Inspection on 25/09/08 for Lammas Lodge

This inspection was carried out on 25th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lammas Lodge 25/09/07

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 17/12/2008.

CARE HOME ADULTS 18-65 Lammas Lodge Lugwardine Hereford Herefordshire HR1 4DS Lead Inspector Jean Littler Unannounced Inspection 25th September 2008 11:45 Lammas Lodge DS0000024739.V372332.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.V372332.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.V372332.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) Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 6 The maximum number of service users who can be accommodated is: 6 25th September 2007 Date of last inspection Brief Description of the Service: Lammas Lodge offers 6 places to younger adults who have a learning disability and needs associated with Autism Spectrum Disorder. 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 state that a high staffing ratio will be provided to meet the assessed support and supervision needs of people with complex needs. The providers have written information about the service that can be sent out to interested parties or is available on their website. The most recent inspection report is on display in the visitors’ area of the Home. The current fee range was not established, as it was not included in the version of the Service User’s Guide that was seen. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We the Commission carried out this inspection over six hours. We looked around the house and spoke with three of the staff. One man let us see his bedroom. Some records were looked at such as care plans and medication. The manager, Mrs Karen Palmer, recently left so a team leader Helped with the inspection. Information about the service had been sent to us before the visit. Some surveys were sent out before the visit. Two were returned. What the service does well: The home only offers a place to someone if they can meet their needs. The men’s needs are included in their care plans and these are reviewed with their representatives. They are supported to have their health and physical care needs met in the way they prefer. Each man 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 men have nice bedrooms and they are supported to keep lots of their own things. They have their own toilet and bathing facilities. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 6 They enjoy the meals and they are offered a choice. What has improved since the last inspection? What they could do better: The men should have their support reviewed and a personal plan agreed with their representatives at least twice a year. More male staff and drivers need to join the team when possible to help the men go into the community safely. The men could be helped more to understand things and make choices with communication aids. More indoor activities need to be provided. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 7 The activities area needs to be re-fitted and set up to help the men know what activities they can choose from. All checks on new staff need to be in place before they work alone with the men. All new staff need to be trained about Autism soon after starting their job. The training given should be more than half a day. More of the staff should become qualified. The home needs a new an experienced manager, who is registered, so the men can be confidence they are the right person to run their home. 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.V372332.R01.S.doc Version 5.2 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.V372332.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 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 can feel confident that their needs would be fully assessed in a person centred way. They would be given the opportunity to trial the service and move in at their own pace. In future the assessment process should consider more carefully the compatibility of new people with the people already living in the home and any negative impact planned for more carefully. EVIDENCE: No new people have moved in since September 2007. The following information was reported at the last inspection after the last two men had moved in. ‘There is an in depth pre-admission assessments and well planned transition visits are carried out. The transition planning has been improved. A clear agreement was made for both men about who is responsible to meet current and anticipated health care needs, as Herefordshire Integrated Community Learning Disability Team does not usually provide a service to people who have moved in from another county’. The mother of one of these men 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 placement. She reported that he was allowed to settle at his own pace. She felt the admissions process was good, with staff visiting his previous placement several times, and with him visiting Lammas Lodge as well. We sampled one file and it Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 10 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. Both men seem to be appropriately placed and had settled in. The agreed staffing levels for one of these men had not been consistently provided and a requirement was made that levels be increased. Both these man have settled well and are developing, which is very positive. One man’s needs have had a significant impact on the other people’s lives. The man living in the flat is nervous of him so plans to integrate him at times into the main house have not been able to happen. Nothing can be left out around the home or he will remove and damage it. It is not clear if this inpact was fully assessed and considered prior to his admission, however, more could be done to adapt the environment rather than just keeping the communal areas bare. For example, built in lockable wall cases and furniture with perspex that allows information and equipment to be on display for the men to see and be prompted to use. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 11 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 men’s complex care needs. Their needs are kept under review but formal review and person centred planning processes could be improved. The men are being assisted to make decisions about their lives and take reasonable risks on a daily basis. EVIDENCE: The personal records of two of the men were sampled. These showed that their needs have been assessed and are reflected in care plans to guide staff. The plans have been written in a person centred way showing that each person has individual needs that need to be met consistently. The plans have not been put into a format the men would understand. They are not involved with seeing or updating their plans due to their understanding level and concentration span. One man’s plans contained more detail than the other as additional information has been written on the back of the sheet. The corporate forms cannot be typed into and only a few lines space is given for each area. It is positive that plans directed staff to promote the men’s independence, choice making, privacy and dignity. The plans contained aims Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 12 and some goals. Areas being developed included encouraging one man to use sentences, accessing the community, expressing feelings appropriately. There is evidence that the men are developing. Examples included; coping with going out more often; becoming more involved in day-to-day activities such as laundry; spending longer in the bath and washing independently; an increasing vocabulary; using the toilet appropriately; using a china plate; joining others for meals; medication levels being successfully reduced. Risk assessments are included in the care plans and guidance is in place about how staff should respond to specific behaviours, such as running across roads, becoming aggressive whilst in a vehicle. Risk assessments are completed on a daily basis before one man is taken on an outing. All information in the plans had been reviewed at least once in the last year and some a lot more often. The Multi-disciplinary Team (MDT) of professionals who meet at the home regularly, are involved in writing some of the risk assessments. A recent example was for one man to go on holiday. Some of the men need to be physically restrained if they become distressed and aggressive to others or put themselves at risk. Behaviour intervention plans are in place and are kept under review by the MDT. Recording systems are in place such as behaviour charts, incident reporting and when physical intervention is used. One man’s records showed that he is having significantly less incidents than he was last year. The physical intervention forms have not been signed by the manager to show they have been read. This is good practice and helps ensure agreed practice methods are used and monitored. The Behavioural Therapist 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. The home delivers a unique service to each man reflecting their Autism and their individuality. The Speech and Language Therapist reported that staff work in a person centred way, but staff could become more involving in the care planning process. Key workers are expected to complete monthly summaries, however, for one man these have not been done during 2008. The keyworker for the other man had made up the headings to report under but in some cases these were blank. A standard format of heading may help staff report consistently across the service. Senior staff need to ensure the summaries are completed to monitor the men’s wellbeing and better demonstrate development in areas such as behaviour, communication, social inclusion and independence. Review meetings with the men’s representatives had been held six monthly, however, the files seen did not contain reports to indicate this had happened over the last year. One indicated an annual review had been held the other looked as though this was over due. Following the inspection confirmation was received that a meeting has been held in 2008. The men are young and have complex and changing needs. It is considered good practice to hold reviews at least Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 13 every six months. These can be used as person centred action planning meetings as well as reviewing the other areas of someone’s life and needs. Staff reported that the men are supported to make decisions at a level that they can cope with. Examples given included food choices, the colour of new clothes, their next planned outing. The Speech and Language Therapist reported that total communication methods need to be used more regularly. She reported the same things last year. The owners and new manager need to consider how to demonstrate how decisions are being made on the men’s behalf, in line with the Mental Capacity Act. Currently only those associated with risks are being well documented in risk assessments. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 14 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 the men with active and enjoyable experiences each day that they have some choice and control over. They receive 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 and social interaction. EVIDENCE: A structure is an important part of each man’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 have been supported following admission such as listening to music or playing computer games. All the men have different activity plans that have been developed based around their assessed needs and interests, for example one man plays badminton, one goes horse riding. Each man is at a different stage of being able to take part in social activities and access community facilities so the Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 15 arrangements are very personalised with at least one-to-one staffing being provided. Two vehicles are provided to facilitate outings. Activities have been limited at time due to a lack of drivers. Currently there are seven and they are reportedly spread evenly across both teams. Three of the four team leaders are drivers and they do not usually leave the building when in charge even if another senior worker is on duty. As the service is now more settled and incidents are less frequent consideration could be given to adopting a more flexible approach to facilitate outings. Activity