Inspection on 25/09/07 for Lammas Lodge

This inspection was carried out on 25th September 2007.

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 6 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 24/04/06

Lammas Lodge 01/12/05

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 25th September 2007 12:30 Lammas Lodge DS0000024739.V344663.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 Lammas Lodge DS0000024739.V344663.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. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lammas Lodge Address Lugwardine Hereford Herefordshire HR1 4DS 01432 853185 01432 851468 lammas.lodge@craegmoor.co.uk Craegmore.co.uk Parkcare Homes Ltd 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) vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 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. 3. A designated senior in charge of the service, who is suitably trained and experienced, must be on duty at all times. 24th April 2006 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 65 years at the point of admission. Personal care needs arise from a learning disability and will include needs associated with Autism Spectrum Disorder. 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 complex needs. The Home is situated on the outskirts of Lugwardine village, which is three miles from Hereford. The house is set in large grounds with an area for activities and a sensory garden. The house is large and is divided into three areas. There is a self-contained one bedroom flat, the main house that provides one ground floor and four first floor en-suite bedrooms, and a staff office and meeting area. Two unmarked vehicles are provided to facilitate community access. The providers have written information about the service that can be sent out to interested parties. The most recent inspection report is on display in the visitors’ area of the Home. The current fee range is between £1613 and £3593 per week dependent on each individual’s assessed needs. Additional charges are made for personal items such as clothes and toiletries, personal services such as chiropody, haircuts, some activities and holidays, although the providers contribute £200 towards the cost of an annual holiday and fund the staff for these. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 5 hrs. The manager was on duty and helped with the process. The inspector looked around the house and spoke with two of the staff. Some records were looked at such as care plans and medication. The manager sent information about the service to the inspector before the visit. Two of the residents, relatives, professionals and visitors gave their views of the service in questionnaires. What the service does well: The home only offers a place to someone if they can meet their needs. The residents’ needs are included in their care plans. Their support is reviewed at least twice a year with their representatives. They are supported to have their health and physical care needs met in the way they prefer. Each resident is supported to have their own chosen daily routines and take part in activities they enjoy and benefit from. They are supported to stay in close touch with their families. The house and garden are spacious, homely, comfortable and safe. The residents have nice bedrooms and they are supported to keep lots of their own things. They have their own toilet and bathing facilities. The residents enjoy the meals and they are offered a menu choice. Lammas Lodge DS0000024739.V344663.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. Lammas Lodge DS0000024739.V344663.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 Lammas Lodge DS0000024739.V344663.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): 1, 2, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given information about the service to help them make an informed choice. This is not always provided in a suitable format for people with a disability. Prospective residents are having their needs assessed in a person centred way. They are given the opportunity to trial the service and move in at their own pace. Good levels of support are being provided to the person and their family during the transition. EVIDENCE: One resident left in September 06 as his family wanted him to live nearer to them. One resident moved in, in November 06 and another in July 07 when the Home became full for the first time. A Service User’s Guide is in place that contains text and some pictures. It may benefit residents if the wording of this is adjusted into plainer English. A copy of the Guide was seen on one of the newer resident’s care plans. The manager said this had been shared with his representatives. This resident has a visual impairment but there was no evidence that the information had been provided for him in an audio or large print format. The Guide did not contain the range of fees the Home charges. There is also a Statement of Purpose that sets out the service that is provided. This does not contain the room sizes. Both of these are requirements of the Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 9 amended Care Home regulations. The administrator agreed to arrange for this information to be added. The manager reported in the Annual Quality Assurance Assessment (AQAA) that was sent to us on 9th August that in depth pre-admission assessments and well planned transition visits are carried out. She feels the transition planning has been improved since the last inspection. Clear arrangements had been made for both of these residents about who is responsible to meet current and anticipated health care needs, as Herefordshire Integrated Community Learning Disability Team (HICLDT) does not usually provide a service to the residents at this Home. One file sampled showed that an assessment had been obtained from the placing authority before a