Inspection on 24/10/07 for Lancaster House

This inspection was carried out on 24th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lancaster House 13/10/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Lancaster House 10 Eccles Old Road Salford Gtr Manchester M6 7AF Lead Inspector Kath Oldham Unannounced Inspection 24th & 30th October 2007 10:00 Lancaster House DS0000008366.V348554.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.V348554.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.V348554.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.V348554.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 29th December 2006 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. The property is a large, 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. Lancaster House is next door to Cairn House, another care home owned by Mrs Audrey and Mr Andrew Kelly. We were told the fees charged for accommodation at Lancaster House ranged from £335.26 to £426.71 per week. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced, which means that the manager, staff and residents were not told that we would be visiting, and took place on 24th October 2007, commencing at 10:00am. A second day was arranged on 30th October 2007 to conclude the inspection and provide feedback to the registered manager and manager. 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. We also sent Lancaster House a form before this visit for them to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information Lancaster House provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Lancaster House was inspected against key 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 people staying and working at Lancaster House, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at Lancaster House; talking with the owner/manager, manager and staff. A tour of Lancaster House was also undertaken and 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 service users and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three service users was looked at in detail to help form an opinion of the quality of the care provided. The term preferred by people consulted during the visit was “residents”. This term is, therefore, used throughout the report when referring to people living at Lancaster House. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 6 A brief explanation of the inspection process was provided to the manager at the beginning of the visit and time was spent at the end of the visit with the registered manager and manager to provide verbal feedback. What the service does well: What has improved since the last inspection? Lancaster House has employed a new manager who is working with the current manager (who is planning to retire) and owners to understand the business processes and, where possible, improve them. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 7 One of the owners is at Lancaster House most days looking at the systems to develop and improve the service provided at Lancaster House. A new care plan system is in its develoment stage and once completed for all residents should detail the needs of people and how those needs should be and are met. The new care plan system is aimed to provide detail of all assessed care needs which will ensure the staff team always know the right care and support they should provide to residents. What they could do better: Four requirements were made on the last inspection, which was undertaken in December 2006. Three remain, as they have not been complied with. Lancaster House needs to comply with these requirements. It would be good if Lancaster House carried out an audit of the service by using satisfaction questionnaires. It is important that the views of not only the residents but those of their relatives, GP’s and other visiting professionals are ascertained to see how they feel the service is being delivered and maintained by the home. By obtaining the views of residents, relatives and visiting professionals, including sending out questionnaires to visitors, the quality of care being delivered would continually be reviewed. All food provided to residents needs to be recorded in sufficient detail to enable a judgement to be made, as to whether the diet provided is sufficient and satisfactory in relation to nutrition or otherwise. All staff who have the responsibility of preparing or serving food need to have food hygiene training or updates to this training to ensure they are aware of or are up-to-date with food hygiene regulations and requirements. To safeguard residents and to ensure they receive the correct medication, all staff who have responsibility of administering medication need to have recognised and suitable medication training. A system needs to be introduced to assess staff competence and abilities to administer medication as per policy, procedure and safe and best practice. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 8 To ensure staff are able to recognise potential abuse and are aware of what to do in this situation, all staff need to attend specialist training on the protection of vulnerable adults. The number of the room needs to be affixed to all bedroom doors to assist the room to be identifiable in an emergency situation. Sufficient numbers of staff must be on duty to support residents and ensure residents and staff’s health and safety are not compromised due to the reduced number of staff on duty at particular times of the day and night. All staff must be provided with the training they need to do the job competently and to ensure they have the skills and knowledge for the job for which they are employed. This will ensure residents are provided with care to the standards outlined in regulation. Lancaster House needs to provide all staff with fire awareness training and fire drills and practices at regular intervals in line with fire, and health and safety legislation. Staff need to sign next to their printed name when they have received fire drill training practice. Discussions need to be undertaken with the Fire Authority about the arrangements for locking the front door to ensure this complies with fire procedures and does not compromise the exit route in the event of an emergency situation. 