plans are in place. Some parts are fixed such as the college courses and badminton but others activities are now more flexible so if the person declines the activity it can be offered again later or the next day. Staff reported that this approach was proving effective. One man’s level of activities and stimulation was reduced significantly last year to try to reduce the number of serious incidents that were occurring. The strategy was effective but work has now started to support him to go out more frequently. He is walking to the local shop to buy items of his choice and has been swimming, go-karting and bowling successfully, which is very positive. Records and discussions indicated that the other men are partaking in activities such as the snoozelen, walking to see local horses, picking fruit, train rides, cinema, drives, the fair and picnics. Some had attended the company Christmas Disco and Easter parade. One man attended a party but as he was excited he spent most of the time in the car park pacing. Some holidays have taken place and others are booked for October. A group of the men and staff walked to the top of Snowdonia earlier in the year and there are plans to use the funds raised to purchase new indoor activity equipment. Examples of in-house activities that are taking place included word and picture recognition, games, snooker and word puzzles. The sensory room is fully equipped and this is used for watching DVDs. The activities area was bare as it is being decorated. Some of the men use the garden and one man has his own summer-house. Involvement in daily living tasks seems to have increased. One man has made a cake and he was seen making his own drink. Records showed some people are doing their own laundry and cleaning their own room. The speech and language therapist supports the development of communication skills. Positive outcomes were reported such as some men speaking more, their behaviour improving as a result of better communication. As mentioned she reported that total communication methods need to be used more. The Behavioural Therapist reported that the men are supported to lead a life they choose. The nature of the clients means an individual service is provided. A flexible and innovative approach is taken to the provision of meaningful activities. Most of the men are being supported to stay in regular contact and/or visit their families. One man was on holiday with his family. One has been supported to stay over night with his family something that had not happened Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 16 for a long time. The staff are guided by the specialist team about how to support the men to develop social skills and how to respond to them expressing their sexuality. Because of their condition the men have not developed close friendships with each other, however some engage at times and the group seems relatively compatible within the highly individualised service. Food is purchased locally every few days and staff prepare the meals. The men are encouraged to take part where possible. A choice is offered and the men’s preferences are known. The records showed a varied diet is being provided. One man is being supported to eat near his peers and another will sometimes choose to eat outside. A trial period of a dairy free diet proved very positive for one man so this is being continued with the support of his representatives and health professionals. Consideration is being given to holding monthly cultural theme nights to encourage the men to have new experiences in music and food. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 17 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 men are being well supported with their personal and physical health care needs. Effective systems are in place to help them manage their emotional health needs. Medication is being safely managed on their behalf. EVIDENCE: The care plans contained detailed guidance showing how the person prefers to be supported. In one case more detail was given as additional information had been recorded on the back of the page. Details included how staff should encourage independence with washing and how to care for specific areas such as an ingrowing toenail. Staff confirmed that the staffing ratio allows each man to be supported to follow their own daily routine. Records showed people are having baths or showers at least daily. The men looked smart and they had their own style. Staff spoken with reported that people are encouraged to buy and choose their own clothes. One man’s clothes are kept in a wardrobe in the laundry as he damages them. A worker said he is still offered a choice of what to wear. The interactions observed during the day indicated that staff treat people with respect and dignity. Both professionals who returned surveys confirmed this. One added that sometimes behaviours mean that staff have to enter the men’s bedrooms or personal space for their own safety. A worker spoken with did refer to incidents as the men, ‘Kicking off’. This is not a Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 18 respectful way of describing when people become upset or angry. Senior staff should ensure respectful terminology is used in the home. The care plans sampled showed that arrangements are in place to meet current physical health needs such as chiropody and dental checks. Records made following health appointments were clear. Monthly summaries could be used to better reflect health concerns, for example, one reported that concerns about weight loss have resulted in one man being prescribed build up drinks. The previous monthly summaries did not mention any concerns about weight loss. The recorded action to weigh him weekly rather than monthly was taking place. Health Action Plans have been completed for each person and well man checks arranged. A record has been made if the men declined the checks such as blood pressure. The staff spoken with reported that health needs are taken seriously and professionals input is valued. Both professionals said in their surveys they felt confident that their advice is taken on board. One reported that sound systems are in place to identify and action health needs. The other