CARE HOME ADULTS 18-65
Lancaster House 10 Eccles Old Road Salford Gtr Manchester M6 7AF Lead Inspector
Stephen O’Connor Unannounced Inspection 21st March2006 1:00pm Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 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) 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.V278567.R01.S.doc Version 5.1 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 31st October 2005 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 the home. The property is a large 3 storey detached house, which has been converted from 2 semi-detached properties. The home is situated in a residential area of Salford, within easy access to public services and amenities. Lancaster House is next door to Cairn House, another care home owned by Mr and Mrs Kelly. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 21st March 2006. Time was spent talking with the deputy manager and staff and observing how staff worked with people. In addition, people’s files and other documents were inspected and a tour of the premises was made. The previous inspection in October 2005 had identified that the home had met all the national Minimum Standards assessed. The CSCI had not received any concerns or complaints about the home since the last inspection. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. What the service does well:
People are encouraged either individually or through the house meetings to discuss and decide on various aspects of their lives at the home. Things like social, leisure and education opportunities and access to information about these activities show that the home is committed to involving people as much as possible in how they live their life. The home also recognises that motivating and encouraging people with a longterm mental health illness to look at new activities or changing their established routines can be very difficult. This can also be seen in trying to encourage people to maintain their person hygiene and appearance. The home does not accept that if a person does not want to wash or change their clothes that this is a positive choice. It is recognised as a symptom of peoples’ enduring mental health needs and they work sensitively with people to support them in this area. The home works with purchasing authorities to make sure that detailed assessments of need and relevant risk assessments are available to help in deciding whether the home can meet a persons’ needs. In addition, a member of the management team would visit a person prior to admission to undertake their own in-house assessment to find out if the person would be compatible with the people living at the home. Peoples’ nutritional and dietary needs are identified through the assessment process and recorded in the person’s care plan. The assessment identifies peoples’ likes and dislikes and this information is available for staff who cook the meals. This information also helps with the selection of the menu and meal
Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 6 choices and suggestions are discussed in the house meetings. The next days’ menu choice is provided and people can request alternatives if required. Meals are taken between set times but there is flexibility in keeping meals, providing snacks and packed lunches. The home recognises the importance of having peoples’ family taking an active role in their lives. Visitors are encouraged at any reasonable time and the home will provide meals for those visitors that have to travel to visit the home. The amount of contact is determined by the people themselves and their wishes are respected. People have the opportunity both individually and collectively to raise their concerns and worries to the management team. They also have information of a local advocacy service that they can contact. Seven of a staff team of thirteen have gained the NVQ Level 2 qualification in Care. Several other staff are currently undertaking the course. The home has a training programme to provide staff with the core skills and knowledge required to support people. What has improved since the last inspection? 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. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Peoples’ needs are assessed and understood prior to being offered a placement at the home. EVIDENCE: Of the files sampled, examples of purchasing authorities assessments under the Care Programme Approach (CPA) was seen. These were detailed assessments of needs and also contained relevant risk assessments. In addition, a member of the management team would visit a person prior to admission to undertake their own in-house assessment. This was to make sure that the home could meet the person’s assessed needs and would be compatible with the people living at the home. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 The home has the systems, procedures and practices to allow people to make decisions and take risks in their day-to-day lives. EVIDENCE: The home supports and encourages people to maintain as much choice and control over their lives as possible. People are encouraged to be involved in identifying their needs through the assessment and in setting goals in the care planning process. People have the opportunity on an individual and group basis to discuss and decide the activities they want to participate in. Several people manage their own personal finances and/or their medication and seek support from the home when they need it. Peoples’ letters go directly to them and they can request support if needed. There are some restrictions placed on peoples’ choices such as the use of cigarettes and alcohol. However, any restriction has to be agreed by people themselves.
Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 10 The home has access to the purchasing authorities risk assessment prior to admission and will clarify any risk situations or behaviours that may require a fuller risk assessment and support guidance. Key areas such as medication, finances, health and safety and behavioural issues are looked at. If a person’s needs or behaviour changes, then a new risk assessment is undertaken to reflect changing support needs. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 15 and 17 The home tries to encourage and support people to be part of their local community. People have the opportunity to maintain links with family and friends. The home has the systems in place to show that people are provided with a healthy and balanced diet. EVIDENCE: The home recognised that motivating and encouraging people to make use of the local community can be difficult. Many people can access the community independently and decide when and where they want to go. Social and leisure activities that the group want to participate in are discussed at the house meetings and a number of outings and holidays have been undertaken and arranged. Some people do attend specialist mental health services but gaining access to these services is difficult. The home has raised these issues at peoples’ CPA reviews but feel that these are not taken on by the relevant mental health services. It is recommended that the home put peoples’ needs to access local mental health services in writing to the relevant professionals.
Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 12 The home recognises the importance of having peoples’ families taking an active role in their lives. Visitors are encouraged to visit at any reasonable time and the home will provide meals for those visitors that have to travel to visit the home. The amount of contact is determined by the people themselves and their wishes are respected. Peoples’ nutritional and dietary needs are identified through the assessment process and recorded in the person’s care plan. The assessment identifies peoples’ likes and dislikes and this information is available for staff who cook the meals. This information also helps with the selection of the menu and meal choices and suggestions are discussed in the house meetings. The next days’ menu choice is provided and people can request alternatives if required. Meals are taken between set times but there is flexibility in keeping meals, providing snacks and packed lunches. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People are supported appropriately in meeting their personal care needs. Peoples’ healthcare needs are not fully met in terms of general healthcare needs. The home’s systems and practices for the administration of medication do not fully protect people. EVIDENCE: People are encouraged to try to maintain their personal hygiene and appearance. The home acknowledges that it is not a persons’ positive choice to not wash and change dirty clothes but an issue that causes stigma and prevents people becoming part of their community. If the home has concerns then they will talk to the person in a sensitive and private manner to encourage them to maintain their personal hygiene. Many people are supported by the local specialist mental health services through the CPA system. Evidence was seen of people accessing psychologists and other healthcare professionals to review their mental health and medication regime. It was not clear whether people had access to general healthcare providers in terms of an annual health check (dentist, optician, chiropodist etc) and so the home must ensure that all people have an annual healthcare check.
Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 14 The home records peoples’ access to health services on a single form that appeared, at times, a little confusing which healthcare professional the person had seen and exactly what the outcome of the meeting was. It is recommended that a separate form be used for each healthcare provider and ensure clear and accurate recording of the outcome of any such appointments. The medication administration system was assessed and found that recording of administering on the MAR charts was accurate. It was found that some peoples’ medication had suddenly stopped and been replaced by another medication. There was no written clarification from the prescribing doctor of these changes. The home must ensure that any changes to a persons’ medication regime has the written clarification of the prescribing doctor. Currently medication training is being carried out in-house. The home stated that they were looking at more in-depth medication administration training. It is recommended that the home view the medication training to ensure it meets the Royal Pharmaceutical Society Guidance for Care Homes and to take appropriate action if required. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has the systems in place that allow people to express their concerns and complaints. However, it does not fully have all the systems and practices in place in providing staff with the required training and awareness of Adult Protection. EVIDENCE: The home has a formal complaints procedure that has been made available to people through the Service User’s Guide. It is recommended that the information in the complaints procedure be updated to include the correct details of the CSCI. People have the opportunity individually and collectively to raise their concerns and worries to the management team. They also have information of a local advocacy service that they can contact. It was found that although there had been no formal complaints, people do raise concerns and worries with the home that can need some action to be taken. It is recommended that the home maintain a separate record of peoples’ concerns and worries that require the home to take action to remedy the situation. The home has committed itself to adhering to the Salford Adult Protection Procedures. These set out the procedures for all providers to take in the event of an incident or allegation of abuse. It was found that the staff have not undertaken specific Adult Protection or Whistleblowing training. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgement was made. EVIDENCE: The core standards were assessed during the previous inspection. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 36 The home provides staff with a programme of qualifications and training to give staff the skills and knowledge required to support peoples’ needs. The home does have the recruitment systems in place to safeguard vulnerable people. The home does not yet provide staff with structured formal supervision. EVIDENCE: Seven of a staff team of thirteen (both Cairn and Lancaster House) have gained the NVQ Level 2 qualification in Care. Several other staff are currently undertaking the course. The home has a training programme to provide staff with the core skills and knowledge required to support people. The staff team has been very consistent over the past two years. It was noted that the home keep an original Criminal Records Bureau (CRB) certificate on the staff files. Also several of the CRB certificates were from other employers and were over two years old. It is recommended that the home keep a record of the individual CRB certificate reference numbers and date of issue on the staff file and destroy the original certificate. It is also recommended that the guidance for renewing CRB certificates is three years and so the home should have in place systems for renewing the relevant CRB’s. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 18 The introduction of the Protection of Vulnerable Adult (POVA) Scheme was discussed in relation to POVA checks and the role of the POVA list. It is recommended that the home makes itself aware of the POVA guidance and reviews its Grievance and Disciplinary policy and procedures to reflect the POVA guidance. The previous inspection report stated that a supervision schedule was being developed. The supervision agenda and contract had been agreed but supervision has not yet begun. The home must provide staff with the required level of supervision. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The home does encourage people to express their views about the quality of the service. EVIDENCE: The previous inspection report highlighted that the home were developing quality assurance questionnaires as part of the quality assurance programme. It was found that these questionnaires to gather peoples’ views had not yet been developed and used. The home also aims to gather the views of other professionals who have a connection with the home. The home does have informal systems, such as house meetings, to gain peoples’ views but it was recommended that the formal system be implemented as soon as possible and a plan of action generated from the quality assurance exercise. Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 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 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X X X 3 X X X X Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA19 YA20 Regulation 12 13 Requirement Timescale for action 30/06/06 3 4 YA23 YA36 13 18 The home must ensure that all people have an annual healthcare check. The home must ensure that any 30/06/06 changes to a persons’ medication regime has the written clarification of the prescribing doctor. Staff must undertake specific 30/06/06 Adult Protection/ Whistleblowing training. The home must provide staff 30/06/06 with the required level of supervision. 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 YA13 YA19 Good Practice Recommendations It is recommended that the home put peoples’ needs to access local mental health services in writing to the relevant professionals. It is recommended that a separate form be used for each healthcare provider and ensure clear and accurate recording of the outcome of any such appointments.
DS0000008366.V278567.R01.S.doc Version 5.1 Page 22 Lancaster House 3 YA20 4 5 6 YA22 YA22 YA34 It is recommended that the home view the medication training to ensure it meets the Royal Pharmaceutical Society Guidance for Care Homes and to take appropriate action if required. It is recommended that the information in the complaints procedure be updated to include the correct details of the CSCI. It is recommended that the home maintain a separate record of peoples’ concerns and worries that require the home to take action to remedy the situation. It is recommended that the home keep a record of the individual CRB certificate reference numbers and date of issue on the staff file and destroy the original certificate. It is also recommended that the guidance for renewing CRB certificates is three years and so the home should have in place systems for renewing the relevant CRB’s. It is recommended that the home makes itself aware of the POVA guidance and reviews its Grievance and Disciplinary policy and procedures to reflect the POVA guidance. It is recommended that the formal system be implemented as soon as possible and a plan of action generated from the quality assurance exercise. 7 YA34 8 YA39 Lancaster House DS0000008366.V278567.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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