placment had been offered. Notes had been made to record the assessment and transition process. The majority of prefered activities detailed in one residents assessment had been reflected in his support plan. He had seemed to be benefitting from using an adapted trike at his last placement so access to one of these should be considered. Both men seem to be appropriately placed and have settled in. The agreed staffing levels for one of these men have not been consistently provided during recent months. Staff reported that he had benefitted from less attention as a lower level of stimulous had led to a decrease in behaviours that are challenging. Despite this unexpected benefit changes to support arrangements should take place through a formal consultation process, in the person’s best interest, and should not be led by the providers drive to cut expenditure. The mother of one new resident said she had been given enough information before his admission. She felt her son’s needs were being met and he was benefiting from the space inside and out. She reported that he was allowed to settle at his own pace and outings are now being built up. She felt the admissions process was good, with staff visiting his previous placement several times, and with him visiting Lammas Lodge as well. She found the staff friendly and helpful. Two residents completed questionnaires. One said he did receive enough information and was asked if he wanted to move in. The other said he did not choose and did not get enough information. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Effective care planning and reviewing systems are in place to ensure staff are aware of the residents’ complex care needs. The residents are being assisted to make decisions about their lives and take reasonable risks on a daily basis. EVIDENCE: The personal records of two residents were sampled. These showed that their needs had been fully assessed and guidance developed about how these would be met. The information had been kept under review. Care areas contained the aim for the person and some goals e.g. one resident was being encouraged to gain confidence and self worth by being enabled to take part in activities where he is integrating with others. This focus on development could be made clearer in the records, such as the monthly summaries, to better reflect the progress that is taking place. The providers have introduced a new care plan format that is designed to help develop person centred care planning. These may need to be typed, rather than hand written, to make them clearer for staff, to allow more information to be fitted in each section, and to enable Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 11 them to be enlarged to help residents understand the content. The plans are not currently being shared with the residents. Risk assessments have also been completed and guidance is in place about how staff should respond to specific behaviours. Assessments are completed on a daily basis before trips into the community take place. This must be time consuming and for some residents it may be sufficient to have assessments in the care plan that give the shift leader scope to make sensible judgements on a day-to-day basis. The records included reports on daily activities and wellbeing, health issues, meals and personal care. Monthly summary reports have been collated from this information in the past and then used to inform the review reports. The manager plans to reintroduce these. Review meetings are held at least every six months with the residents’ representatives. One resident’s social worker reported that the information provided for the last review had been adequate but not as detailed as had been provided in the past. He felt review meetings were used to have full and open discussions about the residents needs. Some residents do need to be physically restrained if they become distressed and aggressive or put themselves at risk. Behaviour intervention plans are in place in some cases that have been developed with the advice of the specialist team. One of these was not found in one mans care plan although restraint was being used to prevent self-harming. The residents’ representatives are aware of the arrangements in place and are told when serious incidents occur. Clear records are kept of all incidents and any injuries are noted. The level and frequency of incidents is being monitored and efforts to reduce them are constantly sought. The required staffing arrangements to implement these plans effectively have not always been provided (see staffing section). All residents are being supported to make decisions at a level that they can cope with e.g. what meal do they want, do they want to go on their next planned outing. Two residents reported in their questionnaires that they choose what to do during the day and at weekends and they do make decisions for themselves. The speech and language therapist reported that communication aids and signing need to be used more regularly and residents could be more engaged in day-to-day activities. The psychologist reported that she was impressed by how issues are identified and advice is consistently sought, choices are offered but the balance is right between choice and meaningful occupation and that the home delivers a unique service to each resident reflecting their Autism and their individuality. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 12 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 excellent. This judgement has been made using available evidence including a visit to this service. Positive arrangements are in place to provide residents with active and enjoyable experiences each day that they have some choice and control over. Staffing arrangements have meant that off site activity plans have not always been followed. The residents are given a very personalised service and are encouraged to develop their life skills and self-confidence. Good efforts are being made to maintain links with families. Mealtime arrangements offer choice whilst encouraging a healthy diet. EVIDENCE: All residents have different activity plans that have been developed based around their assessed needs and interests, for example one resident now enjoys horse riding. The manager reported in the AQAA that the residents are being offered more valued and varied activities and opportunities. It is clear that each resident is at a different stage of being able to take part in social activities and access community facilities. To support them they therefore need at least one-to-one staffing to engage in a structured activity and some need Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 13 two to one support in the community. Two vehicles are provided to facilitate outings. Staffing shortfalls and a lack of drivers have at times led to activity plans not being followed. On these occasions the team have tried to provide substitute activities for example offering a local walk rather than a community based outings. Staff reported that activities such as badminton, swimming and the snoozelem have been affected and the records seen confirmed this. In-house the dining area is used as an activities area for art and games. The grounds are used for games and three residents have their own large trampolines. A structure is an important part of each resident’s daily routine but a flexible approach is also taken so individual’s wishes and frame of mind can be taken into account. Existing hobbies and interests are supported when a new person moves in e.g. one resident’s assessment showed he enjoys water play and music sessions. Records showed both were being offered to him. The residents are being encouraged to develop independence skills such as cleaning their own rooms and doing some cooking. The speech and language therapist supports the development of communication skills. Positive outcomes were reported such as some residents speaking more, their behaviour improving as a result of better communication. The staff are guided by the specialist team about how to support residents to develop social skills and how to respond to them expressing their sexuality. Because of their condition the residents have not developed close friendships with each other, however some engage at times and the group seems relatively compatible within the highly individualised service. All residents are being supported to stay in regular contact and visit their families. Relatives have been involved in supporting the residents to personalise their bedrooms and reviews are being held regularly to provide opportunities for relatives to be part of reviewing and planning the care being provided. Relatives gave overall very positive feedback about the service and felt that they are kept up to date. One resident’s mother said her son is happier than he has been for a long time and that staff are now beginning to help him mix with the other residents. The two residents who completed questionnaires reported that they can make choices about how they spend their time and they are supported to keep in touch with their families. Food is purchased locally every few days and staff prepare the meals. The residents are encouraged to take part where possible. A choice between two meals is offered. The menus confirmed staffs’ reports that a healthy diet is encouraged. Weights are also monitored. One resident is now joining the others for meals, although he still prefers to sit away from them. Another eats in the small lounge. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. The residents have very complex personal and health care needs and are generally being supported with these in the way they prefer and require. Medication continues to be well managed and administered by suitably trained staff. EVIDENCE: The care plans contained detailed guidance showing that how each resident prefers to be supported has been carefully considered. The staffing ratio usually allows each resident to be supported to follow their own daily routine and have baths or showers at least daily. These good outcomes may have been affected at times as there have been days when staffing levels have been lower than those assessed as needed. There is also some evidence that residents are not always being supported in a consistent manner, which may confuse them, for example all but one most female staff do not go into one residents room alone. One resident now has a change of worker every two hours during the day. He had started presenting behaviour patterns that had not been displayed for several months before he moved into the Home. These two things may not be connected, however, consideration should be given to whether anyone receiving a service would want a change in supporter that frequently. The daytime shift now ends earlier and most staff leave at nine pm. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 15 The manager said this had not led to residents being expected to bath and get ready for bed earlier than before. Arrangements are in place to meet each resident’s current physical health needs e.g. chiropody and dental checks. Clear records of health issues are being kept. Staff reported that the residents’ physical health needs are being met. Examples were discussed such as monitoring an in-growing toenail and recurring ear infections. One resident’s family reported their son has a healthy lifestyle and gets lots of fresh air and exercise. His social worker feels the service meets the needs of complex people and works in partnership with their families. Health Action Plans have been introduced since the last inspection, along with Hospital Care Pathways to try to ensure their health needs are met in the Home and if treated in hospital. Currently annual Wellman’s health checks