CARE HOME ADULTS 18-65
Lampton Court Lampton Court Littleham Bideford North Devon EX39 5HT Lead Inspector
Adele Adams Key Unannounced Inspection 12 , 13 and 26 September 2007 11:15
th th th Lampton Court DS0000026736.V339441.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 Lampton Court DS0000026736.V339441.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. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lampton Court Address Lampton Court Littleham Bideford North Devon EX39 5HT 01237 470280 01237 425040 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) www.lamptoncourt.com Health & Care Partnership Limited Post Vacant Care Home 19 Category(ies) of Past or present alcohol dependence (19), Past or registration, with number present drug dependence (19) of places Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th June 2006 Brief Description of the Service: Lampton Court provides 24-hour care for 19 younger adults aged 18 to 65 years with past or present alcohol and/or drug dependencies. The home is registered as a care home. The service is run in a large detached house standing in its own extensive landscaped grounds and is a short drive away from the North Devon town of Bideford. There are 5 single bedrooms and 5 bedrooms are shared. There is a swimming pool on site. The service runs a programme that provides group work, and an activity programme. The programme also provides an experience of community living and day programme. When the inspection was carried out, the fees charged range from £697:00 to £918:00 per week; all basic provisions such as basic toiletries are provided; additional charges are made for personal items such as toiletries, magazines and newspapers. Copies of previous inspection reports are available in the office. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has introduced “Key Standards “ to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. This inspection was unannounced and took place over three days starting at 11:15 and ended at 17:20 on the first day and stated at 9:10 ending at 13:15 on the second day and on the third day 26th September the Regional Lead Pharmacist visited the service to follow up on the concerns raised on the first two days. The purpose for the inspection was to follow up requirements made at the last inspection and to inspect the key standards which include: information; health and social care; leisure activities, complaints and protection; environment; recruitment; management and health & safety. To do this, we looked around the home and also read records, policies and procedures. Time was also spent talking with people that use the service on a one to one basis and in a group. We also spoke to five staff, during the inspection. Surveys were sent to people using the service, health and social care professionals and information from those received are included in the report. There were no visitors to the home during the inspection. Information was also received before the inspection from the service as requested by the Commission for Social Care Inspection. This was in the form of an Annual Quality Assurance Assessment that provided us with important information that supported this inspection. What the service does well:
Everyone using the service provided at Lampton Court has been through a thorough pre admission process, which makes sure that the service can meet the needs of that person. People currently using the service told us that being able to visit, as part of their pre admission assessment process was really important to them as it helped them with their own decision-making. Each person at Lampton Court has a key worker. People told us that the key worker system works well and makes sure that their needs are met in a way that is best for them. People are encouraged to be fully involved in planning and reviewing their care and place value on this They told us ‘we are treated with respect, receive support and work together.’ Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 6 People using the services provided at Lampton Court benefit from the excellent approach to personal development. This includes opportunities to take part in many activities that are purposely designed to be both fun and personally challenging. People told us that they can’t believe how they have changed and are or are considering doing things that they didn’t think would ever be an option for them. In addition, as part of their personal development, people get involved with the preparation of food, learn the importance of eating a well balanced diet and can learn new skills in meal preparation. People told us how the improvement in their diet had had a positive benefit on their general health and well being and that this will lead to an improvement to their diet when they leave Lampton Court. There are some restrictions in place at Lampton Court, for example, with regard to relationships and freedom of movement outside of the home. People using the service saw this as being both positive and acceptable because this is part of the support they need to help them not to return to behaviours associated with substance addiction. People told us that they are able to raise concerns and openly discuss matters with each other and the staff and said that they have a real respect and appreciation for the staff at Lampton Court. They felt confident that if they had to make a complaint the staff would treat it seriously and act upon it. What has improved since the last inspection? What they could do better:
Lampton Court’s Statement of Purpose (which is the document containing all of the information about the service) is currently out of date; this must be improved to make sure that people have access to up to date and accurate
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 7 information about what the service provides and how it is run. This is so that people can confidently make decisions about the service based on the information provided to them. The care records of people using the service should be improved by being better organised and by the people involved in writing them signing to show this. This would make the accessing of information and auditing of records easier. It would also make it easier to see that people using the service are involved in planning and reviewing their care. Individual care records should also contain up to date signed and dated risk assessments. This would show when a risk assessment has been carried out and whether or not is should be reviewed, particularly as individual circumstances change. People using the service at Lampton Court must be able to register with a doctor of their choice. This will give them confidence that there will be access to their NHS records so that any chronic health problems that they may have can be managed in a consistent well informed manner. Medication practices at Lampton Court are currently poor and in one instance unacceptable. These must improve to prevent serious omissions in record keeping. This would enable an audit at any time to check whether controlled drugs were being correctly stored and handled. In addition, medication received into the home on behalf of people using the service must be clearly and appropriately recorded, kept securely, given safely and disposed of correctly. This is to make sure that people receive