Inspection on 30/09/05 for Helen Ley House

This inspection was carried out on 30th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Helen Ley House 17/10/08

Helen Ley House 17/10/06

Helen Ley House 07/02/06

Helen Ley House 20/01/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Helen Ley House Helen Ley House Bericote Road Blackdown Leamington Spa Warwickshire CV32 6QP Lead Inspector Unannounced Inspection 30th September 2005 09:30 Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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 Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Helen Ley House Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Helen Ley House Bericote Road Blackdown Leamington Spa Warwickshire CV32 6QP 01926 331550 01926 888972 Multiple Sclerosis Society Care Home 23 Category(ies) of Physical disability (23) registration, with number of places Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th January 2005 Brief Description of the Service: Helen Ley House is a respite care home with for adults with physical disabilities who have Multiple Sclerosis. The home is set in landscaped gardens in the Warwickshire countryside a short drive from Leamington Spa. The home is a single storey purpose built accommodation with 23 single rooms, the majority of which have track hoists. The home provides long-term accommodation to two service users; the remainder of the 21 beds are for respite care. The home has a physiotherapy department with a hydrotherapy pool for service users to use during their stay. The gardens are mature and well maintained. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was completed by Catherine Mundy and Jo Johnson. The inspection was unannounced and took place on 30th September 2005, between 9.55 am and 1.30 pm. During this time the inspectors had the opportunity to meet with the service users, observe interactions between the service users, staff and their environment, meet members of care and ancillary staff, examine records relating to the residents and tour the home. The inspection was supported by the Nurse-in-charge. A management representative was not present during the inspection, as such the progress towards meeting a number of requirements, made at the last inspection, could not be assessed on this occasion. These will be assessed in full during the next inspection of this home. Since the time of the last inspection the Registered Manager for the home has resigned her post. Until this post can be filled the duties of the Registered Manager have been divided between two nominated members of staff. The organisation also provides additional support. What the service does well: What has improved since the last inspection? The standard of the environment has improved, with the refurbishment of part of the building. This work is near completion. The plan is for the whole building to be refurbished to the same standard. The change to the layout of the building and the facilities now provided has had a positive impact upon the way in which care is delivered to the service users. However some of the service users experienced difficulties in finding their way around the home. It is recommended that the home consider introducing ‘landmarks’ to assist the service users with this. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 6 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. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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 Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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 There is a needs assessment and care planning system in place that adequately provides staff with the information they need to satisfactorily meet service user needs. However, for staff to give appropriate care to individuals, changes made to care plans and assessments need to be clear. EVIDENCE: Service users were spoken with and four assessments and care plans were seen. This included one relating to one of the permanent service users and one relating to a service user who was staying in the home for the first time. The assessments seen covered all the relevant areas of a service user’s needs. The assessments are reviewed and updated prior to and during each stay at the centre. Service users are contacted by telephone the day before their admission. Service users said that staff ask them about what assistance they need before they come in and during their stay. A request for an update on service users’ medical needs and medication is sent to their GP prior to each stay to ensure that staff have the correct medical information. One service user’s assessment and care plan had been amended a number of times and the information was contradictory. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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 and 9 Service users know that the actions needed to be taken by staff, to meet their care and well being needs during their stay, are set out in their care plans. The shortfall of some care plans relating to pressure areas may potentially put service users’ skin state at risk. EVIDENCE: Four service user care plans were seen. This sample included a service user who lives at the home permanently. The care plans were based on the service user’s assessments and risk assessments around nutrition, pressure area care and moving and handling. One pressure area risk assessment highlighted that a service user was at risk but the plan section of the document had not been completed. This means that staff may not have been aware of any action to be taken to prevent the development of any pressure areas. Care plans must be written for any areas of risk identified. Service users knew about the records kept about them and said they had been involved in completing them. Service users said they choose where their care plan is kept. There was evidence that the care plans were reviewed during each subsequent stay. The service user who lives at the home has been involved in the review of her plan following a change in her circumstances. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Service users are offered a healthy and varied diet including specialist diets. Service users are helped to eat and drink in a sensitive way in a relaxed atmosphere. EVIDENCE: Service users spoke highly of the food provided at the home. They said that that the food was ‘lovely’, ‘excellent’, ‘very tasty’, ‘if I don’t like what’s on the menu they’ll cook me something else’. Service users choose their meals for the next day from a menu the evening before. There are at least 2 choices at each meal plus specialist and soft diets. One service user said that there are now menus on each table and ‘it’s better because I can’t always remember what I’ve ordered the night before’. The staff that assisted service users to eat and drink were sensitive and discreet. Staff assisted service users at their own pace. There was a relaxed atmosphere over lunch with lots of conversation between service users and staff. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Service users are supported with their personal support needs in a way that is sensitive to their wishes. Inaccurate recording prevents the home from demonstrating that the service users medication is administered as prescribed, or in a way that reflects the individuals needs and preferences. EVIDENCE: Service users personal preferences are recorded in their care plans. Service users said that staff support them in ways that promotes their independence and maintains their dignity. One service user said that ‘the staff are gentle, it’s lovely’. Staff had a good understanding of the needs of the service users staying at the home. There is suitable specialist equipment at the home to meet the moving and handling, medical and eating and drinking needs of the service users. Service users can also bring in their own specialist equipment for their stays. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 12 The home is part way through a refurbishment programme and service users who are in the new en suite bedrooms said that ‘it’s better now the showers are in the bedrooms’. Service users reported that there is a less rushed feel about mornings since the refurbishment. All of the service users spoke highly of the staff. Comments from the service users include ‘ the staff have always been excellent’ and ‘all of the staff are lovely’. Service users can have access to the physiotherapists, counsellor and other therapists during their stay at the home. One service user said that he really valued being able to have physiotherapy and ‘I love being able to exercise and stand upright’. Arrangements for the administration of medications were inspected. These were generally good, the home ensures that all medications are administered as prescribed by the service users own GP, medication is administered by a registered nurse, unless the service user wishes to retain responsibility for this. Arrangements for the storage of medication are acceptable. Risk assessments are completed and guidance is in place for service users who wish to self medicate. These are reviewed at the start of each stay. The records seen for one of the service users did not make it clear whether this service user wishes to retain his own medication or the level of support he requires to take medication. The service users are responsible for providing their own medication during their stay. The MS society has produced a leaflet to provide advice to the service users about the homes policy on administration of medication. A copy of this leaflet was provided to the inspectors during the inspection. The leaflet states that the homes policy is to count all medication on arrival at the home and again before discharge. This practice will allow the home to confirm that during the service users stay their medication has been administered as prescribed. However in discussions with the nurse in charge it was advised that the procedure adopted by the home is to count only a few types of medication, such as Temazepam and Diazepam. Medication Administration Records (MARS) are completed following administration of medication. Examination of these records identified that there are some gaps in this recording. It is not clear whether the medication has been omitted. Records relating to ‘as required’ medication for another service user were also not clear. Records showed that this medication had been administered nightly for the duration of the residents stay, with the exception of one night. Again it is not clear as to whether this medication was omitted or why. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The service users are confident that any complaints made or concerns raised will be addressed by the home. EVIDENCE: The homes complaints log was not available for inspection. This will be examined during the next inspection of this home. The service users spoken with were very complimentary of the service provided in the home. It was one persons first stay in the home. She said that she was so happy with the service provided that she intended to book further stays in the home. The service users confirmed that if they wished to make a complaint or raise a concern they are confident that this will be addressed by the staff. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The homes policies and procedures reduce the risk of the spread of infection. EVIDENCE: The standards relating to the environment will be fully inspected as part of the registration of the new building. However it was noted that the refurbishment of the home is well under way. The service users are happy with the new facilities that have been provided. It was noted during the inspection that some of the service users, and the inspectors, were having difficulty in finding their way around the new facilities. One service user said that she kept going to the wrong bedroom. This service user was also uncertain as to how to get from her bedroom to the communal areas. It is strongly recommended that the home introduce some ‘landmarks’ to assist the residents and visitors to find their way around the home. Discussions with the staff and observations of their practice confirmed that the home takes appropriate action to reduce the risk of infection. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 15 This is in the employment of a separate staff team to complete domestic duties, implementation of the homes procedures and the provision of protective clothing, including gloves, aprons and shoe covers and hand washing facilities. Arrangements for the laundering of clothing and linen are suitable for the needs of the home. The home was clean, hygienic and free from odour. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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 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): 33 The service users are supported by a team of staff who provide support in a sensitive way. EVIDENCE: Examination of the staffing rotas, and observations during this inspection confirmed that there are sufficient staff on duty to meet the service users needs. As noted throughout this report the feedback received from the service users is very complimentary of the staff and the care that is provided in the home. It is advised that the amount of staff employed through an agency has reduced, however due to holidays and sickness some agency staff had worked in the home on the week of this inspection. The nurse in charge confirmed that appropriate checks are completed, prior to the staff member working in the home, to protect the service users. Records to verify this were not available during this inspection. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 17 Staff members stated that the layout of the newly refurbished part of the home has helped them to care for the service users, with greater space and facilities enabling a less hectic and relaxed routine. it is advised that in the past, due to the layout of the building and restrictions upon space and facilities, the morning routine of supporting service users to get up and dressed was hectic with some service users not being able to rise until late morning. On the day of this inspection the atmosphere was calm and relaxed with service users being able to be helped to rise earlier. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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): X EVIDENCE: The standards relating to this section were not assessed on this occasion Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x 3 2 x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Helen Ley House Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x x x DS0000063467.V252178.R01.S.doc Version 5.0 Page 20 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 Regulation Requirement Any changes made to the service users’ needs assessment and care plans must be clearly recorded. Where risks are identified risk management strategies must be developed. The organisation’s procedure for checking medication at the start and end of a period of care must be adhered to. Accurate records are to be maintained of the medications that have been administered. Records must detail the reasons why medications have been omitted. The organisation must appoint a manager for the home. An application to register the newly appointed manager must be made to the Commission for Social Care Inspection. Timescale for action 30/11/05 YA20YA9YA6YA2 12(1) 2 3 YA6YA9 YA20 13(4)(c ) 13(2) 30/11/05 30/11/05 4 YA20 13(2) 30/11/05 5 YA37 8 31/01/05 Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 21 6 YA34 19 The staff files must meet the requirements detailed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001. These must including a recent photograph, evidence of physical and mental fitness for the purpose of work and evidence of criminal record checks. This requirement has been made previously (1/7/04). Progress towards achieving this could not be assessed on this occasion. 30/11/05 Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 22 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 YA24 YA23 Good Practice Recommendations It is strongly recommended that some ‘landmarks’ are provided to help service users to find their way around the home. It is recommended that the manager review the policy regarding physical intervention (restraint), consult with the MS Society whether they support the current policy and provide training that is BILD accredited in line with Department of Health guidance. This recommendation was made at the last inspection and is met in part. Helen Ley House DS0000063467.V252178.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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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