have not been set up. It is positive that this is one of the manager’s aims for the next year, however this was a recommendation from the last inspection and action should have been taken earlier as the residents may find it difficult to describe any symptoms. One resident is due to have a full check up during a planned operation. The manager will need to consider how best interest decisions, such as those relating to medical treatment, are made and documented in light of the introduction of the Mental Capacity Act. The company provides some health support for residents, for example speech and language therapy and psychology. A team of specialists attends the Home and meet every 4-6 weeks to give advice. A worker spoken with had never attended one of the meetings even though he is keyworker for one resident and works daily to support the resident who can challenge the service the most. The speech and language therapist reported these meetings do address the residents’ needs, she did however highlight that there is no input from an occupational therapist who has an understanding of Autistic Spectrum Disorder e.g. to assist with developing therapeutic activity plans. One resident has a physical disability and two have visual impairments. These residents may well benefit from specialist input for these needs. None has been sought to date. The medication is stored appropriately and the keys are held securely. Staff do not administer medication until they have been formally judged as competent. Accredited training is also provided. Two staff are involved in administration to try to reduce the risk of any errors. The administration and returns records were in order and contained the relevant details. One document that guides staff about when to administer ‘as needed’ medication contained different information to that on the MAR chart about the amount of doses that can be given each day. Only four of the residents are prescribed regular medication. It is positive that these regimes are being kept under review and additional ‘as needed’ medication is rarely used. One resident has been prescribed emergency medication for epilepsy, since the last inspection. Staff have been trained to administer this. The minimum is being stored and it is being logged when taken out on activities. Consideration should be given to also storing this as a controlled drug and using the CD register, in line with the advice of the Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 16 pharmacy inspectors. Constipation medication is being given regularly to two residents. A team leader said the residents’ diet has been improved in an effort to reduce the need for this. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The residents’ relatives and some of the residents know how to make complaints and feel their views are generally being listened to. A framework is in place to help protect the residents from abuse, but staffing arrangements have not always supported this. EVIDENCE: A company complaints procedure is in place. The manager reported in the AQAA that no complaints had been received since the last inspection. One resident’s family reported in their questionnaire that they have had concerns about how the previous manager communicated with them and involved them in the Home. They have had discussions with the new manager and felt positive about the future. The manager was aware of these ongoing concerns and said a new approach had been adopted. Shortly before the inspection an ex-employee had made a formal complaint and a manager from another service was carrying out an investigation. The residents rely heavily on others advocating for them as they may find it difficult to make a complaint through formal channels. The manager reported in the AQAA that the residents are being encouraged to express their views through the company’s new ‘Your Voice’ initiative, however she gave little evidence of positive outcomes that have come as a result of this. Information for the residents about making complaints was not seen on displayed in their areas of the house. One resident removes information on display so the team needs to be creative about how other residents are kept informed, including those with a visual impairment. The two residents who returned questionnaires said they do know who to talk to if they are unhappy. Relatives reported that they do know how to make a complaint and that issues are usually responded to appropriately. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 18 The staff spoken with were clear they would report any concerns promptly. The manager reported that all staff attend Adult Protection training, however, she felt this could be arranged more quickly for new staff. Protection is also covered during the induction process. Policies are in place to give guidance about raising concerns and managing allegations of abuse. No Vulnerable Adult referrals have been made to the local authority or us since the last inspection. Guidance is in place and staff are trained in how to respond positively to residents’ complex behaviours, however this is not always being implemented consistently. Pressures from the providers to reduce the staffing establishment have at times undermined arrangements to meet the residents’ needs and ensure their safety and protection (see staffing section). Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a spacious, comfortable, clean and safe home and have personalised bedrooms. The residents have not been fully assessed to see what specialist equipment they need to maximise their independence. Some furniture has not been replaced and building repairs are not being dealt with quickly enough. EVIDENCE: The Home was refurbished in 2004 and re-opened specifically for people with Autism. The building is fitted with appropriate fire prevention and fire fighting equipment. In the main house there are five bedrooms that are a reasonable size and have en-suite bath or shower facilities. The communal areas are spacious and include a large and small lounge, bathroom and toilets, a dining area, kitchen, laundry and sensory garden. The dining area is also used for activities. It was positive to see some photographs of the residents, past and present, displayed in the hall. Since the last inspection the gym equipment has been removed as it had became damaged. The manager explained that the sensory room is just being used to watch DVDs, however it is hoped that it will be properly equipped in the near future. There are staff facilities and an office Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 20 and meeting area. The sixth resident is accommodated in a self-contained flat at the rear of the house. This has its own entrance, and it is made up of a bedroom, kitchen/diner, lounge and bathroom. Some areas of the home have been refurbished and redecorated since the last inspection. The manager is aware that other areas need attention and has made a request for funding for next year. Throughout the home the communal armchairs were stained on the armrests and the manager said these could not be cleaned off. A full time handy-person is employed to manage the grounds and deal with minor repairs and redecoration. Some of the residents’ relatives gave feedback that the company needs to respond more quickly to maintenance needs. Staff gave examples of work that had taken many weeks to be dealt with including a leak in the kitchen and a broken side gate. Maintenance requests reportedly have to go through several layers of management for approval and communication about progress at the head office is often poor. The layout of the accommodation allows the residents to have personal space inside and outside. The way the house is decorated and fitted reflects some residents’ need to have a low arousal environment. This makes the communal rooms seen less homely than the bedrooms. In line with this the staff facilities are in a separate area. The bedrooms seen were personalised and homely. It was clear that the residents are encouraged to have lots of personal possessions and hobby items. The residents can hold keys to their bedrooms or staff will keep their room locked while they are out. Staff were observed to seek permission from residents before entering their bedrooms. One resident moved to the downstairs bedroom when it became vacant as he was being disturbed by a resident upstairs. He was consulted about this change, went shopping to choose the paint and was involved in moving his belongings. His music had been left on while he was out as he finds it reassuring to have it playing when he returns. The flat was more homely as the resident’s possessions were in every room. His dignity could be improved if the clinical waste and personal care items were kept out of sight. Consideration could also be given to whether he can be supported to store his medication in a more homely manner as he lives alone. To meet his needs the bath had been replaced with a wet room shower before he moved in. An occupational therapist has not assessed his needs to see if his flat could be further adapted. Two residents have visual impairments and no specialist input had been provided in relation to these needs. The Home was found to be generally clean and tidy. Staff carry out these duties and the residents are encouraged to clean their bedrooms, however some have a very limited concentration span. Two residents reported in their questionnaires that the home is always fresh and clean. The laundry is a suitable size and all the equipment was working. The door is kept locked when it is not in use but the residents are supported to do their own washing to develop their skills. The manager reported that the recommendations made at the recent Environmental Health inspection have been actioned and that an infection control audit showed 97 compliance. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 21 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, 33, 34, 35, 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents are not being supported by a fully competent, effective and qualified staff team. They are being protected by the Home’s recruitment process. EVIDENCE: When the Home is fully occupied the required staffing levels are a shift leader and seven support workers. Since the last inspection there have been periods of time when vacancies and other issues have led to agency staff being used regularly. Following the registered manager leaving in May 07 a manager from another service was brought in to look at the staffing arrangements and reduce costs. Staff were given a weeks notice to transfer from working a flexible rota of seven or eight hour shifts to a two team system which involves working twelve hour shifts over two or three day periods. As a result of the new rota system the evening shift now ends at 9pm shortening the residents day, staff are more tired particularly when they have been dealing with behaviours that challenge them, the workers on different teams do not work with each other to ensure consistency, it is much harder to cover sickness, staff meetings and training are more difficult to arrange as staff do not want to give up one of their two days off. On the positive side some residents seem to have benefited from knowing that the staff who they see Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 22 when they get up will be in the home all day. The Home has not had a cleaner employed for two years and there is no cook so staff have to fit these tasks in with their support work. Until August 07 no clerical worker had been provided. The manager reported that it had been difficult to cover gaps on the rota once overtime rates had been withdrawn and agency staff use stopped. She said a mental risk assessment