the correct prescribed medication from people that are qualified to give it to them and that it is stored and disposed of safely, securely and appropriately and that clear audit trails are in place. The medication policy must be reviewed and amended to ensure that staff are working to up to date guidance and that people using the service are protected from potential errors. Staff working at Lampton Court must receive up to date suitable medication training. The staff’s abilities should be regularly monitored and reviewed to limit the possibility of error, to identify if training has been effective and whether further training is needed. The amount of medication storage facilities at Lampton Court should be reviewed to make sure that there is enough suitable storage space as the number of people using the service increases. People looking after their own medicines must be provided with secure storage facilities. A risk assessment must be in place for any person that is responsible for taking their medicines themselves. This is to clearly show that all risks have been considered as part of the decision making process for someone to take responsibility for taking their own medicines.
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 8 The information in the Complaints procedure should be improved by updating and entering the correct contact details of the Commission for Social Care Inspection so that people using the service can contact us should they need to. As the number of people using the service increases, an increase in the number of baths and showers provided should be considered. This is to make sure that people have access to these facilities and can attend to their personal hygiene needs as and when needed. As the number of people using the service increases, an increase in the of number of washing machines and tumble driers provided should be considered. This is to make sure that people have access to these facilities and can attend to their personal hygiene needs as and when needed. All staff employed to work at Lampton Court should be registered and familiar with the General Social Care Council and its Code of Practice. This is to make sure that they are working to and are complying with the standards of conduct and practice that are set out by the Council. All staff working at Lampton Court must have a training plan in place. This is to ensure that they have the skills and knowledge to meet the needs of the people using the service. It would also assist in identifying in advance when training should to be organised. Staff must have regularly planned one to one supervision, to ensure that they have ‘protected time’ when they can receive support and discuss their own development needs. This will enable them to work effectively with people using the service. The service is currently really suffering from not having a Registered Manager in post. This must be improved as a matter of urgency by ensuring that a suitably qualified and experienced person is registered with the Commission for Social Care Inspection. It is important that a Registered Manager is appointed as this will make sure that the service is run efficiently and effectively for the benefit of people using the service. There is currently no quality assurance process in place. This must be addressed (and must include those people using the service) to make sure that the care provided to people using the service is reviewed and that changes as a result of any review are put into place. A report detailing all of this information must be made available to people using the service and the Commission for Social Care Inspection. The service’s policies and procedures should be improved by being reviewed and updated and then regularly amended and reviewed in line with changing practice guidelines. This will help to ensure people using the service receive up to date appropriate care.
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 9 Essential health and safety checks must be undertaken regularly to ensure the safety of people using the service. Areas for action include: • Staff must receive appropriate training in such topics as first aid and moving and handling to ensure they are able to care effectively for people that use the service. Essential health and safety checks must be carried out such as the recommended testing for Legionella in water stored at the home. This is to ensure the safety and well - being of people that use the service. • 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. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 10 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 Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. The service’s performance was assessed against Key standard 2. People who may use the service at Lampton Court undergo a thorough assessment process to determine whether Lampton Court can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment) which described how the service selects people through assessing their individual needs and that clients also have the opportunity to visit the unit prior to admittance to test drive it for a day unless they come directly from custody when this is not possible. The AQAA also advised that the admissions procedure at Lampton Court consists of a three-stage process which includes a telephone assessment followed by a more in depth face to face assessment at Lampton Court and then a care planning meeting to decide whether the applicant is ‘right for us Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 12 and us for them.’ The service also asks the referrer for information about the applicant which helps in making their decision. Three people using the service told us about their own assessments in detail. In addition, the reading of three people’s records showed the amount and quality of the information that is gathered during the assessment process that enables the service to make their decision about whether or not they can meet a person’s needs. People also told us that being able to visit as part of the assessment process was really important to them and really helped them in their decision-making. This information confirmed what had been stated in the AQAA. Although Standard 1 was not fully inspected on this occasion, information provided in the Statement of Purpose was incorrect and needs to be updated. For example the information about the staff employed at the home was incorrect and the person identified as the Registered Manager for the home no longer works there and currently there is no Registered Manager in post. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. The service’s performance was assessed against Key standards 6, 7 and 9. People using the service at Lampton Court are involved in decisions about their lives, and play an active role in planning the care and support they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which informs us that each person has a key worker with whom he/she discusses all aspects of care in weekly (often twice weekly) one to one sessions. This personal approach to individual care allows for the needs of the individual to be monitored continually and adapted as necessary with the agreement of both parties. The AQAA identified that the service is looking at ways of improving the current paper record system that is in use.
