Inspection on 05/07/06 for Lammasmead

This inspection was carried out on 5th July 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lammasmead 31/01/06

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 Mrs Sheila Knopp Unannounced Inspection 5 July 2006 09:50 Lammasmead DS0000029111.V297035.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 Lammasmead DS0000029111.V297035.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. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 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.V297035.R01.S.doc Version 5.2 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 January 2006 Date of last inspection Brief Description of the Service: Lammasmead is a care home providing personal care and accommodation for three younger adults with a learning disability and associated mental disorder. The home is owned by Residential Community Care Services, which is a private organisation. It was opened in June 2002 and consists of a detached three bedroomed house, indistinguishable in appearance from the neighbouring houses. The home is situated in a residential area of Wormley, close to local shops, recreational and educational facilities and public transport. All the homes bedrooms are single, without en-suite facilities. The home has a small, secluded rear garden, surrounded by tall hedges. Details of the homes Service User Guide are available from the home and residents have their own copy. The current fees are based on individual care packages ranging from £1143 - £1519 per week (correct on 13.7.06) Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on an unannounced visit to the home by one inspector who spent a total of 4 hours in the home. The report includes information provided by two residents, one member of staff and the manager. Two care plans were reviewed in detail following contact with the residents concerned and the member of staff who was a key worker for one of the residents at home at the time of the visit. Three service users completed and returned questionnaires on their experiences at Lammasmead. Information received about the home since the last inspection in January 2006 has also been reviewed. No concerns have been brought to the attention of the Commission about this service. A significant event in the lives of the residents since the last inspection is the appointment of a new manager. The manager transferred from another home within the company and was already known to the residents. This report identifies that the care and support provided to residents continues to be good but that work is required on management systems. What the service does well: What has improved since the last inspection? A programme of staff training in the management of challenging behaviour has been introduced to enable staff to recognise and defuse situations in line with current practice. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 6 A planned programme of redecoration and replacement of furniture, fixtures and fittings has continued to maintain a good standard of accommodation for the residents. Door guard automatic self-closing devices have been provided where doors need to be kept open during the day. 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. Lammasmead DS0000029111.V297035.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 Lammasmead DS0000029111.V297035.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The residents at Lammasmead continue to have their needs and aspirations assessed to ensure that the service continues to provide the support they require. EVIDENCE: It was confirmed from discussions with residents, staff and a review of care records that the three service users who have made their home at Lammasmead continue to have their needs assessed. Information on file confirmed service residents have access to the terms and conditions of their tenancy and information about the service in a suitable format. There have been no recent admissions to Lammasmead and the Commission records show that this standard has been met consistently each time it has been reviewed. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Residents are involved in developing and reviewing their plan of care with their key worker and social worker. Residents are supported to make decisions about their lives and also attend groups, which develop their life skills and independence. Any risks to residents from their environment or activities they are involved in are assessed and reviewed. EVIDENCE: A resident was able to confirm they were aware of their care plan. They had been reviewing it the day before with their key worker. Two residents attend college sessions, which develop daily living skills. Details of how residents are being supported to make their own decisions regarding lifestyle choices and relationships were discussed. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 10 Staff were sensitive to the need to support the decisions made by residents. Details of the discussions and decisions reached were supported by information in the care records. Risk assessments are in place to support residents at home and in the community. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The residents at Lammasmead have opportunities to take part in activities, which develop their individual personal skills and independence. Residents are supported to maintain family links and friendships and to access community facilities independently and with the support of staff. Residents are involved in planning, shopping and preparing meals as one would do in a family home with the added support of staff who monitor their nutritional needs. EVIDENCE: Each resident has a weekly timetable of activities, which reflect their individual needs. These include recreational activities, college based activities and contact with friends and family. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 12 Good relationships within the local community were reported. One resident regularly collects their own newspaper and enjoys visits to local cafes. Observations made on the day of inspection and discussions with residents and staff confirmed that the individual routines and lifestyle choices of residents are supported. A resident said ‘I like to go out’. Another resident likes to go out for cups of tea. Both residents the inspector met were positive about the relationships they have with residents living at another nearby address. They drop in for tea and plan their annual holiday together. Meals are taken together with staff in the dining area. Details of the food prepared are recorded enabling an overview on the range and type of meals provided to be reviewed. Fresh fruit was freely available for residents to pick up. Staff record and monitor the weight of the service users and provide information and support to enable residents to make choices about healthy eating. The last visit by an Environmental Health inspector was on 03/02/04. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Staff support residents to achieve a good quality of personal care in a sensitive manner, which supports their dignity and personal preferences. Overall there is good recording of all the residents’ health care and medication needs. However records to show staff had received appropriate training to administer medication were not available. Following discussions with the inspector the manager has put guidelines in place, agreed with the resident’s General Practitioner (GP), for the administration of non-prescribed medication such as Paracetamol and vitamins. A programme of training in the management of challenging behaviour is being rolled out across the staff team by a trainer who has completed an accredited trainers course. The behaviour management guidelines are also being reviewed for each resident. EVIDENCE: The individuality of residents is appropriately expressed through choices of clothing styles purchased, personal care products and visits to hairdressers. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 14 The care plans that were reviewed provide comprehensive details of the residents’ personal care and health care needs. Good interaction between the staff and residents was observed. There are good guidelines in place for monitoring and recording epilepsy, and for the administration of emergency diazepam when required. The manager has provided dates when staff are due to complete their training update in this procedure. All the residents have regular psychiatric reviews of their mental health needs. Behaviour guidelines are in place for each resident and have been updated as situations change. The manager reported that restraint is not used and the guidelines and training are based on early identification and diffusing of situations. 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. The type of chart used had recently changed and the manager agreed to review this with the pharmacist as it was not so easy for staff to make additional records on the back when required. PRN medications are recorded in a separate notebook, with the reason for each dose, the amount taken and the amount remaining. The manager has now received authorisation from GP’s for staff to give discretionary medications (homely remedies). The staff carry out a monthly audit to ensure that the recording is accurate. Records of the competency assessment for assessing staff administering medication were not available. The continued competency of staff also needs to be reviewed at regular intervals. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Appropriate policies and procedures are in place for the protection of the residents. There is a simplified complaints policy in widget format for the residents, and appropriate policies and procedures concerning adult protection that follow the guidelines given in the Hertfordshire County Council adult protection procedures. Dates for staff to receive training in adult protection matters, which have been required following the last two inspections have now been agreed. No concerns have been brought to the attention of the Commission about the service provided at Lammasmead since the last inspection. EVIDENCE: A comprehensive procedure for complaints is in place. The Service Users’ Guide contains a simplified complaints policy in widget format. No formal complaints have been recorded since the last inspection. Day to day issues raised by residents are recorded as part of their care plan. One person said they did not know how to make a complaint so this needs to reviewed when staff are reminding residents on how they can make their views known. The procedures on prevention of abuse contain information on the different forms of abuse, and follow the guidelines given in the Hertfordshire County Council adult protection procedures. There is a clearly written whistle blowing policy. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 16 A requirement made following the last two inspections to provide training in adult protection matters had not been met at the time of this inspection. The manager has since provided dates for training in July and August therefore a further requirement has not been made. Appropriate records, procedures and staff training are in place to support residents in challenging situations. The arrangements for providing service users access to their finances were reviewed. It was advised that two signatures are recorded for money paid into or withdrawn from the resident’s individual personal allowances accounts as receipts are not currently issued to relatives depositing funds. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 17 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): 24 & 30 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Lammasmead provides residents with a safe comfortable family home, which is well maintained and in keeping with the local community. As in other areas of this report, record keeping is identified as a weak area. EVIDENCE: Each resident has their own room, which is personalised to suit their needs and personality. Residents regularly spend time in their room by choice, relaxing, listening to music and having time on their own. There is an on-going refurbishment and redecoration plan to maintain good standards. Regular health & safety audits are carried out. Hot water temperatures are regulated and window restrictors and radiator covers are in place to prevent accidents. Residents are involved in the day-to-day running of the home. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 18 Laundry provision is on a domestic scale as there are currently no issues, which would indicate the need for additional equipment. A copy of the required fire risk assessment was not available and is referred to under Standard 42. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 19 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, 34, & 35 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The home is staffed by a consistent staff team of support workers who are experienced in the care for younger adults with learning disabilities and associated mental health problems. Standard 35 was not fully met on the day of inspection because the training updates required following previous inspections had not been completed within the timescales given. Following the inspection the new manager provided a training plan for 2006 therefore further enforcement action has not been necessary. Appropriate checks on the suitability of staff are carried out before they start work in the home to ensure residents are protected. 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 her to complete the work required for administration, organisation and staff supervision. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 20 This has been subject to previous recommendations and needs to be kept under review in light of the administration problems identified in this report. The staff are encouraged to take NVQ qualifications. Four of the six support workers have NVQ level 2, and one has completed NVQ level 3. Previous requirements in relation to mandatory training, fire training and POVA training had not been met at the time of this inspection. The manager has subsequently provided dates of training to take place during July and August. The company must ensure that staff continue to receive the required annual updates and that there is a training needs assessment for the staff team and training plan in place for each member of staff linked to the revised Skills for Care guidelines and learning Disability Award Framework (Standard 35). The previous inspection required that staff records are kept in the home and made available for inspection. Again this requirement had not been taken forward and the inspector was not able to verify the recruitment procedures for a member of staff. The other files reviewed confirmed that the required checks on staff are being carried out before they start work. The area manager has since provided details of the outstanding information and confirmed that staff files have now been transferred to Lammasmead. A further requirement has therefore not been made. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 21 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, 39 & 42 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The new manager has transferred from another home within the group and has previously been registered by the Commission under the Care Standards Act. The views of service users, relatives and health & social care professionals are included in the quality monitoring systems in place. Directors of the company carry out visits as part of their responsibilities towards monitoring standards. The manager needs to review the risk assessments in place to ensure they still comply with the requirements of other regulatory authorities. A copy of the risk assessment under The Fire Precautions (Workplace) Regulations 1997 (as amended) was not available therefore Standard 42 was not fully met. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 22 EVIDENCE: The current manager moved to Lammasmead in April from another RoCCS home where she was the registered manager. She is nearing completion of the required Registered Managers Award and has achieved an NVQ care qualification at level 4. Quality assurance reports are produced which includes the views of service users, relatives and other key individuals. Reports of monthly visits by representatives of the company to monitor the quality of the service were available in the home. Health & safety audits are carried out and records of fire alarm tests and drills are kept. Door guard automatic self-closing devices have been provided where doors need to be kept open during the day. This meets a requirement made following the last inspection. No concerns regarding immediate health & safety matters were raised by this inspection. However some management issues were identified which require further action. Details of risk assessments for fire safety, safe working practices and reduction of environmental risks were not available at the time of this inspection. Copies have since been provided but the manager and company need to review these to ensure they comply with the legislation listed under standard 42 as they lacked significant details. For example the C.O.S.H.H assessment did not list the chemical products in use or the assessment carried out to see if alternative products were available. Health & safety advice can be obtained from the local Environmental Health department. Fire Precautions risk assessments are required to be in place. The details provided following the inspection did not conform to the standard set by the Hertfordshire Fire safety service. Advice and a pro-forma are available on their web site. There were no concerns regarding the level of accidents or incidents being recorded. The manager needs to remind staff regarding reporting incidents under Regulation 37 as this is an infrequent occurrence. Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 23 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 x 4 x 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 x 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 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 2 x Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement Timescale for action 31/08/06 2. YA42 13(4) 3. YA42 23(4) Details of the training and process for assessing the initial & continued competence of staff to administer medication must be recorded and reviewed. Review the risk assessments 30/09/06 required for the legislation listed under Standard 42.4 to ensure full compliance. A copy of the risk assessment 30/09/06 under The Fire Precautions (Workplace) Regulations 1997 (as amended) must be available. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lammasmead DS0000029111.V297035.R01.S.doc Version 5.2 Page 25 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.V297035.R01.S.doc Version 5.2 Page 26 - 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. 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