instruction within their induction programme and can later access refresher sessions. See Recommendation 1. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 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 the following standard(s): 24, 27 & 30 Significant improvements have been made to the home but there were delays in responding to requirements made by the fire officer, putting the residents and staff at potential risk. EVIDENCE: Improvements were seen to the décor in most of the home but it is recommended that a review of the facilities and the ever-increasing amount of office equipment in 11 Mill Lane should be considered, to improve the quality of life for those living there. See Recommendation 2 The fire officer visited the houses that make up Unit 2 as follows: Winifred Comber in March 2005; Hutton House in March 2005; Kenneth Faulkner in March 2005; 11/12 Mill Lane in February 2005. There were significant delays in responding to the requirements made, in some cases of more than 12 months. See Requirement 8 Residents were not able to use a shower in Winifred Comber due to water leaking through the seal to the floor below. The centre needs to ensure that joint working by the maintenance department and other department (in this instance, the physiotherapy department who commissioned the work to install David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 16 the shower) to ensure the quality of work undertaken by external contractors. See Recommendation 3 David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 Thorough vetting processes for new staff are undertaken to ensure they are suitable for the work for which they are employed. Staff have access to a range of training to ensure they develop their skills to work with the residents. EVIDENCE: A total of eleven staff files were reviewed for staff working throughout the David Lewis Centre, including care staff, learning support assistants, maintenance staff and drivers. Two staff files of staff working in these homes were checked and found to contain the information as required in Schedule 2. Staff members have access to a range of appropriate induction, mandatory and specialist training and the Centre is registered as a Learn Direct Centre. The introduction of a Journal club for all staff allows staff members to increase their knowledge from specialist speakers and helps to inform practice. Foundation training to TOPSS standards is available. All staff members are encouraged to participate in the courses that this provides. David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 In the absence of accurate reporting, or prompt action in relation to the fire officer’s requirements, residents’ welfare is not protected. EVIDENCE: Information seen in a common care file identified that a resident had been found on the floor next to her bed on two occasions. On one of these occasions the resident had sustained an injury. No record of this was found on the accident record, and a risk assessment had not been completed. See Requirement 9 Requirements made by the fire officer were not responded to promptly. (See reporting under Standard 24 and requirement 8) David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 3 2 2 X 2 X I STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X X X X 2 X David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES 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 YA2 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 or their representative must be consulted regarding their care plan or PCP Residents care plans must be reviewed regularly and kept up to date with current information. Risk assessment must be completed in relation to all activities and lifestyle choices of the residents. Satisfactory safeguarding arrangements must be in place to prevent service users being harmed or suffering from abuse or being placed at risk of harm or abuse All staff must receive training in relation to adult protection The registered provider must ensure that effective systems are put into place to ensure that that requirements made by the fire officer are responded to DS0000006647.V278258.R01.S.doc Timescale for action 06/03/06 2. 3 4 5 YA5 YA6 YA6 YA9 5 15 14 13 06/03/06 31/05/06 06/03/06 31/05/06 6 YA23 13 31/05/06 7 8 YA23 YA24 13 24 06/03/06 31/05/06 David Lewis Centre Unit 2 Version 5.1 Page 21 promptly 9 YA42 17 Accident records must be completed for any incident detrimental to residents welfare 31/05/06 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 YA23 Good Practice Recommendations A target date should be set for the introduction of a single method for managing challenging behaviour in adult services at the centre, supported by operational guidance and training for managers and staff. Storage arrangements for office equipment should be reviewed in 11 Mill Lane. The maintenance department should be aware of all contractors engaged to do work for other departments, so they can monitor the quality of the workmanship. 2 3 YA24 YA24 David Lewis Centre Unit 2 DS0000006647.V278258.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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