had been completed about each shift that was understaffed but these decisions had not been recorded. Staff reported that they have adjusted to the new hours but staffing levels have not been maintained as agency staff and overtime rates have been stopped. One worker said levels had dropped as low as three. The sample of rotas seen confirmed that during September 07 on the majority of days there were less than seven support workers and on two occasions there were only four. Five of the six residents have very clear funding agreements about staffing levels and these have not been honoured. One resident has been assessed as needing two male workers to support him during the waking day. There are two male support worker vacancies that were being recruited to. A lack of male staff has led to experienced female staff being counted as male workers to support him. Some staff are reportedly anxious and even scared of the potential for incidents with one resident despite almost all staff having being given advanced physical intervention training. The lack of staff who can drive has impacted on the residents’ activity plans. Corporate systems are in place to monitor individual staffs training profiles and to provide an overview of what training is needed. Core training e.g. health and safety, is being provided through in-house workbooks. A new worker’s multiple-choice answers were seen on her file. They had been marked but were not dated. The corporate induction includes the Learning Disability Award Framework units (LDAF). Some specialist training is also provided e.g. Autism Awareness, however this has not always been provided for new staff within the first three months. This is one of the conditions placed on the registration of the Home as it is essential to staff meeting the needs of the residents. Currently only 28 of the care staff hold an NVQ in Care. This is only a minor improvement from the situation at the last inspection. Four staff are currently working towards gaining an award but the providers need to consider how they can improve staff retention and increase the level of qualified staff in the Home. A team leader has recently been given the responsibility to book staff onto training. The company runs courses in Cardiff or Swansea and staff are being asked to travel down for what is sometimes a two hour refresher course on their days off. An example was given where a colleague got there to find the food hygiene refresher course had been cancelled. In light of the current staffing difficulties at the Home the providers should review how training is being delivered and consider other more effective methods of achieving the same outcomes. Both staff spoken with were very professional and knowledgeable about the residents’ needs. They were committed and felt loyalty to the manager but Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 23 said there was low team morale and gave staffing levels and training arrangements as the reasons for this. The psychologist reported that the staff are skilled and strive to meet the needs of each resident. The service has embraced her suggestions and staff support each other which helps morale. The speech and language therapist reported that staffing has been a problem lately so other than statutory training other training such as Autism and Communication has been patchy. The residents reported in their questionnaires that the staff always treat them well and do listen to them and act on what they say. One resident’s parents said their son was very sensitive to inexperienced staff but the management are aware of this now and are providing more training. They feel the home provides a friendly, homely and safe environment that is also professional. The staff file for one new recruit was seen. The recruitment process seemed in order and all statutory checks had been received before the worker commenced employment. Only one supervision record was seen on the file. The manager reported in the AQAA that staff are now having more regular supervision meetings and further improvements are planned. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. The residents have not always benefited from a well-run service that develops in keeping with the views of the people using it. EVIDENCE: The registered manager who had been in post since the Home reopened three years ago was dismissed in May 07. The longstanding deputy Mrs Karen Palmer acted up into the vacant post and was formally appointed in September 07. She is aware that she now needs to apply for registration. The staff reported that she is approachable and committed to the residents. Some positive comments were received from the residents’ relatives about the way the Home was being run and improved communication links. Mrs Palmer has been charged with a difficult task as in May the office systems were reportedly not up to date or well organised and she was not aware of many of the corporate office management systems. A full time administrator Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 25 only started work to support her in April. This support had been requested by the previous manager since she took up post but was not authorised by the providers. The new manager had been working on shift with the residents as a deputy and has not held a managers post before. She has had some support but feels she could have benefited from more, particularly with the challenge of reducing staffing costs whilst maintaining the service. The previous manager had raised concerns that she was only provided with two supervision sessions during the year prior to her being dismissed. The lack of regular formal supervision for the manager has also been highlighted in previous inspection reports. The manager had only included very brief evidence and information in the AQAA and the information relating to staffing was not reflective of what