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 14 Three people using the service told us about the key worker system that is in place at Lampton Court and that the system works well. They told us that they each have their own records and work towards goals that are discussed and agreed with their key worker in the one to one sessions that take place regularly. We were also told of some of the opportunities that people have and how being supported to take risks in a structured way has increased their confidence, self-belief and self esteem. In addition, the reading of three people’s records showed that individual records are kept for each person at Lampton Court. These records include risk assessments, however the risk assessments were not dated to show when they were carried out. The records held appropriate information but were not particularly clear or well organised and did not always contain information in the same format for each person, which can be confusing. For example in relation to assessment, all of the records read contained assessment details, however these were not always in the same format or in the same place in the file, which can be misleading and confusing for the reader. The three records read all contained evidence of being regularly reviewed. The written content did show that this is done with the involvement of the person using the service. However the sections of the records that are available for the person to sign to show their involvement were not completed. This information confirmed what had been clearly communicated in the AQAA. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is excellent. The service’s performance was assessed against Key standards 12, 13,15,16 and 17. People who use the services at Lampton Court are able to make safe choices about their life style, and are supported to develop their life skills. Social, educational, cultural and recreational activities meet and sometimes exceed expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which in relation to the above standards told us that: “The whole ethos of Lampton Court is about personal development and developing lifestyle choices away from drugs and alcohol. There are some restrictions which are in place to ensure the safety of clients. These
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 16 restrictions are of benefit to the programme and service user and are designed to allow clients time away from the pressures of having to face external challenges before they are well and strong enough to do so. The holistic curriculum includes many outdoor activities which are designed to broaden the clients thinking and be fun. Service users are positively encouraged to review relationships and to examine whether they are healthy. Parents, partners and children are encouraged to visit Lampton Court and after a period of time service users can go off site with visitors. We have a chef tutor who as well as providing tasty and nutritious food also instructs service users on cooking for themselves and nutritional, healthy eating and dietry options.” We spoke to three people using the service who told us of the improvement in their lives since being at Lampton Court and explained what value they place this. They explained that this had been due to being supported to develop through education, leisure pursuits and daily routines. People told us that they couldn’t believe some of the things they have been able to take part in and achieve while being at Lampton Court such as a week long team building exercise that took place off site, being supported to do voluntary work in the local community - which has led to a job offer for one person and being supported to seek employment and attend a job interview. People told us that there are some restrictions are in place with regard to relationships and freedom of movement outside of the home and these are acceptable because they are designed to support them from returning to behaviours associated with substance addiction. People also described how they are supported to maintain healthy meaningful relationships and maintain contact and re establish contact with meaningful others including family, one person described this process in detail. On site, we observed and were told by people that the house is situated in approximately eight acres of land and there are areas for sports such as football and swimming and we were told of some of the pursuits that have been enjoyed such as golf, walking on Dartmoor and kayaking. Gym equipment is available for use and computers are available for personal use – ‘rules’ are in place to ensure appropriate use of equipment and facilities provided. The kitchen was seen and the chef tutor was met, we joined people for a pleasant lunch in the dining room. The menus which are planned on a six weekly basis were seen and the chef tutor was met with and showed us the food storage facilities, the security measures that are in place and records of health and safety checks that are regularly carried out. One person was preparing the evening meal with the chef tutor and told us about the range of
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 17 food preparation they can take part in and what skills can be learnt. One person particularly enjoys baking cakes. Each person has the opportunity to gain a food hygiene qualification and we saw that many chose to do this. In addition, three people’s records were read which all contained details of what they had told us about their daily lives. All we observed read and spoke with people about confirmed what had been stated in the AQAA. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is poor. The service’s performance was assessed against Key standards 18,19 and 20. The health and personal care that people receive is based on their individual needs but could be improved. The principles of respect, dignity and privacy are put into practice. The poor medication management system has the potential to place people using the service at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which in relation to the above standards told us that: ‘The programme is designed to promote emotional and physical health; which is reviewed individually through care planning with the person concerned. The service has a private contract with two GPs who hold surgeries on