agreed but felt consistently is always an area that can be improved. The company provides some health support, 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 said the behavioural therapist spends time with the men, observing them and speaking to keyworkers. They felt that clearer boundaries and a consistent approach with one man have led to him being less anxious and a reduction in aggression. The medication is stored appropriately inside a locked room. The keys are being held securely. Staff do not administer medication until they have been formally judged as competent. Accredited training is also provided. The administration and returns records were in order and contained the relevant details. It is positive that medicines are being kept under regular review with the health professionals involved with each man. Additional ‘as needed’ medication is rarely used. Guidance is in place about when this can be administered. One man is prescribed emergency medication for epilepsy. A team leader reported that staff have been trained to administer this by Mrs Palmer. He thought she had been able to provide the training because she is a nurse but he has not sure. This is being stored in the controlled drug (CD) cabinet with another controlled medication. A CD register is being used for one of these and the worker agreed to arrange the balance of the second medication to be checked regularly and recorded in the register. A record has been set up to log when this is taken out on activities. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. The men’s representatives know how to make complaints and feel any concerns are taken seriously. The men are supported to express their views. A framework is in place to help safeguard the men and they are supported to express their emotions in a constructive way. EVIDENCE: A company complaints procedure is in place. There is an Easy Read version more suitable for people with learning disabilities, however, this was not seen on display in their areas of the house. One man removes information on display, but as reported at the last inspection, no solutions to this have been found, such as locked perspex wall display cases. All the men would most likely need support to raise a concern formally. Staff would usually become aware that they were unhappy about something from their behaviour. The AQAA recorded that no complaints have been received since the last inspection with the exception of the one detailed below. Two men’s families reported in the home’s feedback survey that they knew how to make a complaint and felt that any concerns would be taken seriously. Both professionals who returned surveys to us said they felt confident that concerns are taken seriously. One family often communicates about the arrangements in place for their son. A record is kept of the issues and the action taken in response. A member of staff was observed to listen carefully to the views being expressed over the phone and then pass them on to her colleagues. The owner’s ‘Your Voice’ initiative aims to promote self-advocacy, however it is difficult for the men to engage in decisions about the service they receive. Keyworkers have started to meet with their key clients in private to consult Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 20 them and a sample of forms were seen. The men had answered some questions stating they did like the food, however some questions had not been understood or answered. The AQAA recorded that as not all the men have a social worker the staff are looking into whether any advocates can become involved. Shortly before the inspection one or more employees made an anonymous written complaint to the owners and us about the acting manager. As this included allegations that affected the wellbeing of people living in the home we made a referral to Social Services under local safeguarding procedures. The owners were asked to carry out an investigation and the employee was suspended. All but two staff were interviewed and they concluded that there was no basis to the allegations. They felt the letter might have been malicious possibly because this person had been given the opportunity to act up as manager without internal interviews having been carried out. The two staff spoken with were clear they would report any concerns promptly. The AQAA recorded that all staff have attended Adult Protection training. Protection is also covered during the induction process, however the course is only three hours long. Consideration should be given to staff also accessing the training provided by the local council on this subject. There are policies and procedures in place to give guidance about raising concerns and managing allegations of abuse. Staff have to sign to show they have read these. Guidance is in place and staff are trained in how to respond positively to the men’s complex behaviours. As reported earlier positive outcomes are being seen from the staff working consistently in line with the care plan guidance. The AQAA recorded that physical restraint has been used on 13 occasions in the last year. This is a significant reduction. The staffing levels have been increased since the last inspection and these factors should help to better safeguard people. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 21 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 men are living in a spacious, comfortable, clean and safe home and have personalised bedrooms. Some people have not been fully assessed to see what specialist equipment they need to maximise their independence. Some furniture has not been replaced or provided in a style that best suits the individual. The building has not been suitably adapted to enable information and equipment to be on view without it being damaged. 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. Safety features are fitted such as hot water valves and window restrictors. 