Inspection on 21/08/06 for L and S Care

This inspection was carried out on 21st August 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

L and S Care 28/09/05

L and S Care 23/06/05

L and S Care 11/02/05

L and S Care 05/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 L and S Care L and S Care 3 York Terrace Birchington Kent CT7 9AZ Lead Inspector Brenda Pears Key Unannounced Inspection 21st August 2006 10:00 L and S Care DS0000059423.V300306.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 L and S Care DS0000059423.V300306.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. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service L and S Care Address L and S Care 3 York Terrace Birchington Kent CT7 9AZ 01843 227801 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) Miss Linda Ann Wright Care Home 3 Category(ies) of Learning disability (3) registration, with number of places L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th August 2004 Brief Description of the Service: 3 York Terrace provides residential care for 3 people who require varying degrees of assistance because of their learning disability. Whilst the Home does not purport to provide specialist services, it has access to all necessary specialist services within the community. The Home comprises a semi-detached property in a residential area of Birchington and is within a short distance of amenities such as rail and bus services, health centres, shops and churches, a library and a concert hall. The fees for support from the home are set during the assessment period and are very individual to the needs of the service user, depending on the level of support required and the staffing numbers provided. A guide to average fee levels at this time range from a minimum of around £11000 to a maximum of around £15000 or more depending on the support needs as stated. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken with a focus on the well being, safety and quality of life for service users living in the home. The methods of inspecting the home included speaking to service users and members of staff. A tour of the building and observations of both staff and service users at this time are reflected in this report and evidence outcomes. What the service does well: What has improved since the last inspection? What they could do better: While records contain full information of how time is spent, some discussion was undertaken regarding goals and aspirations. The manager currently feels L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 6 that full potentials have been met. However, a chart or file containing goals and achievements to date, would provide a history of each person’s life. If this were undertaken with the service user and family members, supported with pictures or drawings, a complete record would support achievements to date and may prompt other goals or targets for each person. While clear records are in place for all financial transactions and money is signed for, two signatures must support each transaction at all times. While healthcare needs are being met, regular hearing tests would ensure complete well being is fully supported. The manager must ensure that POVA first information is obtained while waiting for CRB checks to be completed. During this inspection, the manager contacted the organisation dealing with these checks to ensure this is carried out in the future. 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. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 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 L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of the resident’s support needs, which has provided appropriate development for each person. EVIDENCE: There are no referral assessments on record as the current service users have been in the home for some time. The Manager and staff have identified resident’s individual needs from information gleaned from resident’s relatives and from their own observational assessment and have acted upon this collective information. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Changing needs are regularly assessed. Personal goals and developments have been attained and identifying these achievements will further support service users. Service users are consulted about all aspects of their life both inside and outside of the home. Support is given to ensure risks are taken safely and that individuals become as independent as possible. Those living in the home are consulted on a daily basis about daily routines, events and scheduled activities, supporting autonomy and independence. EVIDENCE: While records contain full information of how time is spent, some discussion was undertaken regarding goals and aspirations. The manager currently feels that full potentials have been met. However, a chart or file containing goals and achievements would provide a history of each person’s life. If this were L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 10 undertaken with the service user and family members, supported with pictures or drawings, a complete record would support achievements to date and may prompt other goals or targets for each person. Service users are supported and encouraged to make decisions on a daily basis. The routines of the home revolve around the needs and requests of each person. This was demonstrated by the actions of service users at this time when constantly discussing events that had taken place or that have been planned. Records on care plans are appropriate and informative with thorough records of behaviours. The manager and staff responded positively, expressed a good knowledge of the routines of each person and gave each service user time and their full attention. The inspection was explained fully to each person and staff supported the service user’s wishes, showed respect for decision making and full involvement at all times. Care plans evidence risk assessments re in place and regular reviews are carried out. Regular reviews are undertaken with appropriate agencies and recorded on care plans. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 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): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users undertake appropriate and suitable activities both in the home and in the local community, supporting personal development and autonomy. Family and appropriate personal and relationships are supported. Service users enjoy a varied and nutritious diet that is chosen by individuals with support and guidance from staff, ensuring good health and personal choice. EVIDENCE: Contact with friends and family are encouraged and supported by staff in the home. Reviews of person centred plans are undertaken regularly and discussed with service users, care managers and family members. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 12 Constant contact is maintained with family members and the manager was advised to ensure all conversations and contact is fully recorded. This supports any decisions that are made jointly, fully informs staff and also evidences this continued contact. Menus and records of food provide evidence of a varied and nutritious diet. Service users choose what meals they will eat and also help with the preparation of food. All service users were fully included in the inspection process and were happy for the inspector to join them at lunchtime. This time was spent at a relaxed pace. General discussions evidenced that service users are confident and are given choices about how they spend their time. Two service users live in the main building and the third service user occupies a separate flat. Activities are undertaken on a one to one basis. All three service users undertake chosen activities and joint activities are only at the choice of the individual. The home provides a safe environment in which to live, with risk assessments being completed for all activities and appropriate staff support. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 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 the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support is given to each service user in a way that suits the individual and healthcare needs are appropriately met, fully supporting individual needs. Service users receive one to one support at all times, providing complete support. Medication is stored and handled appropriately. EVIDENCE: While most healthcare needs are being met, ensuring regular hearing checks are undertaken will further support service users and their wellbeing. Health is monitored through observation regarding food that is eaten, weight charts and behaviour patterns. There is a regular review of medication and adjustments are made as recommended. There are also charts maintained for all observations of the individual including food eaten, outings undertaken or refused. All these observations are regularly reviewed to support and inform individual assessments and to identify specific triggers to behaviours. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 14 Medication storage and records evidence that practices support the welfare and safety of service users. There is flexibility and choice for the individual service user and meals and bedtimes are at the chosen time, reflecting individual needs and preferences. The Home secures specialist support where necessary including such services as a physiotherapist, occupational therapist, speech specialist and supporting attendance to medical and hospital appointments. The manager and staff are aware of indicators that may be the result of service user discomfort. Staff recognised these indicators and enabled the quick identification of a medical problem. This supported the swift treatment that was needed for the well being of this service user. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 15 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, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures and practices in the home support and protect service users. EVIDENCE: The Home has a whistle blowing policy and this is displayed in the front entrance. The Home has an adult protection policy and procedures that include definitions and indicators of abuse. It also features information sharing, preventative measures and the importance of recording systems. Staff sign to confirm they have read appropriate information regarding protection and abuse and these guidelines form part of the induction programme. While clear records are in place for all financial transactions and money is signed for, good practice and sound accounting procedures dictate that two signatures must support each transaction at all times. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 16 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was found to be, in the main, appropriate to meet service user needs. The owner is currently working towards addressing areas in need of upgrading. EVIDENCE: The home has a self-contained basement flat and both this and the main building provide a spacious and comfortable environment. As this property is leased, many repair areas have not been addressed as these are currently being discussed and responsibility is to be clearly ascertained. The manager is fully aware of all areas needing upgrading. When responsibilities have been agreed, upgrading will then be undertaken. The communal facilities, such as the lounge, dining room and the kitchen are comfortable and adequately equipped. All areas were found to be clean and tidy with appropriate and comfortable furnishings. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 17 Flooring in some areas is worn and this has been made safe until discussions have identified where responsibility lies for replacement. One door frame contains a number of sections of glass. While there has been no accident to date, this could present a risk to service users and staff. While toughened glass may not be agreed under the lease, these panels of glass do need to be covered with a protective film. This would then ensure protection in the event of any accident. Bathroom and toilet facilities meet service user needs and these areas also require upgrading. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 18 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): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported and protected by the staff training, recruitment and supervision process. EVIDENCE: There is a full induction programme in place for all new staff that lasts for 12 weeks. Staff are now supported through regular supervision and files evidence all aspects of practice, training and development are discussed. Staffing levels are set after a full assessment of daily routines is undertaken. Regular staffing supports one to one support for each service user. Depending on the daily activities, the rota then reflects the service user support that is required. Training is decided and driven by service user needs. A training matrix is currently being developed to ensure training is current. Training undertaken to date includes Health & Safety, Food Hygiene, Challenging Behaviour and Adult Protection. Three staff have obtained NVQ level 2 and new staff undertake NVQ training after they have been in post for three months. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 19 While CRB checks are carried out, the manager must ensure that POVA first information is obtained while waiting for CRB checks to be returned. During this inspection, the manager contacted the organisation dealing with these checks to ensure this is carried out in the future. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 20 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): 37,39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home protects and promotes the safety and well being of service users and is run by an experienced, registered manager. The home is run in the best interests of service users with their choices and goals at the centre of all care delivered. EVIDENCE: L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 21 The current manager has two years management experience following six months as assistant manager. The manager operates an open door policy and observations and discussions undertaken evidence that service users and staff are confident and comfortable to speak to the manager. Regulation 26 visits are to be regularly undertaken and copies of the recording format were discussed at this time. This regularly monitors the quality of the service and identifies any areas needing development or improvement. The health and well being of service users is considered at all times and staff expressed a thorough knowledge of service user needs. All appropriate service checks have been kept up to date and areas posing a risk to service users are securely locked. The manager operates with due consideration for confidentiality. Some discussions were undertaken regarding regulation 37 incident reports. While these are currently being completed, these have not been forwarded to CSCI as per the National Minimum Standards. The manager stated this would be procedure from the date of this inspection. L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 22 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 14, 15 Requirement To develop a record that evidences the goals that have been achieved to date and to support the development of new aspirations. That hearing tests are appropriately undertaken for all service users to ensure complete well being. Staff must ensure there are two signatures for all financial transactions on records. That glass doors are made safe to ensure the full safety of both service users and staff at all times. The Home must ensure that all the relevant POVA checks are obtained before employment is commenced. All appropriate regulation 37 incident reports to be forwarded to CSCI as required. That a review of services and the DS0000059423.V300306.R01.S.doc Timescale for action 30/10/06 2 YA19 13,14,15 02/10/06 3 YA23 12, 17 02/10/06 4 YA24 12, 23 30/10/06 5 YA34 19 02/10/06 6 YA40 37 02/10/06 7 YA39 26 02/10/06 Page 24 L and S Care Version 5.2 environment is regularly undertaken and records maintained. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations L and S Care DS0000059423.V300306.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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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