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 19 Mondays and Fridays at Lampton Court. People are perscribed the medicines that they need and these are recorded in a MARS chart. All medicines are stored safely in a locked meds cupboard within the locked staff office. To add to the service we employ an Registered Mental Nurse as Clinical Lead. This is not a nursing post but the knowlege of the substances of abuse and the way medication works gives extra value to the service. It is unlikely that Standard 21( the aging illness and death of a service user ) would apply to us, but we understand and accept the value of this.’ We spoke to three people using the service who told us how their personal, physical and emotional and medication needs are met at Lampton Court. They told us that they all independently manage their own personal care and that care is taken to ensure that both males and females do have their privacy and dignity respected. Two members of staff also told us this and we saw the bathroom facilities and en suite arrangements during the tour around the home. People told us that a doctor visits the service twice a week on a Monday and Friday. People told us that their health needs were generally met, but not if they have a chronic health problem - we were told that they have concerns, as there is not access to their general NHS records. 2 members of staff also confirmed this as being the case. This was raised with the Responsible Individual as a cause for concern particularly with regard to those people with chronic health problems and the management of these. People told us that their medication is prescribed for them and that it is dispensed individually to them from within the office where medication is securely stored. The Responsible Individual explained as is stated in the AQAA about the employment and the role of the Clinical Lead with regard to medication matters in the home. We found that the service receives its medication from a local chemist and MAR sheets (medication administration records) are in place. It was found that medication record keeping was not adequate. The receipt of medicines, the date of receipt and the amount of medication received were not recorded on the MAR sheets – making a medication audit impossible, there were other lapses in recording on these records as well including; the lack of detail about who the medication is prescribed for – for example if there are any known allergies and the date of birth of the person was also not present. We also found that for service users prescribed medicines to be taken when required that there is no guidance on how these medicines are to be taken. We also found that when people living in the
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 20 service look after any of their own medicines they are not provided with a secure space in which to keep them and also no risk assessment is carried out. The supply of these medicines to these people is not recorded. The entry of the prescribed medicines was also poor – the handwritten entries were not made in capitals and were not signed for by 2 members of staff. We also found that the dose entered on the charts was different to that on the dispensed medicines and there was no record as to why or when the dose had been changed. Doctors’ signatures were not present on medication charts. The storage of medicines is secure, however the amount of storage space may need to be increased as the numbers of people using the service rises. We also found on the third visit that the medicines keys are not always stored securely and were potentially accessible to people living in the service. In addition we saw that a Controlled Drug register is also held on site to record if any Controlled Drugs are being kept and administered. The controlled drug cupboard was opened and found to contain x2 bottles of a Schedule 2 medication – this was in the name of a person using the service but no record of receipt of this medication into the home was found in the Controlled Drug Register. The seriousness of this matter was brought to the attention of the Responsible Individual and an Immediate Requirement was issued. On the third visit we examined the records made for the disposal of this medicine and although two people had witnessed the disposal no record was made of the quantity disposed of and it was also not disposed of in accordance with current guidance. The medication policy was read and was out of date and had not been reviewed. We also found that the home is storing homely remedies but have no records for what they have received and there is no current homely remedy policy. The staff spoken with advised that there had been no recent medication training and that their competency in giving medicines was not regularly reviewed or monitored. The Registered Person and Senior Carer gave assurances that these serious matters of concern would be investigated and changes made as a matter of urgency. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. The service’s performance was assessed against Key standards 22 and 23. People who use the service are able to express their concerns, and have access to an effective complaints procedure, and are protected from abuse, and have their rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which informed us: ‘There is a good system for listening to the views of service users and that all service users are protected from abuse, neglect and self harm through understanding their individual needs. All staff are currently undergoing POVA training, many have already undertaken this training and the remainder are booked to do it at North Devon College on the 24th July 2007. The complaints procedure is displayed on the service users notice board, staff are approperatly trained and are aware what they need to be looking for. We have feedback sheets and questionaires about clients views of activities and value verbal feedback through open meetings and forums.’ We spoke to three people that use the service who told us that there is a complaints procedure posted on the notice board, we saw this and it contained