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 second very small lounge, a bathroom and toilets, a dining area, sensory/movie room, a kitchen, a laundry, an activities area and a sensory garden. A section off the activities room was used as a gym until 2007 when the equipment became damaged. It contains a desk and a computer. A worker reported that in 4 weeks this was due to be set up with Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 22 a web cam to enable one man to communicate with his family. The layout of the accommodation allows the men to have personal space inside and outside. The way the house is decorated and fitted reflects some men’s need to have a low arousal environment. This makes the communal rooms seen less homely than some of the bedrooms. In line with this principle the office and meeting area are in a separate area. The sixth man is accommodated in a selfcontained flat at the rear of the house. This has its own entrance and is made up of a bedroom, kitchen/diner, lounge and bathroom. The flat was not seen on this occasion, as the man living there was away on holiday and therefore unable to give his permission. The grounds were in reasonable order. Three men have their own trampolines on the large lawn and one man has recently had a summerhouse put up that his family has purchased. The kitchen is attractive and well equipped. The men only access this with staff support. The lounge seemed quite comfortable with several large sofas. One man’s relative had raised concerns after hitting their head on the windowsill when they sat down. A low backed sofa was still against the sill so it was not obvious that any action had been taken about this. The armchairs in the small lounge have stained armrests. As reported at the last inspection, efforts to clean these have failed. They look unattractive and covers or replacements should be provided. Some areas of the home have been redecorated recently by staff. The activities area next to the dining area was bare and empty. The table had been moved that week to enable one man to try eating near his peers. The carpeted section that used to have beanbags on it has been removed as it became stained after being used for a time as a dining area. There was no other equipment or facilities visible. A worker reported that one man has played badminton in the area and there are plans to improve the area ready for indoor winter activities. There is scope for this area to be fitted with some robust seating, a secured music system, storage that allows the men to see activities and information without it being damaged. This could help the area be more homely and enable visual choice making. Risk assessments were seen about the safely of people having their own keys and their capacity to manage these. Two of the bedrooms seen were personalised and homely. It was clear that people are encouraged to have lots of personal possessions and hobby items. One man does not like certain items in his bedroom so it is quite minimalist. Staff have been creative and painted pictures and curtains onto the walls. He accepts furniture, but not the wardrobe doors or drawers, so these have been removed. This makes the room look damaged. Consideration should be given to providing him with furniture designed to suit him such as a desk and shelving without doors and drawers. He has a large stained communal style armchair. Staff said he uses his desk surface so perhaps a different style of chair would enable him to sit at his desk comfortably. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 23 It was reported at the last inspection that two men have visual impairments but no specialist input has been provided in relation to these needs. The AQAA did not mention whether this had been addressed. A part-time handy-person is employed to manage the grounds and deal with minor repairs. The owners process requests for more major repairs and some maintenance tasks. Shortfalls were found in the responsiveness of this service at the last inspection. The AQAA did not record if there have been improvements, but the need for staff to undertake painting indicates there is still scope for improvement. No dates were given for when equipment was last serviced but it was recorded that servicing was up to date. The Home was found to be generally clean and tidy. Staff carry out these duties and the men are encouraged to clean their bedrooms and get involved with their laundry where possible. The owners have recently approved the use of agency cleaners to come monthly to carry out a deep clean. There has not been an Environmental Health inspection this year. Fridge and freezer temperatures are being recorded each day and cleaning schedules and kitchen records are in use. The laundry is a suitable size and all the equipment was working. The door is kept locked when it is not in use. Infection control systems are in place, however, there was no soap available in the laundry. How this is kept stocked should be reviewed. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. The men are being supported by staff in sufficient numbers who are trained and understand their needs. Some aspects of training and supervision could be improved that would help ensure better outcomes for the men. The men are not being fully protected by the Home’s recruitment procedures. EVIDENCE: All men need a lot of verbal support from staff to carry out daily tasks. Some also need physical support in some areas and the support of two staff to access the community. Care staff also clean, shop and cook. At the last inspection a requirement was made as staffing levels had been allowed to fall below an acceptable level of several occasions in the months prior. Mrs Palmer had reported that the correct levels had been provided following this and a sample of rotas in November and December 07 were sent to us to evidence this. The September 08 rota showed that there is usually a shift leader and six or seven support workers on duty. At night there is two waking staff and a team leader sleeps in. Staff confirmed that this level of cover is being provided. They said it has been difficult at times and staff have had to work additional Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 25 hours. The AQAA recorded that agency staff are currently not being used as there are bank staff who support the permanent team. There is a reasonable gender balance of 13 female and 9 male staff, however, the need for male staff is more important than in some services as one man needs