Inspection on 01/12/05 for Lammas Lodge

This inspection was carried out on 1st December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lammas Lodge 25/09/08

Lammas Lodge 25/09/07

Lammas Lodge 24/04/06

Lammas Lodge 07/06/05

Lammas Lodge 20/03/05

Lammas Lodge 14/10/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Lammas Lodge Lugwardine Hereford Herefordshire HR1 4DS Lead Inspector Jean Littler Unannounced Inspection 1st December 2005 02:30 Lammas Lodge DS0000024739.V271786.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 Lammas Lodge DS0000024739.V271786.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. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lammas Lodge Address Lugwardine Hereford Herefordshire HR1 4DS 01432 853185 01432 851468 lammas.lodge@craegmoor.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) Parkcare Homes Limited Mrs Rosemary Elizabeth Wooderson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 1. In addition to Learning Disability, Service Users will have needs associated with autism spectrum disorder. 2. For each assessment indicating the need for professional services, a statement is provided to the funding authority, in advance of the admission, showing the agreed contractual arrangements for its delivery. A copy of the statement must be retained at the home and be available for inspection by the Commission. 3. A designated senior in charge of the service, who is suitably trained and experienced, must be on duty at all times. 4. All staff must receive training in autism spectrum disorder and appropriate behaviour management techniques within 12 weeks of starting work at the home. 5. The Care Manager must be provided with formal recorded one to one supervision sessions with a Line Manager every month for the first 12 months of her registration in respect of the service provided at Lammas Lodge. 6. Service users abilities to manipulate bedroom door locks must be assessed at the point of admission. A written record of this assessment must be included in the care plan with details of action taken for any service users who is unable to manage the existing style of fitted lock. 7th June 2005 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Lammas Lodge offers 6 places to younger adults of either sex who are between the ages of 18 and 24 years at the point of admission. Personal care needs arise from a learning disability and will include needs associated with Autism Spectrum Disorder. The service offers a transitional period of residence rather than a home for life. Where a stay is expected to last longer than five years there will be negotiation with the Commission, purchasing authority, service user and next of kin. The Statement of Purpose describes a therapeutic atmosphere and a full social/recreational and educational programme will be identified prior to admission. The providers state that a high staffing ratio will be provided to meet the assessed support and supervision needs of residents with complax needs. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 5 The Home is situated on the outskirts of Lugwardine village which is three miles from Hereford. The house is set in a large grounds with an area for activities and a sensory garden. The house is large and is divided into two areas. There is a self contained one bedroom flat, and the main house that provides one ground floor and four first floor ensuite bedrooms. An unmarked vehicle is provided to facilitate community access. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out on a weekday between 2.30pm and 4.45pm. The providers monthly visit reports to the Commission, and other communication with the Home since the last inspection were all considered as part of the assessment process. The inspector talked with one resident briefly and saw some of the others interacting with staff while they were going about their daily activities. The deputy manager assisted with the inspection process because the manager was conducting interviews. A support worker was interviewed and the building was toured. 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. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 8 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 Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 9 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): EVIDENCE: These standards were not fully assessed, however three new residents have been admitted recently bringing the total to five. Since the last inspection the manager has been requiring written confirmation from the placing authorities to confirm how each resident’s continuing health care needs will be funded. There was no evidence of this agreement in the care plan sampled, however the manager was not available to clarify if this was being held elsewhere. Despite these arrangements the deputy gave an example of recent difficulties in clarifying which health trust was responsible for one resident’s podiatry needs. The manager should ensure that clear and comprehensive agreements are in place for all assessed needs prior to admission in line with Regulation 14 to prevent any further difficulties of this sort. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 10 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, 10. Appropriate arrangements are in place for the management of residents’ personal information and for planning and reviewing their care needs. A shortfall in how care information is shared amongst the team was noted. EVIDENCE: One resident’s care plan was sampled. This contained clear risk assessments and guidance to enable staff to meet the resident’s care and support needs. The information has been updated regularly and formal meetings held to keep the suitability of the placement under review. During the inspection an agency worker reported to the deputy that she had not been fully informed at the start of her shift about the support arrangements in place for the resident she was working with. Although there is a system in place to pass essential information on to agency staff this had not proved effective and therefore needs to be reviewed. Residents’ personal records are being stored in a secure office area. Staff are made aware of the need to keep information confidential. Lammas Lodge DS0000024739.V271786.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): EVIDENCE: These standards were not fully assessed, however personal activity plans continue to be developed for each resident, those sampled included a good range of activities e.g. running club, swimming, gardening, singing in a church choir. It is very positive that a part time post of Activity Coordinator has been created. It was evident during the inspection that the residents were being occupied in an appropriate and structured way e.g. doing art. Now the number of residents has increased and two residents’ assessed needs have changed staff reported that the one vehicle is not sufficient. This is resulting in the two more assertive residents having their outings prioritised. The second vehicle that has been promised by the providers for the New Year must be arranged without delay so all residents can follow their activity plans. Communication systems are in place e.g. the use of symbols, to empower residents. Examples were seen of staff offering residents appropriate levels of choice. Lammas Lodge DS0000024739.V271786.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): 19, 20. Every effort is being made to meet residents’ health needs. A lack of clarity about how specific health care needs will be provided continue to pose some problems. Medication is being managed safely, however staff training arrangements can be further improved. EVIDENCE: The Organisation has now arranged for a Psychiatrist to join their professional multi-disciplinary advisory team who visit the Home monthly to provide support where needed and help staff develop positive strategies. The team also includes a Behavioural Therapist who can be contacted between meetings to provide additional advice. An advisor on Autism is also supporting the service. One residents assessed needs are not being fully met, as a specialist assessment and additional staff training are needed. Negotiations are continuing between the providers and the funding authority to resolve the issue. This needs to be concluded promptly as the current situation is unacceptable. The care plan sampled showed that arrangements were in place to meet the resident’s preventative health care needs e.g. doctors, dentists. Daily records indicated that staff were monitoring his wellbeing and noting any health concerns. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 13 Healthy food and exercise continues to be promoted. Very positive that one resident who is overweight is making very good progress and has lost a significant amount of weight. Medication arrangements were inspected. Appropriate guidance was in place for the administration of ‘as required’ medication. Medication charts showed doses had been administered as prescribed with the exception of gaps from three days of one resident’s antibiotics. Medication was being stored appropriately and the keys held securely. Only team leaders administer medication. They have received some training and it is planned that they will attend more in depth training in the near future. Currently no records are held to demonstrate how the manager has deemed them competent to take on this role. It is advisable that a record is kept to evidence that staff have been observed and judged as competent. It is also good practice that staff are reassessed as competent periodically. Lammas Lodge DS0000024739.V271786.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): EVIDENCE: These standards were not fully assessed however no complaints have been received by the Commission since the last inspection. The manager is aware of the local multi-agency adult protection procedures and has appropriately reported concerns and incidents that have occurred. Lammas Lodge DS0000024739.V271786.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): EVIDENCE: These standards were not fully assessed as the home has recently been refurbished to a high standard. The residents’ bedrooms that were seen had been personalised and were attractive and comfortable. The home was being well maintained and the deputy reported that building repairs have been dealt with promptly since the last inspection. A full time maintenance worker has now been recruited. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33. Staffing arrangements have not been acceptable due to the high level of agency staff being used. This is not good practice in any Home but is particularly undesirable for this client group. EVIDENCE: A high ratio of staff to residents is required to meet the complex needs of the residents. This level has proved difficult to maintain as the number of residents increased by three in a short period of time. Recruitment efforts are continuing and a new group of workers are currently undergoing initial training so arrangements are due to improve significantly in the near future. Further staff are being recruited and the manager hopes to have the Home fully staffed in the near future. The staffing levels required have been maintained by the extensive use of agency staff. On the day of the inspection the evening shift team leader was a permanent employee but all other staff on duty were agency workers. Although some work regular shifts, which allowed them to get to know the residents’ needs, the situation has not been ideal for the residents and has caused low morale amongst for the permanent staff team. Additional pressure has been placed on the team as the assessed needs of two residents have changed since their admission to the Home. Staff have had to deal with a significant degrees of aggression when some of the residents have become distressed and some have been hurt and upset. In response to incidents the manager has reviewed arrangements but these have impacted on Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 17 staffing levels for trips into the community and how male and female staff are deployed around the Home. The Commission is concerned that the staff are being put at significant risk because they are being asked to deal with situations that they are not sufficiently experienced and skilled enough to deal with. The providers must ensure resources are made available for appropriate training to be provided and if the risk assessments still indicate that staff are at significant risk then they and the manager have a duty of care to review the suitability of the placements. A condition on the Home’s registration requires a senior staff member to be in charge of each shift. Only four team leader posts were created but it has not proved possible for them to cover every shift and sleep in duty. Two staff have been acting up into this role on occasion. The manager needs to inform the Commission formally about the qualifications and experience these workers have and negotiate a change in the condition. Staff training and induction arrangements have been improved e.g. the induction is now over 10-14 days and all staff are now attending Autism Awareness training within the first three months of their employment. The member of staff interviewed had been in the post for five months. She had attended most of the necessary training and had commenced her NVQ training. She had not yet attended physical intervention training although this was booked. She confirmed that she would not intervene in a situation that would require this and would call for assistance from more experienced colleagues. She reported that she was receiving regular supervision and generally felt well supported. An instance of staff misconduct have been dealt with appropriated by the manager and reported to the Commission promptly. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not fully assessed, however the following information was noted. The manager has not been able to work in a supernumerary capacity due to the staffing shortages. Despite the pressure on her the Home was well organised and good progress continues to be made in developing this complex service. It is positive that a twenty hour a week administer post has been agreed with the providers to support the manager. The manager confirmed that since the last inspection the providers monthly visits to monitor the service in line with Regulation 26 have been unannounced. This is positive, however the Commissions records show that reports were not received for July, August or November 2005. The organisation has recently introduced a new Quality Assurance system and the providers are aware that this must include consultation with residents and stakeholders and result in periodic reports to the Commission. Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 1 X X x CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lammas Lodge Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X X x DS0000024739.V271786.R01.S.doc Version 5.0 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA41 Regulation 26 Timescale for action The providers must carry out 31/12/05 monthly unannounced visits to the Home and submit a report on the conduct of the Home to the directors and the Commission. Complete the risk assessments 31/07/05 and hazard analysis required at the Environmental Health inspection in February 2005. (Brought forward, not assessed on this occasion) Requirement 2. YA42 13 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 YA1 YA3YA2 YA20 Good Practice Recommendations Further develop formats to provide information about the Home to residents and potential residents in a meaningful way. (Brought forward, not assessed.) The manager should ensure that arrangements to meet all assessed health care needs are in place prior to admission. The manager should formally assess a member of staffs ability to administer medication competently and keep a record of this process prior tothem being given this DS0000024739.V271786.R01.S.doc Version 5.0 Page 21 Lammas Lodge 4 5 6 YA13 YA6 YA41 responsibility. Consideration should also be given to periodically reassessing the level of competence in this area. All staff who administer medication should attend training that is accredited with the Skills of care council. Provide a second vehicle as a matter of urgency. The manager should explore ways to improve the methods used to communicate essential care information to agency staff. Develop a policy and procedure regarding staff taking the role of ‘Appropriate Adult’. (Brought forward, not assessed.) Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Lammas Lodge DS0000024739.V271786.R01.S.doc Version 5.0 Page 23 - 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. 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