Inspection on 28/09/05 for L and S Care

This inspection was carried out on 28th 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

L and S Care 21/08/06

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 Patrick Gough Unannounced Inspection 28th September 2005 11:50 L and S Care DS0000059423.V255704.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 L and S Care DS0000059423.V255704.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. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 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.V255704.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 2005 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. Staffing comprises the Manager and a team of support staff. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which lasted four hours. It commenced at 11.50 am and finished at 4 pm. Two of the three residents were on the premises and the other resident was on an annual holiday, at a seaside resort, accompanied by two members of staff. Three staff were on duty and the Manager, who was off duty at the commencement of the inspection, attended earlier than rostered in order to assist with the inspection. Many of the requirements and recommendations made at the previous inspection had been satisfactorily addressed and where the Manager stated that others had been addressed but where the inspector was unable to evidence the statement, those will be repeated. Resident’s care plans, policies and procedures and other practice documentation was inspected. The inspector also looked at two staff files. The staff were observed to be engaging positively with the residents. What the service does well: What has improved since the last inspection? The Manager has responded positively to requirements and recommendations made at the last inspection. An attempt has been made to acquire more information on the current residents to enhance the quality of their care planning and the Home is attempting to promote the involvement of the placing officers in the residents’ ongoing care. A format has been produced to L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 6 ascertain the views of placing officers and relatives on the care received by the respective residents. The information contained in the daily logs contributes to the implementation of the care plan. 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. L and S Care DS0000059423.V255704.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 L and S Care DS0000059423.V255704.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 The staff have a good understanding of the resident’s support needs, which has enabled them to put in place the necessary resources. EVIDENCE: The three residents currently accommodated were admitted prior to the registered person acquiring the Home. There are no Care Management assessments on file and the manager confirmed that they were not available when she assumed responsibility. Although the residents have been at the Home for a number of years, there were no referral details and no explanation of their disability. There were no records of development or achievement prior to the current proprietor taking charge. The Manager has responded to the requirement made at the previous inspection by contacting the Care Management service in order to access information and advice on the needs of the residents currently placed. To date no response has been received. 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 that information. L and S Care DS0000059423.V255704.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): 6,7,9 The current care plan is implemented, monitored and reviewed within a timescale with the intention that the resident’s needs are addressed or practice altered. Despite communication difficulties, the staff have a good understanding of the resident’s needs and this was evident from the positive relationships formed with the residents. The residents are enabled to participate adequately, within the Home and in the community, through choice and decision-making opportunities and the assessment of risks. EVIDENCE: Each resident has a current care plan and one that was inspected was last reviewed in June ‘05. The plan has headings, which include communication, personal care, dietary issues, health, restrictions on choice and freedom and social behaviour. It also features their likes and dislikes relating to food, leisure and general lifestyle. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 10 Although there are no formal 1:1 key work sessions recorded, the daily log completed at the end of the morning and in the evening, was found to be informative and reflected some elements of the care plan. The Manager stated that the plan is monitored on a monthly timescale and the findings, as well as contributing to change or development, are contained in the six monthly review. The care plan process was discussed with the Manager, who was advised to justify the review response each month with some indication as to there might be ‘no change’ or why amendments might be made. Two of the three residents have communication difficulties, however the staff indicated how they were able to understand and interpret the resident’s mode of communication. Where appropriate the Manager is able to seek the assistance of the residents’ relatives in order to guage their satisfaction with the service and how it could be improved. The daily log contained references to opportunities that the residents were given to make choices and express their preferences. There was no evidence of pre-admission risk assessments, however signed individual and generic assessments, stating the commencement and review dates, had been conducted. The assessments, which identified risk factors and action to minimise the risk, covered absconding, road traffic awareness, use of the kitchen, mealtimes, swimming, bathing and incidents in the community. The Manager stated that the recommendation made at the previous inspection had been noted and that a risk assessment would be made following incidents or accidents. Two incidents, which had occurred recently, were adequately covered through risk assessments. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 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): 16 The staff provide assistance and support where necessary, whilst ensuring that the residents have opportunities to maintain their independence. EVIDENCE: Each resident has their own bedroom and can access their room in private or with assistance. Due to the degree of support that they require, each resident has 1:1 assistance, although this does not compromise their independence or their desire to be alone. The staff were observed to interact appropriately and respectfully with the residents. Any restriction is governed by their assessed needs and risk assessments designed to maintain their safety. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 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): 18,19 The Home provides sufficient staff to ensure that there is the required support and the residents benefit from 1: 1 assistance. The combination of adequate monitoring and the availability of the appropriate specialist resources ensure that the residents’ healthcare needs are met. EVIDENCE: The staff rota is organised so that there is 1:1 support for each resident, which allows for assistance to be given with personal care and life skills support. Where this is given it is evidenced in the daily log. At the time of the inspection there were three staff working with two residents. The staff were observed to be engaging with the residents in a patient and sensitive manner. There is flexibility with bedtimes reflecting the choice of the individual resident; for instance, one resident prefers to go to bed early in the evening. The Home secures additional specialist support where necessary and currently involves a physiotherapist and occupational therapist in the care of the residents. Support is given to residents when accessing medical and hospital appointments. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 13 L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 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 the following standard(s): 23 The staff have been trained and have the necessary guidance to provide the residents with adequate protection. EVIDENCE: The Home has a whistle blowing policy and this is displayed prominently in the front entrance. The Home has an adult protection policy and procedures to be used in the event of a concern about abuse to the residents. The policy includes definitions of abuse, indicators of abuse and how to respond if there is a disclosure or concern. It also features information sharing, the importance of factual records and preventative measures. All the staff have signed to confirm that they have read the policy and five of the eight staff participated in training in ’04 and ’05. Adult protection features in the Induction Programme currently being undertaken by a new appointee. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 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 The Home is suitable for its purpose and adequately furnished enabling the residents to live in comfortable surroundings. The bathroom and toilet facilities are adequate but would benefit from refurbishment to improve infection control and make it more comfortable for the residents. EVIDENCE: The location of the Home, in a terrace of houses in a quiet cul-de-sac allows the residents to enjoy relative anonymity. The layout of the house, which has a self-contained basement flat, provides sufficient privacy and communal facilities for the residents. Both the exterior and the interior of the building are in need of redecoration. Some internal decoration has occurred. The Manager stated that there has been some difficulty in addressing some maintenance issues due to lease arrangements. The communal facilities, such as the lounge, dining room and the kitchen are comfortable and adequately equipped. The furnishings are clean and comfortable. There is sufficient space for the staff and residents with adequate natural light and ventilation. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 16 There is a separate toilet and bathroom, which has a bath with a shower attachment and a sink unit. The bath sill and window sill still need to be repainted. The toilet and bathroom, which are easily accessible from the bedrooms, were clean and free from offensive odours. The recommendation made following the previous inspection to consider alternative floor covering in the bathroom has not yet been addressed. The Manager indicated that the issue was still subject to agreement by the owner of the property. The toilet window, which needs to be accessed for ventilation, should be fitted with some form of restrictor, for safety purposes. A broken tile on the bathroom wall needs to be replaced. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 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): 34,36 Recruitment policies have not been consistently followed resulting in residents receiving care from staff who have not been appropriately vetted. There is no staff appraisal system in place to regulate practice and identify training needs and therefore the quality of practice engaged with the residents is not adequately monitored or assessed. EVIDENCE: The Home has a recruitment policy, which is in line with agreed guidance. There has been some improvement in how the process is applied in that CRB checks are now conducted appropriately. There are, however, still inconsistencies in the process as there was missing recruitment documentation in the two personnel files that were inspected. Only one staff file contained two references, the other contained no references, although the Manager indicated that they had been received but mis-filed. The concern identified at the previous inspection in that some staff that had not been properly vetted were working with residents without the required supervision, has been rectified. On the day of the inspection a new appointee was ‘shadowing’ an experienced member of staff and the staff roster confirmed that this process is followed when he is on duty, until he has satisfactorily completed his induction period. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 18 The Company has yet to implement a staff appraisal system. The Manager stated that formal supervision is given on a two-monthly cycle and recorded sessions on one file confirm that three supervision sessions have occurred in a six month period. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 19 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 The Manager has not received the necessary support or guidance to enable her to perform her role effectively. There is insufficient monitoring by the Provider and the Manager, on a regular basis, to provide effective quality assurance and inform further planning and development. The Home’s policies and procedures support and guide practice enabling staff to engage confidently with the residents. EVIDENCE: The Manager confirmed that her job description is not yet in place although it is being negotiated. There is no arrangement in place to provide regular formal supervision for the Manager. The Manager stated that monitoring of the Home’s practice and management has commenced and that monthly reports have been produced. There was no evidence that this had, however, occurred and the Manager explained that the L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 20 obligatory Regulation 24 and 26 reports had been submitted to the NVQ assessor as evidence for her Registered Manager Award. Copies of the written reports had not been submitted to the Commission. The Manager stated that the original reports were due to be returned from the Assessor by 26/10/05 and the inspector requested that copies be submitted to the Commission immediately following their receipt. The Manager has produced a new format to circulate to Care Management and residents’ relatives in order to ascertain their views on the care given to the residents. This process has not yet been implemented. The Manager indicated that the practice of Care Management being provided through the ‘Duty’ provision by the Placing Authority makes it difficult to achieve continuity, attendance at residents’ reviews and feedback on the service. All the necessary safety checks have been conducted and the appropriate risk assessments have been done. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 21 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 3 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 2 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 2 X 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 L and S Care Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 3 X DS0000059423.V255704.R01.S.doc Version 5.0 Page 22 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 YA34 Regulation 19 Requirement The Home must ensure that all the relevant checks, referred to in Schedule 2, are obtained before employment is commenced. The Registered Provider shall establish and implement a system for reviewing the quality of care provided at the Home and submit a copy of the review report to the Commission on a monthly basis. The Manager shall conduct a review of the care provided in the Home at appropriate intervals in order to assure quality of care and to improve the service and shall submit summary reports to the Commission on a quarterly timescale. Timescale for action 01/12/05 2 YA39 24 01/12/05 3 YA39 26 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 23 No. 1 2 3 4 5 6 Refer to Standard YA24 YA27 YA34 YA36 YA36 YA37 Good Practice Recommendations The Home should create a planned maintenance and renewal programme for the fabric and decoration of the premises. The Registered Provider should maintain the bathroom and toilet facilities to prevent spread of infection. Written references should be verified by a telephone enquiry. The Registered Provider should ensure that the Manager receives regular formal supervision. The Registered Provider should establish and implement an appraisal system for all staff. The Registered Provider should provide the Manager with a job description, which outlines the responsibilities and duties relevant to the role. L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI L and S Care DS0000059423.V255704.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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