Inspection on 04/09/07 for Lambert House

This inspection was carried out on 4th September 2007.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lambert House 20/04/06

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 Debra Allen Unannounced Inspection 4th September 2007 09:20 Lambert House DS0000027475.V350894.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 Lambert House DS0000027475.V350894.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. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lambert House Address 36 Notridge Road Bowthorpe Norwich Norfolk NR5 9BE 01603 749845 01603 749460 dianne@nacha.org.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 Mrs Dianne Dack Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th April 2006 Brief Description of the Service: Lambert House is situated in the middle of a residential area in the suburbs of the City of Norwich. 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. The general fee levels are £768 to £933 per week, though higher fees may be negotiated where service users require additional 1:1 or 2:1 support. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers, (in the form of an Annual Quality Assurance Assessment document), the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This inspection was carried out over a period of six hours during which time discussions were held with the manager, deputy and two members of staff and observations were made of service users at home on the day, including those who were about to embark on their holiday. A tour of the premises was also carried out and care plans, health and safety files and other records required for regulation were examined. Four requirements and one recommendation have been made as a result of this inspection. What the service does well: Care plans are very detailed, informative and clearly written ensuring consistency is maintained by staff supporting each individual. Each service user has an individual daily programme with a wide variety of home based and external activities. Service users are encouraged to do as much for themselves as possible and the staff have a very empowering approach. Involvement with family and friends is actively promoted and supported and care plans include sections for recording information regarding parent & social links and lists of important dates for things like friends’ and relatives’ birthdays. The meals are balanced and healthy and service users are able to choose what they want to eat and, from the records looked at, it is evident that people enjoy their meals. Staff have good training opportunities and Lambert House now has four ‘Total Communication’ Co-ordinators, which offers a better range of communication training for staff and subsequently a better service for the service users. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Lambert House DS0000027475.V350894.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 Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Full assessments will be carried out prior to admission, to ensure prospective service users’ needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions since the last inspection, but the care plans looked at contained pre-admission and assessment information from various sources such as social workers, service user and their families. The Statement of Purpose also clearly explains the pre-admission and assessment process Information received in the Annual Quality Assurance Assessment (AQAA) states that Lambert House’s plans for improvement in the next twelve months are to introduce different methods for publicising the Statement of Purpose such as audio tape and DVD. Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is good. The assessed needs and risk assessments for service users are shown in individual care plans so staff know what support each person needs. Service users are invited and encouraged to be actively involved in all aspects of life in the home and their views are taken into consideration. Service users’ information is secure so that confidentiality is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were looked at in detail for three service users and these were found to be very informative and clearly written, in order to ensure consistency is maintained by staff supporting each individual. There were a number of different parts to each care plan, such as Lifestyle Plan, Current File, Daily Diary Notes and, in some cases, a ‘This is Me’ Pen Portrait. In addition to these, records were also seen in respect of weights, meals and accidents/incidents. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 10 The contents of the Lifestyle Plans were seen to include: Things Essential To Me, Things Important To Me (important, but not critical), My Background, My Enjoyments/Preferences, My Communication, What People Need to Know or Do to Support Me, Daily Routines and Risk Assessments & Protocols. All of the above were seen to be written respectfully with an empowering approach, promoting independence and contained very positive phrasing. Explanations were also given with regard to how some communication may be misinterpreted. Minutes and notes were also seen from regular reviews and key-worker meetings and the service users have regular house meetings, where they have the opportunity to discuss various issues about the home and life in general. The risk assessments looked at were detailed and included information regarding significant hazards and existing measures of control. Each risk assessment was noted to have been reviewed at regular intervals according to the level of hazard. Some of these assessments covered areas such as selfadministering medication, aggression towards others, bowling, shopping, trips out, bathing and horse riding. All the assessments were written in a way that supported people to take risks rather than preventing them from doing things. All the service users’ records and personal information was seen to be stored securely, thereby ensuring confidentiality is maintained. Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. Service users have opportunities for personal development, are part of the local community and engage in appropriate leisure activities. Service users are supported to have appropriate personal relationships. Service users are offered a healthy diet and enjoy their meals and mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans that were looked at, showed evidence of individual daily programmes and activities for each person and included educational elements, home based and external activities such as independence skills, cooking, computer skills, letter writing, attending day centres, local walks, art and craft, cycling, swimming, bowling, horse riding, going to the pub, gardening and feeding the birds. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 12 In addition to a swimming pool on site, Lambert house also has a wellequipped sensory room and a separate activity room, which appeared to be a very popular area. There was lots of evidence of involvement with family and friends such as records of telephone calls, visits and letter writing. The care plans included sections for recording information regarding parental & social links and each file contained a list of important dates for things like friends and relatives’ birthdays. The menus were seen to be varied and there was evidence of people being able to have alternative options for their main evening meal. Choices and variety were also evident for breakfasts and lunches. Good records were observed regarding meals, which showed what people had eaten for breakfast, lunch and dinner and indicators showed whether people ‘ate well’, ‘appeared to really enjoy’, ‘none/small amount eaten’ or ‘clear dislike’. Looking at a selection of these records, it was evident that people generally enjoyed their meals and were offered a balanced and healthy diet. Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. Service users are supported with their personal care in the way they prefer, their physical and emotional healthcare needs are met and they are protected by the home’s policies and procedures for dealing with medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was noted from the records and care plans looked at, that although staff supported service users with their personal care, they were also encouraged to do as much for themselves as possible. Notes were seen to indicate whether service users preferred male or female staff to support them and it was evident that staff adhered to this whenever possible. Evidence was also seen, in the care plans, of involvement and support from external professionals such as speech and language therapist, dietician, GP, community nurse, psychiatrist, chiropodist, dentist and optician. Notes from clinical reviews, where relevant, were also seen on service users’ files. None of the service users are currently self-medicating and risk assessments were seen to support the reasoning behind this. Lambert House currently uses Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 14 a Monitored Dosage System for the majority of medicines and medication was seen to be stored securely in the office. Staff training records showed that staff are appropriately trained in the administration of medication and the most recent session was April 2007. Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. Service users feel their views are listened to and acted on and they are protected from abuse, neglect and self-harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been one complaint in the last twelve months, which was dealt with appropriately and in accordance with NACHA’s complaints procedure. However, although the complaints procedure was observed to be easily accessible and available for reference in a number of different places, such as inside the service users’ care plans, within the Statement of Purpose and as a ‘stand alone’ document, there were variations in these documents which need to be rectified as soon as possible. Information provided by Lambert House in the AQAA confirmed that staff have received training on the Protection of Vulnerable Adults and the appropriate use of physical intervention, which also encompasses ethical and legal requirements. It was also confirmed that the consultant psychiatrist regularly reviews each of the service users and any challenging behaviours are discussed during these reviews. Protocols for dealing with specific behaviours were seen in the service users’ individual files. Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. The premises was found to be clean and hygienic but would greatly benefit from some further redecoration and communal areas, bathrooms and corridors could be made more homely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was carried out and the home was found to be clean, hygienic and free from unpleasant odours. However, the overall décor could be greatly improved, especially the corridor, shower room and toilet on the first floor. The toilet, for example, has been completely painted in one colour (including floor and ceiling) making it bare and clinical, with no definition. The upstairs corridor was also very bleak and had a regimental feel to it, with no pictures on the walls and all the service users’ bedroom doors the same colour and no individuality reflected. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 17 The dining room now benefits from a number of small tables, rather than one large table, making the environment for mealtimes more individual and personal. However, the recent removal of a number of pictures, with fixtures remaining on the walls, make the dining room look very bare and not at all homely. The kitchen has recently been refurbished and was seen to be very clean, hygienic, bright and airy and now provides a very pleasant working environment for service users and staff. Lambert House benefits from a fairly large garden and patio area, which appears to be well used and enjoyed by service users. Although the premises were free from obvious safety hazards, a recommendation has been made to make the locked paint cupboard in the activities room more secure. The information provided by Lambert House in the AQAA states that improvements in the last twelve months are that a large number of the service users’ bedrooms have benefited from having the fixed beds removed and free standing beds purchased, offering more flexibility for the individuals. These bedrooms have also had a total redecoration and soft furnishings replaced. Plans for improvement in the next twelve months are to complete the programme of service user bedroom refurbishment, for those who wish to have changes made. The possibility of having an extension or conservatory to the house is being discussed with Broadland Housing Association. Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good. Training records are maintained to show that staff receive regular and appropriate training. NACHA has a robust recruitment procedure to help ensure service users are protected. Support and supervision sessions for staff need to be carried out on a regular basis. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training records were looked at during the inspection and evidence was seen of courses and training staff have completed or are in the process of doing. Some of the training courses included Manual Handling, First Aid, Autism Awareness, Protection of Vulnerable Adults, Food and Fitness, Food Hygiene, Computer Basics, Health & Safety, REACT, Time Management, Medication Administration and Lifeguarding. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 19 Lambert House now has four ‘Total Communication’ Co-ordinators, which offers a better range of communication training for staff and subsequently a better service for the service users. Recruitment/personnel files are now held at NACHA’s area office in Dereham, but a discussion with the service manager, information provided in the AQAA and a recent inspection at another service run by NACHA provided evidence that all staff have a clear, enhanced Criminal Records Bureau, (CRB), disclosure and a POVA First check prior to starting work. Records of support and supervision sessions were looked at and found to be lacking in regularity, although the manager did confirm that this was due to a number of recent changes and that formal supervision sessions will be carried out on a regular basis from now on. Lambert House DS0000027475.V350894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. Service users benefit from a well run home in which their health, safety and welfare is promoted and protected. Service users’ views underpin the self-monitoring, review and development of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the manager has completed her registration with The Commission, but still has to start her NVQ 4 training. However, it was confirmed that the manager has enrolled with a new company and is awaiting a visit from the assessor, to get things fully underway. It was also confirmed that delay in starting this NVQ has been caused by the previous company ceasing to trade. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 21 Discussion with the deputy manager confirmed a more formal ‘in-house’ quality assurance process is still being developed, although service users’ views are regularly sought through the regular house meetings that take place. Meanwhile, Lambert House is assessed annually by the National Autistic Society, following which it receives an Autism Accreditation report. Records relating to health and safety, accidents and incidents, fire drills and water temperatures were looked at and found to be in order. A full and indepth Fire Risk Assessment has recently been completed which is very clearly compiled and specific to Lambert House. Lambert House DS0000027475.V350894.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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Lambert House DS0000027475.V350894.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. 2. Standard YA37 YA22 Regulation 9 22 Requirement The manager must embark upon NVQ training at level 4. The various copies of the complaints procedure must be consistent and refer to The Commission for Social Care Inspection (CSCI) not the National Care Standards Commission (NCSC) and state that complaints may be referred to The Commission (CSCI) at any stage. The locked paint cupboard in the activities room must be made more secure. Formal support and supervision sessions must be carried out on a regular basis. Timescale for action 31/10/07 30/11/07 3. YA24 13 31/10/07 4. YA36 18 31/12/07 Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations It is recommended that the overall décor in the home is further improved. Especially the corridor, shower room and toilet on the first floor. Lambert House DS0000027475.V350894.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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