Inspection on 31/01/06 for Lammasmead

This inspection was carried out on 31st January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lammasmead 05/07/06

Lammasmead 31/07/05

Lammasmead 25/01/05

Lammasmead 05/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Lammasmead 61 Lammasmead Cheshunt Hertfordshire EN10 6PF Lead Inspector Claire Farrier Unannounced Inspection 31st January 2006 09:45 Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lammasmead Address 61 Lammasmead Cheshunt Hertfordshire EN10 6PF 01992 421020 0208 882 0010 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) Residential Community Care Services Ltd Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate 3 people with mental disorder (only when associated with a learning disability). 31st July 2005 Date of last inspection Brief Description of the Service: Lammasmead is a care home providing personal care and accommodation for three young adults with learning disability and associated mental disorder. The home is owned by Residential Community Care Services (RoCCS), which is a private organisation. It was opened in June 2002. The home is situated in a residential area of Wormley, close to local shops, recreational and educational facilities and public transport. It consists of a detached three bedroomed house, indistinguishable in appearance from the neighbouring houses. All the home’s bedrooms are single, without en-suite facilities. The home has a small, secluded rear garden, surrounded by tall hedges. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one morning, and including preparation time, a total of four hours was allocated to it. The focus of the inspection was to inspect the core standards that were not covered in the last inspection. The inspector spoke with all three residents, one member of staff and the manager. Care plans, staffing records, health and safety records and policies and procedures were checked, and the inspector carried out a brief tour of the premises. This was a positive inspection. The home continues to provide a good quality of care and the residents are happy in the home. The requirements on training that were made in the last report have been repeated, and new requirements were made concerning fire precautions, staffing records and rotas. This was the second inspection of the year. Core standards that were not inspected on this occasion were assessed to have been met in the previous inspection report, to which reference can be made. What the service does well: What has improved since the last inspection? What they could do better: The home continues to provide a good quality of care for the residents, and the manager has acted on the requirements from the last report. However no evidence was seen of a training and development programme for the staff, and this remains the main concern from this inspection. This is the responsibility of the company and funding must be provided to ensure that all required training is put in place, including induction training, fire training, and training in prevention of abuse and in managing challenging behaviour. Although the staff Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 6 know the residents and their needs, appropriate training will enhance their skills and competence and ensure that residents are protected from any risks of possible harm. Although the format of the care plans is very good, they could be further improved by incorporating the principles and practice of person centred planning (PCP), which should focus on the person being totally at the centre of all planning. 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. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 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 Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The good quality of information in the residents’ files has been maintained. The residents’ care plans contain detailed information on all their personal care and health care needs which enable the staff to provide a good quality of care. EVIDENCE: Detailed case tracking was carried out through the files of one resident, which showed what care is provided for the residents and how it is recorded. Another resident’s files were checked more briefly, to confirm that the standard of recording has been maintained. There has been no change to the format of the care plans. They clearly define the residents’ needs and how these needs are to be met. There are comprehensive guidelines available to staff for dealing with challenging behaviour. Each resident has a key worker, who ensures that they understand their care plans, and the care plans are made available to those residents who are able to read them. The care plans were seen to be not only a record of information, but also an effective tool to assist the staff in providing a good standard of care to the service users. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 10 Although there has been no change in the good quality of information provided in the care plans, they could be further improved by incorporating the principles and practice of person centred planning (PCP), which should focus on the person being totally at the centre of all planning. The care plans provide a good framework for providing appropriate information on each resident’s needs and for monitoring their progress, and the format could provide a basis for a PCP approach. The views of residents and their families are taken into account when writing care plans, and the care plans contain good details of all the residents’ care needs, but not in a PCP format. During the last inspection it was suggested that the key workers could assist and enable residents to write and monitor their own objectives, and that care plans should more closely reflect the voice of the resident. The action plan submitted in response to the inspection report stated that the paperwork for PCP is being developed, but no evidence of any change was seen on this occasion. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 The staff provide good quality personal care and treat the residents with sensitivity and respect. There is good recording of all the residents’ health care and medication needs. All personal and health care support is well maintained within the home ensuring that individual needs, choices and preferences are met at all times, but there is a need for appropriate training in the management of challenging behaviour. EVIDENCE: The care plans that were inspected provide comprehensive details of the residents’ personal care and health care needs (see Standard 6), and a good relationship was observed between the staff and the residents. One resident has frequent seizures. He had had a seizure earlier in the morning, and he was still in bed recovering at the start of the inspection. There are good guidelines in place for monitoring and recording epilepsy, and for the administration of rectal diazepam when required. All the residents have regular psychiatric reviews of their mental health needs. Behaviour guidelines are in place for each resident. The behaviour guidelines for one resident include praise for appropriate behaviour, being spoken to firmly for inappropriate behaviour, and loss of a reward, for example going on an outing, for continuous inappropriate behaviour. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 13 One of the proprietors, who is a consultant psychiatrist, provides information for the staff on behaviour management, but there is no formal training available. In the last inspection report a requirement was made that appropriate training in the management of challenging behaviour must be provided for all the staff. The action plan submitted in response to the inspection report stated that arrangements have been made for in-house training from an internal instructor. The deputy manager of another RoCCS home is qualified as a trainer in control and restraint, and he will train the staff of all the homes. It is not clear whether this training will provide sufficient knowledge and expertise for understanding each individual’s behaviour and implementing their behaviour programmes effectively, and there was no evidence of a programme for training for the staff in Lammasmead (see also Standard 35). Medication is supplied in nomad monitored dosage boxes for each resident, and PRN (when required) medication is kept in its original packaging. The administration of regular medications is recorded on a MAR (medicines administration record) chart supplied by the pharmacist. PRN medications are recorded in a separate notebook, with the reason for each dose, the amount taken and the amount remaining. The staff carry out a monthly audit to ensure that the recording is accurate. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. However there was no evidence that staff have undertaken training in prevention of abuse as required in the last inspection report. EVIDENCE: Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 35 The home is staffed by support workers who are experienced and competent to care for younger adults with learning disabilities and associated mental health problems. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. However there is no training and development programme that provides mandatory and specific training to meet the needs of the residents. EVIDENCE: The staffing rotas show that there are two support workers on duty throughout the day from 9am to 9pm, and one during the night. The manager is included on the rota, and no specific time is allowed for him to complete the work required for administration, organisation and staff supervision. It was reported that these tasks are carried out between 7-8 am and 9-10 pm if the residents do not need attention at these times. However these are the times when there is only one member of staff in the home, and the needs of the residents must take priority. Sufficient staff must be employed in the home to ensure that the manager has time to carry out his management tasks effectively. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 17 The staff are encouraged to take NVQ qualifications. Four of the six support workers have NVQ level 2, and one is taking NVQ level 3. However there is no evidence of a training and development programme that provides all the staff with mandatory training. There is no formal training in prevention of abuse, and there has been no fire training this year. The proprietor provides information for the staff on the residents’ behaviour management programmes, but there is no formal training in managing challenging behaviour (see Standard 19). Induction training does not meet the Skills for Care guidelines. It was reported that RoCCS managers have had a meeting to discuss training needs. The company must ensure that sufficient funding is available to provide training for all staff that meets the Skills for Care guidelines and meets the needs of the residents. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 40, 41 and 42 The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is meeting its aims and objectives. The home maintains appropriate records for the health and safety of the residents and staff in the home, with the exception of appropriate staff records. The procedures for fire prevention must be addressed to ensure that all staff have appropriate training and fire doors are not impeded. EVIDENCE: The manager moved to Lammasmead from another RoCCS home where he was the registered manager. He is currently studying for the Registered Managers Award. Evidence was seen of good record keeping and recording in the home, but the manager does not have specific time allowed for his management tasks (see Standard 33). The home’s policies and procedures are reviewed regularly, and changes have been made to the company’s Code of Conduct to include the GSCC (General Social Care Council) Codes of Practice. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 19 The file for one member of staff was inspected that contained all the required information. However there was no file in the home for the newest member of staff. It was reported that recruitment is carried out centrally, and the file has not yet been returned to the home. However the person concerned started work five months ago. All the required information on all members of staff must be maintained in the home. Appropriate procedures are in place for monitoring health and safety, including regular fire drills. The fire drill record includes the names of the staff and residents who took part and an evaluation of the process. However no date has yet been set for fire training, and this is now very overdue (see also Standard 35). The doors to the office, lounge, kitchen and first floor bedrooms were held open with wedges. These are fire doors, and must not be held open. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 3 X 3 X X 3 2 2 X Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA19YA35 Regulation 18(1)(c) Requirement All the residents have challenging behaviour, but there is no formal training available. Appropriate training must be provided for the staff to ensure that they have the skills to implement behaviour programmes effectively. (Previous timescale of 31.12.05 not met) There is no formal training in the prevention of abuse. Training must be provided for all the staff in the procedures for prevention of abuse and protection of vulnerable adults. (Previous timescale of 31.12.05 not met) Timescale for action 30/06/06 2 YA23 13(6) 30/06/06 Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 22 3 YA33 18(1)(a) The manager does not have 30/06/06 specific time allowed for the management tasks in the home. The registered person must ensure that sufficient staff are employed in the home to ensure that the manager has time to carry out his management tasks effectively. There is no evidence of a 30/06/06 training and development programme that provides all the staff with mandatory training, including induction training. The registered person must ensure that sufficient funding is available to provide training for all staff that meets the Skills for Care guidelines and meets the needs of the residents. (Previous timescale of 31.12.05 not met) The staff have had no training in fire prevention this year. All staff must undertake fire training as part of their induction and annually thereafter. (Previous timescale of 31.12.05 not met) There was no file in the home for one member of staff. All the required information on staff, as listed in Schedule 2 and Schedule 4(6) of the regulations, must be kept in the home, including evidence of identity, confirmation of the person’s health and evidence of satisfactory CRB checks. 4 YA35 18(1)(c) 5 YA35YA42 23(4)(d) 30/06/06 6 YA41 17(2), 19(1)(b) 30/06/06 Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 23 7 YA42 23(4)(c)(iii) The doors to the office, lounge, kitchen and first floor bedrooms were held open with wedges. The registered person must consult the fire authority concerning adequate precautions against the risk of fire, in particular with regard to the use of door wedges on bedroom doors, and take action on any subsequent recommendations. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The care plans contain good details of all the residents’ care needs, but not in a PCP format. Consideration should be given to incorporating the principles and practice of PCP into the home’s care plans and reviews. This recommendation has been repeated from the previous inspection report. The action plan submitted in response to the report stated that the paperwork for PCP is being developed, but no evidence of any change was seen on this occasion. Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lammasmead DS0000029111.V281776.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!