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 22 clear information – however the address for the Commission of Social Care Inspection was incorrect as the contact address provided was for an office that is no longer there. We were given an example of a complaint that had been made by one of the people using the service and they told us that it was dealt with in an appropriate and effective manner. They told us that the staff are extremely open and approachable and that the relationships between staff and people using the service are very good with people saying that they feel respected and understood. All people spoken with told us that they would not hesitate to raise any type of concern they may have with the staff or each other. Information about the protection of vulnerable adults is held in the office, staff that had attended the course discussed what they had thought about the training with us. The training plan for this training was posted on the office wall this showed which staff had recently received training in this area and the dates and names of staff that are soon to attend the training. This information confirmed what had been communicated to us in the AQAA. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. The service’s performance was assessed against Key standards 24, 27 and 30. Lampton Court provides an environment suitable to the needs of those who reside there, and encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment) which informs us that: ‘Lampton Court is a delightful Victorian house set in 8.5 acres of gardens over 3 miles from the nearest town. Service users safety, both from risk within the home and from challenges outside the home, are of paramount importance as the feeling of safety and care has a huge effect on the service users recovery. We have a range of different accomodation from single to three bedded rooms. This is so service users can be accommodated in the correct
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 24 environment for themselves and their recovery. Female residents share an ensuite room for privacy and safety. All are encouraged to personalise their rooms with pictures or items with sentimental value. All bedroom doors can be locked for privacy. Each bedroom has its own laundry day and service users who have not used them before are helped to use the washing and drying machines, developing further independent living skills. There is a large comfortable residents lounge which is used outside curriculum time for relaxation and TV. We also have an exception to the new anti smoking law so that clients can smoke in this room. Lampton has a House Keeper and each service user is, each week, given a theraputic duty (TD) to do. The service users TD changes weekly and is supervised by the House Keeper and head resident. This develops a sence of belonging within the house and also keeps the house clean and hygienic. The general feeling of the house is comfortable and homely whilst accepting that it is a temporary residence not a permanent home.’ The AQAA also informs us that over the next 12 months plans for improvement include : We aim to continue decoration the house internallyand have plans to develop another 11 beds in a rebuild of the west wing to increase the unit to 30 beds.” A tour of the home confirmed the details provided in the AQAA. The AQAA also identified that the house is an old rambling Victorian house and that the up keep of the house and grounds is a mammoth task and will in time need a lot of time and money spending on it to regain its original splendour. This indeed was found to be the case with areas of damp being found in several areas of the house including bathrooms and other areas of the house being tired and careworn. We met the housekeeper who was painting an area of the galley kitchen that is provided for people using the service to enable free access to snacks and drinks. Three people using the service told us that they think the accommodation provided is good. They also described what ‘T.D’s’ (therapeutic duties) are and explained how the rotas in place work – for example the laundry rota. Each of the bedroom doors is lockable and two of the bedrooms have recently been redecorated – we could see that people had brought their own possessions into the home with them – some of which were on display. The laundry area was viewed and is by the courtyard and next to the kitchen. The laundry can be accessed without going through areas where food is prepared or eaten. People told us that they didn’t know how they would cope with the laundry in the winter particularly when the house is busy with more people living there – as there is only one domestic washing machine and tumble dryer available, this was raised with the Responsible Individual. The service’s statement of purpose states that the provision of bathrooms and toilets complies with the National Treatment Agency guidelines for short-term drug and rehabilitation units. However it appears that it does not comply with
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 25 the National Minimum standards, we found that there are 2 rooms, room 2 and room 9 that each accommodate up to 3 people that each have an en suite bathroom to be shared by the rooms 3 occupants (when full) and there are only a further 2 bathrooms to accommodate the personal hygiene needs of up to a further 13 people (when the service is full). These bathrooms provide in bathroom 1: one bath, one shower and one toilet and in the second bathroom a bath and toilet is provided. People using the service identified this as a concern, particularly as the number of people in the house increases. This was brought to the attention of the Responsible Individual. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is adequate. The service’s performance was assessed against Key standards 31,32,34,35 and 36. Generally the staff in the home are in sufficient numbers to support the people who use the service. The staff that are in post are enthusiastic, dedicated and strongly believe in the work they do. However, the current lack of a Registered Manager is evident, as this has caused the service to under perform in some areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which tells us: ‘That the staff team at Lampton Court are all highly trained and that each member of staff is clear about their role, the responsibility within that role and how that role works as part of the overall staffing team. The AQAA also states that of the 8 permanent staff 6 have NVQ Level 2 or above. The AQAA also