was found during the visit. This is further evidence that she has not been provided with enough support. Many of the management systems in place have been affected by the change to the rota and need to be monitored closely and timely changes made to ensure the outcomes for the residents are positive. The providers need to give full support to the new manager during this difficult time. Consideration should also be given quickly to providing her with a deputy. A provider’s representative has been carrying out monthly monitoring visits to the Home. These reports are very brief and have not highlighted the shortfalls recorded in this report. The reports prior to the manager being dismissed did not indicate that there were any issues with the management of the Home. Although confidentiality has to be considered these reports are for the purpose of informing the directors and us about the conduct of the Home. Reports from staff indicated that when the Area Manager visits the Home she does not seek staffs’ views and stays in the office. The organisation has a formal Quality Assurance system that involves a series of audits being carried out by the manager over a two-year period. These are designed to trigger any improvements needed. The first cycle of these should end in April 08 when a report will need to be shared with stakeholders and us. This process needs to include evidence of consultation with people who use the service and other stakeholders and show a cycle of continual improvement. It is positive that the Home has registered with the National Autistic Society and has begun work to gain accreditation, however the manager will need to be given support and time for this large undertaking. The manager reported in the AQAA that safety and maintenance checks were being kept up to date. A sample of records confirmed that fire checks and drills were being carried out. Risk assessments are reportedly in place for environmental hazards. As detailed earlier the risks associated with reduced staffing levels were not being formally risk assessed and support to some residents had been altered without the risk assessment being reviewed. As a result of the findings of this inspection the information about staffing arrangements and the potential risks some staff have been exposed to has been shared with Herefordshire Council Environmental Health Department. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 3 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 4 26 3 27 4 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 x LIFESTYLES Standard No Score 11 4 12 3 13 2 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 4 x 2 X 2 x x 2 x Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NA 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 YA33 YA23 YA42 Regulation 18 Suitably qualified, skilled and experienced staff must be provided at all times in line with the residents care plans and associated risk assessments to meet their assessed needs. The providers confirmed on 15/10/07 that this requirement would be complied with. 2 YA33 YA12 18 Enough drivers must be provided to ensure the residents are enabled to follow their agreed activity plans. The providers confirmed on 15/10/07 that this requirement would be complied with. 3 YA35 18 All new staff must be provided with training on Autism within the first three months of their employment to better enable them to meet the residents’ needs. 31/10/07 15/10/07 Requirement Timescale for action 15/10/07 Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 28 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 YA1 YA11 Good Practice Recommendations Provide information for the residents about the Home in suitable formats (Brought forward). Provide information in appropriate formats to aid the residents’ understanding and communication in line with advice from the speech and language therapist. 2. YA6 Develop behaviour intervention plans for all residents who may need to be physically restrained. Consider how the residents’ personal development can be better demonstrated. 3. YA19 Arrange and offer residents the opportunity to have access to an annual Wellman’s health checks. Brought forward. Consult staff about how they may work more closely with the specialist team. Seek input from an occupational therapist and a specialist in visual impairments. 4. YA20 Store and record the new medication used in an emergency for epilepsy in line with controlled drug protocols. Update guidance for ‘as needed’ medications as soon as the directions from the doctor are changed. 5. 6. YA24 YA28 Review how the organisation can make changes to speed up the response time to repairs and maintenance needs. Replace or recover the armchairs that are heavily stained. Equip the sensory room to enable the residents to benefit from this facility. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 29 7. 8. YA32 YA33 YA42 Increase the number of qualified staff to at least 50 of the support team. Complete a risk assessment about the long hours staff are now working and the risks to them when they are expected to respond to incidents of behaviour that challenge them. Enable staff to attend the specialist training that they need to meet the complex needs of the resident group. Provide training on visual impairments. 9. YA35 10. 11. YA36 YA37 Review the rota and consider how staff can be better enabled to attend staff meetings and training. Provide the new manager with more support and regular formal supervision from a suitably experienced person. Appoint a deputy to strengthen the management team. Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. Extracts may not be used or reproduced without the express permission of CSCI Lammas Lodge DS0000024739.V344663.R01.S.doc Version 5.2 Page 31 - 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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