Inspection on 20/04/06 for Lambert House

This inspection was carried out on 20th April 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lambert House 04/09/07

Lambert House 28/02/06

Lambert House 27/09/05

Lambert House 03/03/05

Lambert House 14/06/04

Lambert House 12/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Lambert House 36 Notridge Road Bowthorpe Norwich Norfolk NR5 9BE Lead Inspector Mr Roger Andrews Unannounced Inspection 20th April 2006 09:30 Lambert House DS0000027475.V290810.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 Lambert House DS0000027475.V290810.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. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lambert House Address 36 Notridge Road Bowthorpe Norwich Norfolk NR5 9BE 01603 749845 01603 749460 nacha2@zoom.co.uk 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) Norfolk Autistic Community Housing Association Limited Position Vacant Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: Lambert House is situated in the middle of a residential area. It is a large, detached, two storey building with parking to the front. There is a secure garden to the front of the Home and a secure paved area to the rear. Accommodation is provided to up to eleven adults with a learning disability with autistic spectrum disorders. All service users have a single bedroom, either on the ground or first floors. The Home does not have a passenger lift. There are several communal rooms including activity rooms and a swimming pool. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. It looked at all of the key standards for young people and lasted from 11 am until 6.30 pm. The inspector talked with the manager and four members of staff as well as looking at records and having a look around the building. Only one resident is able to have a meaningful conversation without becoming anxious. However, this resident was at his parents. Other residents were observed during the day with staff and the inspector joined residents for lunch. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 6 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 Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 7 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 Full assessment material will be sought prior to admissions taking place EVIDENCE: Assessments are in place for each of the current 10 residents. A requirement was made at the previous inspection as assessment material was not in place for one resident. This has now been rectified and the manager has undertaken to ensure such material is in place when future admissions are planned. The assessment material seen included questionnaires seeking the detailed views of parents and/or carers as well as other places, such as daycentres, which residents had attended prior to moving to Lambert House. There have been no further admissions since the previous inspection took place. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 8 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 Case files and care plans are informative. Residents can make choices and restrictions are noted in care plans and risk assessments. Risk assessments are in place on each care plan and are reviewed on a regular basis. EVIDENCE: Three case files were studied in detail. These all contained detailed care plans and regular monthly review updates. These documents were informative in respect to background history, descriptions of challenging behaviours, (including trigger factors), goals and programmes being worked towards and personal care and health needs/support. Examples seen included routines for, e.g. bath times, trips out, meal times and bedtimes. These routines are reviewed on a regular basis, usually every four months or so. The records were informative about those tasks that residents could undertake for themselves and those that they required support with. The written documentation was reflected in the knowledge about particular residents that staff members demonstrated in discussion during the inspection. For some of the residents, Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 9 due to their particular autistic disorder, the manner in which they are responded to is especially important in keeping their anxiety levels low and there was a good understanding by the staff of the importance of individualised approaches. One care plan reflected the point that the resident was not able to actively participate, (due to anxiety), in its drawing up, but the care plan was read to the resident. Aims were set out which included increasing the number of key words the resident could use, reducing anxiety in group situations and consistent approaches to be adopted by staff in responding to questions from the resident. Lifestyle plans set out “things I can do and things I need help with” and care plans and discussion with staff gave a good reflection of residents being able to make choices in the process of daily living. Examples include preferred bedtimes, food choices and preferences and choosing when to have a bath. In one case a resident has a key to his bedroom and a key to the kitchen enabling him to make hot drinks and snacks. This facility would be inappropriate for other service users due to the risk of harm. Choices in daily living may need to be restricted or monitored due to the level of understanding of particular residents. However, areas of risk are set out in reasonably detailed risk assessments. These cover a wide range of areas and pastimes and examples looked at during the inspection include eating and drinking, Travelling, swimming, levels of supervision inside and\outside of the building, bathing and using the kitchen facilities. These examples are not exhaustive. Risk assessments are reviewed at regular intervals and are signed and dated when this occurs. Risk assessments dealing with challenging behaviours identify both hazards and measures of control. Residents have two ‘house meetings’ each week at which they discuss issues such as activities, planning annual holidays and general news. One of the residents chooses not to attend this meeting. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 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): 12, 13, 15, 16 & 17 Residents have varied programmes of leisure and work activities. Residents participate in the domestic routine with support from staff where needed. Links with families and friends are promoted. The menu is varied. EVIDENCE: Each resident has an individualised programme of both leisure and work/day centre orientated activities. Leisure activities include both in-house and outdoor pastimes. Examples include swimming, (Lambert House has its own swimming pool), ten pin bowling, horse riding, going to the pub, shopping, visiting local cafes, gardening, (on an allotment), and attending local daycentres during the week. Again, these examples are not exhaustive. There is an activity room next to the lounge which appears to be well used and also a large sensory room with music equipment. One resident was observed dancing Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 11 to music in this room. Various activities are included in the risk assessment analysis as are the required supervision levels. Residents are also encouraged to be involved in some of the domestic routine and examples of recording in the daily diary and care plans reflected this. Recording was generally structured in a positive fashion, e.g. one example of guidance to staff working with a particular resident advised them to encourage him in a task and then say, “Thank you xxxx, that was really good”. Another resident is noted as enjoying staff reading to him and, with encouragement, he will read himself. The guidance advises staff on how to structure the reading sessions so he joins in. One resident is currently able to enjoy considerable freedom and access, for example, the kitchen to make hot drinks and snacks and use the laundry facilities as he wishes. Other residents will be supervised to varying degrees and have restrictions that are clearly documented in care plans. However, residents will participate in cooking and domestic routines and on the day of the inspection one of the residents had helped a member of staff preparing the homemade soup for lunch. Preferred bedtimes and rising times were observed in care plans There were good examples of residents maintaining contact with their families. Contact between the staff and parents/carers is documented and reflects the communication of important matters such as hospital appointments. One parent commented that “I am always made to feel very welcome whenever contact is made”. Records also contained information on important friendships for residents including those that had existed prior to coming to live at Lambert House and of these being promoted and maintained with support from the staff. There is a varied menu and the cook described alternatives that are provided for particular residents who do not like some of the meals on the menu. Vegetarian dishes are also prepared and three of the residents are currently following healthy eating diets. Breakfasts and lunches are usually a choice with the main cooked meal being served in the evening. Lambert House DS0000027475.V290810.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): 18, 19 & 20 Residents are encouraged to participate with their personal care needs and receive appropriate healthcare support. Medicines are properly stored, administered and recorded. EVIDENCE: Residents are encouraged to participate in their personal care routines and care plans give guidance on those tasks that residents are able to do for themselves. One record, for example, notes that “I can dress myself, though sometimes choose clothes that are too hot for the weather. I can tie shoes and laces”. One resident is able to undertake all personal care tasks including bathing independently. Intimate personal care is gender related and staffing provision allows for this. There is currently one female resident living at Lambert House. There was a good deal of documentary evidence relating to health care needs being met and appointments with G.P.s and other specialists such as speech therapists , psychiatrists and local dental services. Specialist dental services at the hospital are utilised when required for specific residents. The local doctors have indicated in their questionnaire that specialist advice given by them is acted upon by the staff. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 13 There was also evidence that parents are involved in discussing health issues and all parents who responded to the inspection questionnaire indicated that they are kept informed of important matters affecting the welfare of their son or daughter. None of the residents administer their own medication. One resident who would be able to do so is currently not on any medication. Medicines are stored in a locked cupboard in a secure office. A monitored dosage system is used to avoid the need for any secondary dispensing. The daily administration charts were seen and were up to date. Where a medication is sent with a resident to their day service a note of the type and quantity of the medication sent is entered onto the back of the administration record. Only senior staff administer medication. Safe handling of medication training took place in July 2005. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 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): 22 & 23 Complaints are dealt with and recorded and the staff are aware of adult protection protocols. EVIDENCE: There have been no complaints made to the Commission for Social Care Inspection since the previous inspection took place. There have been five ‘inhouse’ complaints which have been dealt with. None of these were of a serious nature. Complaints are recorded on a dedicated form and action taken is also documented. Staff receive training in the appropriate use of restraint. All instances of restraint are documented and copies of the incident sent to The Social Worker and/or Community Nurse. The Consultant Psychiatrist is involved in regularly reviewing each resident and any challenging behaviour. Records are in sufficient detail. A number of staff have received formal training in adult protection procedures. A further two members of staff are due to undertake this training at the beginning of May. A number of staff have undertaken this training as part of their NVQ training programme. The manager accesses these courses as and when they arise. Lambert House DS0000027475.V290810.