Inspection on 13/10/08 for Lancaster House

This inspection was carried out on 13th October 2008.

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

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lancaster House 24/10/07

Lancaster House 29/12/06

Lancaster House 21/03/06

Lancaster House 31/10/05

Lancaster House 11/03/05

Lancaster House 29/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOME ADULTS 18-65 Lancaster House 10 Eccles Old Road Salford Gtr Manchester M6 7AF Lead Inspector Kath Oldham Unannounced Inspection 13th October 2008 09:15 Lancaster House DS0000008366.V372678.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 Lancaster House DS0000008366.V372678.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. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lancaster House Address 10 Eccles Old Road Salford Gtr Manchester M6 7AF 0161 737 1536 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) cairn.lancaster@btinternet.com Mrs Audrey Kelly Mr A Kelly Mrs Audrey Kelly Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12), Physical disability (1) of places Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One place is available on the ground floor for a person who has a physical disability as well as mental ill health 24th October 2007 Date of last inspection Brief Description of the Service: Lancaster House is a registered care home providing support, personal care and accommodation to 12 residents with mental ill-health and one resident who also has a physical disability. The home is privately owned and registered to Mr and Mrs Kelly, and Mrs Kelly is the registered manager of Lancaster House. Lancaster House is a three storey, detached house, which has been converted from two semi-detached properties. The home is situated in a residential area of Salford, within easy access of public services and amenities. We were told the fees charged for accommodation at Lancaster House ranged from £335.26 to £426.71 per week. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This visit was unannounced, which means the owners, manager and staff were not told we would be visiting, and took place on 13th October 2008 commencing at 9.15am. The inspection of Lancaster House included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last inspection in October 2007. We also sent the owners a form before the visit for them to complete and tell us what they thought they did well, and what they need to improve on. One of the owners completed this. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). We are trying to improve the way we engage with people who use services, so we gain a real understanding of their views and experiences of social care services. We used an ‘expert by experience’ on this inspection. An “expert by experience” is a person who has experience of using care services. They help us to get a picture of what it is like to live in or use a social care service. Comments from the Expert by Experience’s report are used in this report. Lancaster House was inspected against standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to staff and posted to specific residents to obtain their views of the service, the views expressed in returned comment cards and those given directly to the inspector and expert by experience are included in this report. We found our information at the visit by observing care practices, talking with people staying at Lancaster House; talking with the owners, deputy, and staff. A sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Lancaster House was meeting the needs of residents and how well the staff themselves were supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 6 The care service provided to one resident was looked at in detail to help form an opinion of the quality of the care provided. A brief explanation of the inspection process was provided to the senior on our arrival and then to one of the owners and later to the deputy on their arrival at Lancaster House. Since the last inspection at Lancaster House we have not received any complaints, concerns or safeguarding matters. What the service does well: What has improved since the last inspection? Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 7 On the last inspection there was a requirement which needed addressing by the manager in relation to medication. We were told by the owners that a different pharmacy was now supplying medication to the people living at Lancaster House and this we were told has made improvements to the service received by them. The requirement stated that the manager needed to maintain a record of all medication prescribed to residents on the medication records even when they self-administer their medication. We looked at the medication administration records in use on the inspection visit and this had been addressed. To enable an audit to be undertaken of the medication received and administered the amount of medication received, the date it is received and the signature of staff on receipt needed to be indicated on the medication records. This detail had been maintained on the medication records and also on a separate record. Advice was given that this detail can all be indicated on the medication records for ease. Medication which is no longer required or is discontinued and is returned to the pharmacy needed to be recorded which is signed on receipt by the pharmacist. The manager has obtained a returned medication record which is signed by the pharmacist representative on collection. This section of the requirement is also met. To safeguard residents and to ensure they receive the correct medication all staff who have responsibility of administering medication needed to be provided with medication training and a system has been introduced by the deputy manager to access staff competence and abilities to administer medication as per policy, procedure and safe and best practice. An individual risk assessment has now been undertaken for people who manage their own medication to make sure they are safe. The risk assessment is reviewed now and again to make sure these residents continue to be able to take the medicines safely and correctly. A quality assurance system is in place to provide residents, relatives and professionals with an opportunity to make their views known about the service provided at Lancaster House. Lancaster House had on display a current certificate of public liability insurance. We were told that the statement of purpose and service user guide had been reviewed ensuring the detail is an accurate reflection of the service provided at Lancaster House. The detail in these documents tell residents about the home and what services are provided to them. We didn’t look at this paperwork on this visit. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 9 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 Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents receive information about the home and have their needs assessed; this enables them to make an informed decision about moving into Lancaster House. EVIDENCE: The AQAA indicated, “Prospective residents must have a thorough assessment completed before we would consider offering a place in our home”. People who are thinking about going to live at Lancaster House are invited to visit the home, stay for a meal and then overnight for a short time before moving to the next stage, which would be a six-week trial period. The managers invite representatives of the new resident’s care team, friends and family to visit Lancaster House and discuss the placement. We were told by the owners that Lancaster House have ensured that the new residents’ representatives know up front that they need to provide the manager with the necessary information so that an informed decision can be made by everyone as to whether the new resident would benefit from the service they provide. The manager feels that this is demonstrated by Lancaster House having “ a pleasant and harmonious atmosphere, which shows that our residents get Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 11 along with each other remarkably well. Our trial period ensures that residents have the time to fit-in to their new home before making the decision to stay long-term”. One service user said that they were asked if they wanted to move into this home and added, “to help to improve”. In response to the question did you receive enough info about this home before you moved in so you could decide if it was the right place for you one resident said no and added, “but it is the right place”. We looked at a newly admitted service users care file which included an assessment which was detailed and informed the staff what they needed to know to start writing a plan of care. An assessment had been completed by the local authority and also by the deputy so that the care plan could be written down and the support and care needed by the resident is known by the staff providing care and support. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans provided details of residents’ care needs and the support required to meet needs to ensure residents get the care and support they need. Risk assessments were in place to ensure the safety and well being of residents. EVIDENCE: Staff told us that, “All changes to a residents care plan is always updated every week and any changes are passed on verbally by manager or senior staff”. The AQAA completed by one of the owners indicated, “residents have a wide variety of routines, which are catered for by the way the home is run. Residents are encouraged to help out around the home and are given small financial incentives to keep their rooms and living spaces tidy. Some residents accompany the manager to the shops for the main weekly Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 13 shopping trip and are happy to run errands for the home and for each other. Many of our residents live fairly independent lives; one resident arranges his own annual holidays, sometimes travelling abroad”. The owner states, “We should try to find more ways for the resident’s to be involved in the day-to-day running of the home in order that they might feel more connected to the decision making process”. Changes had been made to support the development of care plan files and the process for carrying out risk assessments. Care needs were identified, and included the strategies and interventions to meet needs. There was information on file about the specific care needs of individual residents. There was important information in the assessment to help and assist staff to manage some aspects of resident’s behaviour. Also, some information documented in meetings with psychiatrists, and community psychiatric nurses had been transferred to the care plan. It is important that this information is available to staff and easily available for reference, in order to ensure the safety of individual residents and the safety and well being of other residents in the home. The deputy manager said the reviewing of care plans was an ongoing process. There was evidence during this visit that files were being organised so that staff had easy access to up-to-date information about current care needs. Staff who were spoken to said it would give them a quick reference tool to assist them in supporting residents appropriately and to help them in communicating efficiently with other professionals. Care plans focused on a person centred approach and there was evidence that residents were consulted on how they wanted to be supported. Care plans were being developed to include a programme of activity and to provide residents with structure to their day. Care plans included risk assessments. In one file, there was a record that risk assessments had been updated to ensure that the staff team managed newly identified risks appropriately. There was evidence that residents were supported to access healthcare services as appropriate. A resident told us that the staff go with them to appointments as they didn’t always want to go on their own. Recordings on files demonstrated that residents were supported to keep appointments with health care professionals, including hospital appointments, contact with community psychiatric nurses, and dental and optical appointments. A resident said they have to go to hospital regularly to have checks and the owner or deputy go with them. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with opportunities for personal development, and leisure, which promote their independence. EVIDENCE: The owner/manager said that some residents attend part-time work or visit day centres, drop-ins and art classes. The in-house basic skills class has shown improvements in the literacy of one of the residents and the others who attend have earned certificates to show improvement and encourage a sense of achievement. The expert by experience spent time during the visit talking to residents. The expert by experiences report indicated that residents said to her, “we go to the precinct in groups with Mrs Kelly, and I could go to all the things if I wanted to”. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 15 The expert by experience report stated that when they asked residents’ if they wanted to engage in any community activities one resident said that they could if they wanted to. Some residents went to Llandudno in September for a week’s holiday. Staff told us, “I have worked for this service for several years. I would not work here if I wasn’t satisfied with the service provided. The owner/manager is always looking for ways to improve, when necessary, the everyday life styles of our residents”. The report completed by the expert by experience said, “One resident likes shopping for staff …..and mentioned that there is a good homely feeling. The resident said they felt very included and go to concerts and shows. The home uses community transport for outings and holidays”. Residents told us, “we have a lovely Christmas and the manager goes out and buys 6 presents for each of them, and a great deal of thought goes into those presents”. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements in place supported residents in meeting their physical and emotional needs. Medication procedures were sufficient to protect the interests of residents. EVIDENCE: The AQAA completed by one of the owners informed us that, “Residents attend regular (3 or 6-monthly) reviews with their consultants and the managers report (distilled from the running sheets) is submitted to that review”. Residents are offered yearly health checks with their GP although some residents see their GP far more often because of the medication they have been prescribed. Residents are encouraged to self administer their medication if their consultant or CPN agrees. The managers have arranged a new pharmacy and staff use the printed medication administration records (MAR charts) supplied. The owner indicated in the AQAA that “we are not happy with the MAR charts because they are not Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 17 as intuitive as the ones we made in-house but the staff have received training on them and are now used to the new system”. We looked at a sample of the medication administration records which were completed appropriately with no unexplained gaps. The deputy said she undertakes a weekly audit of the medication records to ensure staff complete in line with procedures and best practice. We were also told by the deputy that she observes staff practice periodically and this includes medication administration and this would be part of their development supervision. There were no photographs on the medication records that we looked at of resindtes to aid identification. The deputy manager said that they had photographs of residents on care plans and they needed putting with the medication records. To promote best practice and to aid in identification, photographs of residents need to be with their medication administration records. There were handwritten entries on the medication records. This is when a medicine has been prescribed by the residents’ doctor after the medication records have been printed. When handwritten medication is on the medication records the manager needs to make sure that the person writing out this detail signs the record and this is also signed and verified by a second member of staff. This practice needs to be in place to minimise the risk of errors and to make sure residents get the medication as prescribed. In the past year the managers have noted that GPs are initiating the offer of a health check for all residents rather than wait for staff at Lancaster House to request it. Several of the residents attend podiatry clinic and some are escorted by staff to these appointments. Some residents are frightened of visiting doctors, dentists and opticians. Those who feel unable to attend alone are escorted by members of staff. Some residents have visits from their optician who comes to Lancaster House. In response to the question is there anything else you would like to tell us one resident said, “It’s a great deal better than the place I came from”. Another resident said, “I am very pleased to live here. I am being helped with my problems and given things to do”. Staff said that, “The service provides care and understanding promote independence, choice”. We were also told by staff that they feel, “We provide a good and caring environment”. “Both Lancaster and Cairn House are a very caring residential homes which provides a good service to the user”. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 Quality in the outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were knowledgeable about the complaints procedure and were confident they could raise concerns/complaints with staff and they would be listened to. The recruitment procedures in place are not adhered to sufficiently well to ensure that people are kept safe. EVIDENCE: The AQAA indicated that the managers have not had any complaints made in the last 36 months. The managers recognise the need to ensure that residents understand that it is their right to make a complaint. This will be reinforced at future residents’ meetings. Service users appeared aware of who to speak to if they were unhappy, many naming particular staff or the owner managers as possible contacts if they were not happy with anything. Two residents said they were not aware of how to make a compliant one adding that, “not been here long enough”. All staff who completed a comment card said they were aware of what they would do if anyone had concerns about Lancaster House. One member of staff said, “Report all concerns which are put to you by service users, relatives or friends to the manager, support worker, community phyciatric nurse”. “The manager is the first person to whom we go to with any concerns or changes involving service users”. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 19 Since the last inspection at Lancaster House we have not received any complaints, concerns or safeguarding matters. Recruitment procedures are in place to safeguard service users but we identified that they were not being followed. This potentially puts service users at risk and is commented on in more detail in the staffing section. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a comfortable environment for residents. EVIDENCE: The owners in the AQAA indicated, “the home is decorated and maintained to a high standard and monthly checks are undertaken to ensure that any repairs and renewals are completed in good time”. Residents like to personalise their rooms and some have brought in their own furniture. The AQAA indicated that “ the cleaner works with a senior member staff, on a regular basis, to inspect each room and ensure that it is clean and that fixtures and fittings are present and in a good state of repair”. The results of a recent survey gave positive feedback, about the homes environment, from residents and their advocates and relatives. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 21 A visitor’s book is in place and visitors to Lancaster House are encouraged to sign in and out. This is to ensure that, in an emergency situation, everyone in the building is accounted for. In the report to the Commission the expert by experience said, “I found it very difficult to find the home and parking was really difficult as there were little spaces and we had to park on the driveway. The house itself was lovely with a nice summerhouse out back where residents could relax and smoke. The expert by experience also said in their report “my first impression of the home was one of informality and friendliness”. In the expert by experiences report to the commission they said, “A resident invited me to their room and I noticed that the door, though the room was two floors up, was unlocked. It seemed to me that there was real trust on the residents’ part in relation to the others there. The room, I noticed, was lovely and spotless”. The experts by experience report concluded their report to us by saying, “I found it to be a really positive, caring and loving environment” and said, “if every I have to live in supported residence I want to go there”. A resident told us, “Nice and relaxing surroundings”. There was a recommendation on the last inspection to indicate the number of the bedroom on the door to assist the room to be identifiable in an emergency situation. This has been done. The owner/manager said that there is also space if residents wanted to have their name also on the door. The owner managers said that there have been no major changes to the house since the last inspection. On that inspection the environment was described to be good. We reported on the last inspection that the lighting in the combined lounge and dining room is not particularly bright which may make it difficult for residents to read or take part in other activities. There appears to have been no changes made to the lighting. A member of staff said that they had replaced one of the light bulbs and thought that may be why the lighting was dull. The garden is well maintained and accessible for residents to use. A gardener attends to the garden on a weekly basis. Patio furniture was available for residents and their visitors to sit out. A summerhouse in the garden is used by residents to smoke outside. Residents’ said barbeques are arranged in the garden in the summer months and these are enjoyed by everyone. The expert by experience wrote in their report that one resident said they “sit in the summerhouse all day and listens to music, cleans the summer house every day” and Lancaster House “feels like home”. Another resident said, they Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 22 “like to feed wild birds in the garden and carries out tasks around the house when needed”. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 &35 Quality in the outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The shortfalls in the recruitment procedure puts residents at risk from people working at the home who may not be suitable. EVIDENCE: The expert by experience in their report said, “The staff were very pleasant “. When we asked in the AQAA what the home does well in relation to staffing the owner responded, “staff at Lancaster House are caring and friendly towards our residents. They help to promote and friendly and relaxed atmosphere within the home. Our staff work well as a team and conduct clear and useful handovers between shifts. Our staff are familiar with our residents needs and their input to the care plans help us maintain and improve our residents health and wellbeing”. The information we received before the inspection visit identified that some staff have skills in arts & crafts, hairdressing, music, relaxation techniques, Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 24 etc. which are employed to augment the facilities offered by the home. In addition the manager told us that the results of a recent survey by questionnaire gave very positive feedback about the staffs conduct and abilities, from residents and their advocates and relatives. We asked residents about the staff these are some of the comments they made, when asked do staff treat you well one resident said “always” and added, “there very good staff kind and caring”. The resident also responded “usually” when asked do the carers listen and act on what you say. Another resident said, Staff are very cooperative with residents” and, “the carers are very experienced and hard working”. Staff told us that “There is always cover when someone falls absent. The home is run very well it has good atmosphere”. “I have good experience I have looked after my son with learning disability’s so I understand how the clients feel”. Staff receive induction training. We didn’t check out if the induction training provided to all new staff is to Skills for Care specification. We made a recommendation on the last inspection that this should be the case. With regard to recruitment and selection a member of staff said, “All new members of staff are not allowed to start work without references and CRB checks” and “a full induction was given”. We did not find this to be the case when we looked at a new member of staffs file. The most recently appointed member of staff was indicated as starting work at Lancaster House on 1st July 2008. The protection of vulnerable adults (POVA) first check was dated 9th July 2008. Staff shouldn’t start work until the POVA first check is back and should only work under supervision until a full criminal record bureau check is returned. Staff can start work in exceptional circumstances on receipt of the POVA first but only shadowing a member of staff. One member of staff had commenced before the criminal record bureau check and the POVA first check had been received. We were told that although the POVA first check was not received before this member of staff started work they didn’t work with residents initially and spent time with the deputy manager in training. The references were not received until after the member of staff started work. This again is not right as these checks are in place to act as a safeguard for residents and staff and should be received before staff start work in care. The deputy manager said the qualifications quoted by the member of staff had been verified and certificates seen by her. There were no copies of these certificates on the staffs file as there should be. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 25 For the same member of staff there was no completed job application form at Lancaster House. We were told that one of the owners’ had taken it home to do some work with it and that it had not been returned. The owner said that they didn’t see that there would be a problem getting the staff to fill out another job application form. The second staff file that we looked at was for someone who started working at Lancaster House in July 2007. We didn’t see this staff file on the last inspection. The job application form did not detail a full employment history or any reasons for gaps in employment and there was only one telephone reference received. A criminal record bureau disclosure was received before this member of staff started work as it should be. The staff member was recorded as having received induction training and had met with their line manager to assist in their development. Staff felt that “training is always ongoing so we keep up to date with all the changes in service provided”. The expert by experience included in their report to us a conversation they had with a resident about staff who said, ‘I have no complaints. The staff are quite good’. When asked about anything else they might like to say the resident stated ‘you can’t get much better than this’”. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in the outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Keeping up to date with health and safety legislation, promotes the safety and welfare of residents. The management of the service does not fully promote good recruitment which potentially means that services users are not being safeguarded. EVIDENCE: Two requirements have been made relating to the recruitment of staff one of which is outstanding from previous inspections. This has an impact on the safety of people living in the home and gives us some concerns that such an important part of management in respect of proper recruitment is not being done properly. And is an issue we have raised previously. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 27 Staff are able to obtain the skills, guidance and direction needed to support them in their role as carers. We were told that all staff have received one to one supervision. Regular Monday meetings are arranged and staff and residents’ views and opinions have been taken on board to assist in the development of the service provided at Lancaster House. Regular residents meetings are scheduled for future months. The records detailing the fire safety checks are up to date and fire drill training records demonstrated that staff had received fire drill training. The member of staff who is responsible for fire safety said fire checks are undertaken weekly. The deputy manager said to address the recommendations of the last inspection staff have had or are scheduled to have updates in their training in safe moving and handling procedures, food hygiene and health and safety. This supports staff to do their jobs correctly and safely. We were shown copies of comment cards received from residents, their families or representatives and visiting professionals. We saw completed comment cards which had also been given to residents to get their ideas and suggestions for a change to the evening meal on Saturdays. A visitor to Lancaster House commented, “At Lancaster House residents are encouraged to be as independent as possible”. A visiting professional commented, “My experience of Lancaster House is that staff and management are very caring and committed. I have been particularly grateful that they have been prepared to offer a place to a client whose challenges meant no other unit would do so”. We reported on the last inspection that the front door of the house is bolted at night before retiring to bed. We recommended that this practice needs to be discussed with the fire authority, as it may delay exit from the house in an emergency situation. One of the owners told us on this inspection visit that this arrangement had been checked out with the fire authority and was in order. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 28 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 2 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 2 35 3 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 3 X 3 X 3 X X 2 X Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 29 Yes 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 YA34 Regulation 19 (b) Requirement To ensure the safety of residents and staff Lancaster House must obtain a current Criminal Record Bureau certificate for all staff before they commence working at the home. (Previous timescale of 29/01/07 and 12/12/07 not met) Timescale for action 13/11/08 2 YA34 Sche 2 To safeguard residents and offer 13/11/08 some degree of protection ensure that the recruitment and selection procedures are followed and two written references, a completed job application form, copies of identification, qualification certificates and complete employment history are obtained before staff commence work at Lancaster House. And these records are kept on file available for inspection. Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 30 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 YA20 Good Practice Recommendations To promote best practice and to aid in identification, photographs of residents needs to be with their medication administration records. To minimise the risk of errors and to make sure residents get the medication as prescribed. When handwritten medication is on the medication records make sure that the person writing out this detail signs the record and this is also signed and verified by a second member of staff. Review and change the lighting in the combined dining room and lounge to promote residents ease of light when reading or carrying out activities in the rooms. 2. YA20 3 YA24 Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lancaster House DS0000008366.V372678.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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