the support of male staff at all times, including at night. A worker spoken with said as this man stays in a lot the male staff do not get to leave the building during their shifts. If more male staff could be recruited obviously this situation would improve. Following the last registered manager being dismissed in May 07 a manager from another service was brought in to look at the staffing arrangements and charged with reducing 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. This involves working twelve or fourteen hour shifts over two or three day periods. The staff spoken with reported that this has enabled activities to be planned without consideration being given to a shift changeover at 2pm. It has also helped provide reassurance to the men who know which staff will support them throughout the day. The concerns about this system relate to staff becoming tired over long shifts patterns and are therefore more likely to make mistakes or find it difficult to follow guidance when they are in challenging situations. One worker confirmed that she did become tired but felt that staff maintained standards despite this. The owners should closely monitor this working pattern to ensure people are not put at risk. The men in this service have complex needs that require staff to be functioning at their best at all times. In last year 2 full time and 2 part time staff have left. This is a low turnover considering the support needs of the men and the size of the staff team. Both professionals were positive about the staff team in their surveys. One said the skill base of the team is excellent and new staff are given the appropriate training as soon as possible. The other said the skill level is improving but consistency could be further improved. Two men’s parents reported in their surveys that the staff are helpful and know their son’s needs. On the whole suitable training arrangements are in place. A worker employed in April confirmed she had completed an induction, basic safety courses and specialist training such as epilepsy and medication. She had not yet been on physical intervention training so she said she would take care of the other men and not get involved in managing an incident. She had found her colleagues helpful and was able to ask questions. She had not been linked to any mentor. The line manager for the home confirmed she was aware of this requirement under regulation 18, so it was not clear why this has not become part of the induction procedure. She had received supervision after a few weeks and then two monthly. She had attended training on Autism but found this brief and had needed to ask questions in her supervision. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 26 When the service was registered an agreement was made with the owners that all staff would be provided with Autism training within three months of their employment. This had not been achieved at the last inspection so a requirement was made. Of six workers who have started since the last inspection four did attend this training within three months of starting. The others waited seven or eight months. The course provided used to be two days but it is now half a day. Workers are given some written information but are not expected to evidence that they have read and understood this. This service is a specialist service for Autistic people so this knowledge is essential to staff. The owners should review current arrangements and ensure that a higher level of training is provided in a timely manner. Currently of the 24 permanent staff only 7 have an NVQ award, but 3 are working towards one. This is only a minor improvement from the situation at the last inspection where 28 of the staff held an award. Currently 4-5 staff are enrolled at a time. The owners need to review this strategy as it has not been successful in achieving the minimum standard of 50 of staff being qualified. The recruitment records for two staff were sampled. These showed that appropriate pre employment checks had been received prior to them taking up post, with one exception. One worker had taken up his post in November 07 following the receipt of a clear POVA First check. The date recorded for receipt of his full CRB check was the end of January. There was no record on file about this delay and no risk assessment about him working with these vulnerable men before the CRB was returned. A team leader said he would not have worked under supervision for 10 weeks. The actual risk appears to have been low as the worker came directly from another care home job were a CRB would have been completed during 2007, however it shows that the home’s procedure was not followed and if this occurred again people could be at real risk. This worker had had three supervision sessions following his induction. A team leader said she had not had supervision for two years. As recorded under the Complaints and Protection section equal opportunities principles were not applied in relation to the temporary post of acting manager being filled. The AQAA recorded that the team was made up of regular well-trained staff and the induction plan for new staff has been improved. Plans for the next year included providing more regular supervisions and acting more quickly to replace staff to aid consistency. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 27 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, 38, 39, 40, 41 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The men have benefited from the service but the owners have failed to ensure that some management issues have been properly addressed. 