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 The premises would benefit from some general internal redecoration and, (in the first floor bathroom), some personalisation. No safety hazards were identified during the inspection. EVIDENCE: A tour of the building was undertaken and one of the residents allowed access to his room. The ground floor has a lounge, art & crafts room and a sensory room. The lounge is on the small side and is quite crowded when several residents and staff are watching television together. Consideration is being given to making one of the larger communal rooms into the lounge and the possible addition of a conservatory. There is also a large dining room adjacent to the kitchen. Bedrooms are located on both ground and first floors. The original beds were fixed. However, these are gradually being changed to free standing beds. There is a small laundry room on the ground floor that contains industrial washing machines. This room is kept locked when not in use, though one of the residents is able to use the equipment. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 16 There is a large bathroom on the first floor. Consideration could be given to adding some pictures/posters or other designs to this room to give it a more homely feel. There is also a separate shower room. Toilets are located on both floors. See recommendation. The general décor around the building is in need of attention and some of the woodwork, particularly the doors to the staff room and one of the offices, need repainting. See recommendation. Cleaning materials are stored in locked cupboards. No obvious safety hazards were noted during the tour of the building. Lambert House DS0000027475.V290810.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): 32, 34 & 35 Staff receive relevant training and a record of training undertaken is kept. Staff files indicate proper recruitment processes are being followed. EVIDENCE: Four members of staff were talked with during the inspection and gave details of training they have or are undertaking. This includes NVQ training, POVA training. A record of training is maintained in a lever arch file for each member of staff. This includes a record of training and copies of certificates. Examples of training undertaken include fire safety, food hygiene, first aid, Boots MDS systems, Communication, management & leadership skills, autism & diet and loss & bereavement. Four staff files were viewed at random. Each contained an application form, two written references, evidence of a Criminal Records Bureau check, an interview assessment, job description and photograph. Staff reported that staff meetings are held every few weeks and that supervision sessions are in place approximately every two months. Lambert House DS0000027475.V290810.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): 37, 39 & 42 The manager is undertaking NVQ training and is completing her application for registration. Health and safety matters such as fire prevention are attended to and records kept of appropriate checks. A formal quality assurance process needs to be developed. EVIDENCE: The manager is not currently registered. This has been due to legitimate personal reasons. However, the manager is now in the process of completing her application form. The manager also needs to embark on NVQ training at level 4. See requirement. The fire system is checked weekly and the last full drill was carried out in February 2006. The fire officer visited in January 2006. No issues were identified for action. Fire extinguishers are due to be serviced next in June 2006. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 19 Hot water temperatures are regulated and are checked weekly and recorded. The record was seen. Random accident records were viewed for two residents. They were in order. The financial records of two residents were looked at. All of the residents have building society accounts. Receipts and proper records of day to day expenditure are kept. It was suggested to use the term ‘personal allowance’ rather than ‘pocket money’ when referring to residents’ personal funds and allowances. See recommendation. A formal quality assurance process needs to be developed looking at ways in which the service is meeting the needs of residents and consulting with them. However, Lambert House is accredited annually by an external assessor and receives an Autism Accreditation Report. This looks at selected core standards in relation to the care of people with autistic spectrum disorders. See requirement. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 20 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 3 28 X 29 X 30 3 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 3 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 2 X 2 X X 3 X Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 21 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 YA39 Regulation 24 Requirement The registered manager must ensure that a review of the quality of care as specified in regulation 24 of the Care Homes Regulations 2001 is undertaken within the timescales of this report. The manager must embark upon NVQ training at level 4. Timescale for action 31/10/06 2 YA37 9 31/10/06 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 2 3 Refer to Standard YA24 YA27 YA42 Good Practice Recommendations The general decoration in some areas of the home needs repainting The first floor bathroom could be made more homely by the addition of pictures/posters or other designs. The term ‘pocket’ money should not be used in relation to residents’ personal allowances. Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Lambert House DS0000027475.V290810.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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