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.V348554.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.V348554.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): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents needs are assessed prior to them being admitted to the home to ensure that their needs can be met. EVIDENCE: To ensure that residents have the information they need about Lancaster House there is a service user guide, which contains information about the home. Once the resident is admitted to the home, a member of staff, usually the manager, sits with the resident and/or relatives, and goes through the guide explaining the information to them. The statement and purpose and service user guide need to be checked to see that the details are up to date and accurately reflect the changes made. There have been no new admissions to Lancaster House in the last 12 months so the arrangements for assessment were not tried out. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 11 A resident had arranged a visit to Lancaster House then had come for tea. The next stage would be for the resident to stay for a weekend then a decision would be made whether the placement could commence. We were told that residents living at Lancaster House also get involved and their opinions are asked about the placement. If everything goes well, the resident will be offered a trial placement for up to six weeks. Lancaster House DS0000008366.V348554.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 the service. Residents have care plans in place and have their needs recognised and met. Recording systems require some development to enable Lancaster House to demonstrate that actual support is provided at the required times and frequency. EVIDENCE: The information provided to the Commission prior to the visit indicated that, in the next 12 months, Lancaster House plans “to introduce an even better style of care plan that will allow residents needs to be more quickly and accurately identified”. Examination of two care files identified a new care plan format was in the development stage. The detail in the care plan was sometimes vague and didn’t detail what staff have to do to support service users. One such entry was, “offer a healthy well balanced diet, including brown bread, rice, potatoes and pasta”. There was no record to suggest that this had been provided. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 13 Another entry said, “Observe for signs of hyper and hypo glycaemia and treat accordingly”. There was no explanation about the treatment that should be provided or a description to define the symptoms. The care plans should be individualised to the resident and clearly detail the support to be provided by staff so the entries in the running sheets to record how a resident has been can be used to evidence the care provided. There was no clear date when the care plans had been written. A date indicated at the side of the plan didn’t detail what it was related to and evidence of a review was not always recorded. There was comment on the care file for one resident that blood sugar was tested daily for a period of time. There was nothing in the care plan to identify this need or who should do it or what the reading should be. It was not clear what residents liked to do or when they liked to do things. By making improvements to the care plan, it would ensure the staff team always know the right care and support they should provide to residents. Running sheets were adequately completed, however more detailed recordings are needed if the home is to demonstrate the day-to-day life of each person, the support they receive, daytime occupation and activities undertaken. To ensure the needs of people are known and met appropriately, records should clearly detail the needs of people and how those needs should be and are met. Information provided by Lancaster House to the Commission indicated, “residents’ health and wellbeing are monitored on a regular basis. We work in partnership with GP’s, consulants and CPN’s to ensure an holistic approach to healthcare. Residents are weighed every month and action is planned to ensure a healthy lifestyle”. The registered manager confirmed that all residents had received annual healthcare checks. Lancaster House DS0000008366.V348554.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are given opportunities to take part in purposeful activity. menus need some development to include a choice of meal. The EVIDENCE: The home supports individuals who require differing levels of support in aspects of daily living. This is achieved through the support of residents in small, homely accommodation. There is a clear emphasis on developing and maintaining social links with resources and public facilities, which meet residents’ needs. Family and friends are able to visit residents as they desire. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 15 Staff support residents to access social and leisure interests inside and outside of the home. Individual care plans examined did not yet detail social routines and support provided to promote social involvement, hobbies, work or interests. There is a range of activities arranged weekly at Lancaster House and we were told that the home plans to extend and research the activities available to residents. This is to provide additional opportunities for stimulation and occupation. Three residents have jobs, which they go to each week. 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. 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. The menu offered limited choice. There was no indication of them being individualised, they did not always indicate choices available or that residents have access to or are offered nutritious snacks, or were able to have fresh fruit. A record of meals served was recorded, however the detail was not sufficient for anyone looking at the record to determine whether the diet is sufficient in terms of nutrition. Staff take full responsibility for the preparation and serving of meals. All staff had not completed basic food hygiene training. It was unclear if they had knowledge of calorific values of food or were aware of the methods used to promote better health through nutrition. Additional training should be provided to those staff with responsibility for the preparation of meals. Lancaster House DS0000008366.V348554.