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. The owners failed to ensure she applied to be registered and she resigned in August 08. The role of managing the home temporarily was delegated to a team leader. As reported under the Complaints and Protection section the way this was managed appears to have led to allegations being made about this person and the home being disrupted while an investigation was carried out. When the investigation found the allegations were unsubstantiated the team leader returned to their original post. The owners did not inform us of this decision. We were told during the inspection that all four team leaders were Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 28 now managing the service on an equal footing. One spoken with said they had the support of a line manager but supervision sessions for them had not been mentioned. She felt new ideas are now being put into action quicker. She reported that staff meetings had often been cancelled and that only one had been held in the last year. These were now being arranged for the team leaders as well as the care staff. We wrote to the responsible individual to remind her that the regulations indicate that an individual should be appointed to take charge while there is no registered manager. We were subsequently informed that Ms Chrissie Andrews who is the manager of another home will be responsible while a new manager is recruited. Staff were unsure why interviews were only just being held when the last manager had given two months notice. Mrs Palmer had not completed by AQAA by the deadline and only contacted us following this date. Another 7 days was arranged. She then reportedly asked the acting manager to complete this in three days. As a result the AQAA was extremely brief and did not include much of the required information. If the service had been rated as ‘Good’ instead of ‘Adequate’ this would not have been sufficient information to enable us to carry out an Annual service Review instead of an inspection. The Speech and Language Therapist reported that there have been lots of improvements in the last year. She also felt staff morale was a lot better. The two relatives surveys seen were also positive. One had added that their son has lived there for 14 months and the change in him is amazing. The Behavioural Therapist reported that it was positive that the accreditation process for the Nation Autistic Society is well under way and they hope to achieve this status by mid 2009. 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 were not seen on this occasion. The AQAA recorded that these had been carried out along with the provider’s monthly visits and that audits are also carried out by the Clinical Governance department. Surveys have been sent to relatives and efforts to consult the men are being made. Record keeping and other policies are in place but as detailed these had not always been followed, for example, in areas such as equal opportunities and recruitment. The AQAA recorded that safety and maintenance checks have been carried out. It did indicate that there was no emergency plan so this should be addressed if that is the case. Staff reported that health and safety is well managed. There is a culture of completing risk assessments as part of daily work because of the nature of the service provided. The service appears to have been run in the men’s best interests over the last year, however, there have been shortfalls in the management arrangements as Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 29 detailed above and elsewhere in the report such as in recruitment, training and staff supervision. Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 30 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 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 3 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 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 4 12 4 13 3 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 x 2 3 3 2 2 3 x Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA1 YA6 YA23 Good Practice Recommendations The Service User’s Guide should be amended to contain the fee range for the service. Ensure monthly summaries are completed to evidence each man’s overall wellbeing and personal development. Hold care reviews and person centred action planning meetings at least every six months and ensure these are well documented in the care plans. The manager should sign to evidence they have seen all incident reports where physical intervention is used to help safeguard the men. Develop recording systems to better demonstrate how decisions are being made in line with the requirements of the Mental Capacity Act. Provide information in appropriate formats to aid the men’s understanding, choice making and communication in DS0000024739.V372332.R01.S.doc Version 5.2 Page 32 3 YA9 Lammas Lodge 4 5 YA19 YA20 YA35 line with advice from the speech and language therapist. (Brought Forward). Seek input from a specialist in visual impairments. (Brought Forward). Record the medication used in an emergency for epilepsy in line with controlled drug protocols. (Brought Forward). Staff who are asked to administer emergency medication for epilepsy should be trained by a person qualified to teach this procedure. Replace or recover the armchairs that are heavily stained. Refit the activities room and get it back in use. Provide storage and display cases that enable the men to see visual information and the activities available to them. Provide one man with the design of bedroom furniture that better meets his needs. Review the arrangements for redecorating the home and plan proactively so this task does not fall to care staff. Review how hand-washing facilities are kept stocked to ensure infection control systems are effective. Increase the number of qualified staff to at least 50 of the support team. (Brought Forward). Enable staff attend the specialist training on Autism that they need to meet the men’s needs within the first three months of their employment. Provide more in depth training on Autism than the current half a days course. Support staff to access the more in-depth Adult Protection training provided by Hereford council. Ensure recruitment procedures are followed carefully to better safeguard people. Link new staff to a named mentor who works with them on the first few shifts. Recruit more male staff and drivers when possible. The owners need to recruit a competent and experienced manager and ensure they apply to be registered in a timely manner. Develop an emergency plan in case the building has to be evacuated. 6 YA24 YA25 7 8 9 YA30 YA32 YA32 YA35 YA23 10 YA34 11 12 YA37 YA42 Lammas Lodge DS0000024739.V372332.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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