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 27 informs us that there had been problems with inappropriate recruitment and a very relaxed attitude to CRB checks, references etc. and that in the last 12 months all staff have undergone POVA and CRB checks, references have been taken up and the lack of care in recruitment has been corrected.” We spoke with three people living at the home that told us that they have confidence in the skills of the staff employed at Lampton Court and they understand the different positions held by staff in the home. They also told us that there are always enough staff on duty and described how the staffing rota works over a 24 hour period – however people were also aware that there have been problems covering duties as there has been staff sickness, holidays and natural staff turnover. Staffing rotas were supplied to us on request for us to look at. Staffing levels were discussed with staff. Staff told us that shifts are always covered but that at times this has been problematic due to staff turnover, annual leave and sickness. Training was discussed with staff in the absence of any training and development plan. Staff confirmed that they do not have an individual training plan or receive one to one supervision that would also provide an opportunity to discuss individual training and development needs. The staff spoken with felt their previous experience and training was what currently made them effective at work and acknowledge that training in some areas is currently lacking. The training records that were available showed that first aid and fire training was overdue. A member of staff also told us that training needs and records for staff were being looked at but there was nothing to evidence this. Staff did tell us that they do attend a weekly staff meeting, which is of benefit, and that minutes of these meetings are kept, we were also informed that there is good staff communication between shifts. The staff spoken with told us that they are not familiar with the General Social Care Council standards of conduct and practice. 2 members of staff have started the Registered Managers Award, another member of staff confirmed they have achieved their NVQ Level 2 in Care. We were advised when we asked staff about roles and responsibilities that general management systems that addressed essential areas such as training were not currently in place. We were also told that there is a lack of clarity about how or who should take responsibility for certain duties - particularly as there is no Registered Manager in place and this is made worse as a senior member of staff that assisted with
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 28 administrative matters has unfortunately been off work for a long period of time. The staff spoken with were aware that improvement to the recruitment process had been made this was also confirmed when 3 staff recruitment files were read – all contained the information that is legally necessary. We were also told by a member of staff of the induction they had received, which they felt had been really valuable and positive. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 29 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): Quality in this outcome area is poor. The service’s performance was assessed against Key standards 37,39,40 and 42. The service is without a qualified registered manager. This impacts in a negative manner on the service, which is trying to cope without necessary and essential managerial ‘systems’. A meaningful quality assurance system is lacking and health and safety practice is compromised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment) however changes have taken place since the AQQA was supplied to us that effect the information originally supplied.
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 30 The AQAA originally informed us that a new centre manager had been recruited and that an application to register this person with the Commission for Social Care Inspection was to be made. Unfortunately decisions have been taken not to continue with this. This decision appears to have impacted negatively on the running/ management of the service. We spoke with three people that use the service about how the home is run. They told us who they feel are the staff that have greater responsibility in the running of the service and that they have confidence in these people, they also told us that they give feedback to staff on a daily basis and know that what they say is heard and understood by staff and that if any action needs to be taken they know that staff will do so. We were also told by people that they have been instructed what to do if there is a fire – however the level of detail retained by each person was different and this was feedback to the responsible individual. We spoke with five staff at different intervals – it was confirmed that there is no registered manager currently in post. Two staff also confirmed that there is currently no formal quality assurance system or annual development plan in place for the service. The AQAA gave clear details about when maintenance checks were performed at the home, however some lapses had occurred such as; the emergency lighting system had not been checked and the Fire Risk Assessment had not been undertaken or reviewed since 2004. Evidence of fire alarm checks and fire drills being undertaken were seen. There was also a lack of health and safety training – lifting and handling training and first aid training had lapsed. The accident book was seen and was used appropriately. When asked there was uncertainty amongst staff whether any water testing takes place in respect of Legionella. There are comprehensive policies and procedures available but these have not been reviewed and were seen to contain information that is out of date. Many were dated 2004 with no evidence of review having taken place. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 31 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 1 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 1 36 1 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 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 1 X 1 2 X 1 X Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 32 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 YA1 Regulation 4(1)(c) Schedule 1. Requirement The information in the Statement of Purpose that is provided to people that wish to use the service (or are using the service) must be up to date, accurate and regularly reviewed. This is to make sure that people do not misunderstanding how the service is run and what the service provides and offers. This information must be provided to the Commission for Social Care Inspection to be kept on file and a further copy must be supplied to the Commission when any changes are made. This is to make sure that all information held by the Commission about the service is up to date and accurate. People using the service must 31/12/07 be able to register with a doctor of their choice. This will make sure that there is access to a person’s NHS health
Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 33 Timescale for action 31/12/07 2. YA19 13(1) (a) 3. YA20 13(2) records, which is essential to the good management of chronic health care needs. Robust arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home must be in place and monitored. This is to prevent serious record keeping omissions from taking place, which will help to make sure that an audit of all Controlled Drugs held on the premises can be carried out at any time to ensure the correct handling and storage of this type of medication. An immediate requirement was issued. When medication is received into the home on behalf of people using the service it must be clearly and appropriately recorded, kept securely, given safely and disposed of correctly. This is to make sure that people receive the correct prescribed medication from people that are qualified to give it to them and that it is stored and disposed of safely, securely and appropriately and that clear audit trails are in place. The previous timescale of 31/01/07 was not met. An immediate requirement was issued. Arrangements must be made to record the administration directions for those medicines prescribed to be administered
DS0000026736.V339441.R01.S.doc 14/09/07 4. YA20 13(2) 14/09/07 5. YA20 13(2) 31/12/07 Lampton Court Version 5.2 Page 34 when required. Those people looking after their own medicines must be provided with secure storage facilities and a risk assessment must be in place 18(1)(c) (i) People working in a service (ii) must receive suitable training and training plans must be in place to support this. This is to make sure that they are able to carry out their work effectively and can safely and confidently support people using the service. Staff must receive regular supervision. 6. YA35 31/12/07 7. YA36 18(2) 31/12/07 8. YA39 9. YA42 This is to make sure that they have the protected time to receive the support they need to work effectively with people using the service. 24(1)(a)(b) A quality assurance process 31/12/07 (2) & (3) that includes the involvement of people using the service and their representatives must be in place. This must review the care that is provided to people using the service and a report should be made available to people using the service and the Commission for Social Care Inspection. 13(2) Water in the home must be 31/12/07 checked as stated in appropriate guidance. This is to ensure the safety of people that use the service from the risk of Legionella. There must be at least one first aid trained person in the home at all times. This is to make sure that people who use services receive
DS0000026736.V339441.R01.S.doc 10. YA42 13(4) 31/12/07 Lampton Court Version 5.2 Page 35 11. YA42 13(5) appropriate treatment in an accident. A risk assessment that clearly shows that it is not necessary for staff to receive lifting and handling training must be in place or suitable training must be provided for staff. 31/12/07 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 YA6 Good Practice Recommendations Individual care records should be well ordered to make accessing and recording information and auditing of records more effective and efficient. The signature of the person using the service should be included in the spaces available in the care records. This will clearly show that people are involved in their reviews, care planning and goal setting. Risk assessments should be dated to show when they have been carried out. This is to make sure that information in the risk assessment is up to date and can be help to identify when a risk assessment should be reviewed especially if the needs of the person using the service have changed. The amount of secure medication storage will need to be increased to safely store the medicines of the increasing number of people that use this service. This will help to minimise the risk of error and aid with medication audits and the safe storage of medicines. The complaints procedure must provide the correct address for the Commission for Social Care Inspection so that people using the service can contact us should they need to. An increase in the amount of baths and showers provided should be considered as the number of people using the service increases, to make sure that people have access to these facilities and can attend to their personal hygiene
DS0000026736.V339441.R01.S.doc Version 5.2 Page 36 YA7 3 YA9 4 YA20 5 YA22 6 YA27 Lampton Court 7 YA31 8 YA40 needs as and when needed. All staff should be registered and familiar with the General Social Care Council to make sure that they are working to and are complying with the standards of conduct and practice that are set out by the Council. People using the service must be protected by the service’s policies and procedures, which must be up to date and regularly amended and reviewed in line with changing practice guidelines. Lampton Court DS0000026736.V339441.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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