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 this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Arrangements are in place for residents to have access to health care professionals. Medication was not recorded correctly. EVIDENCE: The new care plan system should include how residents receive care and support in the way they prefer and require. Residents spoken to on the visit said they get up when they want, go to bed when they feel like it and can have meals at a time that suits their lifestyle and preferences. Staff support residents to access information and advice about general health care issues. Residents are able to choose their own doctor, this being dependent on whether doctor will visit the resident at Lancaster House. Staff were observed supporting residents in a way which promoted their dignity and privacy. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 17 Residents are supported by the local specialist mental health services through the CPA system. Evidence was seen of residents accessing psychologists and other healthcare professionals to review their mental health. Staff who have the responsibility to administer medication had not all had medication training. This compromises the safety of residents and staff. Some staff had undertaken medication training in the past, however the certification to undertake this had a limited timescale attached to it, which had expired. Staff should be aware of medication they are administering and the possible side effects of specific medications. Personal information sheets with this detail were not available to staff. The supplying pharmacist does not currently print the medication records. Lancaster House undertakes this role, which could lead to errors when transferring this information. We were told that staff at Lancaster House checked these records weekly. The original prescription is not available to staff to check that the information is correct. This omission could lead to staff giving residents incorrect medication. The records do not detail the frequency of administration, for example, two tablets, one in the morning and one at lunch, as indicated on the prescription. Medication which is no longer required or is discontinued and is returned to the pharmacy, is not currently recorded when returned. This needs to be arranged. Photographs to aid identification need to be attached to the medication records, as is best practice. This will be an additional safeguard that the right person is getting their prescribed medication. There were few occasions when there were gaps in the record of medication administration. An explanation as to what had happened to the medication was not indicated. A list of staff and their usual signature and initials is not maintained with the medication administration records, as is best practice. This would enable a check of who gave out medication if there were ever a query. To safeguard residents, and to ensure only staff who have received medication training give out medication, this should be arranged. The information provided to the commission indicated, “Residents are encouraged to self administer their medication. However, we are very aware that some of our residents need to have their medication supervised”. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 18 A number of residents administer their own medication. A risk assessment should be in place to assess whether the resident can administer their medication correctly and properly and that they are aware of what would happen if they didn’t take their medication at the prescribed time or if they took too many. Storage of medication would also be included within the risk assessment to maintain the resident and other residents’ safety. This needs to be organised by Lancaster House to promote residents’ individuality and safety. We were told that alternative pharmacist had been arranged and it was hoped that this service would commence in November 2007. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 19 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 this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The complaints procedure ensures residents have a means to raise views about the service they receive. The lack of recording does not validate the procedures in place. Not enough staff had undertaken protection of vulnerable adults training. EVIDENCE: Residents told the inspector that they would speak to staff if they had any concerns or complaints. Residents were clearly comfortable approaching staff to ask questions or seek reassurance. We were told that there had been no complaints in the last 24 months; therefore we were unable to validate the complaints procedure. An issues record is maintained. This needs to be further developed to include the action taken by Lancaster House and the outcome for the person identifying the issue. The Commission for Social Care Inspection has not received any complaints about the service provided at Lancaster House. A copy of Salford’s All Agency Safeguarding Adults Policy and Procedure was available. Best practice would be to keep documented evidence that all staff have read these procedures. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 20 Some staff have attended safeguarding adults training in the definitions of abuse and how to identify abuse. This training should ensure staff are able to recognise potential abuse. This training needs to be arranged for all staff so they have the knowledge to identify the signs and symptoms of abuse. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home was clean and tidy, bedrooms were personalised and all furnishings, fittings and equipment were in working order. EVIDENCE: Access to the house is by response by staff to the front door. This ensures that no-one enters Lancaster House without the knowledge of staff. 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. The garden is well maintained and accessible for residents to use. A gardener attends to the garden, we were told, 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. We were told that barbeques are arranged in the garden in the summer months and residents like these. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 22 All of the bedrooms looked at had been personalised with resident’s own belongings. Some of the bedroom doors didn’t have a number on them to assist in identification in an emergency situation. The home provided adequate toilet and bathroom facilities. Toilets were conveniently located in close proximity to bedrooms and communal areas. A variety of bathing facilities were provided to meet a range of needs. 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 is no call bell system in Lancaster House to enable residents to summon assistance. This has always been the case since registration. If residents were to need staff support or attention, they would need to alert staff some other way. For one resident, a cordless call bell has been purchased to assist the resident to call for staff support. Lancaster House was odour free and was clean and tidy, which created a pleasant environment for the residents and their visitors. Four of the returned comment cards indicated that the home was always clean. Maintenance contracts are in place and we were told Lancaster House meets the requirements of Health and Safety, Fire and Environmental Health regulations. Lancaster House DS0000008366.V348554.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, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staff training needs to be developed to ensure all staff have the skills to support residents and updates to training need to be undertaken routinely to ensure practices are up to date and safe. EVIDENCE: A staff duty roster was in place, which detailed the name of staff and the role which they are employed at Lancaster House as is required. The duty roster indicated that during the week between the hours of 9.30am and 5.30pm there were two staff on duty. Before and after this time there was one member of staff on duty at Lancaster House to support up to 13 residents. At weekends, there is one member of staff on duty throughout the day and night. We were told that one of the owners is usually at the home each day during the week and the registered manager attends the home at differing times throughout the week. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 24 In addition, one of the owners is on call. Staff are working alone on occasions with up to 13 residents. Lancaster House does not have a lone working policy and staff are vulnerable in the home alone. It is the owners’ responsibility to ensure that there are enough staff on duty to support residents and to ensure the health and safety of staff. Four staff were identified to have been appointed to caring roles at Lancaster House since the last inspection. One being for the newly appointed manager. Examination of staff files identified that for two newly appointed staff and an established staff member, there was no file at Lancaster House. The manager was of the understanding that one of the owners was doing some work on the files and was now away on holiday. The file held on the manager didn’t include all the necessary information, which was needed to evidence that Lancaster House had a thorough recruitment and selection procedure. We were told that this information had been obtained. Criminal record disclosure checks were not contained within some of the staff files examined. Criminal Record Bureau disclosures should be undertaken for all staff before they start work at Lancaster House to protect the residents and other staff employed there. All new staff should attend induction training to Skills for Care specification. This would provide staff with a baseline for what is required when working with adults within a care setting. Induction booklets were in some of the files examined, most of which were not completed. A newly appointed staff who was employed as a senior had not received induction, fire or medication training. This senior carer had no mental health awareness training and was, at times, on duty on their own during the day. Staff need to be provided with the correct training to support them to do their job well, which, in turn, supports the residents at Lancaster House. This needs to be sorted and relevant training provided to all staff and updates to that training arranged. Staff did not receive regular formal supervision to support them in their work. The information provided by Lancaster House before this visit stated, “Our staff have undergone several training courses in the last 12 months to refresh, increase and top-up their skills”. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 25 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 this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The management is approachable and there is a focus on meeting the needs of people living at the home. The omission of fire drill practice training compromises the safety of staff and residents. EVIDENCE: Lancaster House employed a new manager in June 2007 who is working with the registered manager (who is planning to retire) and owners to understand the business processes and, where possible, improve them. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 26 As reported on the last inspection, Lancaster House was displaying its certificate of registration. However, the public liability insurance certificate on display had expired in September 2007. We were told that there had been an error on the new certificate, which had been referred back to the Insurance Company. An up to date certificate must be displayed. Staff need updates in their training in safe moving and handling procedures, food hygiene and health and safety. This will support them to do their jobs correctly and safely. Lancaster House confirmed that work on self-monitoring the service needs to be put in place, including setting up an annual survey. This survey should be aimed at formally seeking the views of people who use the service and other stakeholders, like social and health professionals, about their opinions regarding the quality of service provided at Lancaster House. Once completed, the findings are to be published and copies provided to the residents and the Commission for Social Care Inspection. A record of all accidents concerning service users was kept at Lancaster House; the current system does not comply with Data Protection legislation. Examination of residents’ personal allowance records identified they were completed appropriately. Residents sign on receipt of their monies and, to assist residents to budget, individual times are arranged for collection of their monies. This promotes their dignity and privacy. The home maintained records in respect of fire safety at Lancaster House. The checks to fire safety equipment were recorded as having been completed as required by the fire authority. This practice safeguards residents and staff. The front door of the house is bolted at night before retiring to bed. This practice needs to be discussed with the fire authority, as it may delay exit from the house in an emergency situation. All staff need to be recorded as having taken part in fire drill training practice so they are clear what to do in an emergency situation. Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 X 4 3 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 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 2 X X 2 X Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 28 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 YA20 Regulation 13 Requirement Maintain a record of all medication prescribed to residents on the medication records even when they selfadminister their medication. 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 needs to be indicated on the medication records. Medication which is no longer required or is discontinued and is returned to the pharmacy must be recorded which is signed on receipt by the pharmacist. To safeguard residents and to ensure they receive the correct medication, provide all staff who have responsibility of administering medication with medication training and introduce a system to access staff competence and abilities to administer medication as per Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 29 Timescale for action 12/12/07 policy, procedure and safe and best practice. An individual risk assessment needs to be undertaken which is regularly reviewed to ensure residents who administer their own medication are able to do so safely and correctly. Ensure residents’ prescriptions are available at Lancaster House so staff are aware of its content and know exactly what quantity and dosages indicated for each medication prescribed by residents doctors. 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 not met). Lancaster House must display a current certificate of public liability insurance. (Previous timescale of 29/01/07 not met). 2 YA34 19 (b) 12/12/07 3 YA37 18 12/12/07 Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 30 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. 4 Standard YA39 Regulation 24 Requirement To provide residents, relatives and professionals with an opportunity to make their views known about the service provided at Lancaster House the registered person must implement the formal quality assurance system. (Previous timescale 29/03/07 not met). Timescale for action 12/12/07 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 YA1 YA6 Good Practice Recommendations Review and update the statement of purpose and service user guide ensuring the detail is an accurate reflection of the service provided at Lancaster House. To ensure all residents needs are assessed and are indicated continue with the development of the care plans to ensure all health social and care needs are identified and recorded and when, how and who will meet these needs. A record of all food provided to residents should be recorded in sufficient detail to enable a judgement to be made, as to whether the diet provided is sufficient and satisfactory in relation to nutrition or otherwise. DS0000008366.V348554.R01.S.doc Version 5.2 Page 31 3 YA17 Lancaster House RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 4 Refer to Standard YA20 Good Practice Recommendations A list of staff and their usual signature and initials needs to be maintained, as is best practice with the medication administration records. Obtain personal information sheets for all residents medication which are maintained at Lancaster House so staff are aware of medication they are administering and the possible side effects of specific medications. To promote best practice and to aid in identification, photographs of residents needs to be with their medication administration records. Record all comments and complaints made to Lancaster House Indicate the number of the bedroom on the door to assist the room to be identifiable in an emergency situation. Review and amend the lighting in the combined dining room and lounge to promote residents ease of light when reading or carrying out activities in the rooms. Provide all staff with the training to do the job competently for which they are employed to ensure residents are provided with care to the standards outlined in regulation. To include food hygiene, adult protection, mental health and fire training. Provide updates to that training. Ensure that there are sufficient staff on duty to support residents and ensuring staffs and residents health and safety are not compromised due to the reduced number of staff on duty. Maintain staff files for all staff employed at the home at Lancaster House, which are available for inspection. Provide all staff with induction training to skills for care specification to enable them to support residents and provide them with a baseline for what is required when working with adults within a care setting. 5 6 7 8 9 YA20 YA22 YA24 YA24 YA32 10 YA33 11 12 YA34 YA35 Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 13 Refer to Standard YA36 Good Practice Recommendations Provide all staff with an opportunity to meet formally with their line manager at a minimum of six monthly to discuss career development, training and the philosophy of Lancaster House Discuss with the Fire Authority the arrangements for locking the front door of the house to ensure this complies with fire procedures and does not compromise the exit route in the event of an emergency situation. 14 YA42 Lancaster House DS0000008366.V348554.R01.S.doc Version 5.2 Page 33 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. 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